Vartanian, Lenny R; Novak, Sarah A
Experiences with weight stigma negatively impact both psychological outcomes (e.g., body dissatisfaction, depression) and behavioral outcomes (e.g., dieting, exercise). However, not everyone is equally affected by experiences with weight stigma. This study examined whether internalized societal attitudes about weight moderated the impact of weight stigma. Adult participants (n = 111) completed measures of experiences with weight stigma, as well as two indexes of internalized societal attitudes (the moderators): Internalized anti-fat attitudes and internalization of societal standards of attractiveness. Psychological outcomes included self-esteem, body dissatisfaction, drive for thinness, and bulimic symptoms; behavioral outcomes included avoidance of exercise and self-reported exercise behavior. Weight stigma was positively correlated with body dissatisfaction, drive for thinness, and bulimic symptoms, and was negatively correlated with state and trait self-esteem. Both indexes of internalized attitudes moderated the association between weight stigma and avoidance of exercise: Individuals high in anti-fat attitudes and high in internalization of societal standards of attractiveness were more motivated to avoid exercise if they also experienced a high degree of weight stigma; individuals low in anti-fat attitudes and low in internalization were relatively unaffected. Avoidance of exercise was negatively correlated with self-reported strenuous exercise. These findings suggest that weight stigma can negatively influence motivation to exercise, particularly among individuals who have internalized societal attitudes about weight. Reducing internalization might be a means of minimizing the negative impact of weight stigma and of facilitating healthy weight management efforts.
O'Brien, Kerry S; Latner, Janet D; Puhl, Rebecca M; Vartanian, Lenny R; Giles, Claudia; Griva, Konstadina; Carter, Adrian
Weight stigma is associated with a range of negative outcomes, including disordered eating, but the psychological mechanisms underlying these associations are not well understood. The present study tested whether the association between weight stigma experiences and disordered eating behaviors (emotional eating, uncontrolled eating, and loss-of-control eating) are mediated by weight bias internalization and psychological distress. Six-hundred and thirty-four undergraduate university students completed an online survey assessing weight stigma, weight bias internalization, psychological distress, disordered eating, along with demographic characteristics (i.e., age, gender, weight status). Statistical analyses found that weight stigma was significantly associated with all measures of disordered eating, and with weight bias internalization and psychological distress. In regression and mediation analyses accounting for age, gender and weight status, weight bias internalization and psychological distress mediated the relationship between weight stigma and disordered eating behavior. Thus, weight bias internalization and psychological distress appear to be important factors underpinning the relationship between weight stigma and disordered eating behaviors, and could be targets for interventions, such as, psychological acceptance and mindfulness therapy, which have been shown to reduce the impact of weight stigma. The evidence for the health consequences resulting from weight stigma is becoming clear. It is important that health and social policy makers are informed of this literature and encouraged develop anti-weight stigma policies for school, work, and medical settings. Copyright © 2016 Elsevier Ltd. All rights reserved.
Full Text Available Internalized weight stigma has gained growing interest due to its association with multiple health impairments in individuals with obesity. Especially high internalized weight stigma is reported by individuals undergoing bariatric surgery. For assessing this concept, two different self-report questionnaires are available, but have never been compared: the Weight Self-Stigma Questionnaire (WSSQ and the Weight Bias Internalization Scale (WBIS. The purpose of the present study was to provide and to compare reliability, convergent validity with and predictive values for psychosocial health outcomes for the WSSQ and WBIS.The WSSQ and the WBIS were used to assess internalized weight stigma in N = 78 prebariatric surgery patients. Further, body mass index (BMI was assessed and body image, quality of life, self-esteem, depression, and anxiety were measured by well-established self-report questionnaires. Reliability, correlation, and regression analyses were conducted.Internal consistency of the WSSQ was acceptable, while good internal consistency was found for the WBIS. Both measures were significantly correlated with each other and body image. While only the WSSQ was correlated with overweight preoccupation, only the WBIS was correlated with appearance evaluation. Both measures were not associated with BMI. However, correlation coefficients did not differ between the WSSQ and the WBIS for all associations with validity measures. Further, both measures significantly predicted quality of life, self-esteem, depression, and anxiety, while the WBIS explained significantly more variance than the WSSQ total score for self-esteem.Findings indicate the WSSQ and the WBIS to be reliable and valid assessments of internalized weight stigma in prebariatric surgery patients, although the WBIS showed marginally more favorable results than the WSSQ. For both measures, longitudinal studies on stability and predictive validity are warranted, for example, for weight
Ratcliffe, Denise; Ellison, Nell
Obese individuals frequently experience weight stigma and this is associated with psychological distress and difficulties. The process of external devaluation can lead to negative self-perception and evaluation and some obese individuals develop "internalized weight stigma". The prevalence of weight stigma is well established but there is a lack of information about the interplay between external and internal weight stigma. To synthesize the literature on the psychological effects of weight stigma into a formulation model that addresses the maintenance of internalized weight stigma. Current research on the psychological impact of weight stigma was reviewed. We identify cognitive, behavioural and attentional processes that maintain psychological conditions where self-evaluation plays a central role. A model was developed based on clinical utility. The model focuses on identifying factors that influence and maintain internalized weight stigma. We highlight the impact of negative societal and interpersonal experiences of weight stigma on how individuals view themselves as an obese person. Processing the self as a stigmatized individual is at the core of the model. Maintenance factors include negative self-judgements about the meaning of being an obese individual, attentional and mood shifts, and avoidance and safety behaviours. In addition, eating and weight management behaviours become deregulated and maintain both obesity and weight stigma. As obesity increases, weight stigma and the associated psychological effects are likely to increase. We provide a framework for formulating and intervening with internalized weight stigma as well as making therapists aware of the applicability and transferability of strategies that they may already use with other presenting problems.
One major approach to weight stigma reduction consists of decreasing beliefs about the personal controllability of-and responsibility for-obesity by educating about its biogenetic causes. Evidence on the efficacy of this approach is mixed, and it remains unclear whether this would create a deterministic view, potentially leading to detrimental side-effects. Two independent studies from Germany using randomized designs with delayed-intervention control groups served to (1) develop and pilot a brief, interactive stigma reduction intervention to educate N = 128 university students on gene × environment interactions in the etiology of obesity; and to (2) evaluate this intervention in the general population (N = 128) and determine mechanisms of change. The results showed (1) decreased weight stigma and controllability beliefs two weeks post-intervention in a student sample; and (2) decreased internal attributions and increased genetic attributions, knowledge, and deterministic beliefs four weeks post-intervention in a population sample. Lower weight stigma was longitudinally predicted by a decrease in controllability beliefs and an increase in the belief in genetic determinism, especially in women. The results underline the usefulness of a brief, interactive intervention promoting an interactionist view of obesity to reduce weight stigma, at least in the short term, lending support to the mechanisms of change derived from attribution theory. The increase in genetic determinism that occurred despite the intervention's gene × environment focus had no detrimental side-effect on weight stigma, but instead contributed to its reduction. Further research is warranted on the effects of how biogenetic causal information influences weight management behavior of individuals with obesity.
Full Text Available One major approach to weight stigma reduction consists of decreasing beliefs about the personal controllability of-and responsibility for-obesity by educating about its biogenetic causes. Evidence on the efficacy of this approach is mixed, and it remains unclear whether this would create a deterministic view, potentially leading to detrimental side-effects. Two independent studies from Germany using randomized designs with delayed-intervention control groups served to (1 develop and pilot a brief, interactive stigma reduction intervention to educate N = 128 university students on gene × environment interactions in the etiology of obesity; and to (2 evaluate this intervention in the general population (N = 128 and determine mechanisms of change. The results showed (1 decreased weight stigma and controllability beliefs two weeks post-intervention in a student sample; and (2 decreased internal attributions and increased genetic attributions, knowledge, and deterministic beliefs four weeks post-intervention in a population sample. Lower weight stigma was longitudinally predicted by a decrease in controllability beliefs and an increase in the belief in genetic determinism, especially in women. The results underline the usefulness of a brief, interactive intervention promoting an interactionist view of obesity to reduce weight stigma, at least in the short term, lending support to the mechanisms of change derived from attribution theory. The increase in genetic determinism that occurred despite the intervention's gene × environment focus had no detrimental side-effect on weight stigma, but instead contributed to its reduction. Further research is warranted on the effects of how biogenetic causal information influences weight management behavior of individuals with obesity.
Himmelstein, Mary S; Puhl, Rebecca M; Quinn, Diane M
Obesity is an ongoing public health concern in the U.S. Weight stigma is linked to a number of obesogenic health outcomes, which complicate obesity treatment and prevention. Despite higher rates of obesity in female and minority populations, little research has examined weight stigma in non-white women and men. This study investigated intersectionality in weight stigma and health-related coping responses to stigmatizing experiences across racial groups. In 2015, a total of 2,378 adults completed questionnaires about weight stigma, weight bias internalization, and coping strategies. Analyses were conducted in 2016. No differences in weight stigma emerged as a function of race or gender, but women reported higher weight bias internalization (B=0.19, p=0.004). Further, black men and women reported less weight bias internalization than white men and women (B=-0.43, p=0.009). Compared with white women, black women were less likely to cope with stigma using disordered eating (B=-0.57, p=0.001), whereas Hispanic women were more likely to cope with stigma using disordered eating (B=0.39, p=0.020). Black men were more likely than white men to cope with stigma via eating (B=-0.49, p=0.017). Findings highlight that weight stigma is equally present across racial groups, but that groups internalize and cope with stigma in different ways, which exacerbate health risks. Increased research and policy attention should address stigma as an obstacle in prevention and treatment for obesity to reduce weight-based inequities in underserved populations. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
This article develops a theoretical approach to stigma in international relations and resituates conventional approaches to the study of norms and international order. Correcting the general understanding that common values and norms are the building blocks of social order, this article claims...
Nolan, Laurence J; Eshleman, Amy
Because body weight is largely seen as controllable, weight stigma-the social devaluation of those who are overweight-is not subject to the social norms that condemn open expression of racism and sexism. Indeed, rejection of peers based on perceptions of excess weight is normative. Since weight stigma is internalized, popular views (and often the views of physicians) have suggested that increasing the salience of weight stigma might produce a reduction in overeating and/or an increase in physical activity. However, that perspective is not rooted in scientific evidence. Recent randomized controlled designs demonstrate that stigma may promote overeating. Correlational evidence suggests that self-reported stigma experience is associated with risk for binge eating and decreased interest in physical exercise and dieting, for children and adults. In addition to reviewing these research studies, this paper examines the potential for intersectionality of stigma across multiple social identities and considers alternatives to stigmatizing weight loss interventions. Copyright © 2016 Elsevier Ltd. All rights reserved.
Lillis, Jason; Luoma, Jason B; Levin, Michael E; Hayes, Steven C
Stigma associated with being overweight or obese is widespread. Given that weight loss is difficult to achieve and maintain, researchers have been calling for interventions that reduce the impact of weight stigma on life functioning. Sound measures that are sensitive to change are needed to help guide and inform intervention studies. This study presents the weight self-stigma questionnaire (WSSQ). The WSSQ has 12 items and is designed for use only with populations of overweight or obese persons. Two samples of participants--one treatment seeking, one nontreatment seeking--were used for validation (N = 169). Results indicate that the WSSQ has good reliability and validity, and contains two distinct subscales-self-devaluation and fear of enacted stigma. The WSSQ could be useful for identifying individuals who may benefit from a stigma reduction intervention and may also help evaluate programs designed to reduce stigma.
Puhl, Rebecca M; Quinn, Diane M; Weisz, Bradley M; Suh, Young J
Challenges of maintaining long-term weight loss are well-established and present significant obstacles in obesity prevention and treatment. A neglected but potentially important barrier to weight-loss maintenance is weight stigmatization. We examined the role of weight stigma-experienced and internalized-as a contributor to weight-loss maintenance and weight regain in adults. A diverse, national sample of 2702 American adults completed an online battery of questionnaires assessing demographics, weight-loss history, subjective weight category, experienced and internalized weight stigma, weight-monitoring behaviors, physical activity, perceived stress, and physical health. Analyses focused exclusively on participants who indicated that their body weight a year ago was at least 10% less than their highest weight ever (excluding pregnancy), the weight loss was intentional, and that attempts to lose or maintain weight occurred during the past year (n = 549). Participants were further classified as weight regainers (n = 235) or weight-loss maintainers (n = 314) based on subsequent weight loss/gain. Data were collected in 2015 and analyzed in 2016. Hierarchical logistic regression models showed that internalized weight stigma and subjective weight category made significant individual contributions to prediction of weight-loss maintenance, even after accounting for demographics, perceived stress, experienced stigma, physical health, and weight-loss behaviors. For every one-unit increase in internalized weight stigma, the odds of maintaining weight loss decreased by 28% (95% CI: 14-40%, p < .001). Findings provide initial evidence that overlooked psychosocial factors, like weight stigma, may hinder weight-loss maintenance. Implications for addressing stigma in obesity-focused clinical interventions are highlighted.
Danielle M. Raves
Full Text Available Background: Weight-related stigma is reported frequently by higher body-weight patients in healthcare settings. Bariatric surgery triggers profound weight loss. This weight loss may therefore alleviate patients’ experiences of weight-related stigma within healthcare settings. In non-clinical settings, weight-related stigma is associated with weight-inducing eating patterns. Dietary adherence is a major challenge after bariatric surgery.Objectives: (1 Evaluate the relationship between weight-related stigma and post-surgical dietary adherence; (2 understand if weight loss reduces weight-related stigma, thereby improving post-surgical dietary adherence; and (3 explore provider and patient perspectives on adherence and stigma in healthcare settings. Design: This mixed methods study contrasts survey responses from 300 postoperative bariatric patients with ethnographic data based on interviews with 35 patients and extensive multi-year participant-observation within a clinic setting. The survey measured experiences of weight-related stigma, including from healthcare professionals, on the Interpersonal Sources of Weight Stigma scale and internalized stigma based on the Weight Bias Internalization Scale. Dietary adherence measures included patient self-reports, non-disordered eating patterns reported on the Disordered Eating after Bariatric Surgery scale, and food frequencies. Regression was used to assess the relationships among post-surgical stigma, dietary adherence, and weight loss. Qualitative analyses consisted of thematic analysis.Results: The quantitative data show that internalized stigma and general experiences of weight-related stigma predict worse dietary adherence, even after weight is lost. The qualitative data show patients did not generally recognize this connection, and health professionals explained it as poor patient compliance.Conclusion: Reducing perceptions of weight-related stigma in healthcare settings and weight bias
Alpsoy, Erkan; Polat, Mualla; FettahlıoGlu-Karaman, Bilge; Karadag, Ayse Serap; Kartal-Durmazlar, Pelin; YalCın, Basak; Emre, Selma; Didar-Balcı, Didem; Bilgic-Temel, Asli; Arca, Ercan; Koca, Rafet; Gunduz, Kamer; Borlu, Murat; Ergun, Tulin; Dogruk-Kacar, Seval; Cordan-Yazici, Ayca; Dursun, Pınar; BilgiC, Ozlem; Gunes-Bilgili, Serap; Sendur, Neslihan; Baysal, Ozge; Halil-Yavuz, Ibrahim; Yagcioglu, Gizem; Yilmaz, Ertan; Kavuzlu, Ufuk; Senol, Yesim
Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self-esteem and life-satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross-sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire-12 (P psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease. © 2017 Japanese Dermatological Association.
Earnshaw, Valerie A; Smith, Laramie R; Cunningham, Chinazo O; Copenhaver, Michael M
We adopted an intersectionality framework and examined whether the relationship between internalized HIV stigma and depressive symptoms is moderated by internalized substance use stigma. A total of 85 people living with HIV with a history of substance use in the Bronx, New York, completed a survey. Results revealed evidence of moderation: Participants who internalized HIV stigma experienced greater depressive symptoms only if they also internalized substance use stigma. Researchers should examine stigma associated with multiple socially devalued characteristics to best understand how stigma impacts mental health among people living with HIV. Healthcare providers should address stigma associated with the full range of socially devalued characteristics with which people living with HIV live. © The Author(s) 2013.
Papadopoulos, Stephanie; Brennan, Leah
While evidence regarding associations between weight stigma and biopsychosocial outcomes is accumulating, outcomes are considered in isolation. Thus, little is known about their complex relationships. This article extends existing work by systematically reviewing the biopsychosocial consequences of stigma in adults with overweight/obesity. Articles were identified through Medline, CINAHL, PsycINFO, Embase, Web of Science, and Cochrane databases. Independent extraction of articles was conducted using predefined data fields, including data on biopsychosocial correlates in each study. Twenty-three studies published from 2001 and addressing correlates of stigma in adults with overweight/obesity (body mass index ≥25 kg m(-2); 18-65 years) were identified. Numerous biopsychosocial correlates of weight stigma were studied, particularly in treatment-seeking individuals. Available research shows that weight stigma is consistently associated with medication non-adherence, mental health, anxiety, perceived stress, antisocial behavior, substance use, coping strategies, and social support. Biopsychosocial correlates were not considered in combination in research. Psychological correlates were well documented in comparison to biological and social correlates for each weight stigma type. There were some indications that associations are stronger once stigma is internalized. While there is evidence for biopsychosocial correlates of weight stigma, these are not considered in combination in research; thus their inter-relationships are unknown. Conclusions from the review are limited by this and the small number of studies, types of designs, and variables considered. © 2015 The Obesity Society.
Alexandra Brewis, PhD
Full Text Available College populations are groups of emerging adults undergoing significant transitions in eating and diet, being exposed to new social influences; many experience weight gain. Theoretically, college campuses should be places where weight stigma is evident and matters for dietary decision-making. We present the findings from two studies conducted within the same college population at a large public university, including anthropometric measures of body mass. Study 1 included two different measures of weight stigma (implicit and explicit and measures of weight-control eating behaviors and fruit and vegetable consumption in a randomized representative sample of 204 students. Study 2 included a measure of weight responsibility and multiple measures of eating (food frequency, alcohol intake, and 24-hour dietary recalls, among freshman students (n = 202, n = 157 with 24-hour dietary recalls. Study 1 showed that the three types of stigmas were prevalent. Study 2 had a high prevalence of weight stigma attitudes and demonstrated the occurrence of unhealthful eating and binge drinking behaviors. Both studies found no relationship between weight stigma/responsibility and eating behaviors regardless of weight status. Beyond considering limitations of the study design, we propose two possible reasons for college students' relative immunity to the effects of weight stigma. Those with very high levels of stigma could be suppressing stigmatizing attitudes based on what they think others think is acceptable in a liberal college setting, or the chaotic form of “normal” eating in this population hides the effects of weight stigma.
Vogel, David L.; Bitman, Rachel L.; Hammer, Joseph H.; Wade, Nathaniel G.
Stigma is considered an important barrier to seeking mental health services. Two types of stigma exist: public stigma and self-stigma. Theoretically, it has been argued that public stigma leads to the development of self-stigma. However, the empirical support for this assertion is limited to cross-sectional data. Therefore, the goal of this…
Quinn, Diane M.; Williams, Michelle K.; Weisz, Bradley M.
Objective Internalizing mental illness stigma is related to poorer well-being, but less is known about the factors that predict levels of internalized stigma. This study explored how experiences of discrimination relate to greater anticipation of discrimination and devaluation in the future, and how anticipation of stigma, in turn predicts greater stigma internalization. Method Participants were 105 adults with mental illness who self-reported their experiences of discrimination based on their mental illness, their anticipation of discrimination and social devaluation from others in the future, and their level of internalized stigma. Participants were approached in several locations and completed surveys on laptop computers. Results Correlational analyses indicated that more experiences of discrimination due to one’s mental illness were related to increased anticipated discrimination in the future, increased anticipated social stigma from others, and greater internalized stigma. Multiple serial mediator analyses showed that the effect of experiences of discrimination on internalized stigma was fully mediated by increased anticipated discrimination and anticipated stigma. Conclusion and Implications for Practice Experiences of discrimination over the lifetime may influence not only how much future discrimination people with mental illness are concerned with but also how much they internalize negative feelings about the self. Mental health professionals may need to address concerns with future discrimination and devaluation in order to decrease internalized stigma. PMID:25844910
Quinn, Diane M; Williams, Michelle K; Weisz, Bradley M
Internalizing mental illness stigma is related to poorer well-being, but less is known about the factors that predict levels of internalized stigma. This study explored how experiences of discrimination relate to greater anticipation of discrimination and devaluation in the future and how anticipation of stigma in turn predicts greater stigma internalization. Participants were 105 adults with mental illness who self-reported their experiences of discrimination based on their mental illness, their anticipation of discrimination and social devaluation from others in the future, and their level of internalized stigma. Participants were approached in several locations and completed surveys on laptop computers. Correlational analyses indicated that more experiences of discrimination due to one's mental illness were related to increased anticipated discrimination in the future, increased anticipated social stigma from others, and greater internalized stigma. Multiple serial mediator analyses showed that the effect of experiences of discrimination on internalized stigma was fully mediated by increased anticipated discrimination and anticipated stigma. Experiences of discrimination over one's lifetime may influence not only how much future discrimination people with mental illness are concerned with but also how much they internalize negative feelings about the self. Mental health professionals may need to address concerns with future discrimination and devaluation in order to decrease internalized stigma. (c) 2015 APA, all rights reserved).
Firmin, Ruth L; Lysaker, Paul H; Luther, Lauren; Yanos, Philip T; Leonhardt, Bethany; Breier, Alan; Vohs, Jenifer L
Although internalized stigma is associated with negative outcomes among those with prolonged psychosis, surprisingly little work has focused on when in the course of one's illness stigma is internalized and the impact of internalization on symptoms or social functioning over the course of the illness. Therefore, this study investigated whether (1) internalized stigma is greater among those later in the course of psychosis and (2) whether internalized stigma has a stronger negative relationship with social functioning or symptoms among those with prolonged compared to early phase psychosis. Individuals with early phase (n = 40) and prolonged psychosis (n = 71) who were receiving outpatient services at an early-intervention clinic and a VA medical center, respectively, completed self-report measures of internalized stigma and interview-rated measures of symptoms and social functioning. Controlling for education, race and sex differences, internalized stigma was significantly greater among those with prolonged psychosis compared to early phase. Internalized stigma was negatively related to social functioning and positively related to symptoms in both groups. Furthermore, the magnitude of the relationship between cognitive symptoms and internalized stigma was significantly greater among those with early phase. Stereotype endorsement, discrimination experiences and social withdrawal also differentially related to symptoms and social functioning across the 2 samples. Findings suggest that internalized stigma is an important variable to incorporate into models of early psychosis. Furthermore, internalized stigma may be a possible treatment target among those with early phase psychosis. © 2018 John Wiley & Sons Australia, Ltd.
Baugher, Amy R; Beer, Linda; Fagan, Jennifer L; Mattson, Christine L; Freedman, Mark; Skarbinski, Jacek; Shouse, R Luke
HIV-infected U.S. adults have reported internalized HIV-related stigma; however, the national prevalence of stigma is unknown. We sought to determine HIV-related stigma prevalence among adults in care, describe which socio-demographic groups bear the greatest stigma burden, and assess the association between stigma and sustained HIV viral suppression. The Medical Monitoring Project measures characteristics of U.S. HIV-infected adults receiving care using a national probability sample. We used weighted data collected from June 2011 to May 2014 and assessed self-reported internalized stigma based on agreement with six statements. Overall, 79.1% endorsed ≥1 HIV-related stigma statements (n = 13,841). The average stigma score was 2.4 (out of a possible high score of six). White males had the lowest stigma scores while Hispanic/Latina females and transgender persons who were multiracial or other race had the highest. Although stigma was associated with viral suppression, it was no longer associated after adjusting for age. Stigma was common among HIV-infected adults in care. Results suggest individual and community stigma interventions may be needed, particularly among those who are Stigma was not independently associated with viral suppression; however, this sample was limited to adults in care. Examining HIV-infected persons not in care may elucidate stigma's association with viral suppression.
Lucksted, Alicia; Drapalski, Amy; Calmes, Christine; Forbes, Courtney; DeForge, Bruce; Boyd, Jennifer
This study evaluated "Ending Self-Stigma" (ESS), a structured 9-session group intervention to help people with serious mental illnesses reduce internalized stigma. Participants from two Veterans Administration mental health sites were assessed before and after the intervention regarding their levels of internalized stigma, empowerment, recovery orientation, perceived social support, and beliefs about societal stigma. Internalized stigma significantly decreased, and perceived social support and recovery orientation significantly increased. "Ending Self-Stigma" is the first of its kind and may be a valuable intervention for reducing internalized stigma among people with serious mental illnesses, suitable for both professionally-delivered psychiatric rehabilitation programs and consumer-led programs and services.
Phelan, S M; Burgess, D J; Yeazel, M W; Hellerstedt, W L; Griffin, J M; van Ryn, M
The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care. © 2015 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of International Association for the Study of Obesity (IASO).
Mulherin, K.; Miller, Y. D.; Barlow, F. K.; Diedrichs, P. C.; Thompson, R.
Abstract Background Weight stigma is pervasive in Western society and in healthcare settings, and has a negative impact on victims’ psychological and physical health. In the context of an increasing focus on the management of overweight and obese women during and after pregnancy in research and clinical practice, the current studies aimed to examine the presence of weight stigma in maternity care. Addressing previous limitations in the weight stigma literature, this paper quantitatively explo...
Setchell, J; Gard, M; Jones, L; Watson, B M
In this article, we propose a theory-driven approach to developing interventions for reducing weight stigma in physiotherapy and discuss the design and exploratory trial of such an intervention. Weight stigma has been identified in physiotherapists in empirical investigations. However, there has been little consideration of how this stigma might be addressed. We highlight Goffman's work on stigma that provides social and embodied understandings of stigma. Goffman's approach, however, is notably apolitical, ahistorical and lacks mechanisms for understanding power. We suggest that post-structuralist perspectives can provide insight into these areas. Drawing on these theories, we critically examine the literature on weight stigma reduction, finding that trials have largely been unsuccessful. We argue that this may be due to overly passive and simplistic intervention designs. As context-specific understandings are desirable, we examine the nature of physiotherapy to determine what might be relevant to (re)thinking weight in this profession. We then discuss the development of a multifactorial, active weight stigma intervention we trialed with eight physiotherapists. Supported by theory, the outcomes of the exploratory study suggest that physiotherapy-specific factors such as fostering professional reflexivity and improving understandings of stigma need to be incorporated into an active intervention that considers the complex determinants of weight stigma.
Santos, Jussara C.; Barros, Sônia; Santos, Irma M. M.
In this study, we have surveyed how professionals from multidisciplinary teams at psychosocial care centers (CAPS), in the city of São Paulo, understand the concept of mental illness stigma. The aim of the survey was to characterize the actions developed by the team to overcome stigma and, thus, contribute to develop strategies that incorporate overcoming stigma in the territory. Our objective is to get acquainted to the concepts about stigma shared by the participants. This survey was based on the theory of stigma by Erving Goffman; data were collected through semi-structured interviews with mental health professionals belonging to the CAPS teams. Results indicate that social exclusion is understood as a synonym to stigma, and that proximity of CAPS to society in the territory facilitates social inclusion and the overcoming of the mental illness stigma. PMID:28462343
Jussara C. Santos
Full Text Available In this study, we have surveyed how professionals from multidisciplinary teams at psychosocial care centers (CAPS, in the city of São Paulo, understand the concept of mental illness stigma. The aim of the survey was to characterize the actions developed by the team to overcome stigma and, thus, contribute to develop strategies that incorporate overcoming stigma in the territory. Our objective is to get acquainted to the concepts about stigma shared by the participants. This survey was based on the theory of stigma by Erving Goffman; data were collected through semi-structured interviews with mental health professionals belonging to the CAPS teams. Results indicate that social exclusion is understood as a synonym to stigma, and that proximity of CAPS to society in the territory facilitates social inclusion and the overcoming of the mental illness stigma.
Rebecca L. Pearl
Full Text Available Background/Aims: Sociocultural and familial factors associated with weight bias internalization (WBI are currently unknown. The present study explored the relationship between interpersonal sources of weight stigma, family weight history, and WBI. Methods: Participants with obesity (N = 178, 87.6% female, 71.3% black completed questionnaires that assessed the frequency with which they experienced weight stigma from various interpersonal sources. Participants also reported the weight status of their family members and completed measures of WBI, depression, and demographics. Participant height and weight were measured to calculate body mass index (BMI. Results: Linear regression results (controlling for demographics, BMI, and depression showed that stigmatizing experiences from family and work predicted greater WBI. Experiencing weight stigma at work was associated with WBI above and beyond the effects of other sources of stigma. Participants who reported higher BMIs for their mothers had lower levels of WBI. Conclusion: Experiencing weight stigma from family and at work may heighten WBI, while having a mother with a higher BMI may be a protective factor against WBI. Prospective research is needed to understand WBI's developmental course and identify mechanisms that increase or mitigate its risk.
Ramirez-Valles, Jesus; Molina, Yamile; Dirkes, Jessica
Stigma negatively affects the health of people living with HIV/AIDS (PLWHA). Negative attitudes and discriminatory actions towards PLWHA are thought to be based, among other factors, on stigma towards sexual minorities and beliefs about personal responsibility. Yet, there is little evidence to support these linkages and explain how they take place, especially among Latinos. This study analyzes attitudes towards PLWHA among 643 Latino gay/bisexual men and transgender (GBT) people. It examines whether discriminatory actions are predicted by beliefs about personal responsibility and internalized homosexual stigma. Results indicate that Discriminatory Actions towards PLWHA is associated with HIV/AIDS Personal Responsibility Beliefs and Internalized Homosexual Stigma. Further, HIV/AIDS Personal Responsibility Beliefs partially mediates the relationship between Internalized Homosexual Stigma and Discriminatory Actions towards PLWHA. Latino GBT persons who have internalized negative views about homosexuality may project those onto PLWHA. They may think PLWHA are responsible for their serostatus and, hence, deserving of rejection. PMID:23631713
Ramirez-Valles, Jesus; Molina, Yamile; Dirkes, Jessica
Stigma negatively affects the health of people living with HIV/AIDS (PLWHA). Negative attitudes and discriminatory actions towards PLWHA are thought to be based, among other factors, on stigma towards sexual minorities and beliefs about personal responsibility. Yet, there is little evidence to support these linkages and explain how they take place, especially among Latinos. This study analyzes attitudes towards PLWHA among 643 Latino gay/bisexual men and transgender (GBT) people. It examines whether discriminatory actions are predicted by beliefs about personal responsibility and internalized homosexual stigma. Results indicate that Discriminatory Actions towards PLWHA is associated with HIV/AIDS Personal Responsibility Beliefs and Internalized Homosexual Stigma. Further, HIV/AIDS Personal Responsibility Beliefs partially mediates the relationship between Internalized Homosexual Stigma and Discriminatory Actions towards PLWHA. Latino GBT persons who have internalized negative views about homosexuality may project those onto PLWHA. They may think PLWHA are responsible for their serostatus and, hence, deserving of rejection.
Young, Daniel Kim-Wan; Ng, Petrus Y. N.; Pan, Jia-Yan; Cheng, Daphne
Purpose: This study aims to translate and test the reliability and validity of the Internalized Stigma of Mental Illness-Cantonese (ISMI-C). Methods: The original English version of ISMI is translated into the ISMI-C by going through forward and backward translation procedure. A cross-sectional research design is adopted that involved 295…
Tomiyama, A Janet; Epel, Elissa S; McClatchey, Trissa M; Poelke, Gina; Kemeny, Margaret E; McCoy, Shannon K; Daubenmier, Jennifer
Weight discrimination is associated with increased risk of obesity. The mechanism of this relationship is unknown, but being overweight is a highly stigmatized condition and may be a source of chronic stress that contributes to the development and pathophysiology of obesity. The objective of this study was to test whether weight stigma is associated with physiological risk factors linked to stress and obesity, including hypercortisolism and oxidative stress, independent of adiposity. We examined the frequency of experiencing situations involving weight stigma and consciousness of weight stigma in relation to hypothalamic--pituitary--adrenal axis activity and oxidative stress (F₂-isoprostanes) in 45 healthy overweight to obese women. Independent of abdominal fat, weight stigma was significantly related to measures of cortisol (including salivary measures of cortisol awakening response and serum morning levels) as well as higher levels of oxidative stress. Perceived stress mediated the relationship between weight stigma consciousness and the cortisol awakening response. These preliminary findings show that weight stigma is associated with greater biochemical stress, independent of level of adiposity. It is possible that weight stigma may contribute to poor health underlying some forms of obesity.
Boyd, Jennifer E; Adler, Emerald P; Otilingam, Poorni G; Peters, Townley
The Internalized Stigma of Mental Illness (ISMI) scale is a 29-item questionnaire measuring self-stigma among persons with psychiatric disorders. It was developed with substantial consumer input and has been widely used, but its psychometric qualities have not been comprehensively evaluated across multiple versions. Here we review the 55 known versions, and provide the 47 available versions, including: Arabic, Armenian, Bengali, Bulgarian, Chinese (Mainland, Taiwan, Hong Kong), Croatian, Dutch, English (USA, South Africa), Estonian, Farsi, Finnish, French, German, Greek, Hebrew, Hindi, Japanese, Khmer, Korean, Lithuanian, Lugandan, Maltese, Polish, Portuguese (Portugal, Brazil), Romanian, Russian, Samoan, Slovenian, Spanish (Spain), Swahili, Swedish, Tongan, Turkish, Urdu, and Yoruba, and qualitative English and Swahili versions, as well as versions for depression, schizophrenia, substance abuse, eating disorders, epilepsy, inflammatory bowel disease, leprosy, smoking, parents and caregivers of people with mental illness, and ethnicity. The various versions show reliability and validity across a wide range of languages, cultures, and writing systems. The most commonly reported findings of studies using the ISMI are that internalized stigma correlates with higher depression, lower self esteem, and higher symptom severity. Initial studies of ways to reduce internalized stigma are promising and warrant further investigation. © 2014.
Turan, Bulent; Budhwani, Henna; Fazeli, Pariya L; Browning, Wesley R; Raper, James L; Mugavero, Michael J; Turan, Janet M
Few researchers have attempted to examine the mechanisms through which HIV-related stigma in the community is processed and experienced at an individual level by people living with HIV. We examined how the effects of perceived HIV stigma in the community on health outcomes for people living with HIV are mediated by internalized stigma and anticipated stigma. Participants (N = 203) from an HIV clinic completed self-report measures and their clinical data were obtained from medical records. Results suggested that the association between perceived community stigma and affective, cognitive, and mental health outcomes (self-esteem, depressive symptoms, avoidance coping, self-blame) are mediated by internalized stigma. Furthermore, a serial mediation model suggested that perceived community stigma leads to internalized stigma, which leads to anticipated community stigma, which in turn leads to lower medication adherence. The associations between perceived community stigma and interpersonal outcomes (social support, trust in physicians) were mediated by internalized stigma and anticipated stigma, again in a serial fashion (perceived community stigma leads to internalized stigma, which leads to anticipated stigma, which in turn leads to interpersonal outcomes). These results suggest that perceived HIV-related stigma in the community may cause people living with HIV to internalize stigma and anticipate stigmatizing experiences, resulting in adverse health and psychosocial outcomes-information that can be used to shape interventions.
Budhwani, Henna; Fazeli, Pariya L.; Browning, Wesley R.; Raper, James L.; Mugavero, Michael J.; Turan, Janet M.
Few researchers have attempted to examine the mechanisms through which HIV-related stigma in the community is processed and experienced at an individual level by people living with HIV. We examined how the effects of perceived HIV stigma in the community on health outcomes for people living with HIV are mediated by internalized stigma and anticipated stigma. Participants (N = 203) from an HIV clinic completed self-report measures and their clinical data were obtained from medical records. Results suggested that the association between perceived community stigma and affective, cognitive, and mental health outcomes (self-esteem, depressive symptoms, avoidance coping, self-blame) are mediated by internalized stigma. Furthermore, a serial mediation model suggested that perceived community stigma leads to internalized stigma, which leads to anticipated community stigma, which in turn leads to lower medication adherence. The associations between perceived community stigma and interpersonal outcomes (social support, trust in physicians) were mediated by internalized stigma and anticipated stigma, again in a serial fashion (perceived community stigma leads to internalized stigma, which leads to anticipated stigma, which in turn leads to interpersonal outcomes). These results suggest that perceived HIV-related stigma in the community may cause people living with HIV to internalize stigma and anticipate stigmatizing experiences, resulting in adverse health and psychosocial outcomes—information that can be used to shape interventions. PMID:27272742
Pearl, Rebecca L; Puhl, Rebecca M; Dovidio, John F
This study investigated the effects of experiences with weight stigma and weight bias internalization on exercise. An online sample of 177 women with overweight and obesity (M(age) = 35.48 years, M(BMI) = 32.81) completed questionnaires assessing exercise behavior, self-efficacy, and motivation; experiences of weight stigmatization; weight bias internalization; and weight-stigmatizing attitudes toward others. Weight stigma experiences positively correlated with exercise behavior, but weight bias internalization was negatively associated with all exercise variables. Weight bias internalization was a partial mediator between weight stigma experiences and exercise behavior. The distinct effects of experiencing versus internalizing weight bias carry implications for clinical practice and public health. © The Author(s) 2014.
Full Text Available Abstract Background Weight stigma is pervasive in Western society and in healthcare settings, and has a negative impact on victims’ psychological and physical health. In the context of an increasing focus on the management of overweight and obese women during and after pregnancy in research and clinical practice, the current studies aimed to examine the presence of weight stigma in maternity care. Addressing previous limitations in the weight stigma literature, this paper quantitatively explores the presence of weight stigma from both patient and care provider perspectives. Methods Study One investigated associations between pre-pregnancy body mass index (BMI and experiences of maternity care from a state-wide, self-reported survey of 627 Australian women who gave birth in 2009. Study Two involved administration of an online survey to 248 Australian pre-service medical and maternity care providers, to investigate their perceptions of, and attitudes towards, providing care for pregnant patients of differing body sizes. Both studies used linear regression analyses. Results Women with a higher BMI were more likely to report negative experiences of care during pregnancy and after birth, compared to lower weight women. Pre-service maternity care providers perceived overweight and obese women as having poorer self-management behaviours, and reported less positive attitudes towards caring for overweight or obese pregnant women, than normal-weight pregnant women. Even care providers who reported few weight stigmatising attitudes responded less positively to overweight and obese pregnant women. Conclusions Overall, these results provide preliminary evidence that weight stigma is present in maternity care settings in Australia. They suggest a need for further research into the nature and consequences of weight stigma in maternity care, and for the inclusion of strategies to recognise and combat weight stigma in maternity care professionals’ training.
Picco, Louisa; Pang, Shirlene; Lau, Ying Wen; Jeyagurunathan, Anitha; Satghare, Pratika; Abdin, Edimansyah; Vaingankar, Janhavi Ajit; Lim, Susan; Poh, Chee Lien; Chong, Siow Ann; Subramaniam, Mythily
This study aimed to: (i) determine the prevalence, socio-demographic and clinical correlates of internalized stigma and (ii) explore the association between internalized stigma and quality of life, general functioning, hope and self-esteem, among a multi-ethnic Asian population of patients with mental disorders. This cross-sectional, survey recruited adult patients (n=280) who were seeking treatment at outpatient and affiliated clinics of the only tertiary psychiatric hospital in Singapore. Internalized stigma was measured using the Internalized Stigma of Mental Illness scale. 43.6% experienced moderate to high internalized stigma. After making adjustments in multiple logistic regression analysis, results revealed there were no significant socio-demographic or clinical correlates relating to internalized stigma. Individual logistic regression models found a negative relationship between quality of life, self-esteem, general functioning and internalized stigma whereby lower scores were associated with higher internalized stigma. In the final regression model, which included all psychosocial variables together, self-esteem was the only variable significantly and negatively associated with internalized stigma. The results of this study contribute to our understanding of the role internalized stigma plays in patients with mental illness, and the impact it can have on psychosocial aspects of their lives. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
Gloor Jamie Lee; Puhl Rebecca M.
Considerable evidence indicates that individuals with obesity are vulnerable to stigma and discrimination. However comparably less research has examined strategies to reduce weight bias and the existing evidence is mixed. To help clarify these findings and incorporate prejudice reduction interventions that have been successfully applied to other stigmatized groups (i.e. empathy induction and perspective taking) we experimentally tested and compared 4 different brief stigma reduction intervent...
Schafer, Markus H.; Ferraro, Kenneth F.
Obesity is widely recognized as a health risk, but it also represents a disadvantaged social position. Viewing body weight within the framework of stigma and its effects on life chances, we examine how perceived weight-based discrimination influences identity and physical health. Using national survey data with a 10-year longitudinal follow-up, we…
Bassirnia, Anahita; Briggs, Jessica; Kopeykina, Irina; Mednick, Amy; Yaseen, Zimri; Galynker, Igor
Internalized stigma of mental disorders has significant negative outcomes for patients with bipolar disorder and their families. The aim of this study is to evaluate the association between personality traits and internalized stigma of mental disorders in bipolar patients and their treatment partners. Five different questionnaires were utilized in this study: (1) Demographic data questionnaire, (2) Millon Clinical Multiaxial Inventory-III (MCMI-III) for personality traits, (3) Internalized Stigma of Mental Illness (ISMI) for stigma, (4) Self Report Manic Inventory (SRMI) for mania and (5) Center for Epidemiological Studies-Depression Scale (CES-D) for depression. The scores of personality traits were combined to create externalizing and internalizing personality trait scores. Results showed that patients with bipolar disorder and their treatment partners both experienced internalized stigma of mental health disorders. There was a significant positive correlation between internalized stigma and internalizing personality traits, but not externalizing traits. In a multi-variate regression analysis, internalizing personality trait score was found to be a significant predictor of internalized stigma. In conclusion, patients with bipolar disorder and their treatment partners perceive higher level of internalized stigma of mental disorders if they have internalizing personality traits. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Conner, Kyaien O; McKinnon, Symone A; Ward, Christine J; Reynolds, Charles F; Brown, Charlotte
This article examines the mechanisms through which peer educator (PE) intervention targets and reduces internalized stigma. There is substantial evidence that internalized stigma negatively impacts the lives of those suffering with mental health concerns, and has been identified as 1 of the most significant barriers to seeking professional mental health services. There has been a push toward identifying interventions and programs that effectively reduce and mitigate the impact of internalized stigma. Research suggests that contact with other individuals who share a stigmatized condition may be a promising approach to targeting and reducing internalized stigma. However, there is a dearth of research that has identified the mechanism through which this contact impacts internalized stigma. Study participants (n = 19) completed a 3-month PE intervention. Each participant was matched with an older adult with a history of depression currently in recovery who provided psychoeducation, social support, and motivational interviewing. Participants completed a demographic questionnaire, public stigma (PDD), and internalized stigma (Internalized Stigma of Mental Illness, ISMI) scales pre- and post-PE intervention. They further participated in a brief semistructured qualitative interview to attain in-depth information about their perceptions of stigma and of working with a PE. Overall, internalized stigma scores were significantly reduced after participating in the PE intervention. In addition, participants identified 4 mechanisms through which contact with their PE impacted their stigmatized beliefs: age related concerns, shared understanding, improved mental health literacy, and mutual support. This study suggests that PE is a potentially valuable approach toward reducing internalized stigma among older adults with depression. (c) 2015 APA, all rights reserved).
Phillips, Kenneth D; Moneyham, Linda; Tavakoli, Abbas
Stigma has grave consequences for persons living with HIV/AIDS. Stigma hampers prevention of HIV transmission to sexual partners and to unborn babies, diagnosis, and early treatment, and negatively affects mental and physical health, quality of life, and life satisfaction. Internalized stigma of HIV/AIDS may have even more severe consequences than perceived or enacted stigma. The purpose of this study was to develop an instrument to measure internalized stigma in those with HIV/AIDS. Data were drawn from the Rural Women's Health Project. Research assistants administered structured interviews at baseline, 3 months, and 6 months. Instruments used in these analyses included a demographic data form, the Centers for Epidemiological Studies Depression Scale (CES-D), the Perceived Stigma Scale (PSS), and the Internalized Stigma of AIDS Tool (ISAT). Exploratory factor analysis confirmed that the ten items of the ISAT measure a single factor that explains 88% of the variance in the construct. Internal consistency was demonstrated by a Cronbach's alpha of .91 (Time 1), .92 (Time 2), and .92 (Time 3). Convergent validity was supported with significant positive correlations with the CES-D (rho = 0.33, p Stigma of AIDS Tool appears to be a reliable and valid instrument to measure internalization of the stigma of HIV/AIDS. It may be of value in research and clinical assessment.
Kim, Woo Jung; Song, Youn Joo; Ryu, Hyun-Sook; Ryu, Vin; Kim, Jae Min; Ha, Ra Yeon; Lee, Su Jin; Namkoong, Kee; Ha, Kyooseob; Cho, Hyun-Sang
We aimed to examine internalized stigma of patients with mental illness in Korea and identify the contributing factors to internalized stigma among socio-demographic, clinical, and psychosocial variables using a cross-sectional study design. A total of 160 patients were recruited from a university mental hospital. We collected socio-demographic data, clinical variables and administered self-report scales to measure internalized stigma and levels of self-esteem, hopelessness, social support, and social conflict. Internalized stigma was identified in 8.1% of patients in our sample. High internalized stigma was independently predicted by low self-esteem, high hopelessness, and high social conflict among the psychosocial variables. Our finding suggests that simple psychoeducation only for insight gaining cannot improve internalized stigma. To manage internalized stigma in mentally ill patients, it is needed to promote hope and self-esteem. We also suggest that a relevant psychosocial intervention, such as developing coping skills for social conflict with family, can help patients overcome their internalized stigma. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Hackman, Joseph; Maupin, Jonathan; Brewis, Alexandra A
Weight-related stigma is established as a major psychosocial stressor and correlate of depression among people living with obesity in high-income countries. Anti-fat beliefs are rapidly globalizing. The goal of the study is to (1) examine how weight-related stigma, enacted as teasing, is evident among women from a lower-income country and (2) test if such weight-related stigma contributes to depressive symptoms. Modeling data for 12,074 reproductive-age women collected in the 2008-2009 Guatemala National Maternal-Infant Health Survey, we demonstrate that weight-related teasing is (1) experienced by those both underweight and overweight, and (2) a significant psychosocial stressor. Effects are comparable to other factors known to influence women's depressive risk in lower-income countries, such as living in poverty, experiencing food insecurity, or suffering sexual/domestic violence. That women's failure to meet local body norms-whether they are overweight or underweight-serves as such a strong source of psychological distress is particularly concerning in settings like Guatemala where high levels of over- and under-nutrition intersect at the household and community level. Current obesity-centric models of weight-related stigma, developed from studies in high-income countries, fail to recognize that being underweight may create similar forms of psychosocial distress in low-income countries. Copyright © 2016 Elsevier Ltd. All rights reserved.
Firmin, Ruth; Vohs, Jenifer; Luther, Lauren; Yanos, Philip; Leonhardt, Bethany; Lysaker, Paul
Abstract Background: While internalized stigma is associated with negative outcomes among those with prolonged psychosis, surprisingly little work has focused on when in the course of one’s illness stigma is internalized and the impact of internalization on symptoms or quality of life over the course of the illness. Therefore, this study investigated whether (1) internalized stigma is greater among those later in the course of psychosis and (2) whether internalized stigma has a stronger negative relationship with quality of life or symptoms among those with prolonged compared to early-phase psychosis. Methods: Individuals with early-phase (n = 40) and prolonged psychosis (n = 71) who were receiving outpatient services at an early-intervention clinic and a VA medical center, respectively, completed self-report measures of internalized stigma and interview-rated measures of symptoms and quality of life. Results: Controlling for education, race, and sex differences, internalized stigma was significantly greater among those with prolonged compared to early-phase psychosis. Internalized stigma was negatively related to quality of life and positively related to symptoms in both groups. Furthermore, the magnitude of the relationship between cognitive symptoms and internalized stigma was significantly greater among those with early-phase psychosis. Stereotype endorsement, discrimination experiences, and social withdrawal also deferentially related to symptoms and quality of life across the 2 samples. Conclusion: Findings suggest that internalized stigma is an important variable to incorporate into models of early psychosis. Further, internalized stigma may be a possible treatment target among those in their early phase of psychosis.
Can, Ganime; Tanrıverdi, Derya
The aim of this descriptive study was to determine social functioning and internalized stigma in individuals with substance use disorder. The study sample consisted of 105 patients diagnosed with substance use disorder according to the DSM-IV-TR diagnostic criteria. A Descriptive Information Form, Internalized Stigma of Mental Illness Scale (ISMI) and Social Functioning Scale (SFS) were used for data collection. Average total SFS score of the patients was 103.25±25.09 points, indicating an intermediate level of social functioning. Average total ISMI score of patients was 2.92±0.48 points, reflecting a high level of internalized stigma. A negative significant association was observed between the internalized stigma levels and social functioning of patients. These results suggest that rehabilitation of substance users should include counseling services in order to reduce internal perception of stigma and improve their social functioning. Copyright © 2015 Elsevier Inc. All rights reserved.
Turan, Bulent; Budhwani, Henna; Fazeli, Pariya L.; Browning, Wesley R.; Raper, James L.; Mugavero, Michael J.; Turan, Janet M.
Few researchers have attempted to examine the mechanisms through which HIV-related stigma in the community is processed and experienced at an individual level by people living with HIV. We examined how the effects of perceived HIV stigma in the community on health outcomes for people living with HIV are mediated by internalized stigma and anticipated stigma. Participants (N = 203) from an HIV clinic completed self-report measures and their clinical data were obtained from medical records. Res...
In this edition of PCD Sound Bites, author Erica Kenney, ScD, answers questions about her study, which looked at how frequently U.S. schools used evidence-based obesity prevention programs and how often schools implement programs that may unintentionally worsen weight stigma among students.
Holub, Shayla C.; Tan, Cin Cin; Patel, Sanobar L.
Parents and children hold negative attitudes about obesity, but little is known about individual differences in obesity stigma. The current study examined authoritarian parenting style, beliefs about the controllability of weight and fear of fat in relation to mothers' dislike of overweight individuals. Factors related to children's weight…
Tosangwarn, Suhathai; Clissett, Philip; Blake, Holly
Living in a care home is a source of stigma in Thai culture, although there is currently no measurement tool in the Thai language specifically designed to assess internalized stigma in care home residents. The Thai Version of Internalized Stigma of Living in a Care Home (TIS-LCH) scale was developed and tested for its psychometric properties among Thai older residents. The Thai version of Internalized Stigma of Mental Health Illness (ISMI) Scale was revised into the TIS-LCH by replacing the word of "mental health illness" to "living in a care home." Content validity of the TIS-LCH was determined through expert review (n = 6), and reliability testing was undertaken with older care home residents (n = 128). The TIS-LCH showed good internal consistency, with a Cronbach's alpha of .87. Test-retest reliability coefficient of TIS-LCH was excellent for the full scale (ICC = .90). The Thai version of IS-LCH (TIS-LCH) is a valid and reliable measurement tool for assessing internalized stigma in Thai care home residents. The IS-LCH will be a useful research tool to assess internalized stigma in older adults living in care settings. Understanding stigma will help health and social care professionals to plan interventions aimed at reducing or preventing negative emotional reactions and negative behavioural responses toward stigma, which are known to be associated with mental illness and particularly depression among this population.
Lydecker, Janet A; Cotter, Elizabeth W; Palmberg, Allison A; Simpson, Courtney; Kwitowski, Melissa; White, Kelly; Mazzeo, Suzanne E
Weight stigma involves stereotyping individuals based on body size. Individuals with obesity face weight stigma in many areas of their lives, and consequences can include impairment of mental and physical health, relationships, and academic performance. Weight-stigmatizing messages are pervasive in mass media, but the degree and characteristics of its presence within new-media social environments remain comparatively unknown. This study examined weight stigma on Twitter by coding Tweet content that included the word "fat" within a 4-h timeframe (N = 4596). Coding marked demographic characteristics represented in content, messages about weight, and perceived intent of the message. Of all messages, 56.57 % were negative and 32.09 % were neutral. Of those containing weight-stigmatizing messages (n = 529), themes relating to fatness included: gluttonous (48.58 %), unattractive (25.14 %), not sexually desirable (2.65 %), sedentary (13.80 %), lazy (5.86 %), and stupid (4.16 %). Weight-stigmatizing messages are evident in the increasingly important arena of social media, and themes appear similar to those that emerge in other forms of media. Prevention and intervention body image programs should consider targeting social networks to help individuals manage societal messages.
Karakaş, Sibel Asi; Okanlı, Ayşe; Yılmaz, Emine
This study has been conducted to determine the relationship between internalized stigma and self-esteem in patients with schizophrenia. This study was conducted using 60 patients with schizophrenia who were diagnosed as schizophrenic according to the DSM-IV diagnostic criteria in the psychiatric clinics of hospitals in Erzurum. The data were collected using the "Questionnaire on Internalized Stigma of Mental Illness Scale" (ISMI) that determines the socio-demographic characteristics of patients, and the "Short Form of Self-Esteem Scale" (SF-SES). The mean Internalized Stigma of Mental Illness Scale score was high; the mean of the positive dimension of the self-esteem scale score was lower than negative dimension. A negative significant relationship was found (r=-.758, pself-esteem and internalized stigma levels of the patients. There is a significantly positive relationship between the mean scores of the stigma resistance and SERS-SF (r=.339, pself-esteem decreases with the increasing levels of internalized stigma. In particular, the high level of accepting stereotyped judgments and the low stigma resistance can be associated with low self-esteem. Based on these results, increasing psychoeducation and counseling services for patients with schizophrenia, and increasing the public awareness of this issue are recommended. Advanced quantitative studies should be conducted to determine the factors related to fighting stigma. Copyright Â© 2016 Elsevier Inc. All rights reserved.
Background Despite the potential impact on treatment adherence and recovery, there is a dearth of data on the extent and correlates of internalized stigma in patients with schizophrenia in low income countries. We conducted a study to determine the extent, domains and correlates of internalized stigma amongst outpatients with schizophrenia in Ethiopia. Methods The study was a cross-sectional facility-based survey conducted at a specialist psychiatric hospital in Addis Ababa, Ethiopia. Consecutive consenting individuals with a diagnosis of schizophrenia were recruited and assessed using an Amharic version of the Internalized Stigma of Mental Illness (ISMI) scale. Results Data were collected from 212 individuals, who were mostly single (71.2%), unemployed (70.3%) and male (65.1%). Nearly all participants (97.4%) expressed agreement to at least one stigma item contained in the ISMI; 46.7% had a moderate to high mean stigma score. Rural residence (OR = 5.67; 95% CI = 2.30, 13.00; p stigma score. Almost half of those who discontinued their treatment reported that they had done so because of perceived stigma. Those who had attempted suicide (45.3%) were more likely to have a high stigma score (OR = 2.29; 95% CI = 1.27, 4.11; p = 0.006). Over 60% of the variation in the experience of stigma was explained by four factors: social withdrawal (16.7%), perceived discrimination (14.1%), alienation (13.9%) and stereotype endorsement (12.7%). Conclusion Internalized stigma is a major problem among persons with schizophrenia in this outpatient setting in Ethiopia. Internalized stigma has the potential to substantially affect adherence to medication and is likely to affect the recovery process. PMID:23272796
Mahmoud, Sahar; Zaki, Rania A.
This study was a comparative study aiming to assess the extent of internalized stigma of mental illness among patients with schizophrenia & identify stigma as perceived by family members caring schizophrenic patients. The study was conducted in two settings 1st clinic was outpatient clinic for psychiatric patient affiliated to Abbasia…
Kamışlı, Songül; Dil, Satı; Daştan, Leyla; Eni, Nurhayat
In this study, we investigated whether liberty-restricting and other factors can predict internalized stigma among psychiatric inpatients and outpatients. The study sample comprised of 129 inpatients, admitted at least once to psychiatry ward, and 100 outpatients who have never been hospitalized, receiving psychiatric treatment. In addition to demographic and clinical features, patients were evaluated for perceived deprivation of liberty and internalized stigma levels. Patients stated that their liberty was restrained mostly due to involuntary treatment, communication problems, side effects of medical treatment and inability to choose their treatment team. Regression analysis showed that internalized stigma was predicted by perceived deprivation of liberty, marital status and number of admissions to ward. Stigma was related to marital status and admissions to the psychiatry ward. Perceived deprivation of liberty predicts stigma regardless of the disease severity CONCLUSION: Perception of stigma leads to self-isolation, behavioral avoidance and refusal of aid-seeking. Our study indicated that perceived deprivation of liberty is one of the most important factors that lead to increased stigma. Based on our findings, we can say that as patients experience less perceived deprivation of liberty, they would have less stigma and thus, their compliance would increase.
Full Text Available Abstract Background Despite the potential impact on treatment adherence and recovery, there is a dearth of data on the extent and correlates of internalized stigma in patients with schizophrenia in low income countries. We conducted a study to determine the extent, domains and correlates of internalized stigma amongst outpatients with schizophrenia in Ethiopia. Methods The study was a cross-sectional facility-based survey conducted at a specialist psychiatric hospital in Addis Ababa, Ethiopia. Consecutive consenting individuals with a diagnosis of schizophrenia were recruited and assessed using an Amharic version of the Internalized Stigma of Mental Illness (ISMI scale. Results Data were collected from 212 individuals, who were mostly single (71.2%, unemployed (70.3% and male (65.1%. Nearly all participants (97.4% expressed agreement to at least one stigma item contained in the ISMI; 46.7% had a moderate to high mean stigma score. Rural residence (OR = 5.67; 95% CI = 2.30, 13.00; p Conclusion Internalized stigma is a major problem among persons with schizophrenia in this outpatient setting in Ethiopia. Internalized stigma has the potential to substantially affect adherence to medication and is likely to affect the recovery process.
Tanabe, Yosuke; Hayashi, Kunihiko; Ideno, Yuki
The present study investigated the reliability and validity of a Japanese version of the Internalized Stigma of Mental Illness (ISMI) scale, designed to assess internalized stigma experienced by people with mental illness. A survey was conducted with 173 outpatients with mental illness who attended psychiatric clinics on a regular basis. A retest was conducted with 51 participants to evaluate the scale's psychometric properties. The alpha coefficient for the overall internal consistency was 0.91, and the coefficients of the individual ISMI subscales ranged from 0.57 to 0.81. The test-retest reliability was r = 0.85 (n = 51, P stigma resistance items excluded. The Japanese version of the ISMI scale demonstrated similar reliability and validity to the original English version. Therefore, the Japanese version of the ISMI scale may be an effective and valid tool to measure internalized stigma among Japanese people who have a mental illness.
In this edition of PCD Sound Bites, author Erica Kenney, ScD, answers questions about her study, which looked at how frequently U.S. schools used evidence-based obesity prevention programs and how often schools implement programs that may unintentionally worsen weight stigma among students. Created: 12/21/2017 by Preventing Chronic Disease (PCD), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Date Released: 12/21/2017.
Ran, Mao-Sheng; Zhang, Tian-Ming; Wong, Irene Yin-Ling; Yang, Xin; Liu, Chang-Cheng; Liu, Bo; Luo, Wei; Kuang, Wei-Hong; Thornicroft, Graham; Chan, Cecilia Lai-Wan
It is unknown whether there are differences in self-stigma among persons with different types of severe mental illness (SMI) in rural communities. This study was to examine the differences of self-stigma and its correlates in persons with schizophrenia, major depressive disorder or bipolar disorder in a rural community in China. A total of 453 persons with schizophrenia, major depressive disorder or bipolar disorder in a rural community participated in the study. The Internalized Stigma of Mental Illness (ISMI) was used to measure self-stigma. The t-test and analyses of variance (ANOVA) were used to examine the differences in mean scores of ISMI and subscales among the three diagnoses. Logistic regression was used to explore the contributing factors to the level of self-stigma among the three groups. Self-stigma was moderate and severe with 94.7% of the total sample. Persons with schizophrenia had significantly higher mean scores of total ISMI, alienation and discrimination experience than those with bipolar disorders. Lower family income was significantly associated with higher levels of self-stigma in persons with schizophrenia and major depressive disorder. Factors predicting the level of self-stigma among the three groups were various. Self-stigma is common and severe in persons with schizophrenia, major depressive disorder and bipolar disorder, especially those with lower income status in rural community in China. Persons with schizophrenia may have higher levels of self-stigma than those with bipolar disorder. Individual-level interventions should be developed to reduce self-stigma among persons with SMI in Chinese rural communities.
Tsang, Hector W H; Ching, S C; Tang, K H; Lam, H T; Law, Peggy Y Y; Wan, C N
Internalized stigma can lead to pervasive negative effects among people with severe mental illness (SMI). Although prevalence of internalized stigma is high, there is a dearth of interventions and meanwhile a lack of evidence as to their effectiveness. This study aims at unraveling the existence of different therapeutic interventions and the effectiveness internalized stigma reduction in people with SMI via a systematic review and meta-analysis. Five electronic databases were searched. Studies were included if they (1) involved community or hospital based interventions on internalized stigma, (2) included participants who were given a diagnosis of SMI>50%, and (3) were empirical and quantitative in nature. Fourteen articles were selected for extensive review and five for meta-analysis. Nine studies showed significant decrease in internalized stigma and two showed sustainable effects. Meta-analysis showed that there was a small to moderate significant effect in therapeutic interventions (SMD=-0.43; p=0.003). Among the intervention elements, four studies suggested a favorable effect of psychoeducation. Meta-analysis showed that there was small to moderate significant effect (SMD=-0.40; p=0.001). Most internalized stigma reduction programs appear to be effective. This systematic review cannot make any recommendation on which intervention is more effective although psychoeducation seems most promising. More Randomized Controlled Trials (RCT) on particular intervention components using standard outcome measures are recommended in future studies. Copyright © 2016. Published by Elsevier B.V.
Boyd, Jennifer E; Hayward, H'Sien; Bassett, Elena D; Hoff, Rani
We investigated the relationship between internalized stigma of mental illness at baseline and depressive and psychotic symptoms 3 and 6 months later, controlling for baseline symptoms. Data on homeless veterans with severe mental illness (SMI) were provided by the Northeast Program Evaluation Center (NEPEC) Special Needs-Chronic Mental Illness (SN-CMI) study (Kasprow and Rosenheck, 2008). The study used the Internalized Stigma of Mental Illness (ISMI) scale to measure internalized stigma at baseline and the Symptom Checklist-90-R (SCL-90-R) to measure depressive and psychotic symptoms at baseline and 3 and 6 month follow-ups. Higher levels of internalized stigma were associated with greater levels of depressive and psychotic symptoms 3 and 6 months later, even controlling for symptoms at baseline. Alienation and Discrimination Experience were the subscales most strongly associated with symptoms. Exploratory analyses of individual items yielded further insight into characteristics of potentially successful interventions that could be studied. Overall, our findings show that homeless veterans with SMI experiencing higher levels of internalized stigma are likely to experience more depression and psychosis over time. This quasi-experimental study replicates and extends findings of other studies and has implications for future controlled research into the potential long-term effects of anti-stigma interventions on mental health recovery. Published by Elsevier Ireland Ltd.
Mary Beth Asbury
Full Text Available Background This study examined the relationship between family communication and weight stigma. The Family Communication Patterns Theory was used as a framework to explain the relationships between two dimensions of family communication (i.e., conversation orientation and conformity orientation and antifat attitudes (i.e., physical unattractiveness and weight blame. Participants and procedure A total of 585 college-aged participants completed an on-line questionnaire. We used the following instruments: body mass index (BMI, Antifat Attitudes Scale (AFAT, Revised Family Communication Patterns Scale (RFCP. Results Significant relationships were found between the two dimensions of family communication and antifat attitudes. Conversation orientation was negatively associated with antifat attitudes and conformity orientation was positively associated with antifat attitudes. In addition, pluralistic families were less likely to stigmatize the overweight and obese by demonstrating less discrimination with physical attraction and personal weight blame. Conclusions These findings highlight the important association between family communication and antifat attitudes. Families that endorse a pluralistic family type (i.e., high conversation orientation and low conformity orientation appear to engage in the least amount of discrimination with regard to weight stigma. These families are not only less discriminating of others, they perhaps bring about more awareness and information to family members as compared to other family types.
Yanos, Philip T.; Roe, David; Lysaker, Paul H.
Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally-led treatment to address this issue. In this a...
Johnson, Veronica R. F.; Yarhouse, Mark A.
Theorists, clinicians, and researchers have suggested that shame is a central concern in the lives of sexual minority individuals. Cognitive theorists believe that shame occurs when a person fails to achieve his or her standards, which are often based on social, cultural, and spiritual values. Although it is asserted that stigma causes shame among…
James, Tintu; Kutty, V Raman; Boyd, Jennifer; Brzoska, Patrick
Little is known about internalized stigma of mental illness in India. A reason for this could be the lack of valid assessment instruments adapted for the diverse cultures and languages of the country. One of the most widely used and accepted questionnaires to assess internalized stigma is the 29-item Internalized Stigma of Mental Illness (ISMI) scale. The aim of the present study was to translate and adapt the ISMI to the Malayalam-speaking population of Kerala, India and to assess its content and factorial validity. The content validity of the Malayalam-language ISMI was studied through interviews with 7 experts on stigma in India. Factorial validity was examined by means of a confirmatory factor analysis (CFA) based on a cross-sectional survey among 290 patients with mental illness attending follow-up outpatient and primary care clinics in Kerala, India. The expert panel concluded that the items of the translated questionnaire adequately represent internalized stigma in the Malayalam-speaking population of Kerala. The theorized factor structure of the ISMI consisting of five factors showed a suboptimal model fit (WRMR=0.940; TLI=0.971, CFI=0.948; RMSEA=0.059) which improved considerably after removal of the stigma resistance factor and three items with poor factor loadings (WRMR=0.819; TLI=0.982, CFI=0.966; RMSEA=0.051). Although our study identifies some sources of model ill-fit, it shows that a reduced version of the Malayalam-language ISMI can be a valuable tool for the study of internalized stigma in this cultural setting. Copyright © 2016 Elsevier B.V. All rights reserved.
Kenney, Erica L; Wintner, Suzanne; Lee, Rebekka M; Austin, S Bryn
Despite substantial research on school-based obesity prevention programs, it is unclear how widely they are disseminated. It is also unknown whether schools use obesity programs that inadvertently promote weight stigma or disordered weight-control behaviors. In spring 2016, we distributed an online survey about school wellness programming to a simple random sample of US public school administrators (N = 247 respondents; 10.3% response rate). We analyzed survey responses and conducted immersion/crystallization analysis of written open-ended responses. Slightly less than half (n = 117, 47.4%) of schools offered any obesity prevention program. Only 17 (6.9%) reported using a predeveloped program, and 7 (2.8%) reported using a program with evidence for effectiveness. Thirty-seven schools (15.0%) reported developing intervention programs that focused primarily on individual students' or staff members' weight rather than nutrition or physical activity; 28 schools (11.3% of overall) used staff weight-loss competitions. School administrators who reported implementing a program were more likely to describe having a program champion and adequate buy-in from staff, families, and students. Lack of funding, training, and time were widely reported as barriers to implementation. Few administrators used educational (n = 12, 10.3%) or scientific (n = 6, 5.1%) literature for wellness program decision making. Evidence-based obesity prevention programs appear to be rarely implemented in US schools. Schools may be implementing programs lacking evidence and programs that may unintentionally exacerbate student weight stigma by focusing on student weight rather than healthy habits. Public health practitioners and researchers should focus on improving support for schools to implement evidence-based programs.
Olçun, Zeynep; Şahin Altun, Özlem
The aim of this study is to determine the correlation between schizophrenic patients' level of internalized stigma and their level of hope. The population of the study consisted of patients who had been diagnosed with schizophrenia and also met the study inclusion criteria. The study sample selection from the population was not further divided; the study was conducted with 76 patients. The data of the study were collected using a personal information form, the Internalized Stigma of Mental Illness (ISMI) Scale, and Herth Hope Scale. The patients' mean score on the Internalized Stigma Scale was 72.78±16.05. Their score on the Hope Scale is 50.36±11.91. A significant negative correlation was found between the total mean scores of ISMI and the Herth Hope Scale (r=-0.360, pHope Scale (r=0.510, phope levels were found to be moderate. A significant negative correlation was found between internalized stigma and hope. This study also found a significant positive correlation between the stigma resistance of patients and their hope levels. Copyright © 2017 Elsevier Inc. All rights reserved.
Cullen, Bernadette Am; Mojtabai, Ramin; Bordbar, Elahe; Everett, Anita; Nugent, Katie L; Eaton, William W
Social network size and strength is an important determinant of overall health. This study describes the extent and strength of the social network among a sample of individuals with serious mental illness (SMI) and explores the relationship between an individual's social network and their experience of internal stigma and recovery attitudes. Over a 2-year period, consecutive new patients with SMI attending two community mental health clinics were recruited and interviewed using a comprehensive battery of assessments including assessment of internalized stigma, recovery attitudes and symptom severity. Among the 271 patients interviewed, social network size was small across all diagnostic categories. In adjusted results, the number of friends and support from relatives and friends was significantly related to the personal confidence and hope recovery attitude ( p stigma ( p stigma. There is a significant positive relationship between the size and perceived strength of an individual's social network and internalized stigma and some recovery attitudes. Clinical programs that address any of these factors could potentially improve outcomes for this population.
Hing, Nerilee; Russell, Alex M T
The degree to which anticipated and experienced public stigma contribute to self-stigma remains open to debate, and little research has been conducted into the self-stigma of problem gambling. This study aimed to examine which aspects of anticipated and experienced stigma (if any) predict the anticipated level of public stigma associated with problem gambling and the degree of self-stigma felt by people experiencing problem gambling. An online survey of 177 Australians experiencing problem gambling examined whether aspects of the public characterization of problem gambling, anticipated reactions to problem gamblers, and experiences of devaluation and discrimination predicted anticipated level of public stigma and self-stigma. The study found that self-stigma increases with expectations that the public applies a range of negative stereotypes to people with gambling problems, holds demeaning and discriminatory attitudes toward them, and considers them to lead highly disrupted lives. These variables directly predicted anticipated level of public stigma and indirectly predicted self-stigma. These findings lend weight to conceptualizations of self-stigma as an internalization of actual or anticipated public stigma. They also highlight the need for stigma reduction efforts, particularly those that lower negative stereotyping and prejudicial attitudes, to improve currently low rates of help-seeking amongst people with gambling problems.
Livingston, James D; Boyd, Jennifer E
An expansive body of research has investigated the experiences and adverse consequences of internalized stigma for people with mental illness. This article provides a systematic review and meta-analysis of the extant research regarding the empirical relationship between internalized stigma and a range of sociodemographic, psychosocial, and psychiatric variables for people who live with mental illness. An exhaustive review of the research literature was performed on all articles published in English that assessed a statistical relationship between internalized stigma and at least one other variable for adults who live with mental illness. In total, 127 articles met the inclusion criteria for systematic review, of which, data from 45 articles were extracted for meta-analyses. None of the sociodemographic variables that were included in the study were consistently or strongly correlated with levels of internalized stigma. The review uncovered a striking and robust negative relationship between internalized stigma and a range of psychosocial variables (e.g., hope, self-esteem, and empowerment). Regarding psychiatric variables, internalized stigma was positively associated with psychiatric symptom severity and negatively associated with treatment adherence. The review draws attention to the lack of longitudinal research in this area of study which has inhibited the clinical relevance of findings related to internalized stigma. The study also highlights the need for greater attention on disentangling the true nature of the relationship between internalized stigma and other psychosocial variables. Copyright © 2010 Elsevier Ltd. All rights reserved.
Firmin, Ruth; Luther, Lauren; Lysaker, Paul; Vohs, Jennifer
Abstract Background Motivation deficits predict decreased functioning in schizophrenia. Recent work suggests deficits reflect challenges in separate domains: intrinsic motivation (one’s internal drive to engage in a behavior out of enjoyment or interest) and amotivation (one’s broader decrease in motivated behavior linked to avolition and anhedonia). Internalized stigma is another determinant of functioning for people with schizophrenia that may impact motivation. However, little is known about these relationships, including which aspects of motivation it may impact nor when these links emerge. Identifying the link between these constructs may help to identify whether internalized stigma may be a novel treatment target to facilitate improvements in motivation. Methods Forty adults with early phase schizophrenia and 66 adults with prolonged schizophrenia completed measures of internalized stigma, intrinsic motivation, and amotivation. Pearson’s correlations were examined followed by Fischer’s r-to-z transformations to compare differences in the magnitude of associations between internalized stigma and intrinsic motivation and internalized stigma and amotivation among the first episode and prolonged samples. Next, we conducted stepwise regressions to examine whether internalized stigma was associated with intrinsic motivation above and beyond associations with amotivation in each sample. Results In the early phase sample, the association between internalized stigma was greater with intrinsic motivation (r=-0.48, p=.00) compared to amotivation (r=0.27, p=0.10). Associations with internalized stigma in the prolonged sample were also greater with intrinsic motivation (r=-0.30, p=0.02) versus amotivation (r=0.19, p=0.12). The magnitude of the associations between internalized stigma and intrinsic motivation (z=1.03, p=0.15) and between internalized stigma and amotivation (z=0.41, p = 0.34) did not significantly differ when comparing phase of illness. Regression
Kulesza, Magdalena; Watkins, Katherine E; Ober, Allison J; Osilla, Karen C; Ewing, Brett
Little is known about internalized stigma among primary care patients, and whether the presence of internalized stigma is related to the severity of substance use problems independent of substance use-related variables. We sought to examine the relationship between internalized stigma and substance use problems among primary care patients with opioid or alcohol use disorders (OAUDs). We present baseline data from 393 primary care patients who were enrolled in a study of collaborative care for OAUDs. Regression analyses examined the relationship between internalized stigma and substance use problems, controlling for demographics, psychiatric comorbidity, and quantity/frequency of use. The majority of participants reported thinking, at least sometimes, that they "have permanently screwed up" their lives (60%), and felt "ashamed" (60%), and "out of place in the world" (51%) as a result of their opioid or alcohol use. Higher internalized stigma was significantly related to more substance use problems (β=2.68, p<0.01), even after the effects of covariates were accounted for. Stigma added 22%, out of 51% total variance explained, leading to a significant improvement in prediction of substance use problems. Among this group of primary care patients with OAUDs, rates of internalized stigma were comparable to those reported in specialty substance use treatment settings. Consistent with extant specialty care literature, our results suggest that internalized stigma may be a unique contributor that is associated with treatment outcomes, such as substance use problems, among primary care patients with OAUDs. Copyright © 2017 Elsevier B.V. All rights reserved.
Xu, Xiaohua; Sheng, Yu; Khoshnood, Kaveh; Clark, Kirsty
Internalized stigma in people living with HIV is associated with negative outcomes including sexual risk behaviors and depression. Little research has focused on internalized stigma in men who have sex with men living with HIV (MSMLWH) in China. We measured internalized stigma and examined its potential predictors in a sample of 277 MSMLWH from two infectious disease specialist hospitals in Beijing, China. Descriptive analysis showed an intermediate high level of internalized stigma in these men. Multiple linear regression revealed that higher levels of stereotypes, negative affect, older age, lower levels of mastery, and limited information and emotional support were significant predictors of internalized stigma. Cognitive reconstruction interventions should be developed to change negative stereotypes and reduce internalized stigma, and information and emotional support should be provided to develop mastery, foster coping skills for internalized stigma, and alleviate negative affect. MSMLWH of older ages need more attention in stigma reduction programs. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
Setchell, Jenny; Watson, Bernadette; Jones, Liz; Gard, Michael
Weight management is increasingly considered part of physiotherapists' scope of practice in order to improve patient outcomes by, for example, reducing load on joints, or improving chronic pain. However, interactions with patients involving weight may result in patient perceptions of negative judgement from health professionals, which can result in poorer health outcomes. How physiotherapist/patient interactions involving weight are perceived by patients has not yet been investigated. To explore patients' perceptions of interactions with physiotherapists that involved weight, and investigate how these perceptions may inform physiotherapy practice. Face-to-face interviews with physiotherapy patients, with follow up interviews conducted by telephone. Data were analysed thematically. First interviews were held in a physiotherapy practice with follow up interviews conducted two weeks later. Interviews were audio recorded, transcribed and analysed using an inductive thematic method established by Braun and Clarke. Thirty interviews with 15 patients were analysed. Four main themes relevant to weight were identified: 1) perceptions of being 'in physiotherapy' including pre-conceptions, the physical environment, and exposing the body, 2) emphasis placed on weight in physiotherapy interactions, 3) communication styles, and 4) judgement perception. Some patients perceived negative weight judgements from elements of physiotherapy interactions and environments. Physiotherapists need to be aware of this perception because it may result in poorer patient outcomes and patients avoiding physiotherapy appointments. The results suggest strategies to counteract weight stigma include: adjusting the physical environment of the clinic, portraying an understanding of complex determinants of weight, and employing collaborative, non-judgemental communication styles. Copyright © 2015 Elsevier Ltd. All rights reserved.
Campo-Arias, Adalberto; Herazo, Edwin
The prolonged sociopolitical phenomenon of Colombian violence generated a high number of victims, many of whom suffered a continual process of internal displacement and stigma-discrimination complex. To postulate possible mechanisms by which victims of Colombia's internal armed conflict in a situation of forced displacement were stigmatized and discriminated. Stigma affects mental health, not only because it represents a major stressor for discriminated individuals and groups, but also because it accounts for inequalities and inequities in health. Initially, as the victims of the internal armed conflict in situation of forced displacement were not considered as such, but as responsible for the situation. Thus, they had to cope with the social and economic inequalities, explained partially by low categorization or status that they received, possibly due to poor construction of social capital in the country. Also, victims of the internal armed conflict suffer from intersectional stigma and discrimination due to other characteristics such as gender, sexual orientation, ethnic-racial origin, or meeting criteria for a mental disorder. An active process of inclusive social development is required for the displaced victims of the armed conflict,in order to reduce multiple stigma and ensure their mental health. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.
Bouvet, C; Bouchoux, A
Recent studies on insight in people with schizophrenia showed that insight level is linked with treatment compliance. Therefore, many therapies are aimed at increasing the insight level, such as psycho-education. However, insight level is also probably linked with depression level. So, improving insight is at risk of increasing the level of depression. Nevertheless, results on this topic are not consensual in the scientific literature. Presumably, this could be due to the concept of insight itself, although we could hypothesise that some confounding variables are implied in the interaction between insight and depression, such as internalized stigma. to test the hypothesis that the relationship between insight and depression is mediated by internalized stigma in people with schizophrenia. Sixty-two patients with schizophrenia (DSM-IV or ICD-10) recruited in mental health services in Île de France (75% male), aged 20 to 64 years (m=38.71, σ=0. 43), filled in questionnaires assessing internalized stigma (ISMI), depression (CDSS and BDI) and insight (SAIQ, Q8, IS), after giving their written informed consent. Correlations between insight, depression and different variables were made (Hypothesis 1). Then we ran multiple regressions and partial correlations to test the internalized stigma mediation (Hypothesis 2). Insight, internalized stigma and depression are statistically significantly correlated with each scales used (except Q8). Insight is correlated with depressed mood (correlations between IS and CDSS: r=0.27, P=0.04, and BDI, r=0.40, P=0.001). We also found negative correlations between SAIQ and CDSS (r=-0.35, P=0.005) and the BDI (r=-0.4265, P=0.000) which means that good insight is linked with depression. This result validates our hypothesis 1. The statistic tests reveal other complementary results: the association between insight and depression is mediated by the level of internalized stigma: when ISMI is controlled, the correlation between insight and
Oliveira, Sandra E H; Carvalho, Helena; Esteves, Francisco
People with mental illness who internalize stigma often experience reduced self-esteem and impaired quality of life (QOL). To propose a theoretical model in which self-esteem mediates the effects of internalized stigma on the multidimensional domains comprising QOL. In 403 inpatients and outpatients (DSM-IV, American Psychiatric Association, 1994), from hospital-based and community mental health facilities, self-report measures of internalized stigma (ISMI), self-esteem (RSES) and QOL (WHOQOL-Bref) were administrated. Structural equation modeling results supported the proposed model. Self-esteem fully mediated the relation between internalized stigma and the physical and the social relationships domains, and partially mediated the relationship between internalized stigma and psychological, environment and level of independence QOL domains. Such results provided empirical support and shed light upon previous research. Specifically the results emphasize the mediating role that self-esteem plays in the degree to which internalized stigma exerts a negative effect on specific QOL domains. Self-esteem appears to be a core element in reducing the negative effects of internalized stigma on aspects of QOL among people with mental illness. These findings suggest there is a crucial impact regarding clinical mental health interventions along with important theoretical implications.
Pantelic, Marija; Boyes, Mark; Cluver, Lucie; Meinck, Franziska
Internalized HIV stigma is a key risk factor for negative outcomes amongst adolescents living with HIV (ALHIV), including non-adherence to anti-retroviral treatment, loss-to-follow-up and morbidity. This study tested a theoretical model of multi-level risk pathways to internalized HIV stigma among South African ALHIV. From 2013 to 2015, a survey using t otal population sampling of ALHIV who had ever initiated anti-retroviral treatment (ART) in 53 public health facilities in the Eastern Cape, South Africa was conducted. Community-tracing ensured inclusion of ALHIV who were defaulting from ART or lost to follow-up. 90.1% of eligible ALHIV were interviewed ( n = 1060, 55% female, mean age = 13.8, 21% living in rural locations). HIV stigma mechanisms (internalized, enacted, and anticipated), HIV-related disability, violence victimization (physical, emotional, sexual abuse, bullying victimization) were assessed using well-validated self-report measures. Structural equation modelling was used to test a theoretically informed model of risk pathways from HIV-related disability to internalized HIV stigma. The model controlled for age, gender and urban/rural address. Prevalence of internalized HIV stigma was 26.5%. As hypothesized, significant associations between internalized stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV-related disability, victimization, and enacted stigma were not directly associated with internalized stigma. Instead significant pathways were identified via anticipated HIV stigma and depression. The model fitted the data well (RMSEA = .023; CFI = .94; TLI = .95; WRMR = 1.070). These findings highlight the complicated nature of internalized HIV stigma. Whilst it is seemingly a psychological process, indirect pathways suggest multi-level mechanisms leading to internalized HIV stigma. Findings suggest that protection from violence within homes, communities and schools may interrupt risk pathways from HIV
Kira, Ibrahim A; Lewandowski, Linda; Ashby, Jeffrey S; Templin, Thomas; Ramaswamy, Vidya; Mohanesh, Jamal
Understanding the dynamics of mental health stigma through existing frameworks, especially in minorities with higher stigma, is problematic. There is a need to reconceptualize stigma, particularly in highly traumatized groups. The current study examines the validity of a new development-based trauma framework that conceptualizes stigma as a type III chronic trauma that contributes to negative mental health effects. This framework proposes that public stigma is a unique chronic traumatic stress that mediates the effects of similar trauma types in mental health patients. To test this proposition, this study explores the relationships between internalized stigma of mental illness (ISMI), different trauma types, and posttrauma spectrum disorders. ISMI, posttraumatic stress disorder, other posttrauma spectrum disorders, and cumulative trauma measures were administered to a sample of 399 mental health patients that included Arab (82%), Muslim (84%), and refugee (31%), as well as American patients (18%). Age in the sample ranged from 18 to 76 years (M = 39.66, SD = 11.45), with 53.5% males. Hierarchical multiple regression, t tests, and path analyses were conducted. Results indicated that ISMI predicted posttraumatic stress disorder and other posttrauma spectrum disorders after controlling for cumulative trauma. ISMI was associated with other chronic collective identity traumas. While Arab Americans, Muslims, and refugees had higher ISMI scores than other Americans, the elevated chronic trauma levels of these groups were significant predictors of these differences. The results provide evidence to support ISMI traumatology model. Implications of the results for treating victims of ISMI, especially Arab Americans, Muslims and refugees are discussed. © The Author(s) 2014.
Kim, Mi Young; Jun, Seong Sook
This study was done to develop a internalized stigma reducing program based on cognitive-behavioral therapy and appropriate for patients with schizophrenia and to evaluate its effectiveness. The study design was a mixed method research. Qualitative study, 13 patients with schizophrenia who had experience in overcoming stigma were purposively chosen for interviews and data were analyzed using Giorgi method. Quantitative study, 64 patients with schizophrenia (experimental group=32, control group=32) were recruited. The cognitive-behavioral therapy-based program for reducing internalized stigma in patients with schizophrenia was provided for 8 weeks (12 sessions). Data were collected from June. 20, 2013 to Feb. 14, 2014. Quantitative data were analyzed using χ²-test, t-test, repeated measures ANOVA with the SPSS program. Qualitative results, from the experience of coping with stigma in patients with schizophrenia seventeen themes and five themes-clusters were drawn up. Quantitative results showed that internalized stigma, self-esteem, mental health recovery and quality of life were significantly better in the experimental group compared to the control group. Study findings indicate that this program for reducing internalized stigma in patients with schizophrenia is effective and can be recommended as a rehabilitation program intervention to help patients with schizophrenia to cope with internalized stigma.
Spooner, Catherine; Jayasinghe, Upali W; Faruqi, Nighat; Stocks, Nigel; Harris, Mark F
Rates of obesity have increased globally and weight stigma is commonly experienced by people with obesity. Feeling stigmatised because of one's weight can be a barrier to healthy eating, physical activity and to seeking help for weight management. The aim of this study was to identify predictors of perceived weight among middle-older aged patients with obesity attending general practices in socioeconomically disadvantaged urban areas of Australia. As part of a randomised clinical trial in Australia, telephone interviews were conducted with 120 patients from 17 general practices in socioeconomically disadvantaged of Sydney and Adelaide. Patients were aged 40-70 years with a BMI ≥ 30 kg/m 2 . The interviews included questions relating to socio-demographic variables (e.g. gender, language spoken at home), experiences of weight-related discrimination, and the Health Literacy Questionnaire (HLQ). Multi-level logistic regression data analysis was undertaken to examine predictors of recent experiences of weight-related discrimination ("weight stigma"). The multi-level model showed that weight stigma was positively associated with obesity category 2 (BMI = 35 to stigma and gender, age, education or the other HLQ domains examined. Weight stigma disproportionately affected the patients with obesity most in need of support to manage their weight: those with more severe obesity, from non-English speaking backgrounds and who were not in employment. Additionally, those who had experienced weight stigma were less able to actively engage with healthcare providers further compounding their disadvantage. This suggests the need for a more proactive approach to identify weight stigma by healthcare providers. Addressing weight stigma at the individual, system and population levels is recommended. The trial was registered with the Australian Clinical Trials Registry ACTRN126400102162 .
Incollingo Rodriguez, Angela C; Heldreth, Courtney M; Tomiyama, A Janet
Although a considerable amount of research has revealed connections between weight stigma and mental and physical health outcomes, no studies to date have experimentally manipulated the experience of obesity to understand how weight stigma causally affects eating behavior, physiology, and psychological well-being. Research has also not yet identified effective strategies for reducing weight stigma. In this research, the effect of weight stigma on psychological outcomes, unhealthy eating behavior, and the stress hormone cortisol was examined by randomly assigning participants to appear obese by wearing a fat suit or not. It was hypothesized that the physical alteration of participants' apparent body size would lead to similar consequences as those associated with the experience of weight stigma and reduce antifat attitudes. Supporting these hypotheses, experimentally manipulating apparent body size led participants to consume more unhealthy foods and report higher levels of negative effect. However, the study did not show any differences in cortisol reactivity or reduction in antifat attitudes as a function of the fat suit manipulation. These findings contribute to an understanding of the potentially deleterious psychological and behavioral effects of weight stigma while also informing future interventions to reduce weight stigma. © 2016 The Obesity Society.
Background People with schizophrenia face prejudice and discrimination from a number of sources including professionals and families. The degree of stigma perceived and experienced varies across cultures and communities. We aimed to develop a cross-cultural measure of the stigma perceived by people with schizophrenia. Method Items for the scale were developed from qualitative group interviews with people with schizophrenia in six countries. The scale was then applied in face-to-face interviews with 164 participants, 103 of which were repeated after 30 days. Principal Axis Factoring and Promax rotation evaluated the structure of the scale; Horn’s parallel combined with bootstrapping determined the number of factors; and intra-class correlation assessed test-retest reliability. Results The final scale has 31 items and four factors: informal social networks, socio-institutional, health professionals and self-stigma. Cronbach’s alpha was 0.84 for the Factor 1; 0.81 for Factor 2; 0.74 for Factor 3, and 0.75 for Factor 4. Correlation matrix among factors revealed that most were in the moderate range [0.31-0.49], with the strongest occurring between perception of stigma in the informal network and self-stigma and there was also a weaker correlation between stigma from health professionals and self-stigma. Test-retest reliability was highest for informal networks [ICC 0.76 [0.67 -0.83
Puckett, Jae A; Newcomb, Michael E; Ryan, Daniel T; Swann, Greg; Garofalo, Robert; Mustanski, Brian
Young men who have sex with men (YMSM) experience minority stressors that impact their mental health, substance use, and sexual risk behaviors. Internalized homophobia (IH) and perceived stigma represent two of these minority stressors, and there has been limited research empirically validating measures of these constructs. We validated measures of IH and perceived stigma with a sample of 450 YMSM (mean age=18.9) and a sample of 370 YMSM (mean age=22.9). Results from exploratory and confirmatory factor analyses supported modifications to the IH and perceived stigma scales, ultimately revealing a three factor and one factor structure, respectively. Convergent and discriminant validity were examined utilizing correlations between IH, perceived stigma, and other variables related to minority stress (e.g., victimization). We evaluated predictive validity by examining relations with mental health, substance use, and risky sexual behaviors measured 12-months from baseline. There were mixed findings for IH, with subscales varying in their relations to mental health, drinking, and sexual risk variables. Perceived stigma was not related to mental health or substance use, but was associated with greater prevalence of STIs. Findings supported the use of these modified scales with YMSM and highlight the need for further measurement studies.
Yanos, Philip T.; Roe, David; Lysaker, Paul H.
Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally-led treatment to address this issue. In this article, we discuss our development of a new, group-based approach to the treatment of internalized stigma which we have termed “narrative enhancement and cognitive therapy” (NECT). We describe the treatment approach and offer an illustration of it by way of a case vignette. PMID:21985260
Noor, Ayesha; Bashir, Sajid; Earnshaw, Valerie A
The objective of this study was to examine the impact of workplace bullying on self-esteem, including the mediating effect of internalized stigma and the moderating effect of spirituality, among hepatitis C virus patients. Data were collected from 228 employed hepatitis C virus patients who had been admitted to Gastroenterology and Hepatology wards in Pakistani hospitals. We found support for the hypothesis that workplace bullying is associated with low self-esteem via internalized stigma. In addition, spirituality moderated the association such that participants with greater spirituality were buffered from the impact of stigma on self-esteem. © The Author(s) 2015.
Korkmaz, Gülçin; Küçük, Leyla
This descriptive study aims to identify the relationship between internalized stigma and perceived family support in patients hospitalized in an acute psychiatric unit. The sample is composed of 224 patients treated in an acute inpatient psychiatric ward in İstanbul, Turkey. The data were collected using information obtained from the Internalized Stigma of Mental Illness Scale and Social Support from Family Scale. The mean age of the patients was 37±11.56years, and the mean duration of treatment was 6.27±5.81years. Most patients had been hospitalized three or more times. Of the total number of patients, 66.1% had been taken to the hospital by family members. We noted a statistically significant negative correlation between the total scores obtained from the perceived Social Support from Family Scale and the Internalized Stigma of Mental Illness Scale. The patients were observed to stigmatize themselves more when the perceived social support from their family had decreased. Copyright © 2015 Elsevier Inc. All rights reserved.
Burke, Sara E.; Dovidio, John F.; Levina, Olga S.; Uusküla, Anneli; Niccolai, Linda M.; Heimer, Robert
Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services. PMID:26050155
Bennett, David S; Hersh, Jill; Herres, Joanna; Foster, Jill
Youth living with HIV (YLH) are at elevated risk of internalizing symptoms, although there is substantial individual variability in adjustment. We examined perceived HIV-related stigma, shame-proneness, and avoidant coping as risk factors of internalizing symptoms among YLH. Participants (N = 88; ages 12-24) completed self-report measures of these potential risk factors and three domains of internalizing symptoms (depressive, anxiety, and PTSD) during a regularly scheduled HIV clinic visit. Hierarchical regressions were conducted for each internalizing symptoms domain, examining the effects of age, gender, and maternal education (step 1), HIV-related stigma (step 2), shame- and guilt-proneness (step 3), and avoidant coping (step 4). HIV-related stigma, shame-proneness, and avoidant coping were each correlated with greater depressive, anxiety, and PTSD symptoms. Specificity was observed in that shame-proneness, but not guilt-proneness, was associated with greater internalizing symptoms. In multivariable analyses, HIV-related stigma and shame-proneness were each related to greater depressive and PTSD symptoms. Controlling for the effects of HIV-related stigma and shame-proneness, avoidant coping was associated with PTSD symptoms. The current findings highlight the potential importance of HIV-related stigma, shame, and avoidant coping on the adjustment of YLH, as interventions addressing these risk factors could lead to decreased internalizing symptoms among YLH.
Paraskevoulakou, Alexia; Vrettou, Kassiani; Pikouli, Katerina; Triantafillou, Evgenia; Lykou, Anastasia; Economou, Marina
Since evaluation regarding the impact of mental illness related internalized stigma is scarce, there is a great need for psychometric instruments which could contribute to understanding its adverse effects among Greek patients with severe mental illness. The Brief Internalized Stigma of Mental Illness (ISMI) scale is one of the most widely used measures designed to assess the subjective experience of stigma related to mental illness. The present study aimed to investigate the psychometric properties of the Greek version of the Brief ISMI scale. In addition to presenting psychometric findings, we explored the relationship of the Greek version of the Brief ISMI subscales with indicators of self-esteem and quality of life. 272 outpatients (108 males, 164 females) meeting the DSM-IV TR criteria for severe mental disorder (schizophrenia, bipolar disorder, major depression) completed the Brief ISMI, the RSES and the WHOQOL-BREF scales. Patients reported age and educational level. A retest was conducted with 124 patients. The Chronbach's alpha coefficient was 0 0.83. The test-retest reliability coefficients varied from 0.81 to 0.91, indicating substantial agreement. The ICC was for the total score 0.83 and for the two factors, 0.69 and 0.77 respectively. Factor analysis provided strong evidence for a two factor model. Factors 1 and 2 were named respectively "how others view me" and "how I view myself". They were negatively correlated with both RSES and WHOQOL-BREF scales, as well as with educational level. Factor 2 was significantly associated with the type of diagnosis. The Greek version of the Brief ISMI scale can be used as a reliable and valid tool for assessing mental illness related internalized stigma among Greek patients with severe mental illness.
Brown-Johnson, Cati G.; Cataldo PhD, Janine K.; Orozco, Nicholas; Lisha, Nadra E.; Hickman, Norval; Prochaska, Judith J.
Background and Objectives De-normalization of smoking as a public health strategy may create shame and isolation in vulnerable groups unable to quit. To examine the nature and impact of smoking stigma, we developed the Internalized Stigma of Smoking Inventory (ISSI), tested its validity and reliability, and explored factors that may contribute to smoking stigma. Methods We evaluated the ISSI in a sample of smokers with mental health diagnoses (N=956), using exploratory and confirmatory factor analysis, and assessed construct validity. Results Results reduced the ISSI to 8 items with three subscales: smoking self-stigma related to shame, felt stigma related to social isolation, and discrimination experiences. Discrimination was the most commonly endorsed of the three subscales. A multivariate generalized linear model predicted 21-30% of the variance in the smoking stigma subscales. Self-stigma was greatest among those intending to quit; felt stigma was highest among those experiencing stigma in other domains, namely ethnicity and mental illness-based; and smoking-related discrimination was highest among women, Caucasians, and those with more education. Discussion and Conclusion Smoking stigma may compound stigma experiences in other areas. Aspects of smoking stigma in the domains of shame, isolation, and discrimination related to modeled stigma responses, particularly readiness to quit and cigarette addiction and was found to be more salient for groups where tobacco use is least prevalent. Scientific Significance The ISSI measure is useful for quantifying smoking-related stigma in multiple domains. PMID:25930661
Valiente, Carmen; Provencio, Maria; Espinosa, Regina; Duque, Almudena; Everts, Franziska
Evidence suggests that insight in psychosis has been related to treatment adherence, recovery and good prognosis, but also to depression, low self-esteem, and diminished quality of life. Thus, insight might not be advantageous under all circumstances. Internalized-stigma (i.e. self-acceptance of stigmatizing images of illness) and experiential avoidance (i.e. unwillingness to experience negative private events) have been proposed as moderating variables between insight, and psychological health variables and/or distress. We investigated the patterns of association of insight with satisfaction with life, self-esteem, depression, anxiety and psychotic psychopathology as moderated by self-stigmatizing beliefs and experiential avoidance, in a sample of 47 participants with persecutory beliefs and diagnosed with schizophrenia or other psychotic disorder. Moderation analyses confirm the importance of internalized-stigma and experiential avoidance. The presence of insight was associated with more depression when there were high levels of self-stigma. Whereas, the absence of insight was associated with a greater life satisfaction when there were high levels of experiential avoidance. To summarize, our results help understand the complex relationship between insight, psychological health variables and emotional distress, pointing to a differential pattern of moderation for negative and positive outcomes. We discuss the implications of these results for research and treatment of paranoia. Copyright © 2015 Elsevier B.V. All rights reserved.
Gallo, Verónica Del Valle; Burrone, María Soledad; Fernandez, Alicia Ruth; Boyd, Jennifer E; Abeldaño, Roberto Ariel
People who consume psychoactive substances may experience situations of social stigma on the part of the society in general, and also situations of internalized-stigma derived from their own consumption of substances. The Internalized Stigma of Mental Illness (ISMI) scale has been shown to be valid and reliable to evaluate the internalized-stigma in people with severe mental disorders, but in Argentina there is no a Spanish version of this scale for use with people who use psychoactive substances. The objective of this work was to evaluate the psychometric properties of the Spanish version of the Internalized Stigma of Mental Illness instrument adapted for people who use psychoactive substances. The work was carried out on a sample of 200 patients older than 18 years under treatment of rehabilitation by consumption of psychoactive substances in a public institution of the city of Córdoba (Argentina) between the years 2014 and 2016. The instrument used was the Internalized Stigma of Mental Illness (ISMI) previously adapted for use in these groups of patients. It was determined the reliability of the scale through Cronbach's coefficients α and factorial structure was analyzed through an exploratory factor analysis. The obtained coefficients showed a high reliability, while in the factorial structure emerged the 4 theoretical dimensions described by Ritsher, namely: social isolation, perceived discrimination, alienation and stereotyping. It is concluded that the scale adapted for people who use psychoactive substances is reliable and with an adequate factorial structure.
Levin, Michael E.; Potts, Sarah; Haeger, Jack; Lillis, Jason
Weight self-stigma is a promising target for innovative interventions seeking to improve outcomes among overweight/obese individuals. Preliminary research suggests acceptance and commitment therapy (ACT) may be an effective approach for reducing weight self-stigma, but a guided self-help version of this intervention may improve broad dissemination. This pilot open trial sought to evaluate the potential acceptability and efficacy of a guided self-help ACT intervention, included coaching and a ...
Lieberman, Debra L; Tybur, Josh M; Latner, Janet D
Recent research has established a link between disgust sensitivity and stigmatizing reactions to various groups, including obese individuals. However, previous research has overlooked disgust's multiple evolved functions. Here, we investigated whether the link between disgust sensitivity and obesity stigma is specific to pathogen disgust, or whether sexual disgust and moral disgust--two separate functional domains--also relate to negative attitudes toward obese individuals. Additionally, we investigated whether sex differences exist in the manner disgust sensitivity predicts obesity stigma, whether the sexes differ across the subtypes of obesity bias independent of disgust sensitivity, and last, the association between participants' BMI and different subtypes of obesity stigma. In study 1 (N = 92), we established that obesity elicits pathogen, sexual, and moral disgust. In study 2, we investigated the relationship between these types of disgust sensitivity and obesity stigma. Participants (N = 387) reported their level of disgust toward various pathogen, sexual, and moral acts and their attitudes toward obese individuals. For women, but not men, increased pathogen disgust sensitivity predicted more negative attitudes toward obese individuals. Men reported more negative general attitudes toward obese individuals whereas women reported greater fear of becoming obese. The sexes also differed in how their own BMI related to the subtypes of obesity stigma. These findings indicate that pathogen disgust sensitivity plays a role in obesity stigma, specifically for women. Defining the scope of disgust's activation in response to obesity and its relationship with other variables can help identify possible mechanisms for understanding and ultimately alleviating prejudice and discrimination.
Ciciurkaite, Gabriele; Perry, Brea L
With increasing rates of obesity in the United States, attention to life chances and psychological consequences associated with weight stigma and weight-based discrimination has also intensified. While research has demonstrated the negative effects of weight-based discrimination on mental health, little is known about whether different social groups are disproportionately vulnerable to these experiences. Drawing on the modified labelling theory, the focus of this paper is to investigate the psychological correlates of body weight and self-perceived weight-based discrimination among American women at the intersection of race/ethnicity and socioeconomic status (SES). Analyses use data from the National Health Measurement Study (NHMS), a national multi-stage probability sample of non-institutional, English-speaking adults, ages 35 to 89 in 2005-2006. Our findings demonstrate that the effect of weight-based discrimination on psychological well-being is highly contingent on social status. Specifically, the psychological consequences of discrimination on Hispanic women and women in the lowest household income group is significantly greater relative to White women and women with higher household income, controlling for obesity status and self-rated health. These results suggest that higher social status has a buffering effect of weight stigma on psychological well-being. © 2017 Foundation for the Sociology of Health & Illness.
Full Text Available Jing Li,1,2,* Sawitri Assanangkornchai,1,* Lin Lu,3 Manhong Jia,3,* Edward B McNeil,1,* Jing You,4,* Virasakdi Chongsuvivatwong1,* 1Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand; 2School of Public Health, Kunming Medical University, 3Yunnan Center for Disease Prevention and Control, 4Infectious Diseases Department, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China *These authors contributed equally to this work Background: HIV/AIDS-related stigma is a major barrier of access to care for those infected with HIV. The aim of this study was to examine, validate, and adapt measuring scales of internalized, personal, and occupational stigma developed in Africa into a Chinese context. Methods: A cross-sectional study was conducted from January to September 2015 in Kunming, People’s Republic of China. Various scales were constructed on the basis of the previous studies with modifications by experts using exploratory and confirmatory factor analyses (EFA + CFA. Validation of the new scales was done using multiple linear regression models and hypothesis testing of the factorial structure invariance. Results: The numbers of subjects recruited for the development/validation samples were 696/667 HIV-positive patients, 699/667 non-HIV patients, and 157/155 health care providers. EFA revealed a two-factor solution for internalized and personal stigma scales (guilt/blaming and being refused/refusing service, which were confirmed by CFA with reliability coefficients (r of 0.869 and 0.853, respectively. The occupational stigma scale was found to have a three-factor structure (blaming, professionalism, and egalitarianism with a reliability coefficient (r of 0.839. Higher correlations of factors in the HIV patients (r=0.537 and non-HIV patients (r=0.703 were observed in contrast to low-level correlations (r=0.231, 0.286, and 0.266 among factors
Overstreet, Nicole M.; Earnshaw, Valerie A.; Kalichman, Seth C.; Quinn, Diane M.
Black men who have sex with men (BMSM) are severely affected by the HIV epidemic, yet research on the relationship between HIV stigma and status disclosure is relatively limited among this population. Within this epidemic, internalized HIV stigma, the extent to which people living with HIV/AIDS (PLWHA) endorse the negative beliefs associated with HIV as true of themselves, can negatively shape interpersonal outcomes and have important implications for psychological and physical health. In a s...
Frederick, D A; Saguy, A C; Sandhu, G; Mann, T
In the popular news media, public health officials routinely emphasize the health risks of obesity and portray weight as under personal control. These messages may increase support for policies designed to reduce rates of obesity, but can also increase antifat stigma. Less often, the media cover 'Health at Every Size' or 'Fat Rights' perspectives that may have the opposite effects. We investigated how exposure to different 'fat frames' shifts attitudes about weight and support for obesity policies. Across four experiments (n=2187), people read constructed news articles framing fatness as negative (unhealthy, controllable, acceptable to stigmatize) or positive (healthy, uncontrollable, unacceptable to stigmatize). Compared with people who read fat-positive frames, people who read fat-negative frames expressed more: belief in the health risks of being fat (d=0.95-1.22), belief weight is controllable (d=0.38-0.55), support for charging obese people more for health insurance (d=0.26-0.77), antifat prejudice (in three out of four experiments, d=0.28-0.39), willingness to discriminate against fat people (d=0.39-0.71) and less willingness to celebrate body size diversity (d=0.37-0.64). They were also less willing to say that women at the lower end of the obese range could be healthy at their weights. Effects on support for public policies, however, were generally small and/or nonsignificant. Compared with a control condition, exposure to fat-positive frames generally shifted attitudes more than fat-negative frames. In experiment 4, adding a message about the unacceptability of weight-based discrimination to unhealthy/controllable news articles only reduced antifat stigma on one of three measures compared with articles adding a discrimination-acceptable message. Exposure to different news frames of fat can shift beliefs about weight-related health risks and weight-based stigma. Shifting policy attitudes, however, is more challenging.
Herek, Gregory M.; Gillis, J. Roy; Cogan, Jeanine C.
This article describes a social psychological framework for understanding sexual stigma, and it reports data on sexual minority individuals' stigma-related experiences. The framework distinguishes between stigma's manifestations in society's institutions ("heterosexism") and among individuals. The latter include "enacted sexual stigma" (overt…
Wagner, Glenn J; Bogart, Laura M; Klein, David J; Green, Harold D; Mutchler, Matt G; McDavitt, Bryce; Hilliard, Charles
We examined whether internalized HIV stigma and perceived HIV stigma from social network members (alters), including the most popular and most similar alter, predicted condomless intercourse with negative or unknown HIV status partners among 125 African American HIV-positive men. In a prospective, observational study, participants were administered surveys at baseline and months 6 and 12, with measures including sexual behavior, internalized HIV stigma, and an egocentric social network assessment that included several measures of perceived HIV stigma among alters. In longitudinal multivariable models comparing the relative predictive value of internalized stigma versus various measures of alter stigma, significant predictors of having had condomless intercourse included greater internalized HIV stigma (in all models), the perception that a popular (well-connected) alter or alter most like the participant agrees with an HIV stigma belief, and the interaction of network density with having any alter that agrees with a stigma belief. The interaction indicated that the protective effect of greater density (connectedness between alters) in terms of reduced risk behavior dissipated in the presence of perceived alter stigma. These findings call for interventions that help people living with HIV to cope with their diagnosis and reduce stigma, and inform the targets of social network-based and peer-driven HIV prevention interventions.
Full Text Available BACKGROUND: The current investigation examined the psychometric properties of the Internalized Stigma of Mental Illness (ISMI scale in a sample of patients with mental illness. In addition to the internal consistency, test-retest reliability, and concurrent validity that previous studies have tested for the ISMI, we extended the evaluation to its construct validity and measurement invariance using confirmatory factor analysis (CFA. METHODS: Three hundred forty-seven participants completed two questionnaires (i.e., the ISMI and the Depression and Somatic Symptoms Scale [DSSS], and 162 filled out the ISMI again after 50.23±31.18 days. RESULTS: The results of this study confirmed the frame structure of the ISMI; however, the Stigma Resistance subscale in the ISMI seemed weak. In addition, internal consistency, test-retest reliability, and concurrent validity were all satisfactory for all subscales and the total score of the ISMI, except for Stigma Resistance (α = 0.66; ICC = 0.52, and r = 0.02 to 0.06 with DSSS. Therefore, we hypothesize that Stigma Resistance is a new concept rather than a concept in internalized stigma. The acceptable fit indices supported the measurement invariance of the ISMI across time, and suggested that people with mental illness interpret the ISMI items the same at different times. CONCLUSION: The clinical implication of our finding is that clinicians, when they design interventions, may want to use the valid and reliable ISMI without the Stigma Resistance subscale to evaluate the internalized stigma of people with mental illness.
Ersoy, Mehmet Akif; Varan, Azmi
The aim of this study was to evaluate the reliability and validity of the Turkish version of the Internalized Stigma of Mental Illness Scale (ISMI) in patients with psychiatric disorders. The study included 203 patients diagnosed with various psychiatric disorders in a psychiatry outpatient clinic of a university hospital. The reliability of the scale was assessed by investigation of its internal consistency and split-half reliability. The convergent validity of the scale was demonstrated by the relationship between the Turkish form of the ISMI and various criteria scales. Cronbach's alpha value was 0.93 for the entire scale and ranged between 0.63 and 0.87 for the 5 subscales of the ISMI. In terms of convergent validity, the total score of the Turkish ISMI significantly correlated with the Beck Depression Inventory, Rosenberg Self-Esteem Scale, Sociotropy-Autonomy Scale, Brief Symptom Inventory, Multidimensional Scale of Perceived Social Support, Clinical Global Impression Scale, and Global Assessment of Functioning Scale scores. All values were in the expected direction. In the light of the findings, it was concluded that the Turkish version of ISMI could be used as a reliable and valid tool in assessing internalized stigma of the Turkish psychiatric patients.
Full Text Available Yeon-Jeong Shin,1,2 Yo-Han Joo,1 Jong-Hoon Kim1–3 1Neuroscience Research Institute, 2Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences & Technology, 3Department of Psychiatry, Gil Medical Center, Gachon University School of Medicine, Gachon University, Incheon, Republic of Korea Background: We investigated self-perceived cognitive deficits and their relationship with internalized stigma and quality of life in patients with schizophrenia in order to shed light on the clinical correlates of subjective cognitive deficits in schizophrenia.Methods: Seventy outpatients with schizophrenia were evaluated. Patients’ self-perceived cognitive deficits, internalized stigma, and subjective quality of life were assessed using the Scale to Investigate Cognition in Schizophrenia (SSTICS, the Internalized Stigma of Mental Illness Scale (ISMI, and the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4, respectively. Correlation and regression analyses controlling for the severity of symptoms of schizophrenia were performed, and a mediation analysis was conducted to examine the hypothesis that internalized stigma mediates the relationship between self-perceived cognitive deficits and subjective quality of life.Results: Pearson’s partial correlation analysis showed significant correlations among the SSTICS, ISMI, and SQLS-R4 scores (P<0.01. Multiple regression analysis showed that the SSTICS and ISMI scores significantly predicted the SQLS-R4 score (P<0.01. Mediation analysis revealed that the strength of the association between the SSTICS and SQLS-R4 scores decreased from β=0.74 (P<0.01 to β=0.56 (P<0.01, when the ISMI score was statistically controlled. The Sobel test revealed that this difference was significant (P<0.01, indicating that internalized stigma partially mediated the relationship between self-perceived cognitive deficits and quality of life.Conclusion: The present study indicates that self
Wagner, Glenn J.; Bogart, Laura M.; Klein, David J.; Green, Harold D.; Mutchler, Matt G.; McDavitt, Bryce; Hilliard, Charles
We examined whether internalized HIV stigma and perceived HIV stigma from social network members (alters), including the most popular and most similar alter, predicted condomless intercourse with negative or unknown HIV status partners among 125 African American HIV-positive men. In a prospective, observational study, participants were administered surveys at baseline and months 6 and 12, with measures including sexual behavior, internalized HIV stigma, and an egocentric social network assess...
Trub, Leora; Quinlan, Ella; Starks, Tyrel J; Rosenthal, Lisa
With increasing numbers of same-sex couples raising children in the United States, discriminatory attitudes toward children of same-sex parents (ACSSP) are of increasing concern. As with other forms of stigma and discrimination, lesbian, gay, and bisexual (LGB) individuals are at risk for internalizing these societal attitudes, which can negatively affect parenting-related decisions and behaviors and the mental and physical health of their children. Secure attachment is characterized by positive views of the self as loveable and worthy of care that are understood to develop in early relationships with caregivers. Secure attachment has been associated with positive mental and physical health, including among LGB individuals and couples. This study aimed to test the potential buffering role of secure attachment against stigma internalization by examining associations among secure attachment, discrimination, internalized homonegativity (IH), and ACSSP in an online survey study of 209 U.S. adults in same-sex relationships. Bootstrap analyses supported our hypothesized moderated mediation model, with secure attachment being a buffer. Greater discrimination was indirectly associated with more negative ACSSP through greater IH for individuals with mean or lower levels, but not for individuals with higher than average levels of secure attachment, specifically because among those with higher levels of secure attachment, discrimination was not associated with IH. These findings build on and extend past research, with important implications for future research and clinical work with LGB individuals, same-sex couples, and their families, including potential implementation of interventions targeting attachment security. © 2016 Family Process Institute.
Puhl, R M; Himmelstein, M S; Gorin, A A; Suh, Y J
Pervasive weight stigma and discrimination have led to ongoing calls for efforts to reduce this bias. Despite increasing research on stigma-reduction strategies, perspectives of individuals who have experienced weight stigma have rarely been included to inform this research. The present study conducted a systematic examination of women with high body weight to assess their perspectives about a broad range of strategies to reduce weight-based stigma. Women with overweight or obesity ( N = 461) completed an online survey in which they evaluated the importance, feasibility and potential impact of 35 stigma-reduction strategies in diverse settings. Participants (91.5% who reported experiencing weight stigma) also completed self-report measures assessing experienced and internalized weight stigma. Most participants assigned high importance to all stigma-reduction strategies, with school-based and healthcare approaches accruing the highest ratings. Adding weight stigma to existing anti-harassment workplace training was rated as the most impactful and feasible strategy. The family environment was viewed as an important intervention target, regardless of participants' experienced or internalized stigma. These findings underscore the importance of including people with stigmatized identities in stigma-reduction research; their insights provide a necessary and valuable contribution that can inform ways to reduce weight-based inequities and prioritize such efforts.
Wouters, Edwin; Rau, Asta; Engelbrecht, Michelle; Uebel, Kerry; Siegel, Jacob; Masquillier, Caroline; Kigozi, Gladys; Sommerland, Nina; Yassi, Annalee
The dual burden of tuberculosis and human immunodeficiency virus (HIV) is severely impacting the South African healthcare workforce. However, the use of on-site occupational health services is hampered by stigma among the healthcare workforce. The success of stigma-reduction interventions is difficult to evaluate because of a dearth of appropriate scientific tools to measure stigma in this specific professional setting. The current pilot study aimed to develop and test a range of scales measuring different aspects of stigma-internal and external stigma toward tuberculosis as well as HIV-in a South African healthcare setting. The study employed data of a sample of 200 staff members of a large hospital in Bloemfontein, South Africa. Confirmatory factor analysis produced 7 scales, displaying internal construct validity: (1) colleagues' external HIV stigma, (2) colleagues' actions against external HIV stigma, (3) respondent's external HIV stigma, (4) respondent's internal HIV stigma, (5) colleagues' external tuberculosis stigma, (6) respondent's external tuberculosis stigma, and (7) respondent's internal tuberculosis stigma. Subsequent analyses (reliability analysis, structural equation modeling) demonstrated that the scales displayed good psychometric properties in terms of reliability and external construct validity. The study outcomes support the use of the developed scales as a valid and reliable means to measure levels of tuberculosis- and HIV-related stigma among the healthcare workforce in a resource-limited context. Future studies should build on these findings to fine-tune the instruments and apply them to larger study populations across a range of different resource-limited healthcare settings with high HIV and tuberculosis prevalence. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail email@example.com.
Zeng, Chengbo; Li, Linghua; Hong, Yan Alicia; Zhang, Hanxi; Babbitt, Andrew Walker; Liu, Cong; Li, Lixia; Qiao, Jiaying; Guo, Yan; Cai, Weiping
Previous studies have shown positive association between HIV-related stigma and depression, suicidal ideation, and suicidal attempt among people living with HIV/AIDS (PLWH). But few studies have examined the mechanisms among HIV-related stigma, depression, and suicidal status (suicidal ideation and/or suicidal attempt) in PLWH. The current study examined the relationships among perceived and internalized stigma (PIS), depression, and suicidal status among PLWH in Guangzhou, China using structural equation modeling. Cross-sectional study by convenience sampling was conducted and 411 PLWH were recruited from the Number Eight People's Hospital from March to June, 2013 in Guangzhou, China. Participants were interviewed on their PIS, depressive symptoms, suicidal status, and socio-demographic characteristics. PLWH who had had suicidal ideation and suicidal attempts since HIV diagnosis were considered to be suicidal. Structural equation model was performed to examine the direct and indirect associations of PIS and suicidal status. Indicators to evaluate goodness of fit of the structural equation model included Chi-square Statistic, Comparative Fit Index (CFI), Root Mean Square Error of Approximation (RMSEA), Standardized Root Mean Square Residual (SRMR), and Weighted Root Mean Square Residual (WRMR). More than one-third (38.4%) of the PLWH had depressive symptoms and 32.4% reported suicidal ideation and/or attempt since HIV diagnosis. The global model showed good model fit (Chi-square value = 34.42, CFI = 0.98, RMSEA = 0.03, WRMR = 0.73). Structural equation model revealed that direct pathway of PIS on suicidal status was significant (standardized pathway coefficient = 0.21), and indirect pathway of PIS on suicidal status via depression was also significant (standardized pathway coefficient = 0.24). There was a partial mediating effect of depression in the association between PIS and suicidal status. Our findings suggest that PIS is associated
Full Text Available Formal equality constitutes a paramount vindication in order to achieve the state acknowledgment of LGBTI people. However, it can be observed that there is a factual platform of inequality beyond juridical norms, whereby stigma is constructed so as to impede the effective enjoyment of social rights such as education and health, among others. In this sense, the Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity illustrate the expectations of compliance with this group’s rights. Therefore, it can be noticed that these principles have attained major fulfilment throughout cases and official papers, which have emerged in different countries over last year. Then, the material analysed in this essay reflects that the stigma against sexual diversity is constructed in the immediate scope of daily life. This demands that the respect towards LGBTI people’s rights shall begin from the closest levels of domestic laws based on public policies designed with a human rights approach.
Phelan, Sean M.; Burgess, Diana J.; Puhl, Rebecca; Dyrbye, Liselotte N.; Dovidio, John F.; Yeazel, Mark; Ridgeway, Jennifer L.; Nelson, David; Perry, Sylvia; Przedworski, Julia M.; Burke, Sara E.; Hardeman, Rachel R.; van Ryn, Michelle
BACKGROUND The stigma of obesity is a common and overt social bias. Negative attitudes and derogatory humor about overweight/obese individuals are commonplace among health care providers and medical students. As such, medical school may be particularly threatening for students who are overweight or obese. OBJECTIVE The purpose of our study was to assess the frequency that obese/overweight students report being stigmatized, the degree to which stigma is internalized, and the impact of these fa...
Pérez-Garín, Daniel; Molero, Fernando; Bos, Arjan E R
The goal of this study is to test a model in which personal discrimination predicts internalized stigma, while group discrimination predicts a greater willingness to engage in collective action. Internalized stigma and collective action, in turn, are associated to positive and negative affect. A cross-sectional study with 213 people with mental illness was conducted. The model was tested using path analysis. Although the data supported the model, its fit was not sufficiently good. A respecified model, in which a direct path from collective action to internalized stigma was added, showed a good fit. Personal and group discrimination appear to impact subjective well-being through two different paths: the internalization of stigma and collective action intentions, respectively. These two paths, however, are not completely independent, as collective action predicts a lower internalization of stigma. Thus, collective action appears as an important tool to reduce internalized stigma and improve subjective well-being. Future interventions to reduce the impact of stigma should fight the internalization of stigma and promote collective action are suggested.
Chou, Chih-Chin; Robb, Jayci Lynn; Clay, Matthew Christopher; Chronister, Julie Ann
In this study, 51 individuals from online substance abuse support groups were surveyed to investigate the mediating role of social support on the relationship between internalized stigma and coping. Regression and bootstrapping were conducted to perform mediation analysis. Findings suggest that social support mediates the negative impact of…
Overstreet, Nicole M; Earnshaw, Valerie A; Kalichman, Seth C; Quinn, Diane M
Black men who have sex with men (BMSM) are severely affected by the HIV epidemic, yet research on the relationship between HIV stigma and status disclosure is relatively limited among this population. Within this epidemic, internalized HIV stigma, the extent to which people living with HIV/AIDS endorse the negative beliefs associated with HIV as true of themselves, can negatively shape interpersonal outcomes and have important implications for psychological and physical health. In a sample of HIV-positive BMSM (N=156), the current study examined the effect of internalized stigma on HIV status disclosure to sexual partners, which can inform sexual decision-making in serodiscordant couples, and HIV status disclosure to family members, which can be beneficial in minimizing the psychological distress associated with HIV. Results revealed that greater internalized stigma was associated with less HIV status disclosure to participants' last sexual partner and to family members. Findings from this study provide evidence that internalized negative beliefs about one's HIV status are linked to adverse interpersonal consequences. Implications of these findings are discussed with regard to prevention and intervention efforts to reduce HIV stigmatization.
Baiocco, Roberto; Laghi, Fiorenzo; Di Pomponio, Ileana; Nigito, Concetta Simona
This study is the first contribution to the understanding of gender differences in best friendship patterns of adolescents sexual minorities. We explored friendship patterns, self-disclosure, and internalized sexual stigma in an Italian sample of lesbian (N = 202) and gay (N = 201) adolescents (aged 14-22 years). We found gender differences in…
Zuba, Anna; Warschburger, Petra
Anti-fat bias is widespread and is linked to the internalization of weight bias and psychosocial problems. The purpose of this study was to examine the internalization of weight bias among children across weight categories and to evaluate the psychometric properties of the Weight Bias Internalization Scale for Children (WBIS-C). Data were collected from 1484 primary school children and their parents. WBIS-C demonstrated good internal consistency (α = .86) after exclusion of Item 1. The unitary factor structure was supported using exploratory and confirmatory factor analyses (factorial validity). Girls and overweight children reported higher WBIS-C scores in comparison to boys and non-overweight peers (known-groups validity). Convergent validity was shown by significant correlations with psychosocial problems. Internalization of weight bias explained additional variance in different indicators of psychosocial well-being. The results suggest that the WBIS-C is a psychometrically sound and informative tool to assess weight bias internalization among children. Copyright © 2018 Elsevier Ltd. All rights reserved.
Quinn, Diane M.; Williams, Michelle K.; Quintana, Francisco; Gaskins, Jennifer L.; Overstreet, Nicole M.; Pishori, Alefiyah; Earnshaw, Valerie A.; Perez, Giselle; Chaudoir, Stephenie R.
Understanding how stigmatized identities contribute to increased rates of depression and anxiety is critical to stigma reduction and mental health treatment. There has been little research testing multiple aspects of stigmatized identities simultaneously. In the current study, we collected data from a diverse, urban, adult community sample of people with a concealed stigmatized identity (CSI). We targeted 5 specific CSIs – mental illness, substance abuse, experience of domestic violence, experience of sexual assault, and experience of childhood abuse – that have been shown to put people at risk for increased psychological distress. We collected measures of the anticipation of being devalued by others if the identity became known (anticipated stigma), the level of defining oneself by the stigmatized identity (centrality), the frequency of thinking about the identity (salience), the extent of agreement with negative stereotypes about the identity (internalized stigma), and extent to which other people currently know about the identity (outness). Results showed that greater anticipated stigma, greater identity salience, and lower levels of outness each uniquely and significantly predicted variance in increased psychological distress (a composite of depression and anxiety). In examining communalities and differences across the five identities, we found that mean levels of the stigma variables differed across the identities, with people with substance abuse and mental illness reporting greater anticipated and internalized stigma. However, the prediction pattern of the variables for psychological distress was similar across the substance abuse, mental illness, domestic violence, and childhood abuse identities (but not sexual assault). Understanding which components of stigmatized identities predict distress can lead to more effective treatment for people experiencing psychological distress. PMID:24817189
Diane M Quinn
Full Text Available Understanding how stigmatized identities contribute to increased rates of depression and anxiety is critical to stigma reduction and mental health treatment. There has been little research testing multiple aspects of stigmatized identities simultaneously. In the current study, we collected data from a diverse, urban, adult community sample of people with a concealed stigmatized identity (CSI. We targeted 5 specific CSIs--mental illness, substance abuse, experience of domestic violence, experience of sexual assault, and experience of childhood abuse--that have been shown to put people at risk for increased psychological distress. We collected measures of the anticipation of being devalued by others if the identity became known (anticipated stigma, the level of defining oneself by the stigmatized identity (centrality, the frequency of thinking about the identity (salience, the extent of agreement with negative stereotypes about the identity (internalized stigma, and extent to which other people currently know about the identity (outness. Results showed that greater anticipated stigma, greater identity salience, and lower levels of outness each uniquely and significantly predicted variance in increased psychological distress (a composite of depression and anxiety. In examining communalities and differences across the five identities, we found that mean levels of the stigma variables differed across the identities, with people with substance abuse and mental illness reporting greater anticipated and internalized stigma. However, the prediction pattern of the variables for psychological distress was similar across the substance abuse, mental illness, domestic violence, and childhood abuse identities (but not sexual assault. Understanding which components of stigmatized identities predict distress can lead to more effective treatment for people experiencing psychological distress.
Pérez-Garín, Daniel; Molero, Fernando; Bos, Arjan E R
This study examines the relationships between internalized stigma, psychological well-being, and subjective well-being in a sample of people with mental illness. We conducted a cross-sectional study with 213 outpatients from the Spanish public social care network. The results showed that (a) internalized stigma was significantly negatively correlated with psychological well-being and subjective well-being (affect balance and life satisfaction) (all correlations are significant with at least pstigma on affect balance and life satisfaction was mediated by psychological well-being. The component of internalized stigma most consistently associated with both types of well-being was alienation (life satisfaction: B=-0.35, p=0.001; affect balance: B=-0.38, p=0.001). These findings should be confirmed in future longitudinal or experimental research. On the basis of these results we recommend that interventions to combat self-stigma aim to reduce feelings of alienation and improve self-acceptance and other aspects of positive psychological functioning. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Background: Parents of children suffering from neurodevelopmental disorders, frequently face public stigma which is often internalized and leads to psychological burden. However, there is a lack of data on the perceptions of internalized stigma among parents of children with neurodevelopmental disorders, especially from lower-middle-income countries like India. Aims: This study aims to develop an adapted version of the Internalized Stigma of Mental Illness (ISMI scale for use in parents of children suffering from neurodevelopmental disorders and to explore the factor structure of this instrument through exploratory factor analysis (EFA. Settings and Design: A cross-sectional study was conducted in an outpatient setting in a tertiary care hospital in India. Materials and Methods: A total of 105 parents of children suffering from neurodevelopmental disorders (according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition were recruited for the study after screening for psychiatric disorder using Mini International Neuropsychiatric Interview version 6.0. A modified 16-item scale was constructed Parents' Internalized Stigma of Neurodevelopmental Disorder in Child (PISNC scale and applied on 105 parents of children suffering from neurodevelopmental disorders, after translation to Hindi and back-translation, in keeping with the World Health Organization's translation-back-translation methodology. Statistical Analysis: EFA was carried out using principal component analysis with orthogonal (varimax rotation. Internal consistency of the Hindi version of the scale was estimated in the form of Cronbach's alpha. Spearman–Brown coefficient and Guttman split-half coefficient were calculated to evaluate the split-half reliability. Results: The initial factor analysis yielded three-factor models with an eigenvalue of >1 and the total variance explained by these factors was 62.017%. The internal consistency of the 16-item scale was 0
Hernansaiz-Garrido, Helena; Alonso-Tapia, Jesús
Internalized stigma and disclosure concerns are key elements for the study of mental health in people living with HIV. Since no measures of these constructs were available for Spanish population, this study sought to develop such instruments, to analyze their reliability and validity and to provide a short version. A heterogeneous sample of 458 adults from different Spanish-speaking countries completed the HIV-Internalized Stigma Scale and the HIV-Disclosure Concerns Scale, along with the Hospital Anxiety and Depression Scale, Rosenberg's Self-esteem Scale and other socio-demographic variables. Reliability and correlation analyses, exploratory factor analyses, path analyses with latent variables, and ANOVAs were conducted to test the scales' psychometric properties. The scales showed good reliability in terms of internal consistency and temporal stability, as well as good sensitivity and factorial and criterion validity. The HIV-Internalized Stigma Scale and the HIV-Disclosure Concerns Scale are reliable and valid means to assess these variables in several contexts.
Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders.
Lysaker, Paul H; Roe, David; Yanos, Philip T
Research has paradoxically linked awareness of illness to both better function outcomes and lesser hope and self-esteem. One possible explanation for these findings is that acceptance of having schizophrenia may impact outcomes differently depending on the meanings the person attaches to this acceptance, particularly whether he or she accepts stigmatizing beliefs about mental illness. To explore this possibility we performed a cluster analysis of 75 persons with schizophrenia spectrum disorders based on single measures of insight using the Positive and Negative Syndrome Scale, internalized stigma using the Internalized Stigma of Mental Illness Scale, and compared groups on concurrent assessments of hope and self-esteem. Three groups were produced by the cluster analyses: low in sight/mild stigma (n = 23), high insight/minimal stigma (n = 25), and high insight/moderate stigma (n = 27). As predicted, analysis of variance-comparing groups revealed that the high insight/moderate stigma group had significantly the lowest levels of hope on the Beck Hopelessness Scale and self-esteem using the Multidimensional Self-esteem Inventory. As predicted, the high insight/minimal stigma group also had significantly less impaired social function than the other groups. Implications for assisting persons to come to cope with awareness of illness and stigma are discussed.
Boone, Melissa R.; Cook, Stephanie H.; Wilson, Patrick A.
Experiences of internalized homophobia and HIV stigma in young Black gay and bisexual men (GBM) may lead to psychological distress, but levels of distress may be dependent upon their sexual identity or HIV status. In this study, we set out to explore the associations between psychological distress, sexual identity, and HIV status in young Black GBM. Participants were 228 young Black GBM who reported on their psychological distress, their HIV status, and their sexual identity. Results indicated that internalized homophobia was significantly related to psychological distress for gay men, but not for bisexual men. HIV stigma was related to psychological stress for HIV-positive men, but not for HIV-negative men. Results indicate a need for more nuanced examinations of the role of identity in the health and well-being of men who have sex with men. PMID:27017893
Boone, Melissa R; Cook, Stephanie H; Wilson, Patrick A
Experiences of internalized homophobia and HIV stigma in young Black gay and bisexual men (GBM) may lead to psychological distress, but levels of distress may be dependent upon their sexual identity or HIV status. In this study, we set out to explore the associations between psychological distress, sexual identity, and HIV status in young Black GBM. Participants were 228 young Black GBM who reported on their psychological distress, their HIV status, and their sexual identity. Results indicated that internalized homophobia was significantly related to psychological distress for gay men, but not for bisexual men. HIV stigma was related to psychological stress for HIV-positive men, but not for HIV-negative men. Results indicate a need for more nuanced examinations of the role of identity in the health and well-being of men who have sex with men.
Granberg, Ellen M.
In this article, I employ a structural symbolic interaction framework to examine the processes by which persons can exit a stigmatized identity. Using the empirical example of weight loss, I analyze how individuals evolve from an identity as "fat" and stigmatized to one that is "normal" with respect to weight and free from identification with…
Muñoz, Manuel; Sanz, María; Pérez-Santos, Eloísa; Quiroga, María de Los Ángeles
The social stigma of mental illness has received much attention in recent years and its effects on diverse variables such as psychiatric symptoms, social functioning, self-esteem, self-efficacy, quality of life, and social integration are well established. However, internalized stigma in people with severe and persistent mental illness has not received the same attention. The aim of the present work was to study the relationships between the principal variables involved in the functioning of internalized stigma (sociodemographic and clinical variables, social stigma, psychosocial functioning, recovery expectations, empowerment, and discrimination experiences) in a sample of people with severe and persistent mental illness (N=108). The main characteristics of the sample and the differences between groups with high and low internalized stigma were analyzed, a correlation analysis of the variables was performed, and a structural equation model, integrating variables of social, cognitive, and behavioral content, was proposed and tested. The results indicate the relationships among social stigma, discrimination experiences, recovery expectation, and internalized stigma and their role in the psychosocial and behavioral outcomes in schizophrenia spectrum disorders. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Mashiach-Eizenberg, Michal; Hasson-Ohayon, Ilanit; Yanos, Philip T; Lysaker, Paul H; Roe, David
Research has revealed the negative consequences of internalized stigma among people with serious mental illness (SMI), including reductions in self-esteem and hope. The purpose of the present study was to investigate the relation between internalized stigma and subjective quality of life (QoL) by examining the mediating role of self-esteem and hope. Measures of internalized stigma, self-esteem, QoL, and hope were administrated to 179 people who had a SMI. Linear regression analysis and structural equation modeling (SEM) were used to analyze the cross-sectional data. Self-esteem mediated the relation between internalized stigma and hope. In addition, hope partially mediated the relationship between self-esteem and QoL. The findings suggest that the effect of internalized stigma upon hope and QoL may be closely related to levels of self-esteem. This may point to the need for the development of interventions that target internalized stigma as well as self-esteem. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Turan, Bulent; Smith, Whitney; Cohen, Mardge H; Wilson, Tracey E; Adimora, Adaora A; Merenstein, Daniel; Adedimeji, Adebola; Wentz, Eryka L; Foster, Antonina G; Metsch, Lisa; Tien, Phyllis C; Weiser, Sheri D; Turan, Janet M
Internalization of HIV-related stigma may inhibit a person's ability to manage HIV disease through adherence to treatment regimens. Studies, mainly with white men, have suggested an association between internalized stigma and suboptimal adherence to antiretroviral therapy (ART). However, there is a scarcity of research with women of different racial/ethnic backgrounds and on mediating mechanisms in the association between internalized stigma and ART adherence. The Women's Interagency HIV Study (WIHS) is a multicenter cohort study. Women living with HIV complete interviewer-administered questionnaires semiannually. Cross-sectional analyses for the current article included 1168 women on ART for whom data on medication adherence were available from their last study visit between April 2013 and March 2014, when the internalized stigma measure was initially introduced. The association between internalized stigma and self-reported suboptimal ART adherence was significant for those in racial/ethnic minority groups (AOR = 0.69, P = 0.009, 95% CI: 0.52 to 0.91), but not for non-Hispanic whites (AOR = 2.15, P = 0.19, 95% CI: 0.69 to 6.73). Depressive symptoms, loneliness, and low perceived social support mediated the association between internalized stigma and suboptimal adherence in the whole sample, as well as in the subsample of minority participants. In serial mediation models, internalized stigma predicted less-perceived social support (or higher loneliness), which in turn predicted more depressive symptoms, which in turn predicted suboptimal medication adherence. Findings suggest that interconnected psychosocial mechanisms affect ART adherence, and that improvements in adherence may require multifaceted interventions addressing both mental health and interpersonal factors, especially for minority women.
Simbayi, Leickness C.; Strebel, Anna; Cloete, Allanise; Henda, Nomvo; Mqeketo, Ayanda
AIDS stigmas interfere with HIV prevention, diagnosis and treatment and can become internalized by people living with HIV/AIDS. However, the effects of internalized AIDS stigmas have not been investigated in Africa, home to two-thirds of the more than 40 million people living with AIDS in the world. The current study examined the prevalence of discrimination experiences and internalized stigmas among 420 HIV positive men and 643 HIV positive women recruited from AIDS services in Cape Town, So...
Pearl, Rebecca L; Wadden, Thomas A; Hopkins, Christina M; Shaw, Jena A; Hayes, Matthew R; Bakizada, Zayna M; Alfaris, Nasreen; Chao, Ariana M; Pinkasavage, Emilie; Berkowitz, Robert I; Alamuddin, Naji
Weight stigma is a chronic stressor that may increase cardiometabolic risk. Some individuals with obesity self-stigmatize (i.e., weight bias internalization, WBI). No study to date has examined whether WBI is associated with metabolic syndrome. Blood pressure, waist circumference, and fasting glucose, triglycerides, and high-density lipoprotein cholesterol were measured at baseline in 178 adults with obesity enrolled in a weight-loss trial. Medication use for hypertension, dyslipidemia, and prediabetes was included in criteria for metabolic syndrome. One hundred fifty-nine participants (88.1% female, 67.3% black, mean BMI = 41.1 kg/m 2 ) completed the Weight Bias Internalization Scale and Patient Health Questionnaire (PHQ-9, to assess depressive symptoms). Odds ratios and partial correlations were calculated adjusting for demographics, BMI, and PHQ-9 scores. Fifty-one participants (32.1%) met criteria for metabolic syndrome. Odds of meeting criteria for metabolic syndrome were greater among participants with higher WBI, but not when controlling for all covariates (OR = 1.46, 95% CI = 1.00-2.13, P = 0.052). Higher WBI predicted greater odds of having high triglycerides (OR = 1.88, 95% CI = 1.14-3.09, P = 0.043). Analyzed categorically, high (vs. low) WBI predicted greater odds of metabolic syndrome and high triglycerides (Ps metabolic syndrome require further exploration. © 2017 The Obesity Society.
Świtaj, Piotr; Grygiel, Paweł; Chrostek, Anna; Nowak, Izabela; Wciórka, Jacek; Anczewska, Marta
To elucidate the mechanism through which internalized stigma reduces the quality of life (QoL) of people with mental illness by exploring the mediating roles of self-esteem and sense of coherence (SOC). A cross-sectional analysis of 229 patients diagnosed with schizophrenia or affective disorders was undertaken to test a sequential mediation model assuming that more severe internalized stigma is related to lower self-esteem, which is associated with weaker SOC, which in turn relates to worse QoL. The proposed model was supported by the data. A sequential indirect effect from internalized stigma to QoL via self-esteem and SOC turned out to be significant [beta = -0.06, SE = 0.02; 95% CI (-0.11, -0.03)]. Support was also found for simple mediation models with either self-esteem or SOC as single mediators between internalized stigma and QoL. Self-esteem and SOC are personal resources that should be considered as potential targets of interventions aiming to prevent the harmful consequences of internalized stigma for the QoL of people receiving psychiatric treatment.
Judy Anne Swift
Full Text Available Background: Weight bias is an important clinical issue that the educators of tomorrow's healthcare professionals cannot afford to ignore. This study, therefore, aimed to pilot a randomized controlled trial of the effects of educational films designed to reduce weight stigmatization toward obese patients on trainee dietitians' and doctors' attitudes. Methods: A pre-post experimental design with a 6-week follow-up, which consisted of an intervention group (n = 22 and a control group (n = 21, was conducted to assess the efficacy of brief anti-stigma films in reducing weight bias, and to test whether future, larger-scale studies among trainee healthcare professionals are feasible. Results: Participants at baseline demonstrated weight bias, on both implicit and explicit attitude measures, as well as strong beliefs that obesity is under a person's control. The intervention films significantly improved explicit attitudes and beliefs toward obese people, and participant evaluation was very positive. The intervention did not significantly improve implicit anti-fat bias. Conclusion: The current study suggests both that it is possible to conduct a substantive trial of the effects of educational films designed to reduce weight stigma on a larger cohort of trainee healthcare professionals, and that brief educational interventions may be effective in reducing stigmatizing attitudes in this population.
Li, Jie; Huang, Yuan-Guang; Ran, Mao-Sheng; Fan, Yu; Chen, Wen; Evans-Lacko, Sara; Thornicroft, Graham
Comprehensive interventions including components of stigma and discrimination reduction in schizophrenia in low- and middle-income countries (LMICs) are lacking. We developed a community-based comprehensive intervention to evaluate its effects on clinical symptoms, social functioning, internalized stigma and discrimination among patients with schizophrenia. A randomized controlled trial including an intervention group (n = 169) and a control group (n = 158) was performed. The intervention group received comprehensive intervention (strategies against stigma and discrimination, psycho-education, social skills training and cognitive behavioral therapy) and the control group received face to face interview. Both lasted for nine months. Participants were measured at baseline, 6 months and 9 months using the Internalized Stigma of Mental Illness scale (ISMI), Discrimination and Stigma Scale (DISC-12), Global Assessment of Functioning (GAF), Schizophrenia Quality of Life Scale (SQLS), Self-Esteem Scale (SES), Brief Psychiatric Rating Scale (BPRS) and PANSS negative scale (PANSS-N). Insight and medication compliance were evaluated by senior psychiatrists. Data were analyzed by descriptive statistics, t-test, chi-square test or Fisher's exact test. Linear Mixed Models were used to show intervention effectiveness on scales. General Linear Mixed Models with multinomial logistic link function were used to assess the effectiveness on medication compliance and insight. We found a significant reduction on anticipated discrimination, BPRS and PANSS-N total scores, and an elevation on overcoming stigma and GAF in the intervention group after 9 months. These suggested the intervention may be effective in reducing anticipated discrimination, increasing skills overcoming stigma as well as improving clinical symptoms and social functioning in Chinese patients with schizophrenia. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.
Molina, Yamile; Lehavot, Keren; Beadnell, Blair; Simoni, Jane
There are documented disparities in physical health behaviors and conditions, such as physical activity and obesity, with regard to both race/ethnicity and sexual orientation. However, physical health disparities for lesbian and bisexual (LB) women who are also racial minorities are relatively unexplored. Minority stressors, such as internalized stigma, may account for disparities in such multiply marginalized populations. We sought to (1) characterize inequalities among non-Hispanic white and African American LB women and (2) examine the roles of internalized sexism and homophobia in disparities. Data on health behaviors (diet, physical activity); physical health (hypertension, diabetes, overweight/obesity); internalized sexism; and internalized homophobia were collected via a web-based survey. Recruitment ads were sent electronically to over 200 listservs, online groups, and organizations serving the lesbian, gay, and bisexual community in all 50 U.S. states. The analytic sample consisted of 954 white and 75 African American LB women. African American participants were more likely than white participants to report low fruit/vegetable intake and physical activity, a higher body mass index, and a history of diabetes and hypertension. There were no racial differences in internalized homophobia, but African American women reported higher levels of internalized sexism. Internalized sexism partially mediated racial disparities in physical activity and diabetes, but not in the other outcomes. Findings suggest that African American LB women may be at greater risk than their white counterparts for poor health and that internalized sexism may be a mediator of racial differences for certain behaviors and conditions. PMID:25364769
Austin, Ashley; Goodman, Revital
The transgender and gender non-conforming (TGNC) community continues to represent a notably marginalized population exposed to pervasive discrimination, microaggressions, and victimization. Congruent with the minority stress model, TGNC individuals persistently experience barriers to wellbeing in contemporary society; however, research uncovering resilience-based pathways to health among this population is sparse. This study aimed to explore the impact and interaction between internalized transphobic stigma and a potential buffer against minority stress-social connectedness-on the self-esteem of TGNC identified adults. Data were collected from 65 TGNC identified adults during a national transgender conference. Multiple regression analysis reveals that self-esteem is negatively impacted by internalized transphobia and positively impacted by social connectedness. Social connectedness did not significantly moderate the relationship between internalized transphobia and self-esteem. Micro and macro interventions aimed at increasing social connectedness and decreasing internalized transphobic stigma may be paramount for enhancing resiliency and wellbeing in the TGNC community.
Wee, Christina C; Davis, Roger B; Huskey, Karen W; Jones, Daniel B; Hamel, Mary B
Obesity is a stigmatizing condition associated with adverse psychosocial consequences. The relative importance of weight stigma in reducing health utility or the value a person places on their current health state is unknown. We conducted a telephone survey of patients with obesity. All were seeking weight loss surgery at two bariatric centers (70 % response rate). We assessed patients' health utility (preference-based quality life measure) via a series of standard gamble scenarios assessing patients' willingness to risk death to lose various amounts of weight or achieve perfect health (range 0 to 1; 0 = death and 1 = most valued health/weight state). Multivariable models assessed associations among quality of life domains from the Short-form 36 (SF-36) and Impact of Weight on Quality of Life-lite (IWQOL-lite) and patients' health utility. Our study sample (n = 574) had a mean body mass index of 46.5 kg/m(2) and a mean health utility of 0.87, reflecting the group's average willingness to accept a 13 % risk of death to achieve their most desired health/weight state; utilities were highly variable, however, with 10 % reporting a utility of 1.00 and 27 % reporting a utility lower than 0.90. Among the IWQOL-lite subscales, Public Distress and Work Life were the only two subscales significantly associated with patients' utility after adjustment for sociodemographic factors. Among the SF-36 subscales, Role Physical, Physical Functioning, and Role Emotional were significantly associated with patients' utility. When the leading subscales on both IWQOL-lite and SF-36 were considered together, Role Physical, Public Distress, and to a lesser degree Role Emotional remained independently associated with patients' health utility. Patients seeking weight loss surgery report health utilities similar to those reported for people living with diabetes or with laryngeal cancer; however, utility values varied widely with more than a quarter of patients willing to accept more than a
Johannson, Annika; Vorobjov, Sigrid; Heimer, Robert; Dovidio, John F; Uusküla, Anneli
Disclosure of injecting drug use and its associations with stigma have received very little research attention. This cross-sectional study examined the role of internalized HIV and drug stigma (i.e., self-stigmatization) in the disclosure of injecting drug use among people who inject drugs (PWID) self-reporting as HIV-positive (n = 312) in Kohtla-Järve, Estonia. The internalization of both stigmas was relatively high. On average, PWID disclosed to three disclosure targets out of seven. Disclosure was highest to close friends and health care workers and lowest to employers and casual sex partners. Internalized drug stigma was negatively associated with disclosure to other family members (AOR = 0.48; 95% CI 0.30-0.77) and health care workers (AOR = 0.46; 95% CI 0.25-0.87). Internalized HIV stigma was positively associated with disclosure to health care workers (AOR = 2.26; 95% CI 1.27-4.00). No interaction effect of internalized stigmas on disclosures emerged. We concluded that effects of internalized stigmas on disclosures are few and not uniform.
Moradi, Bonnie; Wiseman, Marcie C.; DeBlaere, Cirleen; Goodman, Melinda B.; Sarkees, Anthony; Brewster, Melanie E.; Huang, Yu-Ping
Conceptual discussions about LGB people of color suggest that, compared with White LGB individuals, LGB people of color may be exposed to greater levels of heterosexist stigma and its deleterious correlates (greater risk) or may be more resilient to such stigma (resilience). This study tested tenets of these two perspectives with a sample of 178…
Processes of change in quality of life, weight self-stigma, body mass index and emotional eating after an acceptance-, mindfulness- and compassion-based group intervention (Kg-Free) for women with overweight and obesity.
Palmeira, Lara; Cunha, Marina; Pinto-Gouveia, José
This study examined the effectiveness of Kg-Free: an acceptance-, mindfulness- and compassion-based group intervention for women with overweight and obesity at post-treatment and 3-month follow-up and explored the psychological processes that underlie changes in quality of life, weight self-stigma, body mass index and emotional eating at post-treatment. Overall, 53 women completed Kg-Free. At post-treatment and 3-month follow-up, participants reported increased quality of life, mindfulness and self-compassion abilities and decreased weight self-stigma, emotional eating, shame, weight-related experiential avoidance, self-criticism and body mass index. Shame and self-criticism reductions were important mediators of changes in health-related outcomes, whereas weight-related experiential avoidance, mindfulness and self-compassion mediated changes in weight and eating-related outcomes.
Full Text Available Several studies have shown that internalized homophobia is a risk factor for mental health illness in homosexual individuals, whereas the perception of social support is a protective factor for their psychological well-being. In line with those studies, the present research has investigated the levels of internalized homophobia, anxiety, depression and social support, among two groups of gay men and lesbian individuals living in two European countries (N = 194: 86 Italian and 108 Belgian, where legislations grant different civil rights to lesbian and gay individuals (LG. The main goal of this research has been to verify the possible differences between the two groups. Results showed some significant differences in terms of observed levels of internalized homophobia, which was higher in the Belgian gay men’s group compared to the Italian one. Furthermore, path analysis emphasized the role of social support as a potential factor of mediation between internalized homophobia and mental health.
Zuba, Anna; Warschburger, Petra
Weight-related teasing is a widespread phenomenon in childhood, and might foster the internalization of weight bias. The goal of this study was to examine the role of weight teasing and weight bias internalization as mediators between weight status and negative psychological sequelae, such as restrained eating and emotional and conduct problems in childhood. Participants included 546 female (52%) and 501 (48%) male children aged 7-11 and their parents, who completed surveys assessing weight teasing, weight bias internalization, restrained eating behaviors, and emotional and conduct problems at two points of measurement, approximately 2 years apart. To examine the hypothesized mediation, a prospective design using structural equation modeling was applied. As expected, the experience of weight teasing and the internalization of weight bias were mediators in the relationship between weight status and psychosocial problems. This pattern was observed independently of gender or weight status. Our findings suggest that the experience of weight teasing and internalization of weight bias is more important than weight status in explaining psychological functioning among children and indicate a need for appropriate prevention and intervention approaches.
Burnham, Kaylee E; Cruess, Dean G; Kalichman, Moira O; Grebler, Tamar; Cherry, Chauncey; Kalichman, Seth C
Gay, bisexual, and other men who have sex with men (MSM) remain the highest risk group for HIV infection. One reason is the increased use of the Internet to meet potential sex partners, which is associated with greater sexual risk behavior. To date, few studies have investigated psychosocial predictors of sexual risk behavior among gay and bisexual men seeking sex partners online. The purpose of the current study was to test a conceptual model of the relationships between trauma symptoms indexed on the event of HIV diagnosis, internalized HIV stigma, and social support on sexual risk behavior among gay and bisexual MSM who seek sex partners online. A sample of 142 gay and bisexual MSM recruited on- and offline completed a comprehensive online assessment battery assessing the factors noted above. A number of associations emerged; most notably internalized HIV stigma mediated the relationship between trauma-related symptoms indexed on the event of HIV diagnosis and sexual risk behavior with HIV-negative and unknown serostatus sex partners. This suggests that gay and bisexual MSM who are in greater distress over their HIV diagnosis and who are more sensitive to HIV stigma engage in more HIV transmission risk behavior. As sexual risk environments expand with the increasing use of the Internet to connect with others for sex, it is important to understand the predictors of sexual risk behavior so that tailored interventions can promote sexual health for gay and bisexual MSM seeking sex online.
Hofer, Alex; Mizuno, Yuya; Frajo-Apor, Beatrice; Kemmler, Georg; Suzuki, Takefumi; Pardeller, Silvia; Welte, Anna-Sophia; Sondermann, Catherine; Mimura, Masaru; Wartelsteiner, Fabienne; Fleischhacker, W Wolfgang; Uchida, Hiroyuki
Resilience is becoming an important topic in people with schizophrenia since there is evidence that it increases the probability for long-term recovery. The current study investigated transcultural differences in resilience across schizophrenia patients from two different geographical regions, Austria and Japan. Another objective was to examine transcultural differences in internalized stigma, self-esteem, and hopelessness, which can be expected to be relevant in this context, as well as the interrelations between these subjective elements of recovery and symptom severity. To this end, patients from outpatient mental health services in Innsbruck, Austria (N=52) and Tokyo, Japan (N=60) as well as 137 healthy comparison subjects from both countries were included into this cross-sectional study. Notably, we detected a significant country effect with markedly lower resilience (F=74.4, pself-esteem scores (F=226.0, pself-esteem (F=51.8, p<0.001), and hope (F=29.5, p<0.001) compared to healthy control subjects. The inter-correlations between subjective elements of recovery were comparable in size in the two patient samples, but the inter-correlations between these issues and residual symptoms of schizophrenia as objective domains of recovery were markedly higher in Austrian subjects. This suggests that schizophrenia patients from Western European and Japanese cultures may have different needs to achieve recovery. In conclusion, it will be critical to develop culture-specific psychosocial programs and to examine their feasibility and effectiveness among these patients. Copyright © 2016 Elsevier B.V. All rights reserved.
Bhattacharya, K; Mukherjee, G; Manna, S S; Saramäki, J; Kaski, K
Tools of the theory of critical phenomena, namely the scaling analysis and universality, are argued to be applicable to large complex web-like network structures. Using a detailed analysis of the real data of the International Trade Network we argue that the scaled link weight distribution has an approximate log-normal distribution which remains robust over a period of 53 years. Another universal feature is observed in the power-law growth of the trade strength with gross domestic product, the exponent being similar for all countries. Using the 'rich-club' coefficient measure of the weighted networks it has been shown that the size of the rich-club controlling half of the world's trade is actually shrinking. While the gravity law is known to describe well the social interactions in the static networks of population migration, international trade, etc, here for the first time we studied a non-conservative dynamical model based on the gravity law which excellently reproduced many empirical features of the ITN
Vally, Zahir; Cody, Brettjet L; Albloshi, Maryam A; Alsheraifi, Safeya N M
Scholars argue that public stigma is predictive of self-stigma, and self-stigma is a primary predictor of attitudes toward seeking psychological help (ATPH). This assertion remains undetermined outside of the United States. This study examines a potential mediational model in which internalized stigma was hypothesized to mediate the relationship between public stigma and ATPH using a sample in the United Arab Emirates. Cross-sectional, correlational design; 114 students completed measures of public stigma, self-stigma, and ATPH. Full mediation occurred. The sample exhibited high levels of both public stigma and self-stigma. Psychology students manifested diminished levels of stigma and more favorable ATPH. Results are discussed in relation to the prevalent cultural and contextual factors. Stigma reduction campaigns in this locale should target internalized stigma and its associated socio-cultural nuances. © 2018 Wiley Periodicals, Inc.
Daumerie, N; Vasseur Bacle, S; Giordana, J-Y; Bourdais Mannone, C; Caria, A; Roelandt, J-L
The INDIGO study (INternational study of DIscrimination and stiGma Outcomes) aims at assessing the impact of schizophrenic disorders diagnosis on privacy, social and professional life, in terms of discrimination. In the general population, and even among health and social professionals, erroneous negative stereotypes (double personality, dangerosity) lead to high social distance. And this has an impact on various parts of daily life: employment, housing, compliance, self-esteem… About a tenth of the adult population suffers from mental disorders at any one time. These disorders now account for about 12% of the global impact of disability, and this will rise to 15% by the year 2020. People living with schizophrenia, for example, experience reduced social participation, whilst public images of mental illness and social reactions add a dimension of suffering, which has been described as a "second illness". Stigmatizing attitudes and discriminatory behavior among the general population against people with severe mental illness are common in all countries. Globally, little is known of effective interventions against stigma. It is clear that the negative effects of stigma can act as formidable barriers to active recovery. The INDIGO study intends to establish detailed international data on how stigma and discrimination affect the lives of people with a diagnosis of schizophrenia. The first aim of the INDIGO study is to conduct qualitative and quantitative interviews with 25 people with a diagnosis of schizophrenia in each participating site, to elicit information on how the condition affects their everyday lives, with a focus upon sites in Europe. The second is to gather data for all participating countries on the laws, policies and regulations which set a clear distinction between people with a diagnosis of mental illness and others, to establish an international profile of such discrimination. A new scale (Discrimination and Stigma Scale [DISC]), used in a face
Internal and external stigmas are often lumped together while addressing issues of stigma and HIV-testing, not considering that one of them may actually affect the disposition HIV-testing than the other. This study, therefore, investigated the effect of HIV/AIDS-related internal and external stigma on the disposition of pregnant ...
Gee, Stephanie; Skovdal, Morten
This article explores the homecoming experiences of international health care workers who responded to the 2014 to 2016 West African Ebola outbreak. Interviews with 11 frontline international medical staff were undertaken and data thematically analyzed. It was found that international health care workers faced an unforeseen risk of stigmatization upon their return home, related to others' fears of their infectious status. Media representations of the disease appear to have played a significant role in heightening societal perceptions of the risks associated with the returning health care workers, resulting in public hostility toward them. For participants, these social risks overtook concerns about biological risks during the immediate postmission period. The participants developed different strategies to cope with courtesy stigma, by rationalizing stigmatizing attitudes, educating people, or simply through an avoidance of others.
Kleinert, Evelyn; Martin, Olaf; Brähler, Elmar; Stöbel-Richter, Yve
Same-sex parents are increasingly a topic of public discourse. A growing number of homosexuals openly speak about their desire to have children or are already living together in different family constellations. The current study examined the decisions for or against having children and the motivations behind those decisions among nonheterosexuals living in Germany. A sample of 1,283 nonheterosexuals participated by means of an online survey. As some nonheterosexual individuals do not identify themselves with a male or female gender identity, a third category, "gender different," was generated. Motives for (not) having children, perceptions of social acceptance, experiences of discrimination in relation to one's sexual orientation, and levels of internalized stigma were taken into account regarding their influence on the decision about parenthood. Most respondents (80%) reported that they did not have children. However, among this group, 43% stated that they had decided to have children later in their lives, 24% were undecided, and 11% had already decided against having children. The most important influences on the decision of whether to have children were respondents' age and their desire for emotional stabilization. Negative experiences as a result of sexual orientation and internalized stigma had no impact on the decisions regarding parenthood.
Hale, Brent; Knackmuhs, Eric; Mackert, Michael
Background Anonymous verbal attacks against overweight individuals on social media are common and widespread. These comments often use negative, misogynist, or derogatory words, which stigmatize the targeted individuals with obesity. These verbal attacks may cause depression in overweight individuals, which could subsequently promote unhealthy eating behavior (ie, binge eating) and further weight gain. To develop an intervention policy and strategies that tackle the anonymous, Web-based verbal attacks, a thorough understanding of the comments is necessary. Objective This study aimed to examine how anonymous users verbally attack or defend overweight individuals in terms of 3 themes: (1) topic of verbal attack (ie, what aspects of overweight individuals are verbally attacked), (2) gender of commenters and targeted overweight individuals, and (3) intensity of derogation depending on the targeted gender (ie, the number of swear words used within comments). Methods This study analyzed the content of YouTube comments that discuss overweight individuals or groups from 2 viral videos, titled “Fat Girl Tinder Date” and “Fat Guy Tinder Date.” The twin videos provide an avenue through which to analyze discussions of obesity as they organically occurred in a contemporary setting. We randomly sampled and analyzed 320 comments based on a coding instrument developed for this study. Results First, there were twice as many comments verbally attacking overweight individuals (n=174) than comments defending them (n=89). Second, overweight women are attacked for their capacities (eg, laziness, maturity; 14/51, 28%), whereas overweight men are attacked for their heterosocial skills (eg, rudeness, annoyance; 24/29, 83%). Third, the majority of commenters who attacked overweight women are male (42/52, 81%). Fourth, attacking comments generated toward overweight women included more swear words (mean 0.44, SD 0.77) than those targeting men (mean 0.23, SD 0.48). Conclusions Our data
Jeon, Yongwoog Andrew; Hale, Brent; Knackmuhs, Eric; Mackert, Michael
Anonymous verbal attacks against overweight individuals on social media are common and widespread. These comments often use negative, misogynist, or derogatory words, which stigmatize the targeted individuals with obesity. These verbal attacks may cause depression in overweight individuals, which could subsequently promote unhealthy eating behavior (ie, binge eating) and further weight gain. To develop an intervention policy and strategies that tackle the anonymous, Web-based verbal attacks, a thorough understanding of the comments is necessary. This study aimed to examine how anonymous users verbally attack or defend overweight individuals in terms of 3 themes: (1) topic of verbal attack (ie, what aspects of overweight individuals are verbally attacked), (2) gender of commenters and targeted overweight individuals, and (3) intensity of derogation depending on the targeted gender (ie, the number of swear words used within comments). This study analyzed the content of YouTube comments that discuss overweight individuals or groups from 2 viral videos, titled "Fat Girl Tinder Date" and "Fat Guy Tinder Date." The twin videos provide an avenue through which to analyze discussions of obesity as they organically occurred in a contemporary setting. We randomly sampled and analyzed 320 comments based on a coding instrument developed for this study. First, there were twice as many comments verbally attacking overweight individuals (n=174) than comments defending them (n=89). Second, overweight women are attacked for their capacities (eg, laziness, maturity; 14/51, 28%), whereas overweight men are attacked for their heterosocial skills (eg, rudeness, annoyance; 24/29, 83%). Third, the majority of commenters who attacked overweight women are male (42/52, 81%). Fourth, attacking comments generated toward overweight women included more swear words (mean 0.44, SD 0.77) than those targeting men (mean 0.23, SD 0.48). Our data elucidate a worrying situation of frequent disinhibited
Puhl, Rebecca M; Heuer, Chelsea A
Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity. Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health.
Pont, Stephen J; Puhl, Rebecca; Cook, Stephen R; Slusser, Wendelin
The stigmatization of people with obesity is widespread and causes harm. Weight stigma is often propagated and tolerated in society because of beliefs that stigma and shame will motivate people to lose weight. However, rather than motivating positive change, this stigma contributes to behaviors such as binge eating, social isolation, avoidance of health care services, decreased physical activity, and increased weight gain, which worsen obesity and create additional barriers to healthy behavior change. Furthermore, experiences of weight stigma also dramatically impair quality of life, especially for youth. Health care professionals continue to seek effective strategies and resources to address the obesity epidemic; however, they also frequently exhibit weight bias and stigmatizing behaviors. This policy statement seeks to raise awareness regarding the prevalence and negative effects of weight stigma on pediatric patients and their families and provides 6 clinical practice and 4 advocacy recommendations regarding the role of pediatricians in addressing weight stigma. In summary, these recommendations include improving the clinical setting by modeling best practices for nonbiased behaviors and language; using empathetic and empowering counseling techniques, such as motivational interviewing, and addressing weight stigma and bullying in the clinic visit; advocating for inclusion of training and education about weight stigma in medical schools, residency programs, and continuing medical education programs; and empowering families to be advocates to address weight stigma in the home environment and school setting. Copyright © 2017 by the American Academy of Pediatrics.
Oexle, Nathalie; Rüsch, Nicolas; Viering, Sandra; Wyss, Christine; Seifritz, Erich; Xu, Ziyan; Kawohl, Wolfram
Mental illness stigma is a source of distress for persons with mental illness. Self-stigma occurs when negative stereotypes are internalized, leading to low self-esteem, shame and hopelessness. Due to its consequences self-stigma may contribute to suicidality and be a modifiable target for suicide prevention. Based on 222 disability pensioners with mental illness we examined whether self-stigma at baseline is associated with suicidal ideation over a 2-year period, controlling for baseline suicidal ideation, symptoms, age and gender. More self-stigma predicted suicidal ideation at baseline and longitudinally. Interventions on different levels to reduce self-stigma could improve suicide prevention.
Hazari, Puja; Mishra, Sunil Kumar
Preservation of ridge dimensions is critical for denture success. For long the concept of an internally weighted denture, which suggested that gravity and the additional weight to the mandibular complete denture aids in prosthetic retention is widely accepted. However, excessive weight and pressure can accelerate bone resorption. Here, we describe a unique modification of internally weighted metal denture base for the resorbed mandibular ridge with an incorporated additional hollow section ov...
Various family responses to the courtesy stigma concept (a stigma acquired as a result of being related to a person with a stigma) are examined with regard to mental retardation in particular and disability in general. Also examined is how the social attribution of stigma serves to create distinctions, moral and otherwise, in society. (Author/DB)
Kumar, Anuradha; Hessini, Leila; Mitchell, Ellen M. H.
Abortion stigma is widely acknowledged in many countries, but poorly theorised. Although media accounts often evoke abortion stigma as a universal social fact, we suggest that the social production of abortion stigma is profoundly local. Abortion stigma is neither natural nor 'essential' and relies
Rüsch, Nicolas; Angermeyer, Matthias C; Corrigan, Patrick W
Persons with mental illness frequently encounter public stigma and may suffer from self-stigma. This review aims to clarify the concept of mental illness stigma and discuss consequences for individuals with mental illness. After a conceptual overview of stigma we discuss two leading concepts of mental illness stigma and consequences of stigma, focussing on self-stigma/empowerment and fear of stigma as a barrier to using health services. Finally, we discuss three main strategies to reduce stigma -- protest, education, and contact -- and give examples of current anti-stigma campaigns. Well-designed anti-stigma initiatives will help to diminish negative consequences of mental illness stigma.
Bengochea-Seco, Rosario; Arrieta-Rodríguez, Marta; Fernández-Modamio, Mar; Santacoloma-Cabero, Iciar; Gómez de Tojeiro-Roce, Juan; García-Polavieja, Bárbara; Santos-Zorrozúa, Borja; Gil-Sanz, David
Patients with schizophrenia sometimes internalise social stigma associated to mental illness, and they develop personal stigma. Personal stigma includes self-stigma (internalisation of negative stereotypes), perceived stigma (perception of rejection), and experienced stigma (experiences of discrimination). Personal stigma is linked with a poorer treatment adherence, and worst social functioning. For this reason, it is important to have good measurements of personal stigma. One of the most frequently used measurements is the Internalised Stigma of Mental Illness (ISMI) scale. There is a Spanish version of the scale available, although its psychometric properties have not been studied. The main aim of this study is to analyse the psychometric properties of a new Spanish version of the ISMI scale. The new version was translated as Estigma Interiorizado de Enfermedad Mental (EIEM). Internal consistency and test-retest reliability were calculated in a sample of 69 patients with a diagnosis of schizophrenia or schizoaffective disorder. The rate of patients showing personal stigma was also studied, as well as the relationship between personal stigma and sociodemographic and clinical variables. The adapted version obtained good values of internal consistency and test-retest reliability, for the total score of the scale (0.91 and 0.95 respectively), as well as for the five subscales of the EIEM, except for the Stigma Resistance subscale (Cronbach's alpha 0.42). EIEM is an appropriate measurement tool to assess personal stigma in a Spanish population with severe mental disorder, at least in those with a diagnosis of schizophrenia or schizoaffective disorder. Copyright © 2016. Published by Elsevier España.
Hazari, Puja; Mishra, Sunil Kumar
Preservation of ridge dimensions is critical for denture success. For long the concept of an internally weighted denture, which suggested that gravity and the additional weight to the mandibular complete denture aids in prosthetic retention is widely accepted. However, excessive weight and pressure can accelerate bone resorption. Here, we describe a unique modification of internally weighted metal denture base for the resorbed mandibular ridge with an incorporated additional hollow section over the anterior knife-edge ridge. The weight provided retention and stability while the hollow portion prevented further resorption of the bone.
Latalova, Klara; Kamaradova, Dana; Prasko, Jan
There are two principal types of stigma in mental illness, ie, "public stigma" and "self-stigma". Public stigma is the perception held by others that the mentally ill individual is socially undesirable. Stigmatized persons may internalize perceived prejudices and develop negative feelings about themselves. The result of this process is "self-stigma". Stigma has emerged as an important barrier to the treatment of depression and other mental illnesses. Gender and race are related to stigma. Among depressed patients, males and African-Americans have higher levels of self-stigma than females and Caucasians. Perceived stigma and self-stigma affect willingness to seek help in both genders and races. African-Americans demonstrate a less positive attitude towards mental health treatments than Caucasians. Religious beliefs play a role in their coping with mental illness. Certain prejudicial beliefs about mental illness are shared globally. Structural modeling indicates that conformity to dominant masculine gender norms ("boys don't cry") leads to self-stigmatization in depressed men who feel that they should be able to cope with their illness without professional help. These findings suggest that targeting men's feelings about their depression and other mental health problems could be a more successful approach to change help-seeking attitudes than trying to change those attitudes directly. Further, the inhibitory effect of traditional masculine gender norms on help-seeking can be overcome if depressed men feel that a genuine connection leading to mutual understanding has been established with a health care professional.
Carpiniello, Bernardo; Pinna, Federica
Although suicidality is frequently the cause of stigma, it is conversely true that stigma may be the cause of suicidality. The present paper focuses on the complex relationships that exist between suicidal behavior and stigmatizing attitudes. A narrative review of the topic will be presented on the basis of the relevant literature collected from an electronic search of PubMed, ISI Web of Knowledge, and Scopus databases, using stigma, public stigma, structural stigma, perceived stigma, self-stigma, suicide, attempted suicide, and suicidality as key words. A negative perception is frequently held of suicidal people, labeling them as weak and unable to cope with their problems, or selfish. Individuals who have attempted suicide are subject to similar processes of stigmatization and "social distancing"; insurance policies include an exclusion clause against death by suicide. Subjects with a direct personal experience of depression or suicide strongly endorse a feeling of self-stigma; those who have attempted suicide are often ashamed and embarrassed by their behavior and tend to hide the occurrence as much as possible. Similar processes are observed among family members of subjects who have committed suicide or made a suicide attempt, with a higher perceived stigma present in those bereaved by suicide. Perceived or internalized stigma produced by mental or physical disorders, or through belonging to a minority group, may represent a significant risk factor for suicide, being severely distressing, reducing self-esteem and acting as a barrier in help-seeking behaviors. With the aim of preventing suicide, greater efforts should be made to combat the persisting stigmatizing attitudes displayed toward mental disorders and suicide itself. Indeed, the role of stigma as a risk factor for suicide should further motivate and spur more concerted efforts to combat public stigma and support those suffering from perceived or internalized stigma. Experts and scientific societies
Hatcher, Abigail M.; Weiser, Sheri D.; Johnson, Mallory O.; Rice, Whitney S.; Turan, Janet M.
We present a conceptual framework that highlights how unique dimensions of individual-level HIV-related stigma (perceived community stigma, experienced stigma, internalized stigma, and anticipated stigma) might differently affect the health of those living with HIV. HIV-related stigma is recognized as a barrier to both HIV prevention and engagement in HIV care, but little is known about the mechanisms through which stigma leads to worse health behaviors or outcomes. Our conceptual framework posits that, in the context of intersectional and structural stigmas, individual-level dimensions of HIV-related stigma operate through interpersonal factors, mental health, psychological resources, and biological stress pathways. A conceptual framework that encompasses recent advances in stigma science can inform future research and interventions aiming to address stigma as a driver of HIV-related health. PMID:28426316
Monteiro, Simone S; Villela, Wilza V; Soares, Priscilla S
This study aimed to conduct a systematic literature review in order to identify how recent studies have addressed the interaction between social inequality and the processes of exclusion and marginalisation related to HIV/AIDS stigma and discrimination. The review was conducted using PubMed and Scopus databases and included publications from 2008 to 2011. Of 497 summaries found in the review, 42 were selected and classified based on topic, population, axes of inequality employed, conceptualisation of stigma and relationship between stigma and vulnerability. Results demonstrated that there is a predominance of research on stigma and discrimination towards people living with HIV/AIDS, sexual and racial/ethnic minorities and migrants. The axes of inequality examined in the literature were linked to specific cultural and socio-economic dimensions and analysed as factors that behave synergistically to increase social groups' vulnerability to HIV. Half of the 42 articles viewed expression of stigma/discrimination to be the result of power dynamics that reinforce the processes of social exclusion. The other half of the articles tended to describe stigma as intrinsic to social interaction. Some researchers are making a visible effort to devise consistent theoretical and methodological approaches in order to understand stigma as a complex social process produced at the intersection of different axes of inequality. These efforts provide vital information that can inform how best to address HIV/AIDS stigma.
Full Text Available Objective: To synthesize research findings on experiences and attitudes about obesity and stigma in health care. Methods: We compiled qualitative studies and applied Noblitt & Hare's meta ethnography to identify, translate, and summarize across studies. Thirteen qualitative studies on experiences and attitudes about obesity and stigma in health care settings were identified and included. Results: The study reveals how stigmatizing attitudes are enacted by health care providers and perceived by patients with obesity. Second-order analysis demonstrated that apparently appropriate advice can be perceived as patronizing by patients with obesity. Furthermore, health care providers indicate that abnormal bodies cannot be incorporated in the medical systems—exclusion of patients with obesity consequently happens. Finally, customary standards for interpersonal respect are legitimately surpassed, and patients with obesity experience contempt as if deserved. Third-order analysis revealed conflicting views between providers and patients with obesity on responsibility, whereas internalized stigma made patients vulnerable for accepting a negative attribution. A theoretical elaboration relates the issues of stigma with those of responsibility. Conclusion: Contradictory views on patients’ responsibility, efforts, knowledge, and motivation merge to internalization of stigma, thereby obstructing healthy coping and collaboration and creating negative contexts for empowerment, self-efficacy, and weight management. Professionals need to develop their awareness for potentially stigmatizing attitudes towards vulnerable patient populations.
In the present work the induced cancer component of detriment by the relative risk (RR) as well as US National Institute of Health (NIH) models using Indian organ based baseline cancer data and the all-causes mortality of the Indian population has been estimated. The Indian values of tissue weighting factors (W T ) have been worked out by the ICRP-60 methodology. The Indian values of detriment from the exposure of principal organs stomach, lung, colon and bone marrow are factors of 1.5 to 2.5 lower than the corresponding ICRP values. The Indian values of W T differ significantly from the ICRP five population average values. A tissue weighting factor of 0.08 for breast, colon, lung and stomach for the Indian population is more appropriate than the ICRP assigned factors of 0.05, 0.12, 0.12 and 0.12 respectively for these organs. For gonads, the appropriate Indian factor is 0.29 instead of the ICRP value of 0.20. The use of appropriate Indian values of W T is advocated for the Indian population in special investigation cases requiring regulatory intervention. (author). 11 refs., 11 figs., 4 tabs
De Domingo Bartolomé, M; López Guzmán, José
People who are overweight are at increased risk of certain chronic diseases and premature death. However, the physiological consequences are not limited to health symptoms and signs but transcend the social field. In fact, the stigma and discrimination faced by obese people has been proven in multiple areas (work, family, education, etc...). This can contribute to reduce the quality of patients life. From a gender perspective, in the literature there seems to be evidence that the undesirable social effects of obesity affect women more than men. To minimize the obesity impact people adopt proactive methods to lose weight. However the solution to this problem is not on medication but changes in lifestyle and in the proposal of inclusive aesthetic models. Also it is necessary to clear that the complex etiology of obesity can help to reduce the weight stigma and the negative consequences of this condition.
Pattyn, Elise; Verhaeghe, Mieke; Sercu, Charlotte; Bracke, Piet
Individuals in need of psychiatric treatment often avoid seeking help because of stigma. This study examined the impact of two stigma dimensions on help-seeking attitudes. Perceived public stigma refers to discrimination and devaluation by others, and anticipated self-stigma refers to internalization of negative stereotypes about people who seek help. Data were from the 2009 Stigma in a Global Context-Belgian Mental Health Study, in which face-to-face interviews were conducted with a representative sample of the general Belgian population. The study reported here included 728 respondents who received a vignette depicting major depression or schizophrenia. Perceived public stigma and anticipated self-stigma were measured with validated instruments. Respondents' attitudes toward help seeking were measured by the importance they assigned to care from formal and informal providers: general practitioners, psychiatrists, psychologists, family members, or friends. Multiple linear regression models were estimated. Respondents with higher levels of anticipated self-stigma attached less importance to care provided by general practitioners or psychiatrists, and those with higher levels of perceived public stigma rated informal help seeking as less important. The gender and the ethnicity of the person and respondents' sociodemographic characteristics had relatively little effect on help-seeking attitudes. Anticipated self-stigma and perceived public stigma appeared to have a differential impact on attitudes toward formal and informal help seeking. Internalization of negative stereotypes was negatively associated with the perceived importance of care from medical providers (general practitioners and psychiatrists). Awareness of stereotypes held by others deterred respondents from acknowledging the importance of informal care.
Jorm Anthony F
Full Text Available Abstract Background To investigate and compare the predictors of personal and perceived stigma associated with depression. Method Three samples were surveyed to investigate the predictors: a national sample of 1,001 Australian adults; a local community sample of 5,572 residents of the Australian Capital Territory and Queanbeyan aged 18 to 50 years; and a psychologically distressed subset (n = 487 of the latter sample. Personal and Perceived Stigma were measured using the two subscales of the Depression Stigma Scale. Potential predictors included demographic variables (age, gender, education, country of birth, remoteness of residence, psychological distress, awareness of Australia's national depression initiative beyondblue, depression literacy and level of exposure to depression. Not all predictors were used for all samples. Results Personal stigma was consistently higher among men, those with less education and those born overseas. It was also associated with greater current psychological distress, lower prior contact with depression, not having heard of a national awareness raising initiative, and lower depression literacy. These findings differed from those for perceived stigma except for psychological distress which was associated with both higher personal and higher perceived stigma. Remoteness of residence was not associated with either type of stigma. Conclusion The findings highlight the importance of treating the concepts of personal and perceived stigma separately in designing measures of stigma, in interpreting the pattern of findings in studies of the predictors of stigma, and in designing, interpreting the impact of and disseminating interventions for stigma.
Pearl, Rebecca L; White, Marney A; Grilo, Carlos M
This study aimed to evaluate the roles of self-esteem and overvaluation of shape and weight in accounting for the internalization of weight bias among patients with binge eating disorder (BED) and obesity. Two hundred forty-five treatment-seeking individuals with BED and obesity were evaluated with diagnostic and semi-structured interviews and completed the Weight Bias Internalization Scale (WBIS) and the Rosenberg Self-Esteem Scale (RSE). Correlations and bootstrapping mediation analyses were computed to evaluate the relationships among self-esteem, overvaluation of shape/weight, and weight bias internalization. The effects of body mass index (BMI) and binge-eating frequency were also tested. Significant correlations emerged between WBIS, RSE, and overvaluation of shape and weight. BMI did not correlate with any measure, and binge-eating frequency only correlated with overvaluation. Mediation analyses provided support for the hypothesis that overvaluation of shape and weight mediates the relationship between self-esteem and weight bias internalization. These findings provide support to the proposed model that self-esteem and overvaluation of shape and weight contribute to weight bias internalization among patients with BED, which holds implications for clinical efforts to address weight bias and associated eating and weight-related psychopathology. Copyright © 2014 Elsevier Ltd. All rights reserved.
Peters, R.M.H.; Lusli, M.M.; Zweekhorst, M.B.M.; Miranda Galarza, H.B.; van Brakel, W.H.; Bunders-Aelen, J.G.F.
International attention for disability recognises that it plays an important role in persistent poverty. Leprosy can cause preventable disability. Stigma associated with leprosy often has greater implications for people affected than physical impairments. The Stigma Assessment and Reduction of
Alonso, J.; Buron, A.; Bruffaerts, R.; He, Y.; Posada-Villa, J.; Lepine, J-P.; Angermeyer, M. C.; Levinson, D.; de Girolamo, G.; Tachimori, H.; Mneimneh, Z. N.; Medina-Mora, M. E.; Ormel, J.; Scott, K. M.; Gureje, O.; Haro, J. M.; Gluzman, S.; Lee, S.; Vilagut, G.; Kessler, R. C.; Von Korff, M.
Objective: We assessed the prevalence of perceived stigma among persons with mental disorders and chronic physical conditions in an international study. Method: Perceived stigma (reporting health-related embarrassment and discrimination) was assessed among adults reporting significant disability.
Bonfils, Kelsey A; Lysaker, Paul H; Yanos, Philip T; Siegel, Alysia; Leonhardt, Bethany L; James, Alison V; Brustuen, Beth; Luedtke, Brandi; Davis, Louanne W
Self-stigma is the internalization of negative societal stereotypes about those with mental illnesses. While self-stigma has been carefully characterized in severe mental disorders, like schizophrenia, the field has yet to examine the prevalence and correlates of self-stigma in post-traumatic stress disorder (PTSD). Thus, we assessed self-stigma in veterans diagnosed with PTSD and compared with veterans with schizophrenia. We further examined associations between PTSD, depressive symptoms and self-stigma in the PTSD sample. Data came from two larger studies of people with PTSD (n = 46) and schizophrenia-spectrum disorders (n = 82). All participants completed the Internalized Stigma of Mental Illness Scale (ISMIS). Results revealed that people with schizophrenia report more experiences of discrimination as a result of stigma than do those with PTSD, but these diagnostic groups did not differ for other subscales. In the PTSD group, feelings of alienation positively correlated with PTSD and depressive symptoms; other subscales positively correlated with depressive symptoms only. Taken together, results suggest a significant level of self-stigma exists among veterans with PTSD, and that self-stigma has an effect on PTSD and commonly comorbid symptoms, like depression. Future work should investigate whether current self-stigma interventions for other groups could be applicable for those with PTSD. Published by Elsevier B.V.
Mehak, Adrienne; Friedman, Aliza; Cassin, Stephanie E
Self-objectification and weight bias internalization are two internalization processes that are positively correlated with binge eating among young women. However, the mechanisms underlying these relationships are understudied. Consistent with objectification theory, this study examined appearance anxiety and body shame as mediators between self-objectification, weight bias internalization and binge eating. Female undergraduates (N=102) completed self-report measures of self-objectification, weight bias internalization, appearance anxiety, body shame, and binge eating. Results indicated that women who self-objectified and internalized negative weight-related attitudes reported greater binge eating (r s =.43 and r s =.57, respectively) and these associations were mediated by the combined effects of body shame and appearance anxiety. The contrast between the two mediators was also significant, such that body shame emerged as a stronger mediator within both mediational models. Results demonstrated that these internalization processes contribute to negative affect in young women, which may in turn lead to binge eating. Copyright © 2018 Elsevier Ltd. All rights reserved.
Birtel, Michèle; Wood, Lisa; Kempa, Nancy J.
Individuals with substance abuse may suffer from severe public and internalized stigma. Little is known about how social support can reduce stigma and improve mental health and well-being for them. This research examined how perceived stigma influences individuals in treatment for substance abuse, and whether internalized stigma and shame are mechanisms which link social support with better mental health and well-being. Sixty-four participants in treatment for substance abuse (alcohol, drugs)...
Takada, Sae; Weiser, Sheri D; Kumbakumba, Elias; Muzoora, Conrad; Martin, Jeffrey N; Hunt, Peter W; Haberer, Jessica E; Kawuma, Annet; Bangsberg, David R; Tsai, Alexander C
Cross-sectional studies show that human immunodeficiency virus (HIV) stigma is negatively correlated with social support. The purpose of this study is to examine the bidirectional relationship between social support and HIV stigma. We collected quarterly data from a cohort of 422 people living with HIV in Uganda, followed for a median of 2.1 years. We used multilevel regression to model the contemporaneous and 3-month-lagged associations between social support and both enacted and internalized stigma. Lagged enacted stigma was negatively correlated with emotional and instrumental social support, and lagged instrumental social support was negatively correlated with enacted stigma. Internalized stigma and emotional social support had reciprocal lagged associations. Interventions to reduce enacted stigma may strengthen social support for people living with HIV. Improved social support may in turn have a protective influence against future enacted and internalized stigma.
Weiser, Sheri D.; Kumbakumba, Elias; Muzoora, Conrad; Martin, Jeffrey N.; Hunt, Peter W.; Haberer, Jessica E.; Kawuma, Annet; Bangsberg, David R.; Tsai, Alexander C.
Background Cross-sectional studies show that human immunodeficiency virus (HIV) stigma is negatively correlated with social support. Purpose The purpose of this study is to examine the bidirectional relationship between social support and HIV stigma. Methods We collected quarterly data from a cohort of 422 people living with HIV in Uganda, followed for a median of 2.1 years. We used multilevel regression to model the contemporaneous and 3-month-lagged associations between social support and both enacted and internalized stigma. Results Lagged enacted stigma was negatively correlated with emotional and instrumental social support, and lagged instrumental social support was negatively correlated with enacted stigma. Internalized stigma and emotional social support had reciprocal lagged associations. Conclusions Interventions to reduce enacted stigma may strengthen social support for people living with HIV. Improved social support may in turn have a protective influence against future enacted and internalized stigma. PMID:24500077
Khan, Nashi; Kausar, Rukhsana; Khalid, Adeela; Farooq, Anum
This study aims to examine Gender Difference in the level of Discrimination and Stigma experienced by people diagnosed with Major Depressive Disorder in Pakistan. It was hypothesized that Women diagnosed with Depression are likely to be experiencing more Discrimination and Internalized Stigma in comparison to Men. This is a Cross Sectional Study. Thirty eight patients diagnosed with Major Depressive Disorder recruited from different Government Sector Hospitals of Lahore; were approached after obtaining informed consent. Discrimination and Stigma were measured through Discrimination and Stigma Scale and Internalized Stigma of Mental Illness Inventory respectively. Both Men and Women experience considerably high level of associated Stigma and Discrimination due to their Mental Illness. However, Women in comparison to Men experience significantly greater level of Internalized Stigma especially in domains of Discrimination Experience and Social Withdrawal. The findings of this study highlight the fact that people with Depression can be more benefited with psychological treatment if dealing with Stigma and Discrimination is also addressed in Intervention Plans.
Schenner, Manuela; Kohlbauer, Daniela; Meise, Ullrich; Haller, Christina; Pixner-Huber, Martina; Stürz, Kristina; Günther, Verena
The project "Stigma Management - StigMa" aims on the evaluation of an adaptive therapy program for patients with psychiatric illness to help them in managing internalized stigma and self-stigmatization. The patients for this pilot-study were recruited in day-hospitals of pro mente tirol . 26 patients participated in 11 group sessions, following 6 modules: "Education", "Activation of Resources", "Social Network", "Self-Esteem", "Social competence in public places" and "My personal stigma management". The control group consisted of 20 patients who did not participate in StigMa. Pre-post-evaluation was done by the Internalized Stigma of Mental Illness-Scale 1. No significant interaction effects could be observed, although in the treatment group, the burden of perceived discrimination was significantly less pronounced after training than before it. The program, however, was evaluated as being extremely positive by the participants. The program StigMa will be adapted in accordance with the suggestions of the participants and reevaluated taking into consideration methodological optimization. © Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available Objectives: To assess the internal consistency and factor structure of the abridged Spanish version of the Berger HIV Stigma Scale (HSS-21, provide evidence for its convergent and discriminant validity, and describe perceived stigma in an urban population from northeast Mexico. Methods: Seventy five HIV-positive men who have sex with men (MSM were recruited. Participants answered the Spanish versions of three Likert-type scales: HSS-21, Robsenberg’s self-esteem scale, and the abbreviated version of the Zung’s Depression Scale.Results: HSS-21 showed high reliability and validity; its factor structure included four components: concern with public attitudes; negative self-image; disclosure concerns; and enacted stigma. The level of stigma was high in 27 out of 75 (36% participants; nevertheless, the score found in the component related to disclosure concerns indicated high level of stigma in 68% of participants. The score of HSS-21 was positively correlated with the score of depression and negatively correlated with the score of self-esteem. Conclusion: Results demonstrated high reliability for the HSS-21; correlations with other scales supported its validity. This scale demonstrated to be a practical tool for assessing stigma among Mexican HIV-positive MSM. High level of stigma was found only in the factor related to disclosure concerns. Policy Implications: Identifying HIV-associated stigma through a short, reliable and validated instrument will allow the development of interventions that cope and manage stigma in HIV-positive MSM. HSS-21 distinguishes between different dimensions of stigma and will contribute to a better understanding of this phenomenon.
Vidović, Domagoj; Brecić, Petrana; Vilibić, Maja; Jukić, Vlado
Poor insight and high level of self-stigma are often present among patients with schizophrenia and are related to poorer treatment adherence, poorer social function and rehabilitation, aggressive behavior, higher level of depression, social anxiety, lower quality of life and self-esteem. Reports on a relationship between insight and stigma are controversial. We examined the relationship of the level of insight and self-stigma in a sample of 149 patients with schizophrenia. Insight was measured with the Scale to assess Unawareness of Mental Disorder and self-stigma with the Internalized Stigma of Mental Illness. Results showed 88.6% of the patients to have high or moderate insight, with a mean value of 2.73. General insight showed the highest level (2.58) and insight in positive symptoms the lowest level (2.9). The self-stigma score in general was 2.13, with stereotype endorsement being lowest (1.98). According to study results, 77.1% of patients felt minimal or low self-stigma across all subscales, except for stigma resistance subscale. Statistically significant correlation was found between insight and four subscales of self-stigma, while no correlation was found for the stigma resistance subscale only. These results imply the need of individually tailored antistigma and insight promoting programs for patients with schizophrenia.
Corrigan, Patrick W; Rao, Deepa
People with mental illness have long experienced prejudice and discrimination. Researchers have been able to study this phenomenon as stigma and have begun to examine ways of reducing this stigma. Public stigma is the most prominent form observed and studied, as it represents the prejudice and discrimination directed at a group by the larger population. Self-stigma occurs when people internalize these public attitudes and suffer numerous negative consequences as a result. In our article, we more fully define the concept of self-stigma and describe the negative consequences of self-stigma for people with mental illness. We also examine the advantages and disadvantages of disclosure in reducing the impact of stigma. In addition, we argue that a key to challenging self-stigma is to promote personal empowerment. Lastly, we discuss individual- and societal-level methods for reducing self-stigma, programs led by peers as well as those led by social service providers.
Pescosolido, Bernice A.; Martin, Jack K.
Since the beginning of the twenty-first century, research on stigma has continued. Building on conceptual and empirical work, the recent period clarifies new types of stigmas, expansion of measures, identification of new directions, and increasingly complex levels. Standard beliefs have been challenged, the relationship between stigma research and public debates reconsidered, and new scientific foundations for policy and programs suggested. We begin with a summary of the most recent Annual Review articles on stigma, which reminded sociologists of conceptual tools, informed them of developments from academic neighbors, and claimed findings from the early period of “resurgence.” Continued (even accelerated) progress has also revealed a central problem. Terms and measures are often used interchangeably, leading to confusion and decreasing accumulated knowledge. Drawing from this work but focusing on the past 14 years of stigma research (including mental illness, sexual orientation, HIV/AIDS, and race/ethnicity), we provide a theoretical architecture of concepts (e.g., prejudice, experienced/received discrimination), drawn together through a stigma process (i.e., stigmatization), based on four theoretical premises. Many characteristics of the mark (e.g., discredited, concealable) and variants (i.e., stigma types and targets) become the focus of increasingly specific and multidimensional definitions. Drawing from complex and systems science, we propose a stigma complex, a system of interrelated, heterogeneous parts bringing together insights across disciplines to provide a more realistic and complicated sense of the challenge facing research and change efforts. The Framework Integrating Normative Influences on Stigma (FINIS) offers a multilevel approach that can be tailored to stigmatized statuses. Finally, we outline challenges for the next phase of stigma research, with the goal of continuing scientific activity that enhances our understanding of stigma and builds
Sherwood, Nancy E.; Neumark-Sztainer, Dianne
Surveyed adolescent girls regarding body dissatisfaction, dieting, and internalization of sociocultural values, media-influenced knowledge, acceptance of varied body shapes, and media exposure. Girls understood media influence on self-image and behavior and accepted varied body shapes. Significant numbers reported dissatisfaction with weight and…
Xu, Helian; Cheng, Long
Based on QAP (Quadratic Assignment Procedure) correlation and complex network theory, this paper puts forward a new method named QAP Weighted Network Analysis Method. The core idea of the method is to analyze influences among relations in a social or economic group by building a QAP weighted network of networks of relations. In the QAP weighted network, a node depicts a relation and an undirect edge exists between any pair of nodes if there is significant correlation between relations. As an application of the QAP weighted network, we study international services trade by using the QAP weighted network, in which nodes depict 10 kinds of services trade relations. After the analysis of international services trade by QAP weighted network, and by using distance indicators, hierarchy tree and minimum spanning tree, the conclusion shows that: Firstly, significant correlation exists in all services trade, and the development of any one service trade will stimulate the other nine. Secondly, as the economic globalization goes deeper, correlations in all services trade have been strengthened continually, and clustering effects exist in those services trade. Thirdly, transportation services trade, computer and information services trade and communication services trade have the most influence and are at the core in all services trade.
Latalova K; Kamaradova D; Prasko J
Klara Latalova, Dana Kamaradova, Jan Prasko Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, Olomouc, Czech Republic Abstract: There are two principal types of stigma in mental illness, ie, “public stigma” and “self-stigma”. Public stigma is the perception held by others that the mentally ill individual is socially undesirable. Stigmatized persons may internalize perceived prejudices and develop negative feeling...
Frey, Laura M; Hans, Jason D; Cerel, Julie
Previous research has failed to examine perceptions of stigma experienced by individuals with a history of suicidal behavior, and few studies have examined how stigma is experienced based on whether it was perceived from treatment providers or social network members. This study examined stigma experienced by individuals with previous suicidal behavior from both treatment providers and individuals in one's social and family networks. Individuals (n = 156) with a lifetime history of suicidal behavior were recruited through the American Association of Suicidology listserv. Respondents reported the highest rates of perceived stigma with a close family member (57.1%) and emergency department personnel (56.6%). Results indicated that individuals with previous suicidal behavior were more likely to experience stigma from non-mental health providers and social network members than from mental health providers. A hierarchical regression model including both source and type of stigma accounted for more variance (R(2) = .14) in depression symptomology than a model (R(2) = .06) with only type of stigma. Prevalence of stigma perceived from social network members was the best predictor of depression symptom severity. These findings highlight the need for future research on how social network members react to suicide disclosure and potential interventions for improving interactions following disclosure.
Boyle, Michael P.
Purpose: To create a psychometrically sound scale that measures different levels of internalized stigma (i.e., self-stigma) among adults who stutter and to analyze factor structure, reliability, and initial construct validity of the scale. Method: Two-hundred ninety-one adults who stutter were recruited from Board Recognized Specialists in Fluency…
Brown, Charlotte; Conner, Kyaien O.; Copeland, Valire Carr; Grote, Nancy; Beach, Scott; Battista, Deena; Reynolds, Charles F., III
This study examined the relationship between internalized and public stigma on treatment-related attitudes and behaviors in a community sample of 449 African American and white adults aged 18 years and older. Telephone surveys were administered to assess level of depressive symptoms, demographic characteristics, stigma, and treatment-related…
Ahmedani, Brian K.
Mental health stigma operates in society, is internalized by individuals, and is attributed by health professionals. This ethics-laden issue acts as a barrier to individuals who may seek or engage in treatment services. The dimensions, theory, and epistemology of mental health stigma have several implications for the social work profession. PMID:22211117
Ahmedani, Brian K.
Mental health stigma operates in society, is internalized by individuals, and is attributed by health professionals. This ethics-laden issue acts as a barrier to individuals who may seek or engage in treatment services. The dimensions, theory, and epistemology of mental health stigma have several implications for the social work profession.
Hartman, Leah I.; Michel, Natalie M.; Winter, Ariella; Young, Rebecca E.; Flett, Gordon L.; Goldberg, Joel O.
Despite the prevalence of mental health problems, society continues to stigmatize and discriminate against people with mental illness and in particular, schizophrenia. Among the negative consequences of stigma, is that some individuals with mental illness internalize negative stereotypes about themselves, referred to as self-stigma, which is…
Link, Bruce G; Wells, Jennifer; Phelan, Jo C; Yang, Lawrence
Important components of stigma include imagining what others might think of a stigmatized status, anticipating what might transpire in an interaction with others, and rehearsing what one might do if something untoward occurs. These imagined relations are here called symbolic interaction stigma and can have an impact even if the internalization of negative stereotypes fails to occur. Concepts and measures that capture symbolic interaction stigma are introduced, and a preliminary assessment of their impact is provided. Four self-report measures of symbolic interaction stigma (perceived devaluation discrimination, anticipation of rejection, stigma consciousness, and concern with staying in) were developed or adapted and administered to a sample of individuals who have experienced mental illness (N = 65). Regression analyses examined whether forms of symbolic interaction stigma were associated with withdrawal, self-esteem, and isolation from relatives independent of measures of internalization of stigma and rejection experiences. As evidenced by scores on 4 distinct measures, symbolic interaction stigma was relatively common in the sample, somewhat more common than the internalization of stigma. In addition, measures of symbolic interaction stigma were significantly associated with withdrawal, self-esteem, and isolation from relatives even when a measure of the internalization of stigma was statistically controlled. The study suggests the potential importance of considering symbolic interaction forms of stigma in understanding and addressing stigma and its consequences. Being aware of symbolic interaction stigma could be useful in enhancing rehabilitation goals if an approach to counteracting the negative effects of these aspects of stigma can be developed. (c) 2015 APA, all rights reserved).
-economic status, level of education below secondary level, disclosure of status, history of weight loss, previous smoking and alcohol history. Also, patients unable to work on clinic days were more likely to experience stigma. Sexs, religion ...
Elkington, Katherine S.; Hackler, Dusty; Walsh, Tracy A.; Latack, Jessica A.; McKinnon, Karen; Borges, Cristiane; Wright, Eric R.; Wainberg, Milton L.
The current study examines the role of mental illness-related stigma on romantic or sexual relationships and sexual behavior among youth with mental illness (MI), including youths' experiences of stigma, the internalization of these experiences, and the behavior associated with managing stigma within romantic and sexual relationships. We conducted…
Liu, Hongjie; Xu, Yongfang; Sun, Yehuan; Dumenci, Levent
Courtesy stigma is the stigmatization a person perceives or experiences due to their association with a stigmatized individual or group. Most HIV-related stigma scales have been developed for people living with HIV/AIDS (PLWHAs), but not for their HIV-uninfected family members. To date, few measurement scales have been designed to measure the degree of stigma among both PLWHAs and their HIV-uninfected family members at the family level. We developed a set of courtesy stigma scales and estimated their reliability and validity from 256 PLWHAs and 256 of their HIV-uninfected family members. Exploratory and confirmatory factor analyses were performed in two independent samples: a development sample (N = 216) and a validation sample (N = 296), respectively. Two factors ("public stigma" and "self-perceived stigma") had high internal consistency reliability (Cronbach's alpha coefficient between 0.83-0.90) and good construct validity (standardized factor loading range: 0.37-0.95) in both samples. These findings document that the newly developed brief instrument is a psychometrically sound measure of HIV-related stigma among both PLWHAs and their HIV-uninfected family members.
Moore, Donna; Ayers, Susan; Drey, Nicholas
This study aimed to develop and validate a scale to measure perceived stigma for perinatal mental illness in women. Stigma is one of the most frequently cited barriers to seeking treatment and many women with perinatal mental illness fail to get the treatment they need. However, there is no psychometric scale that measures how women may experience the unique aspects of perinatal mental illness stigma. A draft scale of 30 items was developed from a literature review. Women with perinatal mental illness (n = 279) were recruited to complete the City Mental Illness Stigma Scale. Concurrent validity was measured using the Internalised Stigma of Mental Illness Scale. Factor analysis was used to create the final scale. The final 15-item City Mental Illness Stigma Scale has a three-factor structure: perceived external stigma, internal stigma and disclosure stigma. The scale accounted for 54% of the variance and had good internal reliability and concurrent validity. The City Mental Illness Stigma Scale appears to be a valid measure which provides a potentially useful tool for clinical practice and research in stigma and perinatal mental illness, including assessing the prevalence and characteristics of stigma. This research can be used to inform interventions to reduce or address the stigma experienced by some women with perinatal mental illness.
Hing, Nerilee; Russell, Alex M. T.
Background and aims Few studies have examined the stigma of problem gambling and little is known about those who internalize this prejudice as damaging self-stigma. This paper aimed to identify psychological factors, sociodemographic characteristics, and coping mechanisms associated with the self-stigma of problem gambling. Methods An online survey was conducted on 177 Australian adults with a current gambling problem to measure self-stigma, self-esteem, social anxiety, self-consciousness, ps...
Cook, Rebecca J; Dickens, Bernard M
Stigmatization marks individuals for disgrace, shame, and even disgust-spoiling or tarnishing their social identities. It can be imposed accidentally by thoughtlessness or insensitivity; incidentally to another purpose; or deliberately to deter or punish conduct considered harmful to actors themselves, others, society, or moral values. Stigma has permeated attitudes toward recipients of sexual and reproductive health services, and at times to service providers. Resort to contraceptive products, to voluntary sterilization and abortion, and now to medically assisted reproductive care to overcome infertility has attracted stigma. Unmarried motherhood has a long history of shame, projected onto the "illegitimate" (bastard) child. The stigma of contracting sexually transmitted infections has been reinvigorated with HIV infection. Gynecologists and their professional associations, ethically committed to uphold human dignity and equality, especially for vulnerable women for whom they care, should be active to guard against, counteract, and relieve stigmatization of their patients and of related service providers. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Full Text Available Klara Latalova, Dana Kamaradova, Jan Prasko Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, Olomouc, Czech Republic Abstract: There are two principal types of stigma in mental illness, ie, “public stigma” and “self-stigma”. Public stigma is the perception held by others that the mentally ill individual is socially undesirable. Stigmatized persons may internalize perceived prejudices and develop negative feelings about themselves. The result of this process is “self-stigma”. Stigma has emerged as an important barrier to the treatment of depression and other mental illnesses. Gender and race are related to stigma. Among depressed patients, males and African-Americans have higher levels of self-stigma than females and Caucasians. Perceived stigma and self-stigma affect willingness to seek help in both genders and races. African-Americans demonstrate a less positive attitude towards mental health treatments than Caucasians. Religious beliefs play a role in their coping with mental illness. Certain prejudicial beliefs about mental illness are shared globally. Structural modeling indicates that conformity to dominant masculine gender norms (“boys don’t cry” leads to self-stigmatization in depressed men who feel that they should be able to cope with their illness without professional help. These findings suggest that targeting men’s feelings about their depression and other mental health problems could be a more successful approach to change help-seeking attitudes than trying to change those attitudes directly. Further, the inhibitory effect of traditional masculine gender norms on help-seeking can be overcome if depressed men feel that a genuine connection leading to mutual understanding has been established with a health care professional. Keywords: stigma, self-stigma, depression, male gender
Griffith, James L.; Kohrt, Brandon A.
Psychiatric education is confronted with three barriers to managing stigma associated with mental health treatment. First, there are limited evidence-based practices for stigma reduction, and interventions to deal with stigma against mental health care providers are especially lacking. Second, there is a scarcity of training models for mental health professionals on how to reduce stigma in clinical services. Third, there is a lack of conceptual models for neuroscience approaches to stigma reduction, which are a requirement for high-tier competency in the ACGME Milestones for Psychiatry. The George Washington University (GWU) psychiatry residency program has developed an eight-week course on managing stigma that is based on social psychology and social neuroscience research. The course draws upon social neuroscience research demonstrating that stigma is a normal function of normal brains resulting from evolutionary processes in human group behavior. Based on these processes, stigma can be categorized according to different threats that include peril stigma, disruption stigma, empathy fatigue, moral stigma, and courtesy stigma. Grounded in social neuroscience mechanisms, residents are taught to develop interventions to manage stigma. Case examples illustrate application to common clinical challenges: (1) helping patients anticipate and manage stigma encountered in the family, community, or workplace; (2) ameliorating internalized stigma among patients; (3) conducting effective treatment from a stigmatized position due to prejudice from medical colleagues or patients’ family members; and (4) facilitating patient treatment plans when stigma precludes engagement with mental health professionals. This curriculum addresses the need for educating trainees to manage stigma in clinical settings. Future studies are needed to evaluate changes in clinical practices and patient outcomes as a result of social neuroscience-based training on managing stigma. PMID:26162463
Griffith, James L; Kohrt, Brandon A
Psychiatric education is confronted with three barriers to managing stigma associated with mental health treatment. First, there are limited evidence-based practices for stigma reduction, and interventions to deal with stigma against mental health care providers are especially lacking. Second, there is a scarcity of training models for mental health professionals on how to reduce stigma in clinical services. Third, there is a lack of conceptual models for neuroscience approaches to stigma reduction, which are a requirement for high-tier competency in the ACGME Milestones for Psychiatry. The George Washington University (GWU) psychiatry residency program has developed an eight-week course on managing stigma that is based on social psychology and social neuroscience research. The course draws upon social neuroscience research demonstrating that stigma is a normal function of normal brains resulting from evolutionary processes in human group behavior. Based on these processes, stigma can be categorized according to different threats that include peril stigma, disruption stigma, empathy fatigue, moral stigma, and courtesy stigma. Grounded in social neuroscience mechanisms, residents are taught to develop interventions to manage stigma. Case examples illustrate application to common clinical challenges: (1) helping patients anticipate and manage stigma encountered in the family, community, or workplace; (2) ameliorating internalized stigma among patients; (3) conducting effective treatment from a stigmatized position due to prejudice from medical colleagues or patients' family members; and (4) facilitating patient treatment plans when stigma precludes engagement with mental health professionals. This curriculum addresses the need for educating trainees to manage stigma in clinical settings. Future studies are needed to evaluate changes in clinical practices and patient outcomes as a result of social neuroscience-based training on managing stigma.
Walwyn S, G.; Gutierrez L, S.; Tamayo G, J.A.; Gonzalez R, N.; Alonso V, G.
The declared mission of the International Bureau of Weights and Measures are the world uniformity of the measurement, however until some years ago a formal mechanism didn't exist for its complete implementation. With this end arose the Mutual Recognition Agreement whose specific objective is to establish the grade of equivalence of the national standards, the one of mutually recognizing the calibration and measurement certificates and the one of providing to the governments of a sure technical tool in its commercial negotiations and regulatory matters at international level. Cuba like an associated country to the Meter Convention, signed the agreement and it intended to demonstrate the international equivalence of its standards. The best measurement and calibration capacities of the country in the dosimetric magnitudes are in the Secondary Laboratory of Dosimetric Calibration of the Protection and Hygiene of Radiations Center. This capacities were included in the Regional Metrological Organization COOMET in the year 2003. In June of the 2005 the metrological capacities have been approved and published in the databases of the International Bureau of Weights and Measures as demonstration of the high competition of the calibration works that its are carried out in the laboratory. This approval is one of the maximum international recognitions that the patterns of a country can receive and its are the result of 10 years of work of the laboratory like part of the international net OIEA/OMS, which has given it the possibility to gauge the patterns and of adopting internationally validated calibration methodologies. On the other hand, it has been decisive the participation of the laboratory in multiple international comparisons of their patterns, as well as the implementation of a system of administration of the quality credited by the competent national organ. The article reviews the technical work of the laboratory during several years that it gave as result this
Epilepsy-associated stigma in Bolivia: a community-based study among the Guarani population: an International League Against Epilepsy/International Bureau for Epilepsy/World Health Organization Global Campaign Against Epilepsy Regional Project.
Bruno, Elisa; Bartoloni, Alessandro; Sofia, Vito; Rafael, Florentina; Magnelli, Donata; Padilla, Sandra; Quattrocchi, Graziella; Bartalesi, Filippo; Segundo, Higinio; Zappia, Mario; Preux, Pierre-Marie; Nicoletti, Alessandra
Epilepsy is associated with a significant burden of social stigma that appears to be influenced by psychosocial and cultural factors. Stigma has a negative effect on the management of people with epilepsy (PWE), representing one of the major factors that contribute to the burden of epilepsy. To assess stigma perception among the Guarani population, one hundred thirty-two people living in Guaraní communities in Bolivia were invited to complete the Stigma Scale of Epilepsy questionnaire. The main determinants of stigma identified were: the fear linked to loss of control, the feelings of sadness and pity toward PWE, the difficulties faced by PWE in the professional and relationship fields, the level of education and type of seizure. Our study pointed out that, in this population, PWE face difficulties in everyday life because of epilepsy-associated stigma and the results attest to the importance of promoting community-based educational programs aimed at reducing the stigmatization process. Copyright © 2012 Elsevier Inc. All rights reserved.
Bommaraju, Aalap; Kavanaugh, Megan L; Hou, Melody Y; Bessett, Danielle
To examine whether race and reported history of abortion are associated with abortion stigma and miscarriage stigma, both independently and comparatively. Self-administered surveys with 306 new mothers in Boston and Cincinnati, United States. Abortion stigma perception (ASP); miscarriage stigma perception (MSP); and comparative stigma perception (CSP: abortion stigma perception net of miscarriage stigma perception). Regardless of whether or not they reported having an abortion, white women perceived abortion (ASP) to be more stigmatizing than Black and Latina women. Perceptions of miscarriage stigma (MSP), on the other hand, were dependent on reporting an abortion. Among those who reported an abortion, Black women perceived more stigma from miscarriage than white women, but these responses were flipped for women who did not report abortion. Reporting abortion also influenced our comparative measure (CSP). Among those who did report an abortion, white women perceived more stigma from abortion than miscarriage, while Black and Latina women perceived more stigma from miscarriage than abortion. By measuring abortion stigma in comparison to miscarriage stigma, we can reach a more nuanced understanding of how perceptions of reproductive stigmas are stratified by race and reported reproductive history. Clinicians should be aware that reproductive stigmas do not similarly affect all groups. Stigma from specific reproductive outcomes is more or less salient dependent upon a woman's social position and lived experience. Copyright © 2016 Elsevier B.V. All rights reserved.
Singh, Aakanksha; Mattoo, Surendra K.; Grover, Sandeep
Background: Very few studies from India have studied stigma experienced by patients with schizophrenia. Aim of the Study: To study stigma in patients with schizophrenia (in the form of internalized stigma, perceived stigma and social-participation-restriction stigma) and its relationship with specified demographic and clinical variables (demographic variables, clinical profile, level of psychopathology, knowledge about illness, and insight). Materials and Methods: Selected by purposive random sampling, 100 patients with schizophrenia in remission were evaluated on internalized stigma of mental illness scale (ISMIS), explanatory model interview catalog stigma scale, participation scale (P-scale), positive and negative syndrome scale for schizophrenia, global assessment of functioning scale, scale to assess unawareness of mental disorder, and knowledge of mental illness scale. Results: On ISMIS scale, 81% patients experienced alienation and 45% exhibited stigma resistance. Stereotype endorsement was seen in 26% patients, discrimination experience was faced by 21% patients, and only 16% patients had social withdrawal. Overall, 29% participants had internalized stigma when total ISMIS score was taken into consideration. On P-scale, 67% patients experienced significant restriction, with a majority reporting moderate to mild restriction. In terms of associations between stigma and sociodemographic variables, no consistent correlations emerged, except for those who were not on paid job, had higher participation restriction. Of the clinical variables, level of functioning was the only consistent predictor of stigma. While better knowledge about the disorder was associated with lower level of stigma, there was no association between stigma and insight. Conclusion: Significant proportion of patients with schizophrenia experience stigma and stigma is associated with lower level of functioning and better knowledge about illness is associated with lower level of stigma. PMID
Link, Bruce G.; Wells, Jennifer; Phelan, Jo C.; Yang, Lawrence
Objective Important components of stigma include imagining what others might think of a stigmatized status, anticipating what might transpire in an interaction with others, and rehearsing what one might do if something untoward occurs. These imagined relations are here called “symbolic interaction stigma” and can be impactful even if the internalization of negative stereotypes fails to occur. Concepts and measures that capture symbolic interaction stigma are introduced and a preliminary assessment of their impact provided. Methods Four self-report measures of symbolic interaction stigma (perceived devaluation discrimination, anticipation of rejection, stigma consciousness and concern with staying in) were developed or adapted and administered to a sample of individuals who have experienced mental illness (N=65). Regression analyses examined whether forms of symbolic interaction stigma were associated with withdrawal, self-esteem and isolation from relatives independent of measures of internalization of stigma and rejection experiences. Results As evidenced by scores on four distinct measures symbolic interaction stigma was relatively common in the sample, somewhat more common than the internalization of stigma. Additionally, measures of symbolic interaction stigma were significantly associated with withdrawal, self-esteem and isolation from relatives even when a measure of the internalization of stigma was statistically controlled. Conclusions and Implications for Practice The study suggests the potential importance of considering symbolic interaction forms of stigma in understanding and addressing stigma and its consequences. Being aware of symbolic interaction stigma could be useful in enhancing rehabilitation goals if an approach to counteracting the negative effects of these aspects of stigma can be developed. PMID:26075528
For use of bioassay data in internal dose assessment, research should be done to clarify the goal desired, the choice of method to achieve the goal, the selection of adjustable parameters, and on the ensemble of information that is available. Understanding of these issues should determine choices of weighting factors for bioassay data used in regression models. This paper provides an assessment of the relative importance of the various factors
Chang, Chih-Cheng; Yen, Cheng-Fang; Jang, Fong-Lin; Su, Jian-An; Lin, Chung-Ying
The family caregivers of people with mental illness may internalize the public stereotypes into the affiliate stigma (i.e., the self-stigma of family members). This study aimed to compare the affiliate stigma across schizophrenia, bipolar disorder, and major depressive disorder, and to investigate potential factors associated with affiliate stigma. Each caregiver of family members with schizophrenia (n = 215), bipolar disorder (n = 85), and major depressive disorder (n = 159) completed the Affiliate Stigma Scale, Rosenberg Self-Esteem Scale, Caregiver Burden Inventory, Taiwanese Depression Questionnaire, and Beck Anxiety Inventory. After controlling for potential confounders, the hierarchical regression models showed that caregivers of a family member with schizophrenia had a higher level of affiliate stigma than those of bipolar disorder (β = -0.109; p stigma. The affiliate stigma of caregivers is associated with their self-esteem, caregiver burden, and by the diagnosis.
William B Young
Full Text Available BACKGROUND: People who have a disease often experience stigma, a socially and culturally embedded process through which individuals experience stereotyping, devaluation, and discrimination. Stigma has great impact on quality of life, behavior, and life chances. We do not know whether or not migraine is stigmatizing. METHODS: We studied 123 episodic migraine patients, 123 chronic migraine patients, and 62 epilepsy patients in a clinical setting to investigate the extent to which stigma attaches to migraine, using epilepsy as a comparison. We used the stigma scale for chronic illness, a 24-item questionnaire suitable for studying chronic neurologic diseases, and various disease impact measures. RESULTS: Patients with chronic migraine had higher scores (54.0±20.2 on the stigma scale for chronic illness than either episodic migraine (41.7±14.8 or epilepsy patients (44.6±16.3 (p<0.001. Subjects with migraine reported greater inability to work than epilepsy subjects. Stigma correlated most strongly with the mental component score of the short form of the medical outcomes health survey (SF-12, then with ability to work and migraine disability score for chronic and episodic migraine and the Liverpool impact on epilepsy scale for epilepsy. Analysis of covariance showed adjusted scores for the stigma scale for chronic illness were similar for chronic migraine (49.3; 95% confidence interval, 46.2 to 52.4 and epilepsy (46.5; 95% confidence interval, 41.6 to 51.6, and lower for episodic migraine (43.7; 95% confidence interval, 40.9 to 46.6. Ability to work was the strongest predictor of stigma as measured by the stigma scale for chronic illness. CONCLUSION: In our model, adjusted stigma was similar for chronic migraine and epilepsy, which were greater than for episodic migraine. Stigma correlated most strongly with inability to work, and was greater for chronic migraine than epilepsy or episodic migraine because chronic migraine patients had less ability
Hübner, Claudia; Baldofski, Sabrina; Zenger, Markus; Tigges, Wolfgang; Herbig, Beate; Jurowich, Christian; Kaiser, Stefan; Dietrich, Arne; Hilbert, Anja
Physical activity (PA) seems to be important for long-term weight loss after bariatric surgery; however, studies provide evidence for insufficient PA levels in bariatric patients. Research found self-efficacy to be associated with PA and weight bias internalization, for which an influence on mental and physical health has been shown in recent studies. The purpose of the present study was to investigate the influence of general self-efficacy on PA, mediated by weight bias internalization. In 179 bariatric surgery candidates, general self-efficacy, weight bias internalization, and different intensities of PA were assessed by self-report questionnaires. Structural equation modeling was used to analyze the assumed mediational relationship. After controlling for sociodemographic variables, weight bias internalization fully mediated the association between general self-efficacy and moderate-intense as well as vigorous-intense PA. Lower general self-efficacy predicted greater weight bias internalization, which in turn predicted lower levels of moderate-intense and vigorous-intense PA. The results suggest an influence of weight bias internalization on preoperative PA in bariatric surgery candidates. Subsequently, implementation of interventions addressing weight bias internalization in the usual treatment of bariatric surgery candidates might enhance patients' preoperative PA, while longitudinal analyses are needed to further examine its predictive value on PA after bariatric surgery. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Sheehan, Lindsay; Nieweglowski, Katherine; Corrigan, Patrick
This article reviews the recent literature on the stigma of personality disorders, including an overview of general mental illness stigma and an examination of the personality-specific stigma. Overall, public knowledge of personality disorders is low, and people with personality disorders may be perceived as purposefully misbehaving rather than experiencing an illness. Health provider stigma seems particularly pernicious for those with borderline personality disorder. Most stigma research on personality disorders has been completed outside the USA, and few stigma-change interventions specific to personality disorder have been scientifically tested. Limited evidence suggests that health provider training can improve stigmatizing attitudes and that interventions combining positive messages of recovery potential with biological etiology will be most impactful to reduce stigma. Anti-stigma interventions designed specifically for health providers, family members, criminal justice personnel, and law enforcement seem particularly beneficial, given these sources of stigma.
Birtel, Michèle D; Wood, Lisa; Kempa, Nancy J
Individuals with substance abuse may suffer from severe public and internalized stigma. Little is known about how social support can reduce stigma and improve mental health and well-being for them. This research examined how perceived stigma influences individuals in treatment for substance abuse, and whether internalized stigma and shame are mechanisms which link social support with better mental health and well-being. Sixty-four participants in treatment for substance abuse (alcohol, drugs), aged between 18 and 64, completed an online survey measuring perceived stigma, internalized stigma, shame, perceived social support, and mental health and well-being (self-esteem, depression and anxiety, sleep). We found that perceived stigma was associated with lower self-esteem, higher depression and anxiety, and poorer sleep. Furthermore, perceived social support followed the opposite pattern, and was associated with higher self-esteem, lower depression and anxiety, and better sleep. The effects of perceived stigma and of perceived social support on our outcome measures were mediated by internalized stigma and by internalized shame. Helping individuals with substance abuse to utilize their social support may be fruitful for combatting the negative impact of internalized stigma and shame on mental health and well-being. Copyright © 2017. Published by Elsevier B.V.
Wainberg, Milton L; Cournos, Francine; Wall, Melanie M; Norcini Pala, Andrea; Mann, Claudio Gruber; Pinto, Diana; Pinho, Veronica; McKinnon, Karen
The majority of people in psychiatric care worldwide are sexually active, and studies have revealed sharply elevated rates of HIV infection in that group compared with the general population. Recovery-oriented treatment does not routinely address sexuality. We examined the relationship between gender, severe mental illness diagnosis, and stigma experiences related to sexuality among people in psychiatric outpatient care. Sexually active adults attending 8 public outpatient psychiatric clinics in Rio de Janeiro (N = 641) were interviewed for psychiatric diagnosis and stigma experiences. Stigma mechanisms well-established in the literature but not previously examined in relation to sexuality were measured with the Mental Illness Sex Stigma Questionnaire, a 27-item interview about stigma in sexual situations and activities. Experiences of stigma were reported by a majority of participants for 48% of questionnaire items. Most people reported supportive attitudes toward their sexuality from providers and family members. Those with severe mental illness diagnoses showed greater stigma on individual discrimination and structural stigma mechanisms than did those with nonsevere mental illness diagnoses, whereas there was no difference on the social psychological processes (internalized stigma) mechanism. Regardless of diagnosis or gender, a majority of participants devalued themselves as sexual partners. Adults in psychiatric outpatient care frequently reported stigma experiences related to aspects of their sexual lives. From the perspectives of both HIV prevention and recovery from mental illness, examinations of the consequences of stigma in the sexual lives of people in psychiatric care and improving their measurement would have wide applicability. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Greene-Shortridge, Tiffany M; Britt, Thomas W; Castro, Carl Andrew
The present review addresses the perceived stigma associated with admitting a mental health problem and seeking help for that problem in the military. Evidence regarding the public stigma associated with mental disorders is reviewed, indicating that the public generally holds negative stereotypes toward individuals with psychological problems, leading to potential discrimination toward these individuals. The internalization of these negative beliefs results in self-stigma, leading to reduced self-esteem and motivation to seek help. Even if soldiers form an intention to seek help for their psychological difficulty, barriers to mental health care may prevent the soldier from receiving the help they need. An overall model is proposed to illustrate how the stigma associated with psychological problems can prevent soldiers getting needed help for psychological difficulties and proposed interventions for reducing stigma in a civilian context are considered for military personnel.
Kaufman, Kenneth R
Stigma impacts >50% of persons with epilepsy (PWE) and is a key factory in quality of life. Stigma can be both enacted (external factors) and felt (internal factors). In this article, felt/perceived stigma is more broadly defined as a combination of internal factors and perceptions of external factors. Secondary perceived stigma is felt/perceived stigma by a third party. A key, but often underappreciated, consideration in felt/perceived stigma may occur when a seemingly innocuous statement by a speaker is perceived as stigmatizing by the PWE and/or even by an unintended third party. This autobiographic short report addresses secondary perceived stigma in a social setting, the theater. Copyright © 2016 Elsevier Inc. All rights reserved.
Rüsch, Nicolas; Corrigan, Patrick W; Todd, Andrew R; Bodenhausen, Galen V
People with mental illness often internalize negative stereotypes, resulting in self-stigma and low self-esteem ("People with mental illness are bad and therefore I am bad, too"). Despite strong evidence for self-stigma's negative impact as assessed by self-report measures, it is unclear whether self-stigma operates in an automatic, implicit manner, potentially outside conscious awareness and control. We therefore assessed (i) negative implicit attitudes toward mental illness and (ii) low implicit self-esteem using 2 Brief Implicit Association Tests in 85 people with mental illness. Implicit self-stigma was operationalized as the product of both implicit measures. Explicit self-stigma and quality of life were assessed by self-report. Greater implicit and explicit self-stigma independently predicted lower quality of life after controlling for depressive symptoms, diagnosis, and demographic variables. Our results suggest that implicit self-stigma is a measurable construct and is associated with negative outcomes. Attempts to reduce self-stigma should take implicit processes into account.
Mackay, Rob; Bradstreet, Simon; McArthur, Andy; Dunion, Linda
This study explored self-stigma in 2 Scottish communities and strategies for challenging stigma and discrimination. A mixed-methods approach was used encompassing a survey including the Internalized Stigma of Mental Illness Inventory (ISMI) and facilitated dyad conversations with people with lived experience of mental illness. Self-reported experience of self-stigma across 2 communities was most closely associated with the ISMI Alienation cluster, accompanied by a high level of agreement with the Stigma Resistance cluster. Some 44% agreed that stereotypes about people with mental health problems applied to them, and almost 2/3 felt that having a mental health problem had spoiled their lives. Many participants reported reduced confidence, loss of hope, a sense of failure, and protecting oneself through social withdrawal. The findings also offer hope through narratives from people who have "pushed back" and are striving to reduce their own self-stigma by engaging with others and managing their own recovery journey. The journey through self-stigma and beyond has to be informed by what we know works with recovery from a mental health problem. At a policy and practice level, we recommend emphasis on 4 priorities: (a) refocusing antistigma and discrimination efforts more on the experiences of people who report stigma, (b) rights-based approaches, (c) identity-based work, and (d) information sharing and educational strategies. (c) 2015 APA, all rights reserved).
Deitz, Mandi F; Williams, Stacey L; Rife, Sean C; Cantrell, Peggy
The current study investigated a model explaining sexual assault victims' severity of trauma symptoms that incorporated multiple stigma constructs. Integrating the sexual assault literature with the stigma literature, this study sought to better understand trauma-related outcomes of sexual assault by examining three levels of stigma-cultural, social, and self. Results showed self-stigma was significantly and positively related to trauma symptom severity. Thus, results revealed that the internalized aspect of stigma served as a mechanism in the relation between sexual assault severity and increased levels of trauma symptom severity, highlighting the importance of assessing self-stigma in women reporting sexual assault experiences. © The Author(s) 2015.
Stigma is a special impact of radioactive waste disposal resulting from the perceptions of risk people have of nuclear waste. In this case, stigma is the devaluing or discrediting of a person, group, or geographical area because of proximity to a nuclear waste disposal site, resulting in negative consequences for the individual and collective (e.g., local economy, community relations, perceived quality of life). As part of a social and economic impact assessment of the proposed HLWR at Hanford Site, WA for Washington State, focus groups were conducted in the Tri-Cities near Hanford to identify stigma effects. Results from the groups showed strong evidence of individual impacts of stigmatization: local residents described prejudice towards them because they live near Hanford which appeared to affect their self-respect, the use of the phrase glowing in the dark by outsiders to symbolize the stigma, and showed concern about the possibility that local products might suffer from reduced demand because of products becoming associated with radioactivity in the public's mind. These results indicate that stigma effects are real and should be studied in research and assessments
Kelly, Claire M; Jorm, Anthony F
To update the reader on current research on stigmatizing attitudes towards people suffering from mood disorders and to describe recent interventions in this area. The public generally feels their own attitudes are more favourable to people with depression than 'most other people's' attitudes are. Among those with depressive symptoms, self-stigma in relation to depression is higher than perceived stigma from others, including professionals, thus hindering help seeking. The main factor that seems to improve the attitudes towards people with any mental illness is personal contact. Moderate improvements in attitudes have been achieved with an online intervention. Caution must be taken when ensuring that improvements in knowledge about mental disorders do not lead to increased social distance. There exists little research on stigmatizing attitudes towards people with mood disorders. Most of the literature on the stigma towards people with mental illness relates to people with more severe disorders such as schizophrenia. When research has been done on mood disorders, the focus has been on perceived stigma and self-stigma. No up-to-date research exists on discrimination experienced by people with mood disorders, and very little research exists on interventions designed to decrease stigmatizing attitudes towards them.
Full Text Available Objectives: Stigma is a negative value. Many behaviors are to ward Stigmatized people. Down syndrome is one of conditions with Stigma. The aim of this study is to determine the sources of labeling in iranian Down syndrome. Methods: The View of 105 Down syndrome families concerning stigma were conducted. All of Down syndrome was under 50 years. Results: A fair proportion of Down syndrome families perceived that stigma had a negative effect from social. Causes of stigma are different. Stigma due social interaction, Media and health professionals are significant than others. Discussion: The diagnostic label of Down syndrome may render the person and his family vulnerable to stigmatization. The most causes of stigma were determined therefore, in the destigmatization programs, they must be attended. Stigma must be detected, too.
Sanjeev V Thomas
Full Text Available Stigma and resultant psychosocial issues are major hurdles that people with epilepsy confront in their daily life. People with epilepsy, particularly women, living in economically weak countries are often ill equipped to handle the stigma that they experience at multiple levels. This paper offers a systematic review of the research on stigma from sociology and social psychology and details how stigma linked to epilepsy or similar conditions can result in stereotyping, prejudice and discrimination. We also briefly discuss the strategies that are most commonly utilized to mitigate stigma. Neurologists and other health care providers, social workers, support groups and policy makers working with epilepsy need to have a deep understanding of the social and cultural perceptions of epilepsy and the related stigma. It is necessary that societies establish unique determinants of stigma and set up appropriate strategies to mitigate stigma and facilitate the complete inclusion of people with epilepsy as well as mitigating any existing discrimination.
Campellone, Timothy R.; Caponigro, Janelle M.; Kring, Ann M.
Stigmatizing beliefs about mental illness can be a daily struggle for people with schizophrenia. While investigations into the impact of internalizing stigma on negative symptoms have yielded mixed results, resistance to stigmatizing beliefs has received little attention. In this study, we examined the linkage between internalized stigma, stigma resistance, negative symptoms, and social power, or perceived ability to influence others during social interactions among people with schizophrenia. Further, we sought to determine whether resistance to stigma would be bolstered by social power, with greater power in relationships with other possibly buffering against motivation/pleasure negative symptoms. Fifty-one people with schizophrenia or schizoaffective disorder completed measures of social power, internalized stigma, and stigma resistance. Negative symptoms were assessed using the Clinical Assessment Interview for Negative Symptoms (CAINS). Greater social power was associated with less internalized stigma and negative symptoms as well as more stigma resistance. Further, the relationship between social power and negative symptoms was partially mediated by stigma resistance. These findings provide evidence for the role of stigma resistance as a viable target for psychosocial interventions aimed at improving motivation and social power in people with schizophrenia. PMID:24326180
Campellone, Timothy R; Caponigro, Janelle M; Kring, Ann M
Stigmatizing beliefs about mental illness can be a daily struggle for people with schizophrenia. While investigations into the impact of internalizing stigma on negative symptoms have yielded mixed results, resistance to stigmatizing beliefs has received little attention. In this study, we examined the linkage between internalized stigma, stigma resistance, negative symptoms, and social power, or perceived ability to influence others during social interactions among people with schizophrenia. Further, we sought to determine whether resistance to stigma would be bolstered by social power, with greater power in relationships with other possibly buffering against motivation/pleasure negative symptoms. Fifty-one people with schizophrenia or schizoaffective disorder completed measures of social power, internalized stigma, and stigma resistance. Negative symptoms were assessed using the Clinical Assessment Interview for Negative Symptoms (CAINS). Greater social power was associated with less internalized stigma and negative symptoms as well as more stigma resistance. Further, the relationship between social power and negative symptoms was partially mediated by stigma resistance. These findings provide evidence for the role of stigma resistance as a viable target for psychosocial interventions aimed at improving motivation and social power in people with schizophrenia. © 2013 Published by Elsevier Ireland Ltd.
Weidmann, Anita Elaine; Cunningham, Scott; Gray, Gwen; Hansford, Denise; Bermano, Giovanna; Stewart, Derek
Obesity has reached pandemic levels, with more than 1.5 billion adults being affected worldwide. In Scotland two-thirds of men and more than half of women are either overweight or obese, placing Scotland overall third behind the United States of America and Mexico. All community pharmacies in Scotland are contracted to provide public health services such as smoking cessation and there is increasing interest in their contribution to weight management. Researching this area in Scotland may provide valuable information to facilitate the development of community pharmacy services in other parts of the UK and internationally. To describe the views of the Scottish general public on the provision of weight management services via community pharmacies. General public in Scotland. A cross-sectional postal questionnaire survey of 6,000 randomly selected members of the Scottish general public aged 18 years and over. Views on community pharmacy led weight management services. Questionnaires were returned by 20.6% (n = 1,236). Over half 60.1% (n = 751) agreed or strongly agreed that they had easy access to pharmacy services in general and around one-third agreed (35%; n = 438) that it was more convenient to obtain weight management advice from a pharmacist than it is to make an appointment with a GP. Most respondents however lacked awareness of the types of health services available through community pharmacy (13.2%; n = 162) and would not feel comfortable speaking to a pharmacist or medicines counter assistant about weight related issues (25%; n = 320). Concerns over privacy (47.3%; n = 592) and perceived lack of pharmacists' specialist knowledge (open comments) were identified as potential barriers to service uptake by the general public. Overall, respondents appear to be receptive to the idea of accessing weight management services through community pharmacy but a perceived lack of privacy, poor knowledge of pharmacists' skill level and of public health services available to
Overton, Stacy L.; Medina, Sondra L.
Stigma surrounding major mental illness creates many barriers. People who experience mental illness face discrimination and prejudice when renting homes, applying for jobs, and accessing mental health services. The authors review the current literature regarding stigma and mental illness. They define stigma and review theories that explain its…
Evans-Lacko, S.; Brohan, E.; Mojtabai, R.; Thornicroft, G.
Background. Little is known about how the views of the public are related to self-stigma among people with mental health problems. Despite increasing activity aimed at reducing mental illness stigma, there is little evidence to guide and inform specific anti-stigma campaign development and messages to be used in mass campaigns. A better understanding of the association between public knowledge, attitudes and behaviours and the internalization of stigma among people with mental health problems...
Bandstra, Nancy F; Camfield, Carol S; Camfield, Peter R
Epilepsy directly affects 50 million people worldwide. Most can achieve excellent seizure control; however, people living with epilepsy continue to suffer from enacted or perceived stigma that is based on myths, misconceptions and misunderstandings that have persisted for thousands of years. This paper reviews the frequency and nature of stigma toward epilepsy. Significant negative attitudes prevail in the adolescent and adult public worldwide leading to loneliness and social avoidance both in school and in the workplace. People with epilepsy are often wrongly viewed as having mental health and antisocial issues and as being potentially violent toward others. Twenty-five percent of adults having epilepsy describe social stigma as a result of their epilepsy. They fear rejection and often feel shame or loneliness from this diagnosis. The psychosocial and social impact of epilepsy is significant. Yet few specific interventions have been demonstrated to alter this perception. The effect on public education is primarily short-term, while change over the long-term in attitudes and inaccurate beliefs have not presently been proven effective. School education programming demonstrates improved knowledge and attitude a month after a classroom intervention, but persisting change over a longer period of time has not been evaluated. In-depth adult psycho-educational programs for adults with epilepsy improves knowledge, coping skills and level of felt stigma. However these gains have not demonstrated persistence over time. Myths, misconceptions and misunderstandings about epilepsy continue and programs aimed at increasing knowledge and reducing negative public attitudes should be enhanced.
Evans-Polce, Rebecca J.; Castaldelli-Maia, Joao M.; Schomerus, Georg; Evans-Lacko, Sara E.
Objective Little is known about the consequences of tobacco smoking stigma on smokers and how smokers may internalize smoking-related stigma. This review summarizes existing literature on tobacco smoking self-stigma, investigating to what extent smokers are aware of negative stereotypes, agree with them and apply them to themselves. Methods We carried out a systematic search of Pubmed/Web of Science/PsycInfo databases for articles related to smoking self-stigma through June 2013. Reference lists and citations of included studies were also checked and experts were contacted. After screening articles for inclusion/exclusion criteria we performed a quality assessment and summarized findings according to the stages of self-stigma as conceptualized in Corrigan’s progressive model of self-stigma (aware, agree, apply and harm). Initial searches yielded 570 articles. Results Thirty of these articles (18 qualitative and 12 quantitative studies) met criteria for our review. Awareness of smoking stigma was virtually universal across studies. Coping strategies for smoking stigma and the degree to which individuals who smoke internalized this stigma varied both within and across studies. There was considerable variation in positive, negative, and non-significant consequences associated with smoking self-stigma. Limited evidence was found for subgroup differences in smokingrelated stigma. Conclusion While there is some evidence that smoking self-stigma leads to reductions in smoking, this review also identified significant negative consequences of smoking self-stigma. Future research should assess the factors related to differences in how individuals respond to smoking stigma. Public health strategies which limit the stigmatization of smokers may be warranted. PMID:26439764
Shimotsu, Sakie; Horikawa, Naoshi; Emura, Rina; Ishikawa, Shin-Ichi; Nagao, Ayako; Ogata, Akiko; Hiejima, Shigeto; Hosomi, Jun
There is evidence that the stigma surrounding mental illness may be greater in Japan than elsewhere. However, few Japanese studies have focused on self-stigma (the internalization of social stigma), and few interventions to reduce self-stigma exist. To remedy this deficiency, we evaluated the efficacy of group cognitive-behavioral therapy (CBT) in reducing self-stigma and examined the relationship between cognitive restructuring and self-stigma. We administered a 10-session group CBT program to 46 Japanese outpatients with anxiety and depressive symptoms (36 men, 10 women; mean age=38.57 years, SD=8.33; 20 diagnosed with mood disorders; 24 with neurotic, stress-related, or somatoform disorders; and 2 with other disorders). A pretest-posttest design was used to examine the relationship between cognitive restructuring and self-stigma. Outcomes were measured using the Japanese versions of the Devaluation-Discrimination Scale, Dysfunctional Attitude Scale, Beck Depression Inventory-II, State-Trait Anxiety Inventory State-Form, and Rosenberg's Self Esteem Scale. Participants exhibited significant improvements in depression, anxiety, and maladjusted cognitive bias and reductions in self-stigma. Cognitive bias was significantly correlated with self-stigma. Group CBT is effective in improving both emotional symptoms and self-stigma in outpatients with anxiety and depressive symptoms. Reduction in self-stigma plays a mediating role in alleviating emotional symptoms and improving cognition. Copyright © 2014 Elsevier B.V. All rights reserved.
Grover, Sandeep; Avasthi, Ajit; Singh, Aakanksha; Dan, Amitava; Neogi, Rajarshi; Kaur, Darpan; Lakdawala, Bhavesh; Rozatkar, Abhijit R; Nebhinani, Naresh; Patra, Suravi; Sivashankar, Priya; Subramanyam, Alka A; Tripathi, Adarsh; Gania, Ab Majid; Singh, Gurvinder Pal; Behere, Prakash
This study aimed to evaluate the stigma and its correlates among patients with severe mental disorders. Patients with diagnosis of schizophrenia (N = 707), bipolar disorder (N = 344) and recurrent depressive disorder (N = 352) currently in clinical remission from 14 participating centres were assessed on Internalized Stigma of Mental Illness Scale (ISMIS). Patients with diagnosis of schizophrenia experienced higher level of alienation, sterotype endorsement, discrimination experience and total stigma when compared to patients with bipolar disorder and recurrent depressive disorder. Patients with bipolar disorder experienced higher stigma than those with recurrent depressive disorder in the domain of stigma resistance only. Overall compared to affective disorder groups, higher proportion of patients with schizophrenia reported stigma in all the domains of ISMIS. In general in all the 3 diagnostic groups' stigma was associated with shorter duration of illness, shorter duration of treatment and younger age of onset. To conclude, this study suggests that compared to affective disorder, patients with schizophrenia experience higher self stigma. Higher level of stigma is experienced during the early phase of illness. Stigma intervention programs must focus on patients during the initial phase of illness in order to reduce the negative consequences of stigma. Copyright © 2017 Elsevier B.V. All rights reserved.
Murray, Sarah McIvor; Robinette, Katie L; Bolton, Paul; Cetinoglu, Talita; Murray, Laura K; Annan, Jeannie; Bass, Judith K
Stigma related to sexual violence (SV) is associated with many negative physical and social outcomes. We sought to create a contextually relevant measure of SV-related stigma for women in the Democratic Republic of Congo (DRC) and assess itspsychometrics and validity. Using baseline screening data from two randomized controlled trials of services for female SV survivors in Eastern DRC ( n = 1,184), we conducted exploratory and confirmatory factor analyses to test the measurement model. Cronbach's alphas and Kuder-Richardson 20 (KR-20) statistics were used to evaluate internal consistency. Logistic and linear regressions of the stigma measures with related constructs were used to assess construct validity. Two distinct but related scales were developed based on factor analyses: a four-item scale of discrimination-related stigma (i.e., enacted stigma) and an eight-item scale of combined perceived and internalized stigma (i.e., felt stigma). Both scales showed good internal consistency (KR-20 = .68; α = .86). A higher felt stigma score was associated with significant increases in combined depression and anxiety and trauma symptoms, as well as functional impairment ( p < .001). Having a child as a result of SV was associated with both significantly higher enacted and felt stigma ( p < .001). Neither SV stigma scale was associated with medical care seeking. To address harmful ramifications of stigma among SV survivors, locally relevant quantitative measures are necessary to understand the nature and severity of stigma they experience. Our process of scale creation and evaluation can serve as an example for developing locally relevant SV-related stigma measures.
Jiao, Sunny; Bungay, Vicky
Men engaged in sex work experience significant stigma that can have devastating effects for their mental health. Little is known about how male sex workers experience stigma and its effects on mental health or their strategies to prevent its effects in the Canadian context. This study examined the interrelationships between stigma and mental health among 33 Canadian indoor, male sex workers with a specific goal of understanding how stigma affected men's mental health and their protective strategies to mitigate against its effects. Men experienced significant enacted stigma that negatively affected their social supports and ability to develop and maintain noncommercial, romantic relationships. Men navigated stigma by avoidance and resisting internalization. Strategy effectiveness to promote mental health varied based on men's perspectives of sex work as a career versus a forced source of income. Programming to promote men's mental health must take into consideration men's diverse strategies and serve to build social supports.
Werner, Perla; Stein-Shvachman, Ifat; Heinik, Jeremia
Depression is common in old age and is often associated with stigma. However, to date, little is known about self-stigma (internalization of stigmatic beliefs) in depressed older people despite its importance and consequences. The aim of this study was to examine self-stigma and its correlates in depressed older people. Phone interviews were conducted with 54 persons diagnosed with major depression (78% female, average age = 74) from a psychogeriatric clinic in the central area of Israel. Self-stigma was assessed using an adapted version of the Internalized Stigma of Mental Health (ISMI) scale. Symptoms of depression were assessed using the short form of the Geriatric Depression Scale (GDS). Self-esteem was measured using Rosenberg's Self Esteem Scale. Information regarding sociodemographic and psychiatric health characteristics was also collected. Self-stigma was relatively moderate with 10% to 20% of the participants reporting self-stigma. Those who reported higher levels of self-stigma were younger than those who did not report it. Income and education were lower in persons who reported high levels of stigmatization. Persons who reported stigmatization scored higher on the GDS and reported lower self-esteem than those without stigmatization. This study represents an effort to examine the correlates of self-stigma in depressed older people. Since self-stigma exists among older adults, further studies are required to extend this body of knowledge.
Thornicroft, Graham; Brohan, Elaine; Kassam, Aliya; Lewis-Holmes, Elanor
Abstract This paper proposes that stigma in relation to people with mental illness can be understood as a combination of problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). From a literature review, a series of candidate interventions are identified which may be effective in reducing stigmatisation and discrimination at the following levels: individuals with mental illness and their family members; the workplace; and local, national and international. The ...
Chang, Chih-Cheng; Su, Jian-An; Chang, Kun-Chia; Lin, Chung-Ying; Koschorke, Mirja; Rüsch, Nicolas; Thornicroft, Graham
People with mental illness and their family caregivers often perceive public stigma, which may lead to stigma-related stress (or stigma stress). However, no instruments have been developed to measure this stress for family caregivers of people with mental illness. We modified an instrument that measures the stigma stress of people with mental illness (i.e., the cognitive appraisal of stigma as a stressor) and examined the psychometric properties of the scores of the newly developed instrument: the Family Stigma Stress Scale (FSSS). Primary family caregivers of people with mental illness in Southern Taiwan ( n = 300; mean age = 53.08 ± 13.80; 136 males) completed the FSSS. An exploratory factor analysis showed that the FSSS score had two factors; both factor scores had excellent internal consistency (α = .913 and .814) and adequate test-retest reliability ( r = .627 and .533; n = 197). Significant correlations between FSSS factor scores and other instruments supported its concurrent validity and the ability of the FSSS to differentiate between clinical characteristics, for example, having been previously hospitalized or not. The FSSS is a brief and effective measure of the stigma stress of family caregivers of people with mental illness.
Logie, Carmen H.; Earnshaw, Valerie
Lesbian, bisexual and queer (LBQ) women experience pervasive sexual stigma that harms wellbeing. Stigma is a multi-dimensional construct and includes perceived stigma, awareness of negative attitudes towards one’s group, and enacted stigma, overt experiences of discrimination. Despite its complexity, sexual stigma research has generally explored singular forms of sexual stigma among LBQ women. The study objective was to develop a scale to assess perceived and enacted sexual stigma among LBQ women. We adapted a sexual stigma scale for use with LBQ women. The validation process involved 3 phases. First, we held a focus group where we engaged a purposively selected group of key informants in cognitive interviewing techniques to modify the survey items to enhance relevance to LBQ women. Second, we implemented an internet-based, cross-sectional survey with LBQ women (n=466) in Toronto, Canada. Third, we administered an internet-based survey at baseline and 6-week follow-up with LBQ women in Toronto (n=24) and Calgary (n=20). We conducted an exploratory factor analysis using principal components analysis and descriptive statistics to explore health and demographic correlates of the sexual stigma scale. Analyses yielded one scale with two factors: perceived and enacted sexual stigma. The total scale and subscales demonstrated adequate internal reliability (total scale alpha coefficient: 0.78; perceived sub-scale: 0.70; enacted sub-scale: 0.72), test-retest reliability, and construct validity. Perceived and enacted sexual stigma were associated with higher rates of depressive symptoms and lower self-esteem, social support, and self-rated health scores. Results suggest this sexual stigma scale adapted for LBQ women has good psychometric properties and addresses enacted and perceived stigma dimensions. The overwhelming majority of participants reported experiences of perceived sexual stigma. This underscores the importance of moving beyond a singular focus on
Carmen H Logie
Full Text Available Lesbian, bisexual and queer (LBQ women experience pervasive sexual stigma that harms wellbeing. Stigma is a multi-dimensional construct and includes perceived stigma, awareness of negative attitudes towards one's group, and enacted stigma, overt experiences of discrimination. Despite its complexity, sexual stigma research has generally explored singular forms of sexual stigma among LBQ women. The study objective was to develop a scale to assess perceived and enacted sexual stigma among LBQ women. We adapted a sexual stigma scale for use with LBQ women. The validation process involved 3 phases. First, we held a focus group where we engaged a purposively selected group of key informants in cognitive interviewing techniques to modify the survey items to enhance relevance to LBQ women. Second, we implemented an internet-based, cross-sectional survey with LBQ women (n=466 in Toronto, Canada. Third, we administered an internet-based survey at baseline and 6-week follow-up with LBQ women in Toronto (n=24 and Calgary (n=20. We conducted an exploratory factor analysis using principal components analysis and descriptive statistics to explore health and demographic correlates of the sexual stigma scale. Analyses yielded one scale with two factors: perceived and enacted sexual stigma. The total scale and subscales demonstrated adequate internal reliability (total scale alpha coefficient: 0.78; perceived sub-scale: 0.70; enacted sub-scale: 0.72, test-retest reliability, and construct validity. Perceived and enacted sexual stigma were associated with higher rates of depressive symptoms and lower self-esteem, social support, and self-rated health scores. Results suggest this sexual stigma scale adapted for LBQ women has good psychometric properties and addresses enacted and perceived stigma dimensions. The overwhelming majority of participants reported experiences of perceived sexual stigma. This underscores the importance of moving beyond a singular focus on
Mittal, Dinesh; Sullivan, Greer; Chekuri, Lakshminarayana; Allee, Elise; Corrigan, Patrick W
The purpose of this article was to comprehensively review published literature about strategies to reduce self-stigma among people with mental illness. Recommendations and implications for research also are discussed. The electronic databases of Ovid, PubMed, and PsycINFO were searched for peer-reviewed articles published between January 2000 and August 2011 by using the key words “self-stigma,” “internalized stigma,” “perceived stigma,” and “stigma intervention.” The search was further narrowed to studies that described a detailed intervention and that used self-stigma as a primary or secondary outcome, tested the intervention among individuals with a psychiatric illness, and analyzed data quantitatively with acceptable statistical tools. Fourteen articles met inclusion criteria, and eight reported significant improvement in self-stigma outcomes. Participants predominantly had schizophrenia and related disorders or depression. Six self-stigma reduction strategies were identified. Psychoeducation was the most frequently tested intervention. Self-stigma definitions, measurements, and conceptual frameworks varied considerably across these studies. Several studies lacked a theoretical framework for their intervention. Six different scales were used to measure self-stigma. Two prominent approaches for self-stigma reduction emerged from our review: one, interventions that attempt to alter the stigmatizing beliefs and attitudes of the individual; and two, interventions that enhance skills for coping with self-stigma through improvements in self-esteem, empowerment, and help-seeking behavior. The second approach seems to have gained traction among stigma experts. Targeting high-risk groups to preempt self-stigma appears to be a promising area for future research.
This paper describes mental health related stigma expressed by police to police using a newly developed 11-item Police Officer Stigma Scale and reports on the preliminary psychometric properties (factor structure and internal reliability) of this scale. The scale used an indirect measurement approach adapted from the Perceived Devaluation and Discrimination Scale. Five themes appropriate to police culture were adapted and six additional items were added. Responses were rated on a 5-point agreement scale with an additional don't know option. Data were collected from officers attending a mandatory workshop (90.5% response). Exploratory factor analysis showed the scale to be unidimensional and internally reliable (Cronbach's alpha was 0.82). The most endorsed items pertained to avoiding disclosure to a supervisor/manager or to a colleague (85% agreement), that most officers would expect discrimination at work (62%), and that most officers would not want a supervisor or manager who had a mental illness (62%). Findings highlight that (a) Police-to-police mental illness stigma may be a particularly strong feature of police cultures; (b) police should be a focus for targeted anti-stigma interventions; and (c) though further psychometric testing is needed, the Police Office Stigma Scale may provide important insights into the nature and functioning of police-to-police stigma in police cultures in future research.
Mousley, Victoria L; Chaudoir, Stephenie R
Although stigma has been linked to suboptimal psychological and physical health outcomes in marginalized communities such as persons of color, sexual minorities, and people living with HIV/AIDS, no known research has examined these effects among deaf individuals. In the present research, we examine the associations between anticipated, enacted, and internalized stigma and psychological well-being (i.e., depressive symptoms, anxiety) and physical well-being (i.e., quality of life, alcohol use) among a sample of 171 deaf emerging adults. Furthermore, we consider whether trait resilience and benefit-finding moderate these effects. Enacted stigma, but not anticipated or internalized stigma, was related to worse depressive symptoms, anxiety, and quality of life. However, none of these variables predicted alcohol use and neither resilience nor benefit-finding moderated these effects. These findings are consistent with other research among marginalized populations, though they are also the first to suggest that experiences of discrimination are related to suboptimal well-being among deaf emerging adults. The discussion considers how these findings may illuminate the potential causes of disparities in well-being between hearing and deaf emerging adults.
Meyer-Bahlburg, Heino F L; Khuri, Jananne; Reyes-Portillo, Jazmin; Ehrhardt, Anke A; New, Maria I
The risk of intersex-related stigma often serves as social indication for "corrective" genital surgery, but has not been comprehensively documented. In preparation for the development of an intersex-specific stigma assessment tool, this qualitative project aimed to explore stigma in girls and women with classical congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. As part of a comprehensive follow-up project, 62 adult women with classical CAH (age range 18-51 years) took part in an open-ended retrospective interview focusing on the impact of CAH and its treatment on various aspects of girls' and women's lives. Deductive qualitative content analysis (Patton, 2014) of de-identified transcripts involved categorization of three types of stigma: experienced, anticipated, and internalized. Two-fifths of the participants reported CAH-related stigma in romantic/sexual situations. Stigma enactment by romantic partners occurred in reaction to both genital and non-genital sex-atypical features of CAH and sometimes included explicit questioning of the women's true gender. Stigma anticipation by the women and their related avoidance of nudity, genital exposure, and romantic involvement altogether were frequent. Internalization of stigma occurred as well. In conclusion, the data suggest that many women with CAH experience, anticipate, and/or internalize intersex-related stigma in the context of their romantic/sexual lives.
Ekstrand, Maria L; Heylen, Elsa; Mazur, Amanda; Steward, Wayne T; Carpenter, Catherine; Yadav, Kartik; Sinha, Sanjeev; Nyamathi, Adey
HIV stigma continues to be a barrier to physical and mental health among people living with HIV globally, especially in vulnerable populations. We examined how stigma is associated with health outcomes and quality of life among rural women living with HIV in South India (N = 600). Interviewer-administered measures assessed multiple dimensions of stigma, as well as loneliness, social support, ART adherence, time since diagnosis, and quality of life. Internalized stigma and a lack of social support were associated with a lower quality of life, while the association between internalized stigma and adherence was mediated by the use of stigma-avoidant coping strategies, suggesting that keeping one's diagnosis a secret may make it more difficult to take one's medications. These findings suggest that these women constitute a vulnerable population who need additional services to optimize their health and who might benefit from peer support interventions and stigma-reduction programs for family and community members.
Maluccio, John A; Wu, Fan; Rokon, Redwan B; Rawat, Rahul; Kadiyala, Suneetha
HIV-related stigma among persons living with HIV/AIDS (PLHIV) is prevalent throughout sub-Saharan Africa. There is limited evidence, however, on which interventions are effective in reducing it. We used data from a prospective impact evaluation of a 12-month food assistance intervention among 904 antiretroviral therapy (ART)- naïve PLHIV in Uganda to examine the program impact on stigma. Stigma was measured using the comprehensive HASI-P scale, which demonstrated good internal consistency (Cronbach's alpha = 0.87) and was correlated with several related constructs including physical and mental health-related quality of life, disclosure, and physical health symptoms in the sample. Using quasi-experimental difference-in-difference matching methods to better infer causality, we tested whether the intervention improved the overall stigma scale and its subscales. The food assistance intervention had a significant effect on reported internalized (but not external) stigma of approximately 0.2 SD (p stigma scale is a useful tool for measuring and tracking stigma. Food assistance interventions, embedded in an HIV care program, can reduce internalized stigma.
Erhabor S. Idemudia
< .004; and depression (F = (97 = 3.390 p < .001. The perceived community stigma had one main effect for depression (F = (1.98 = 1.452, p < .05. There were no significant main effects for internally felt stigma and psychological dysfunctions. Both hypotheses were partially supported. Conclusion: Recommendations included tailoring interventions to meet the cultural needs of patients. Other recommendations were made in accordance with the findings of the study.
Yang, Lawrence H; Lai, Grace Y; Tu, Ming; Luo, Maggie; Wonpat-Borja, Ahtoy; Jackson, Valerie W; Lewis-Fernández, Roberto; Dixon, Lisa
Mental illness stigma has adverse effects on both the caregivers' psychological well-being and the effectiveness of care that consumers receive. While anti-stigma interventions for family caregivers from Western settings have recently shown efficacy, these interventions may not be equally applicable across culturally diverse groups. Specifically, Chinese immigrant caregivers experience heightened internalized stigma, which predisposes the adoption of harmful coping strategies and reduced quality of social networks. We present an anti-stigma intervention based on a peer-family group format, co-led by a clinician and a trained family caregiver, to counter stigma among Chinese immigrants. Data are presented from a brief intervention administered to a pilot sample of 11 Chinese immigrant caregivers that provides: psychoeducation, strategies to counter experienced discrimination, and techniques to resist internalized stigma. Case vignettes illustrate implementation of this intervention, and how the peer-family format via interactive contact counteracts internalized stereotypes, encourages adaptive coping strategies, and reinvigorates social networks. Quantitative results further suggest preliminary efficacy in reducing internalized stigma for caregivers who evidenced at least some prior internalized stigma. This study constitutes an initial but important step towards reducing mental illness stigma among Asian Americans, for whom stigma has played a powerful role in the delay and underuse of treatment.
Barney, Lisa J; Griffiths, Kathleen M; Christensen, Helen; Jorm, Anthony F
Self-stigma may feature strongly and be detrimental for people with depression, but the understanding of its nature and prevalence is limited by the lack of psychometrically-validated measures. This study aimed to develop and validate a measure of self-stigma about depression. Items assessing self-stigma were developed from focus group discussions, and were tested and refined over three studies using surveys of 408 university students, 330 members of a depression Internet network, and 1312 members of the general Australian public. Evaluation involved item-level and bivariate analyses, and factor analytic procedures. Items performed consistently across the three surveys. The resulting Self-Stigma of Depression Scale (SSDS) comprised 16 items representing subscales of Shame, Self-Blame, Social Inadequacy, and Help-Seeking Inhibition. Construct validity, internal consistency and test-retest reliability were satisfactory. The SSDS distinguishes self-stigma from perceptions of stigma by others, yields in-depth information about self-stigma of depression, and possesses good psychometric properties. It is a promising tool for the measurement of self-stigma and is likely to be useful in further understanding self-stigma and evaluating stigma interventions. Copyright © 2010 John Wiley & Sons, Ltd.
Hasanuddin; Setyawan, A.; Yulianto, B.
Assessment to the performance of road pavement is deemed necessary to improve the management quality of road maintenance and rehabilitation. This research to evaluate the road base on functional and structural and recommendations handling done. Assessing the pavement performance is conducted with functional and structural evaluation. Functional evaluation of pavement is based on the value of IRI (International Roughness Index) which among others is derived from reading NAASRA for analysis and recommended road handling. Meanwhile, structural evaluation of pavement is done by analyzing deflection value based on FWD (Falling Weight Deflectometer) data resulting in SN (Structural Number) value. The analysis will result in SN eff (Structural Number Effective) and SN f (Structural Number Future) value obtained from comparing SN eff to SN f value that leads to SCI (Structural Condition Index) value. SCI value implies the possible recommendation for handling pavement. The study done to Simpang Tuan-Batas Kota Jambi road segment was based on functional analysis. The study indicated that the road segment split into 12 segments in which segment 1, 3, 5, 7, 9, and 11 were of regular maintenance, segment 2, 4, 8, 10, 12 belonged to periodic maintenance, and segment 6 was of rehabilitation. The structural analysis resulted in 8 segments consisting of segment 1 and 2 recommended for regular maintenance, segment 3, 4, 5, and 7 for functional overlay, and 6 and 8 were of structural overlay.
Hoogsteder, M; Veling, Willem; van Weeghel, Jaap; Pijnenborg, Marieke; van 't Veer, Job; Kienhorst, Gerdie
Mensen met psychische aandoeningen hebben vaak te maken met sociale afwijzing en uitsluiting. Het stigma op psychische problemen speelt een belangrijke rol bij het in stand houden van belemmeringen voor maatschappelijke participatie, zelfs nadat mensen hersteld zijn. Daarnaast heeft het stigma vaak
Goldstein, Susan B.
As evidence builds for straight allies' contributions to battling sexual prejudice, barriers to assuming this role must be identified and dismantled. This study investigated stigma and stigma by association in perceptions of straight allies in a college population. Adjective rating items were completed by 505 participants who identified as…
Tavormina, Maurilio Giuseppe Maria; Tavormina, Romina; Nemoianni, Eugenio; Tavormina, Giuseppe
Psychiatric patients often suffer for two reasons: due to the illness and due to the social stigma of mental illness, that increases the uneasiness and psychic pain of the person suffering from serious psychiatric disorder. This unwell person is often the object of stigma because he is "different" from others, and he also can be margenalised by society. In this study we intend to assess whether these margenalising attitudes might be also present among mental health professionals who have presented psychic problems in a previous period of their life, against sick persons suffering of the same illness even if he is a mental health professional. Two questionnaires have been developed, one for professionals and another for the patients, with the aim of identifying these marginalising attitudes. We intend that this study shall be a multicenter, observational and international study, promoted by the Mental Health Dept. of Naples (ASL Naples 3 South, Italy).
Mushtaq, Muhammad Umair; Gull, Sibgha; Mushtaq, Komal; Abdullah, Hussain Muhammad; Khurshid, Usman; Shahid, Ubeera; Shad, Mushtaq Ahmad; Akram, Javed
Abstract Background Child growth is internationally recognized as an important indicator of nutritional status and health in populations. This study was aimed to compare age- and gender-specific height, weight and BMI percentiles and nutritional status relative to the international growth references among Pakistani school-aged children. Methods A population-based study was conducted with a multistage cluster sample of 1860 children aged five to twelve years in Lahore, Pakistan. Smoothed heigh...
Griffiths, Kathleen M; Carron-Arthur, Bradley; Parsons, Alison; Reid, Russell
The stigma associated with mental disorders is a global public health problem. Programs to combat it must be informed by the best available evidence. To this end, a meta-analysis was undertaken to investigate the effectiveness of existing programs. A systematic search of PubMed, PsycINFO and Cochrane databases yielded 34 relevant papers, comprising 33 randomized controlled trials. Twenty-seven papers (26 trials) contained data that could be incorporated into a quantitative analysis. Of these trials, 19 targeted personal stigma or social distance (6,318 participants), six addressed perceived stigma (3,042 participants) and three self-stigma (238 participants). Interventions targeting personal stigma or social distance yielded small but significant reductions in stigma across all mental disorders combined (d=0.28, 95% CI: 0.17-0.39, pmental illness (d=0.30, 95% CI: 0.10-0.50, preducing personal stigma (d=0.33, 95% CI: 0.19-0.42, preducing personal stigma as face-to-face delivery. There was no evidence that stigma interventions were effective in reducing perceived or self-stigma. In conclusion, there is an evidence base to inform the roll out of programs for improving personal stigma among members of the community. However, there is a need to investigate methods for improving the effectiveness of these programs and to develop interventions that are effective in reducing perceived and internalized stigma. Copyright © 2014 World Psychiatric Association.
Cook, Jonathan E; Germano, Adriana L; Stadler, Gertraud
We conducted a preliminary investigation into dimensions of stigma and their relation to disease concealment in a sample of American adults living with multiple sclerosis (MS). Fifty-three adults with MS in the United States completed an online survey assessing anticipated, internalized, and isolation stigma, as well as concealment. Responses to all the scales were relatively low, on average, but above scale minimums (P stigma and concealment were highest. Anticipated stigma strongly predicted concealment. Many adults living with MS may be concerned that they will be the target of social stigma because of their illness. These concerns are associated with disease concealment. More research is needed to investigate how MS stigma and concealment may be independent contributors to health in patients with MS.
Hing, Nerilee; Russell, Alex M T
Background and aims Few studies have examined the stigma of problem gambling and little is known about those who internalize this prejudice as damaging self-stigma. This paper aimed to identify psychological factors, sociodemographic characteristics, and coping mechanisms associated with the self-stigma of problem gambling. Methods An online survey was conducted on 177 Australian adults with a current gambling problem to measure self-stigma, self-esteem, social anxiety, self-consciousness, psychological distress, symptom severity, most problematic gambling form, stigma coping mechanisms, and sociodemographic characteristics. Results All variables significantly correlated with self-stigma were considered for inclusion in a regression model. A multivariate linear regression indicated that higher levels of self-stigma were associated with: being female, being older, lower self-esteem, higher problem gambling severity score, and greater use of secrecy (standardized coefficients: 0.16, 0.14, -0.33, 0.23, and 0.15, respectively). Strongest predictors in the model were self-esteem, followed by symptom severity score. Together, predictors in the model accounted for 38.9% of the variance in self-stigma. Discussion and conclusions These results suggest that the self-stigma of problem gambling may be driven by similar mechanisms as the self-stigma of other mental health disorders, and impact similarly on self-esteem and coping. Thus, self-stigma reduction initiatives used for other mental health conditions may be effective for problem gambling. In contrast, however, the self-stigma of problem gambling increased with female gender and older age, which are associated with gaming machine problems. This group should, therefore, be a target population for efforts to reduce or better cope with the self-stigma of problem gambling.
Saka, Bayaki; Tchounga, Boris; Ekouevi, Didier K; Sehonou, Céphas; Sewu, Essèboè; Dokla, Augustin; Maboudou, Angèle; Kassankogno, Yao; Palokinam Pitche, Vincent
Stigma and discrimination experienced by people living with HIV (PLWHA) prevent and delay access to prevention and treatment services. The aim of this study was to describe the patterns of stigma and discrimination experienced by PLWHA in Togo and to identify the associated factors. A cross-sectional study was conducted in 2013 among PLWHA in Togo in order to collect data on stigma or discrimination experiences. Univariate and multivariate analyses were performed to identify associated factors. A total of 891 PLWHA were interviewed, including 848 (95.2%) receiving antiretroviral therapy. External stigma (37.9%) was the major form of stigmatization followed by internalized stigma (35.4%). The main features of external stigma were gossip (36.5%) and issues to access education (36.0%). Internalized stigma mainly consisted of a feeling of guilt (37.6%) and self-devaluation (36.0%). In univariate and multivariate analysis, female gender was significantly associated with stigma (aOR = 1.73, 95% CI [1.08-2.77]). Of the 891 PLWHA, 75 (8.4%) reported a violation of their rights. Finally 27 (4.1%) were discouraged from having children by a health professional because of their HIV status. Stigma affects more than one-third of PLWHA in Togo, more particularly females. It appears necessary to design new interventions and integrate psychosocial care in the management of PLWHA, in addition to antiretroviral therapy.
Pachankis, John E; Sullivan, Timothy J; Feinstein, Brian A; Newcomb, Michael E
This study investigated longitudinal trajectories of stigma (i.e., enacted, anticipated, internalized, concealed); stress-sensitive mental health disorder symptoms (i.e., depression, social anxiety); and their associations across 8 annual assessments in a sample of 128 young gay and bisexual U.S. university students. All forms of stigma significantly decreased over time, while depressive symptoms remained stable and social anxiety symptoms significantly increased. Men from higher socioeconomic backgrounds experienced quicker reductions in anticipated stigma, compared to men from lower socioeconomic backgrounds. More self-described feminine men experienced quicker reductions in concealment, compared to more self-described masculine men. Enacted stigma demonstrated contemporaneous associations with depression and social anxiety across 8 years; and anticipated stigma and internalized stigma demonstrated contemporaneous associations with social anxiety across 8 years. Enacted stigma was more strongly associated with depressive symptoms among men who reported greater masculinity compared to those who reported greater femininity. Findings are discussed in terms of common developmental influences across early sexual orientation identity formation, including gay and bisexual young men's resilience to stigma-based stress; the transition from college; and the rapidly changing social climate surrounding sexual minority individuals. Findings suggest the need for future longitudinal examinations of stigma and mental health among sexual minorities that utilize multiple age cohorts to determine the relative contribution of cohort-specific versus common maturational factors influencing the mental health of this population. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Sienko, Rachel M; Saules, Karen K; Carr, Meagan M
This study tested the potential mediating role of Internalized Weight Bias (IWB) in the relationship between depressive symptoms (DEP-SX) and disordered eating behavior. In particular, we hypothesized that IWB may be an intervening variable in the well documented association between depression and disordered eating. College women (N=172) who were taking undergraduate psychology courses and who endorsed thinking they were overweight completed the Patient Health Questionnaire depression screener (PHQ-9), the Weight Bias Internalization Scale (WBIS), and the Eating Disorder Examination Questionnaire (EDE-Q). Bootstrapping mediation analyses were conducted to explore the relationships between these variables. IWB was significantly correlated with eating disorder symptoms and DEP-SX, but not Body Mass Index. Mediation analyses supported a model in which IWB mediated the relationship between DEP-SX and disordered eating behavior. Results indicate that individuals with elevated DEP-SX may be likely to internalize weight bias, which may in turn lead to maladaptive approaches to eating and weight control, regardless of one's actual weight status. Copyright © 2016 Elsevier Ltd. All rights reserved.
Goldberg, Abbie E.; Smith, JuliAnna Z.
This is the first study to examine change in depression and anxiety across the first year of adoptive parenthood in same-sex couples (90 couples: 52 lesbian, 38 gay male). Given that sexual minorities uniquely contend with sexual orientation-related stigma, this study examined how both internalized and enacted forms of stigma affect the mental…
Dunaev, Jamie; Markey, Charlotte H; Brochu, Paula M
Internalized weight bias and body dissatisfaction are associated with a number of negative psychological and physical health outcomes. The current study examined the effectiveness of body-focused gratitude, through a short writing exercise, as a strategy to reduce internalized weight bias and improve body image. Young adults (M age = 22.71, SD = 2.08, 51.2% female) were randomly assigned to either a body gratitude condition (n = 185) or a control condition (n = 184). Results indicated that participants in the gratitude condition reported significantly lower weight bias internalization and significantly more favorable appearance evaluation and greater body satisfaction when compared to the control condition. These effects were in the small range (ds = 0.27-0.33), and neither gender nor BMI moderated these effects. These findings provide preliminary support for body-focused gratitude writing exercises as an effective individual-level strategy for both reducing internalized weight bias and improving body image. Copyright © 2018 Elsevier Ltd. All rights reserved.
World oldest authority for scientific constants and the keeper of the original metre standard, the International Bureau of Weights and Measures (BIPM) in Paris, France has accomplished a historic confirmation of the Omerbashich's (first-ever) scientific prediction of value of the Newtonian gravitational constant G.
Firmin, Ruth L; Lysaker, Paul H; McGrew, John H; Minor, Kyle S; Luther, Lauren; Salyers, Michelle P
Although associated with key recovery outcomes, stigma resistance remains under-studied largely due to limitations of existing measures. This study developed and validated a new measure of stigma resistance. Preliminary items, derived from qualitative interviews of people with lived experience, were pilot tested online with people self-reporting a mental illness diagnosis (n = 489). Best performing items were selected, and the refined measure was administered to an independent sample of people with mental illness at two state mental health consumer recovery conferences (n = 202). Confirmatory factor analyses (CFA) guided by theory were used to test item fit, correlations between the refined stigma resistance measure and theoretically relevant measures were examined for validity, and test-retest correlations of a subsample were examined for stability. CFA demonstrated strong fit for a 5-factor model. The final 20-item measure demonstrated good internal consistency for each of the 5 subscales, adequate test-retest reliability at 3 weeks, and strong construct validity (i.e., positive associations with quality of life, recovery, and self-efficacy, and negative associations with overall symptoms, defeatist beliefs, and self-stigma). The new measure offers a more reliable and nuanced assessment of stigma resistance. It may afford greater personalization of interventions targeting stigma resistance. Copyright © 2017 Elsevier B.V. All rights reserved.
Full Text Available Leprosy is a disease associated with a strong social stigma and fear. This is due to the disfigurations and crippling which it causes, resulting in socio-economic hardships for the victims. Also, misconceptions and erroneous beliefs about leprosy abound, even now, and in almost all the sections of the population. The human and social impact and the age - old prejudices against the disease add insult to injury. Even the law, and media have played a very damaging role for the leprosy patients by perpetuating the stigma of leprosy. The strategy for elimination of leprosy must specially stress on the psycho-social aspects of the disease and also the rehabilitation of the leprosy patient in the home, work place and society. There is absolutely no need to regard leprosy as ‘special’ and the well - being of leprosy patients should become an integral part of the general health services of the community.
Jiménez, Julio; Puig, Marieva; Sala, Ana Cecilia; Ramos, Juan Carlos; Castro, Eida; Morales, Marangelie; Santiago, Lydia; Zorrilla, Carmen
Though many studies have conclusively linked felt stigma and HIV, few have focused on the experiences of rejection felt by members of such socially marginalized groups as intravenous drug users (IDU) and sex workers (SW). Using focus groups, our study explored these experiences in 34 individuals (17 male UDUs and 17 female SWs) at risk of becoming infected with HIV, the objective being to discover why they engaged in maladaptive behaviors as a way of coping with felt stigma. We used deductive and inductive analysis to codify the resulting data. Concepts associated with the word stigma, emotional reactions to felt stigma, and the impact of felt stigma on self-schema helped elucidate how the internalization of felt stigma can lead to negative affective states and self-destructive behaviors (e.g., drug use and syringe exchange). Results underline the importance of developing intervention models that reduce stigma as a means of HIV prevention in vulnerable populations.
Parcesepe, Angela; Tymejczyk, Olga; Remien, Robert; Gadisa, Tsigereda; Kulkarni, Sarah Gorrell; Hoffman, Susie; Melaku, Zenebe; Elul, Batya; Nash, Denis
Recent World Health Organization HIV treatment guideline expansion may facilitate timely antiretroviral therapy (ART) initiation. However, large-scale success of universal treatment strategies requires a more comprehensive understanding of known barriers to early ART initiation. This work aims to advance a more comprehensive understanding of interrelationships among three known barriers to ART initiation: psychological distress, HIV-related stigma, and low social support. We analyzed cross-sectional interview data on 1175 adults initiating ART at six HIV treatment clinics in Ethiopia. Experience of each form of HIV-related stigma assessed (e.g., anticipatory, internalized, and enacted) was associated with increased odds of psychological distress. However, among those who reported enacted HIV-related stigma, there was no significant association between social support and psychological distress. Interventions to improve mental health among people living with HIV should consider incorporating components to address stigma, focusing on strategies to prevent or reduce the internalization of stigma, given the magnitude of the relationship between high internalized stigma and psychological distress. Interventions to increase social support may be insufficient to improve the mental health of people living with HIV who experienced enacted HIV-related stigma. Future research should examine alternative strategies to manage the mental health consequences of enacted HIV-related stigma, including coping skills training.
Full Text Available Objectives: Psychiatric stigma refers to systemic and internalized stereotypical negative attitudes against individual with mental illness. This article describes the level of self stigma, stereotype endorsement and perceived discrimination experienced by patients with Bipolar-I disorder in Tehran. Methods: Data were collected from a total of 126 patients with Bipolar-I disorder who responded to acute phase treatment using the Internalized Stigma of Mental Illness scale. The ISMI scale has five subscales: Alienation, Stereotype Endorsement, Perceived Discrimination, Social Withdrawal and Stigma Resistance. Results: In this study 26.7% of participants reported moderate to high levels of self stigma, 57.49% moderate to high levels of stigma resistance and 18.3% moderate to high levels of Perceived discrimination. Discussion: The results suggest that, self stigma appears in over one fifth of individuals with Bipolar-I disorder in Iran. The symptoms of Bipolar-I disorder has profound impacts on the quality of life of affected patients. Psychosocial functioning and self-esteem is impaired in people with Bipolar-I disorder. Interventions are required to reduce the negative effects of internalized stigma in this group.
Xu, Bowen; Zhang, Qingsong; An, Siqi; Pei, Baorui; Wu, Xiaobo
To establish the model of compression fracture of acetabular dome, and to measure the contact characteristics of acetabular weight-bearing area of acetabulum after 3 kinds of internal fixation. Sixteen fresh adult half pelvis specimens were randomly divided into 4 groups, 4 specimens each group. Group D was the complete acetabulum (control group), and the remaining 3 groups were prepared acetabular dome compression fracture model. The fractures were fixed with reconstruction plate in group A, antegrade raft screws in group B, and retrograde raft screws in group C. The pressure sensitive films were attached to the femoral head, and the axial compression test was carried out on the inverted single leg standing position. The weight-bearing area, average stress, and peak stress were measured in each group. Under the loading of 500 N, the acetabular weight-bearing area was significantly higher in group D than in other 3 groups ( P area were significantly higher in group B and group C than in group A, and the average stress and peak stress were significantly lower than in group A ( P 0.05). For the compression fracture of the acetabular dome, the contact characteristics of the weight-bearing area can not restore to the normal level, even if the anatomical reduction and rigid internal fixation were performed; compared with the reconstruction plate fixation, antegrade and retrograde raft screws fixations can increase the weight-bearing area, reduce the average stress and peak stress, and reduce the incidence of traumatic arthritis.
Fitzgerald-Husek, Alanna; Van Wert, Michael J.; Ewing, Whitney F.; Holland, Claire E.; Katterl, Rachel; Rosman, Lori; Baral, Stefan D.
Background Stigma involves discrediting a person or group based on a perceived attribute, behaviour or reputation associated with them. Sex workers (SW) and men who have sex with men (MSM) are key populations who are often at increased risk for the acquisition and transmission of HIV and who are affected by stigma that can negatively impact their health and well-being. Although stigma was included as an indicator in the US National HIV/AIDS Strategic Plan and there have been consultations focused on adding a stigma indicator within PEPFAR and the Global Fund in relation to potentiating HIV risks among key populations, there remains limited consensus on the appropriate measurement of SW- or MSM-associated stigma. Consequently, this systematic review summarizes studies using quantitative, qualitative, or mixed methods approaches to measure stigma affecting sex workers and men who have sex with men. Methods and findings This systematic review included English, French, and Spanish peer-reviewed research of any study design measuring SW- or MSM-associated stigma. Articles were published from January 1, 2004 to March 26, 2014 in PsycINFO, PubMed, EMBASE, CINAHL Plus, Global Health, and World Health Organization Global Health Library Regional Indexes. Of the 541 articles reviewed, the majority measured stigma toward MSM (over 97%), were conducted in North America, used quantitative methods, and focused on internalized stigma. Conclusions With the inclusion of addressing stigma in several domestic and international HIV strategies, there is a need to ensure the use of validated metrics for stigma. The field to date has completed limited measurement of stigma affecting sex workers, and limited measurement of stigma affecting MSM outside of higher income settings. Moving forward requires a concerted effort integrating validated metrics of stigma into health-related surveys and programs for key populations. PMID:29190642
Full Text Available Stigma involves discrediting a person or group based on a perceived attribute, behaviour or reputation associated with them. Sex workers (SW and men who have sex with men (MSM are key populations who are often at increased risk for the acquisition and transmission of HIV and who are affected by stigma that can negatively impact their health and well-being. Although stigma was included as an indicator in the US National HIV/AIDS Strategic Plan and there have been consultations focused on adding a stigma indicator within PEPFAR and the Global Fund in relation to potentiating HIV risks among key populations, there remains limited consensus on the appropriate measurement of SW- or MSM-associated stigma. Consequently, this systematic review summarizes studies using quantitative, qualitative, or mixed methods approaches to measure stigma affecting sex workers and men who have sex with men.This systematic review included English, French, and Spanish peer-reviewed research of any study design measuring SW- or MSM-associated stigma. Articles were published from January 1, 2004 to March 26, 2014 in PsycINFO, PubMed, EMBASE, CINAHL Plus, Global Health, and World Health Organization Global Health Library Regional Indexes. Of the 541 articles reviewed, the majority measured stigma toward MSM (over 97%, were conducted in North America, used quantitative methods, and focused on internalized stigma.With the inclusion of addressing stigma in several domestic and international HIV strategies, there is a need to ensure the use of validated metrics for stigma. The field to date has completed limited measurement of stigma affecting sex workers, and limited measurement of stigma affecting MSM outside of higher income settings. Moving forward requires a concerted effort integrating validated metrics of stigma into health-related surveys and programs for key populations.
Egbe, Catherine O; Brooke-Sumner, Carrie; Kathree, Tasneem; Selohilwe, One; Thornicroft, Graham; Petersen, Inge
Stigma and discrimination against people with mental illness remain barriers to help seeking and full recovery for people in need of mental health services. Yet there is scarce research investigating the experiences of psychiatric stigma on mental health service users in low- and middle-income countries (LMICs). The aim of this study was therefore to explore the experiences of psychiatric stigma by service users in order to inform interventions to reduce such stigma and discrimination in one LMIC, namely South Africa. Participants comprised a total of 77 adults aged above 18 years, made up of service providers including professional nurses (10), lay counsellors (20), auxiliary social workers (2); and service users (45). Psychiatric stigma was found to be perpetuated by family members, friends, employers, community members and health care providers. Causes of psychiatric stigma identified included misconceptions about mental illness often leading to delays in help-seeking. Experiencing psychiatric stigma was reported to worsen the health of service users and impede their capacity to lead and recover a normal life. Media campaigns and interventions to reduce stigma should be designed to address specific stigmatizing behaviours among specific segments of the population. Counselling of families, caregivers and service users should include how to deal with experienced and internalized stigma.
Werner, Perla; Aviv, Alex; Barak, Yoram
The relationship between self-stigma and self-esteem in patients with schizophrenia is receiving increased attention. However, studies to date have been limited to samples of persons under the age of 65. To examine the relationship between self-stigma and self-esteem in people with schizophrenia in both younger and older age groups. Face-to-face interviews were completed with 86 inpatients with schizophrenia in a psychiatric hospital (mean age = 54, 55% female). Self-esteem was assessed using Rosenberg's Self Esteem Scale. Self-stigma was assessed using an adapted version of the Internalized Stigma of Mental Health (ISMI) scale. Information regarding socio-demographic characteristics and psychiatric history and symptomatology was collected. Self-stigma was moderate with only 20-33% of the participants reporting high levels of stigmatization. Older participants reported lower levels of self-stigma than younger participants. A relatively strong association between self-stigma and self-esteem was found. The findings point to the complexity of the association between self-stigma, self-esteem and age in people with schizophrenia. This study stresses the importance of clinicians taking the issue of self-stigma into consideration when treating young and old patients with schizophrenia.
Loch, Alexandre A; Wang, Yuan-Pang; Guarniero, Francisco B; Lawson, Fabio L; Hengartner, Michael P; Rössler, Wulf; Gattaz, Wagner F
Our purpose was to assess stigma toward schizophrenia in a representative sample of the Brazilian general population. The sample consisted of 1015 individuals interviewed by telephone. A vignette describing someone with schizophrenia was read, and four stigma aspects regarding this hypothetical individual were assessed: stereotypes, restrictions, perceived prejudice and social distance. Latent profile analysis searched for stigma profiles among the sample. Multinomial logistic regression was used to find correlates of each class. Four stigma profiles were found; 'no stigma' individuals (n = 251) mostly displayed positive opinions. 'Labelers' (n = 222) scored high on social distance; they more often had familial contact with mental illness and more often labeled the vignette's disorder as schizophrenia. 'Discriminators', the group with the majority of individuals (n = 302), showed high levels of stigmatizing beliefs in all dimensions; discriminators were significantly older. 'Unobtrusive stigma' individuals (n = 240) seemed to demonstrate uncertainty or low commitment since they mostly answered items with the middle/impartial option. Some findings from the international literature were replicated; however, familial contact increased stigma, possibly denoting a locally modulated determinant. Hereby, our study also adds important cross-cultural data by showing that stigma toward schizophrenia is high in a Latin-American setting. We highlight the importance of analyzing the general population as a heterogeneous group, aiming to better elaborate anti-stigma campaigns. © The Author(s) 2013.
Full Text Available Background: From a medical model perspective of substance use disorders (SUDs, opioid use disorders are associated with some degree of disability. This study aimed to assess the disability among patients with opioid use disorders (OUDs and its relationship with internalized stigma. Methodology: This cross-sectional study assessed patients with SUDs at a tertiary care center. Disability among patients with OUDs was assessed using Indian Disability Evaluation and Assessment Scale (IDEAS while stigma was measured using Internalized Stigma of Mental Illness Scale (ISMIS. Results: Among 168 patients with OUD, the disability was greatest in the domain of work followed by interpersonal activities. About 48.2% and 3.0% of the participants had moderate and severe disability according to IDEAS. Disability (IDEAS scores had a robust correlation with the stigma (ISMIS scores (r = 0.453, P < 0.01. Multiple regression analysis found that internalized stigma (ISMIS score was an independent predictor of disability among patients with OUDs (β =0.42, P < 0.01. Conclusions: From a medical perspective, OUDs are associated with considerable disability which has significant correlation with internalized stigma. Designing interventions which can target internalized stigma among patients with OUD may help in reducing the disability associated with it.
Hall, Kelli Stidham; Manu, Abubakar; Morhe, Emmanuel; Harris, Lisa H.; Loll, Dana; Ela, Elizabeth; Kolenic, Giselle; Dozier, Jessica L.; Challa, Sneha; Zochowski, Melissa K.; Boakye, Andrew; Adanu, Richard; Dalton, Vanessa K.
Young women’s experiences with sexual and reproductive health (SRH) stigma may contribute to unintended pregnancy. Thus, stigma interventions and rigorous measures to assess their impact are needed. Based on formative work, we generated a pool of 51 items on perceived stigma around different dimensions of adolescent SRH and family planning (sex, contraception, pregnancy, child-bearing, abortion). We tested items in a survey study of 1,080 women ages 15 to 24 recruited from schools, health facilities, and universities in Ghana. Confirmatory factor analysis (CFA) identified the most conceptually and statistically relevant scale, and multivariable regression established construct validity via associations between stigma and contraceptive use. CFA provided strong support for our hypothesized Adolescent SRH Stigma Scale (chi-square p value stigma (six items), enacted stigma (seven items), and stigmatizing lay attitudes (seven items). The scale demonstrated good internal consistency (α = 0.74) and strong subscale correlations (α = 0.82 to 0.93). Higher SRH stigma scores were inversely associated with ever having used modern contraception (adjusted odds ratio [AOR] = 0.96, confidence interval [CI] = 0.94 to 0.99, p value = 0.006). A valid, reliable instrument for assessing SRH stigma and its impact on family planning, the Adolescent SRH Stigma Scale can inform and evaluate interventions to reduce/manage stigma and foster resilience among young women in Africa and beyond. PMID:28266874
Quick, V.; Nansel, T.; Liu, D.
for weight loss were assessed in the Health Behaviour in School-aged Children survey conducted in 24 countries cross-sectionally at three time points (2001/2002, 2005/2006 and 2009/2010). Logistic regression models examined change over time in overestimation of body size in non-overweight adolescents......-perceived overweight with increased odds of dieting diminished over time. CONCLUSIONS: Body size perceptions among adolescents may have changed over time concurrent with shifts in country-level body weight. However, controlling for country-level overweight prevalence did not impact trends in dieting for weight loss...
Hoffman, Susie; Tymejczyk, Olga; Kulkarni, Sarah; Lahuerta, Maria; Gadisa, Tsigereda; Remien, Robert H; Melaku, Zenebe; Nash, Denis; Elul, Batya
Stigma harms the mental health of HIV-positive individuals and reduces adherence to antiretroviral therapy (ART), but less is known about stigma and other outcomes across the HIV care continuum. Among 1180 Ethiopian adults initiating ART at 6 urban HIV clinics, we examined the relationship of internalized, anticipated, and enacted stigma to HIV care-related outcomes ascertained by interview (repeat HIV-positive testing, provider vs. self-referred testing, missed clinic visit before ART initiation, eagerness to begin ART), and by abstraction of routinely collected clinical data (late ART initiation, 3-month gap in care following ART initiation). Logistic regression was used to assess the association of each type of stigma with each outcome, adjusting for potential confounders. Scoring higher on each stigma domain was associated with 50%-90% higher odds of repeat HIV-positive testing. High internalized stigma was associated with higher odds of provider vs. self-referred test [adjusted odds ratio (aOR)high vs. low: 1.7; 95% confidence interval (CI): 1.3 to 2.2]. Higher anticipated stigma was associated with lower eagerness to begin ART (aORhigh vs. low: 0.55; 0.35-0.87; aORmedium vs. low: 0.45; 95% CI: 0.30 to 0.69). Any enacted stigma was associated with higher odds of a missed visit (aORany vs. none 1.8; 1.2-2.8). Stigma was not associated with late ART-initiation or with a subsequent gap in care. These findings provide further evidence of the importance of measuring and addressing stigma across the entire care continuum. Future work should test hypotheses about specific stigma domains and outcomes in prospective intervention or observational studies.
Hing, Nerilee; Russell, Alex M. T.
The degree to which anticipated and experienced public stigma contribute to self-stigma remains open to debate, and little research has been conducted into the self-stigma of problem gambling. This study aimed to examine which aspects of anticipated and experienced stigma (if any) predict the anticipated level of public stigma associated with problem gambling and the degree of self-stigma felt by people experiencing problem gambling. An online survey of 177 Australians experiencing problem ga...
Mushtaq Muhammad Umair
Full Text Available Abstract Background Child growth is internationally recognized as an important indicator of nutritional status and health in populations. This study was aimed to compare age- and gender-specific height, weight and BMI percentiles and nutritional status relative to the international growth references among Pakistani school-aged children. Methods A population-based study was conducted with a multistage cluster sample of 1860 children aged five to twelve years in Lahore, Pakistan. Smoothed height, weight and BMI percentile curves were obtained and comparison was made with the World Health Organization 2007 (WHO and United States' Centers for Disease Control and Prevention 2000 (USCDC references. Over- and under-nutrition were defined according to the WHO and USCDC references, and the International Obesity Task Force (IOTF cut-offs. Simple descriptive statistics were used and statistical significance was considered at P Results Height, weight and BMI percentiles increased with age among both boys and girls, and both had approximately the same height and a lower weight and BMI as compared to the WHO and USCDC references. Mean differences from zero for height-, weight- and BMI-for-age z score values relative to the WHO and USCDC references were significant (P Conclusion Pakistani school-aged children significantly differed from the WHO and USCDC references. However, z score means relative to the WHO reference were closer to zero and the present study as compared to the USCDC reference. Overweight and obesity were significantly higher while underweight and thinness/wasting were significantly lower relative to the WHO reference as compared to the USCDC reference and the IOTF cut-offs. New growth charts for Pakistani children based on a nationally representative sample should be developed. Nevertheless, shifting to use of the 2007 WHO child growth reference might have important implications for child health programs and primary care pediatric clinics.
Full Text Available Abstract This paper proposes that stigma in relation to people with mental illness can be understood as a combination of problems of knowledge (ignorance, attitudes (prejudice and behaviour (discrimination. From a literature review, a series of candidate interventions are identified which may be effective in reducing stigmatisation and discrimination at the following levels: individuals with mental illness and their family members; the workplace; and local, national and international. The strongest evidence for effective interventions at present is for (i direct social contact with people with mental illness at the individual level, and (ii social marketing at the population level.
Thornicroft, Graham; Brohan, Elaine; Kassam, Aliya; Lewis-Holmes, Elanor
This paper proposes that stigma in relation to people with mental illness can be understood as a combination of problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). From a literature review, a series of candidate interventions are identified which may be effective in reducing stigmatisation and discrimination at the following levels: individuals with mental illness and their family members; the workplace; and local, national and international. The strongest evidence for effective interventions at present is for (i) direct social contact with people with mental illness at the individual level, and (ii) social marketing at the population level.
Bachleda, Catherine L; El Menzhi, Leila
In light of the chronic shortage of health professionals willing to care for HIV/AIDS patients, and rising epidemics in many Muslim countries, this qualitative study examined susceptibility and resistance to courtesy stigma as experienced by nurses, doctors, and social workers in Morocco. Forty-nine in-depth interviews provided rich insights into the process of courtesy stigma and how it is managed, within the context of interactions with Islam, interactions within the workplace (patients, other health professionals), and interactions outside the workplace (the general public, friends, and family). Theoretically, the findings extend understanding of courtesy stigma and the dirty work literature. The findings also offer practical suggestions for the development of culturally appropriate strategies to reduce susceptibility to courtesy stigmatization. This study represents the first to explore courtesy stigma as a process experienced by health professionals providing HIV/AIDS care in an Islamic country.
Mak, Winnie W S; Ho, Connie Y Y; Wong, Venus U T; Law, Rita W; Chan, Randolph C H
Substance use is regarded as one of the most stigmatizing conditions worldwide. To achieve recovery, individuals with substance use problems must learn to cope with stigma. Despite the potential importance of cultural factors in the internalization process of stigma, few studies have incorporated culturally salient factors in understanding self-stigma. We responded to this gap in the literature by investigating a mechanism of self-stigma that focused on a cultural value salient to the Chinese-face concern. Specifically, we hypothesized that two types of face concern (mianzi concern and lian concern) would affect self-stigma and mental health through self-conscious moral emotions and rumination. A total of 199 Hong Kong Chinese adults with substance use problems completed standardized questionnaires. Test of the proposed model using structural equation modeling showed excellent fit to the data. The findings support the role of face concern in affecting self-stigma and mental health among Chinese with substance use problems. In particular, the findings showed significant indirect effects of lian concern on rumination, self-stigma, and mental health via moral emotions. The present study provides preliminary empirical support for the importance of cultural factors in the internalization process of stigma and the maintenance of mental health among individuals with substance use problems. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Hanschmidt, Franz; Linde, Katja; Hilbert, Anja; Riedel-Heller, Steffi G; Kersting, Anette
Although stigma has been identified as a potential risk factor for the well-being of women who have had abortions, little attention has been paid to the study of abortion-related stigma. A systematic search of the databases Medline, PsycArticles, PsycInfo, PubMed and Web of Science was conducted; the search terms were "(abortion OR pregnancy termination) AND stigma * ." Articles were eligible for inclusion if the main research question addressed experiences of individuals subjected to abortion stigma, public attitudes that stigmatize women who have had abortions or interventions aimed at managing abortion stigma. To provide a comprehensive overview of this issue, any study published by February 2015 was considered. The search was restricted to English- and German-language studies. Seven quantitative and seven qualitative studies were eligible for inclusion. All but two dated from 2009 or later; the earliest was from 1984. Studies were based mainly on U.S. samples; some included participants from Ghana, Great Britain, Mexico, Nigeria, Pakistan, Peru and Zambia. The majority of studies showed that women who have had abortions experience fear of social judgment, self-judgment and a need for secrecy. Secrecy was associated with increased psychological distress and social isolation. Some studies found stigmatizing attitudes in the public. Stigma appeared to be salient in abortion providers' lives. Evidence of interventions to reduce abortion stigma was scarce. Most studies had limitations regarding generalizability and validity. More research, using validated measures, is needed to enhance understanding of abortion stigma and thereby reduce its impact on affected individuals. Copyright © 2016 by the Guttmacher Institute.
Full Text Available Kristyna Vrbova,1 Jan Prasko,1 Michaela Holubova,1,2 Dana Kamaradova,1 Marie Ociskova,1 Marketa Marackova,1 Klara Latalova,1 Ales Grambal,1 Milos Slepecky,3 Marta Zatkova3 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc, 2Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic; 3Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, Slovak Republic Objective: The aim of this study was to investigate the degree of self-stigma in schizophrenia and its association with clinical and demographic factors. Patients and methods: A total of 197 outpatients (54.3% females diagnosed with schizophrenia spectrum disorders (schizophrenia, schizoaffective disorder, delusional disorder according to International Classification of Diseases – tenth edition participated in the study. The mean age of the patients was 40.10±11.49 years. All individuals completed the Internalized Stigma of Mental Illness (ISMI scale and a demographic questionnaire. The disorder severity was assessed by both a psychiatrist (the objective version of Clinical Global Impression – severity scale [objCGI-S] and the patients (the subjective version of Clinical Global Impression – severity scale [subjCGI-S]. Treatment with antipsychotics stabilized the patients. Results: The overall level of self-stigma measured by the total score of the ISMI was 63.32±13.59. The total score of the ISMI positively correlated with the severity of the disorder measured by the objCGI-S and subjCGI-S. In addition, self-stigma positively correlated with the treatment duration and the number of psychiatric hospitalizations. The backward stepwise regression was applied to identify the most significant factors connected to self-stigma. The regression analysis identified the following regressors as the most relevant to self-stigma: the number of
Williams, Janet K; Erwin, Cheryl; Juhl, Andrew R; Mengeling, Michelle; Bombard, Yvonne; Hayden, Michael R; Quaid, Kimberly; Shoulson, Ira; Taylor, Sandra; Paulsen, Jane S
Genetic discrimination may be experienced in the day-to-day lives of people at risk for Huntington disease (HD), encompassing occurrences in the workplace, when seeking insurance, within social relationships, and during other daily encounters. At-risk individuals who have tested either positive or negative for the genetic expansion that causes HD, as well as at-risk persons with a 50% chance for developing the disorder but have not had DNA testing completed the International RESPOND-HD (I-RESPOND-HD) survey. One of the study's purposes was to examine perceptions of genetic stigmatization and discrimination. A total of 412 out of 433 participants provided narrative comments, and 191 provided related codable narrative data. The core theme, Information Control, refers to organizational policies and interpersonal actions. This theme was found in narrative comments describing genetic discrimination perceptions across employment, insurance, social, and other situations. These reports were elaborated with five themes: What They Encountered, What They Felt, What Others Did, What They Did, and What Happened. Although many perceptions were coded as hurtful, this was not true in all instances. Findings document that reports of genetic discrimination are highly individual, and both policy as well as interpersonal factors contribute to the outcome of potentially discriminating events. (c) 2010 Wiley-Liss, Inc.
Goodin, Burel R; Owens, Michael A; White, Dyan M; Strath, Larissa J; Gonzalez, Cesar; Rainey, Rachael L; Okunbor, Jennifer I; Heath, Sonya L; Turan, Janet M; Merlin, Jessica S
"Intersectional health-related stigma" (IHRS) refers to stigma that arises at the convergence of multiple health conditions. People living with HIV (PLWH) and chronic pain have two highly stigmatized health conditions, and thus may be at especially high risk for internalizing these stigmas and consequently experiencing depression. This study examined the intersectionality of internalized HIV and chronic pain stigma in relation to depressive symptoms in a sample of PLWH and chronic pain. Sixty participants were recruited from an HIV clinic in the Southeastern United States. Chronic pain was defined as pain that has been present for at least three consecutive months, and that has been an ongoing problem for at least half the days in the past six months. All participants completed the HIV Stigma Mechanisms Scale, Internalized Stigma in Chronic Pain Scale, the Short-Form Brief Pain Inventory, and the Center for Epidemiological Studies - Depression Scale. Clinical data was collected from medical records. An intersectional HIV and chronic pain composite variable was created and participants were categorized as either high (28%), moderate (32%), or low (40%). Results revealed that intersectional HIV and chronic pain stigma was significantly associated with severity of depressive symptoms (p = .023). Pairwise contrasts revealed that participants with high (p = .009) and moderate (p = .033) intersectional stigma reported significantly greater mean depressive symptom severity than those with low intersectional stigma. Participants who reported the highest levels of internalized HIV and chronic pain stigma also reported the greatest severity of depressive symptoms. This suggests that the experience of both HIV and chronic pain stigma (i.e., IHRS) among PLWH and chronic pain may synergistically perpetuate negative mood in a more profound manner than experiencing either one stigma alone.
Levy, Boaz; Tsoy, Elena; Brodt, Madeline; Petrosyan, Karen; Malloy, Mary
Studies indicate that comorbid anxiety disorders predict a more severe course of illness in bipolar disorder (BD). The relatively high prevalence of social anxiety in BD points to the potential role that socio-cultural factors, such as stigma, play in exacerbating the progression of this disorder. Stigma creates social anxiety in affected individuals because it essentially forces them into a vulnerable social status that is marked by public disgrace. Although the etiology of debilitating social anxiety in BD may involve multiple factors, stigma deserves particular clinical attention because research in this area indicates that it is common and its internalization is associated with poor outcome. We conducted a literature review using search terms related to stigma, social anxiety, bipolar disorder, illness severity, and outcomes. The electronic databases searched included PsychINFO, PubMed, JSTOR, and EBSCOhost Academic Search Complete with limits set to include articles published in English. The literature indicates that internalized stigma often triggers the core psychological experiences of social anxiety and is highly correlated with clinical and functional outcome in BD. On a psychological level, internalized stigma and social anxiety can create distress that triggers symptoms of BD. From a biological perspective, stigma constitutes a chronic psychosocial stressor that may interact with the pathophysiology of BD in inflammatory ways. The connection between stigma and social anxiety, and their combined effects on people with BD, carries important implications for psychiatric care. To obtain an accurate clinical formulation, initial evaluations may seek to examine stigma-related experiences and determine their relationship to anxiety symptoms and psychosocial functioning. In addition, direct interventions for reducing the ill effects of stigma in BD deserve clinical attention, because they may carry the potential to enhance outcomes.
Abiri, Sadat; Oakley, Linda Denise; Hitchcock, Mary E; Hall, Amanda
The purpose of this integrative review is to synthesize primary evidence of the impact of internalized stigma on avoidance in adult community treatment patients living with SMI. A keyword database search of articles published through 2015 yielded 21 papers and a total of 4256 patients. Our analyses found that stigmatizing beliefs associated with avoidance are related to significant loss of self-esteem. Factors generally thought to reduce stigma internalized as self-stigmatizing beliefs, such as improved insight, increased self-awareness, and psycho-education to improve stigma coping skills, do not appear to improve self-esteem.
Yu, Chia-Hui; Chiu, Yi-Chi; Cheng, Su-Fen; Ko, Nai-Ying
HIV infection has been a manageable and chronic illness in Taiwan since the highly active antiretroviral therapy was introduced in 1997. HIV infection is a stigmatized disease due to its perceived association with risky behaviors. HIV often carries a negative image, and people living with HIV(PLWH) face discrimination on multiple fronts. Internalized HIV stigma impacts the spiritual health of people living with HIV in terms of increased levels of shame, self-blame, fear of disclosing HIV status, and isolation and decreased value and connections with God, others, the environment, and the self. Nursing professionals provide holistic care for all people living with HIV and value their lives in order to achieve the harmony of body, mind, and spirit. This article describes the stigma that is currently associated with HIV and how stigma-related discrimination affects the spiritual health of PLWH and then proposes how to reduce discrimination and stigma in order to improve the spiritual health of PLWH through appropriate spiritual care. Reducing HIV stigma and promoting spiritual well-being will enable Taiwan to achieve the 'Three Zeros' of zero discrimination, zero infection, and zero death advocated by the Joint United Nations Programme on HIV/AIDS for ending the AIDS epidemic in 2030.
Hall, Kelli Stidham; Morhe, Emmanuel; Manu, Abubakar; Harris, Lisa H; Ela, Elizabeth; Loll, Dana; Kolenic, Giselle; Dozier, Jessica L; Challa, Sneha; Zochowski, Melissa K; Boakye, Andrew; Adanu, Richard; Dalton, Vanessa K
Using our previously developed and tested Adolescent Sexual and Reproductive Health (SRH) Stigma Scale, we investigated factors associated with perceived SRH stigma among adolescent girls in Ghana. We drew upon data from our survey study of 1,063 females 15-24yrs recruited from community- and clinic-based sites in two Ghanaian cities. Our Adolescent SRH Stigma Scale comprised 20 items and 3 sub-scales (Internalized, Enacted, Lay Attitudes) to measure stigma occurring with sexual activity, contraceptive use, pregnancy, abortion and family planning service use. We assessed relationships between a comprehensive set of demographic, health and social factors and SRH Stigma with multi-level multivariable linear regression models. In unadjusted bivariate analyses, compared to their counterparts, SRH stigma scores were higher among girls who were younger, Accra residents, Muslim, still in/dropped out of secondary school, unemployed, reporting excellent/very good health, not in a relationship, not sexually experienced, never received family planning services, never used contraception, but had been pregnant (all p-values <0.05). In multivariable models, higher SRH stigma scores were associated with history of pregnancy (β = 1.53, CI = 0.51,2.56) and excellent/very good self-rated health (β = 0.89, CI = 0.20,1.58), while lower stigma scores were associated with older age (β = -0.17, 95%CI = -0.24,-0.09), higher educational attainment (β = -1.22, CI = -1.82,-0.63), and sexual intercourse experience (β = -1.32, CI = -2.10,-0.55). Findings provide insight into factors contributing to SRH stigma among this young Ghanaian female sample. Further research disentangling the complex interrelationships between SRH stigma, health, and social context is needed to guide multi-level interventions to address SRH stigma and its causes and consequences for adolescents worldwide.
McHenry, Megan Song; Nyandiko, Winstone M.; Scanlon, Michael L.; Fischer, Lydia J.; McAteer, Carole I.; Aluoch, Josephine; Naanyu, Violet; Vreeman, Rachel C.
Stigma shapes all aspects of HIV prevention and treatment, yet there are limited data on how HIV-infected youth and their families are affected by stigma in sub-Saharan Africa. The authors conducted a qualitative study using focus group discussions among 39 HIV-infected adolescents receiving care at HIV clinics in western Kenya and 53 caregivers of HIV-infected children. Participants felt that while knowledge and access to treatment were increasing, many community members still held negative and inaccurate views about HIV, including associating it with immorality and believing in transmission by casual interactions. Stigma was closely related to a loss of social and economic support but also included internalized negative feelings about oneself. Participants identified treatment-related impacts of stigma, including nonadherence, nondisclosure of status to child or others, and increased mental health problems. Qualitative inquiry also provided insights into how to measure and reduce stigma among affected individuals and families. PMID:27655835
McHenry, Megan Song; Nyandiko, Winstone M; Scanlon, Michael L; Fischer, Lydia J; McAteer, Carole I; Aluoch, Josephine; Naanyu, Violet; Vreeman, Rachel C
Stigma shapes all aspects of HIV prevention and treatment, yet there are limited data on how HIV-infected youth and their families are affected by stigma in sub-Saharan Africa. The authors conducted a qualitative study using focus group discussions among 39 HIV-infected adolescents receiving care at HIV clinics in western Kenya and 53 caregivers of HIV-infected children. Participants felt that while knowledge and access to treatment were increasing, many community members still held negative and inaccurate views about HIV, including associating it with immorality and believing in transmission by casual interactions. Stigma was closely related to a loss of social and economic support but also included internalized negative feelings about oneself. Participants identified treatment-related impacts of stigma, including nonadherence, nondisclosure of status to child or others, and increased mental health problems. Qualitative inquiry also provided insights into how to measure and reduce stigma among affected individuals and families.
Doyle, David Matthew; Molix, Lisa
To bolster knowledge of determinants of relationship functioning among sexual minorities, the current meta-analysis aimed to quantitatively review evidence for the association between social stigma and relationship functioning as well as examine potential moderators. Thirty-five studies were identified, including 130 effect sizes (39 independent; N = 10,745). Across studies, evidence was found for a small but significant inverse association between social stigma and relationship functioning. Furthermore, this association was moderated by stigma type (with more deleterious associations for internalized relative to perceived stigma) and dimension of relationship functioning (with more deleterious associations for affective relative to cognitive and negative relative to positive). Evidence for demographic moderators (region, sex, race, age) was generally mixed although important limitations related to unique characteristics of study samples are discussed. We conclude by highlighting the importance of social stigma for relationship functioning and point toward directions for future research and policy action. PMID:26199218
Doyle, David Matthew; Molix, Lisa
To bolster knowledge of determinants of relationship functioning among sexual minorities, the current meta-analysis aimed to quantitatively review evidence for the association between social stigma and relationship functioning as well as examine potential moderators. Thirty-five studies were identified, including 130 effect sizes (39 independent; N = 10,745). Across studies, evidence was found for a small but significant inverse association between social stigma and relationship functioning. Furthermore, this association was moderated by stigma type (with more deleterious associations for internalized relative to perceived stigma) and dimension of relationship functioning (with more deleterious associations for affective relative to cognitive and negative relative to positive). Evidence for demographic moderators (region, sex, race, age) was generally mixed although important limitations related to unique characteristics of study samples are discussed. We conclude by highlighting the importance of social stigma for relationship functioning and point toward directions for future research and policy action. © 2015 by the Society for Personality and Social Psychology, Inc.
Full Text Available Modern enterprise management strives to become effective and pragmatic, usually, KPI is the most essential key indicator for the enterprise examination department. However, because the supporting and bearing roles of KPI for different departments are different, no a rather scientific quantification for the weight between them is available, unbalanced examination weights between indicators and departments usually exists. Here, it is with balanced score card to breakdown enterprise’s key tasks, card the performance indicators supporting enterprise’s key tasks, and utilize AHP and QFD method to dynamically establish a standard for measuring each department’s indicators so as to provide a basis for enterprise’s scientific examination.
Nikus Fido N
Full Text Available Neno Nikus Fido, Mamusha Aman, Zewdie Brihnu Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia Background: HIV stigma has an important role in the spread of the AIDS epidemic. It profoundly affects the lives of individuals living with HIV/AIDS. Fear of being identified as having HIV may discourage a person from getting tested, accessing medical services, and obtaining medications. Thus, this study was aimed at assessing HIV-related stigma and associated factors among antiretroviral treatment (ART clients in Jimma town, Oromia region, Southwest Ethiopia. Methods: A facility-based cross-sectional study was conducted from March 11 to April 26, 2015, in ART clinics in Jimma town. Consecutively identified sample was obtained from ART clients who voluntarily participated in the survey after signing written consent. A structured interviewer-administered questionnaire was used to collect the data. Multiple linear regressions were conducted to assess the factors associated with various stigma domains. Results: Out of 349 clients requested, 318 (91.1% respondents voluntarily participated in the study; among them, 204 (64.2% respondents were females and the mean age of the respondents was 32.9 years. The mean score (and possible range of experienced HIV stigma was 41.5±12.6 (20.0–86.7, internalized stigma was 50.5±16.4 (20–96.5, and perceived stigma was 56.2±19.2 (20–100. Conclusion: The study revealed that duration of ART use and provider-initiated and forced HIV testing were significantly associated with the three HIV stigma domains. Despite the lower experienced HIV stigma, there were higher internalized and perceived stigmas. Therefore, HIV counseling services should be strengthened for new ART beginners, including pretest counseling. Keywords: HIV/AIDS, Jimma, stigma, ART clients, PLWHA
Werner, Perla; Mittelman, Mary S.; Goldstein, Dovrat; Heinik, Jeremia
Purpose: The stigma experienced by the family members of an individual with a stigmatized illness is defined by 3 dimensions: caregiver stigma, lay public stigma, and structural stigma. Research in the area of mental illness suggests that caregivers' perception of stigma is associated with increased burden. However, the effect of stigma on…
Hanschmidt, Franz; Lehnig, Franziska; Riedel-Heller, Steffi G.; Kersting, Anette
Background considerable proportion of the population experiences major life disruptions after losing a loved one to suicide. Social stigma attached to suicide survivors adds to complications occurring in the course of suicide bereavement. Despite its known risks, stigma related to suicide survivors has been sparsely investigated. Methods We conducted a systematic literature search in PubMed, Web of Science, PsycInfo and PsyArticles, of studies indexed up through August 2015. Articles were eligible for inclusion if they addressed experiences of stigma in suicide survivors, compared them to other bereavement populations, or investigated stigmatizing attitudes within the public. The search was restricted to English-language studies. Results 25 records matched inclusion criteria. Study designs were heterogeneous, making comparisons difficult. Results demonstrated that suicide survivors experience stigma in the form of shame, blame, and avoidance. Suicide survivors showed higher levels of stigma than natural death survivors. Stigma was linked to concealment of the death, social withdrawal, reduced psychological and somatic functioning, and grief difficulties. Only one study investigated stigmatizing attitudes towards suicide survivors among the general population. Limitations Internal and external validity of the studies was restricted by a lack of valid measures and selection bias. Conclusions More methodologically sound research is needed to understand the impact of stigma on suicide survivors’ grief trajectories and to separate it from other grief aspects. Clinicians and grief-counselors as well as the public should be educated about the persistent stigma experienced by suicide survivors. PMID:27657887
Kim, Ji-Beom; Yi, Young; Kim, Jae-Young; Cho, Jae-Ho; Kwon, Min-Soo; Choi, Seung-Hyuk; Lee, Woo-Chun
To assess the incidence of abnormal internal rotation of the talus in the axial plane in patients with varus ankle osteoarthritis, and to determine whether this incidence differs from the severity of varus ankle osteoarthritis (moderate versus severe). We retrospectively evaluated weight-bearing computed tomography (CT) and plain radiographs of 52 ankles with no abnormalities (control group) and 96 ankles with varus osteoarthritis (varus-OA group), which were further stratified into a moderate-OA subgroup (50 ankles) and a severe-OA subgroup (46 ankles). A new radiographic parameter on weight-bearing CT, the talus rotation ratio, was used to assess the rotation of the talus in the axial plane. The normal range of the talus rotation ratio was defined as the 95% prediction interval for talus rotation ratio values in the control group. Abnormal internal rotation of the talus was defined for talus rotation ratio values above the normal range. We determined the incidence of abnormal internal rotation of the talus in the varus-OA group, moderate-OA subgroup, and severe-OA subgroup. In the varus-OA group, the incidence of abnormal internal rotation of the talus was 45% (43 ankles), which corresponded to an incidence of 32% (16 ankles) in the moderate-OA subgroup and 59% (27 ankles) in the severe-OA subgroup (p = 0.013). Our study demonstrates that abnormal internal rotation of the talus occurs in patients with varus ankle osteoarthritis, and is more frequently noted in severe than in moderate varus ankle osteoarthritis.
Kim, Ji-Beom; Yi, Young; Lee, Woo-Chun [Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seochogu, Seoul (Korea, Republic of); Kim, Jae-Young; Kwon, Min-Soo; Choi, Seung-Hyuk [Inje University Seoul Paik Hospital, Department of Orthopaedic Surgery, Jung-gu, Seoul (Korea, Republic of); Cho, Jae-Ho [Hallym University, ChunCheon Sacred Heart Hospital, Department of Orthopaedic Surgery, Chuncheon, GangWon-do (Korea, Republic of)
To assess the incidence of abnormal internal rotation of the talus in the axial plane in patients with varus ankle osteoarthritis, and to determine whether this incidence differs from the severity of varus ankle osteoarthritis (moderate versus severe). We retrospectively evaluated weight-bearing computed tomography (CT) and plain radiographs of 52 ankles with no abnormalities (control group) and 96 ankles with varus osteoarthritis (varus-OA group), which were further stratified into a moderate-OA subgroup (50 ankles) and a severe-OA subgroup (46 ankles). A new radiographic parameter on weight-bearing CT, the talus rotation ratio, was used to assess the rotation of the talus in the axial plane. The normal range of the talus rotation ratio was defined as the 95% prediction interval for talus rotation ratio values in the control group. Abnormal internal rotation of the talus was defined for talus rotation ratio values above the normal range. We determined the incidence of abnormal internal rotation of the talus in the varus-OA group, moderate-OA subgroup, and severe-OA subgroup. In the varus-OA group, the incidence of abnormal internal rotation of the talus was 45% (43 ankles), which corresponded to an incidence of 32% (16 ankles) in the moderate-OA subgroup and 59% (27 ankles) in the severe-OA subgroup (p = 0.013). Our study demonstrates that abnormal internal rotation of the talus occurs in patients with varus ankle osteoarthritis, and is more frequently noted in severe than in moderate varus ankle osteoarthritis. (orig.)
Kim, Ji-Beom; Yi, Young; Lee, Woo-Chun; Kim, Jae-Young; Kwon, Min-Soo; Choi, Seung-Hyuk; Cho, Jae-Ho
To assess the incidence of abnormal internal rotation of the talus in the axial plane in patients with varus ankle osteoarthritis, and to determine whether this incidence differs from the severity of varus ankle osteoarthritis (moderate versus severe). We retrospectively evaluated weight-bearing computed tomography (CT) and plain radiographs of 52 ankles with no abnormalities (control group) and 96 ankles with varus osteoarthritis (varus-OA group), which were further stratified into a moderate-OA subgroup (50 ankles) and a severe-OA subgroup (46 ankles). A new radiographic parameter on weight-bearing CT, the talus rotation ratio, was used to assess the rotation of the talus in the axial plane. The normal range of the talus rotation ratio was defined as the 95% prediction interval for talus rotation ratio values in the control group. Abnormal internal rotation of the talus was defined for talus rotation ratio values above the normal range. We determined the incidence of abnormal internal rotation of the talus in the varus-OA group, moderate-OA subgroup, and severe-OA subgroup. In the varus-OA group, the incidence of abnormal internal rotation of the talus was 45% (43 ankles), which corresponded to an incidence of 32% (16 ankles) in the moderate-OA subgroup and 59% (27 ankles) in the severe-OA subgroup (p = 0.013). Our study demonstrates that abnormal internal rotation of the talus occurs in patients with varus ankle osteoarthritis, and is more frequently noted in severe than in moderate varus ankle osteoarthritis. (orig.)
Kozuki, Naoko; Katz, Joanne; Christian, Parul
) status. OBJECTIVES: To compare the birth weight distributions of the INTERGROWTH-21st international standard to commonly used US references and examine the differences in the prevalence and neonatal mortality risk of SGA status (below the 10th percentile of a population reference). DESIGN, SETTING...... variance. MAIN OUTCOMES AND MEASURES: We examine neonatal mortality (death within the first 28 days after birth) as the main outcome measure. RESULTS: The pooled SGA prevalence was 23.7% (95% CI, 16.5%-31.0%) using the INTERGROWTH-21st standard compared with 36.0% (95% CI, 27.0%-45.0%) with the US 2000...... and no significant change in the associated neonatal mortality risk, resulting in a decrease in the percentage of neonatal death attributable to SGA. Our study sheds light on how previously published studies on SGA status may be reinterpreted with the introduction of this new birth weight standard....
Using a sample of university students (N = 362), the role of gender and both the self-stigma and public stigma associated with one's decision to seek psychological help in predicting attitudes toward psychological helpseeking were examined. Moreover, gender differences regarding both the self-stigma and the public stigma associated with…
Using the concept generagency and stigma, the article identifies problem gaming as a part of the generational conflict......Using the concept generagency and stigma, the article identifies problem gaming as a part of the generational conflict...
The task of the BIPM is to ensure world-wide unification of physical measurements; its function is thus to: establish fundamental standards and scales for the measurement of the principal physical quantities and maintain the international standards; carry out comparisons of national and international standards; ensure the coordination of corresponding measurement techniques; carry out and coordinate measurements of the fundamental physical constants relevant to these activities. The BIPM operates under the exclusive supervision of the Comite International des Poids et Mesures (CIPM) which itself comes under the authority of the Conference Generale des Poids et Mesures (CGPM) and reports to it on the work accomplished by the BIPM. Delegates from all Member States of the Metre Convention attend the General Conference which, at present, meets every four years. The function of these meetings is to: discuss and initiate the arrangements required to ensure the propagation and improvement of the International System of Units (SI), which is the modern form of the metric system; confirm the results of new fundamental metrological determinations and various scientific resolutions of international scope; take all major decisions concerning the finance, organization and development of the BIPM. The CIPM has eighteen members each from a different State: at present, it meets every year. The officers of this committee present an annual report on the administrative and financial position of the BIPM to the Governments of the Member States of the Metre Convention. The principal task of the CIPM is to ensure world-wide uniformity in units of measurement. It does this by direct action or by submitting proposals to the CGPM. The activities of the BIPM, which in the beginning were limited to measurements of length and mass, and to metrological studies in relation to these quantities, have been extended to standards of measurement of electricity (1927), photometry and radiometry (1937
By the 1990s, sociology faced a frustrating paradox. Classic work on mental illness stigma and labeling theory reinforced that the “mark” of mental illness created prejudice and discrimination for individuals and family members. Yet that foundation, coupled with deinstitutionalization of mental health care, produced contradictory responses. Claims that stigma was dissipating were made, while others argued that intervention efforts were needed to reduce stigma. While signaling the critical role of theory-based research in establishing the pervasive effects of stigma, both claims directed resources away from social science research. Yet the contemporary scientific foundation underlying both claims was weak. A reply came in a resurgence of research directed toward mental illness stigma nationally and internationally, bringing together researchers from different disciplines for the first time. The author reports on the general population’s attitudes, beliefs, and behavioral dispositions that targeted public stigma and implications for the next decade of research and intervention efforts. PMID:23325423
Sharp, Marie-Louise; Fear, Nicola T; Rona, Roberto J; Wessely, Simon; Greenberg, Neil; Jones, Norman; Goodwin, Laura
Approximately 60% of military personnel who experience mental health problems do not seek help, yet many of them could benefit from professional treatment. Across military studies, one of the most frequently reported barriers to help-seeking for mental health problems is concerns about stigma. It is, however, less clear how stigma influences mental health service utilization. This review will synthesize existing research on stigma, focusing on those in the military with mental health problems. We conducted a systematic review and meta-analysis of studies between 2001 and 2014 to examine the prevalence of stigma for seeking help for a mental health problem and its association with help-seeking intentions/mental health service utilization. Twenty papers met the search criteria. Weighted prevalence estimates for the 2 most endorsed stigma concerns were 44.2% (95% confidence interval: 37.1, 51.4) for "My unit leadership might treat me differently" and 42.9% (95% confidence interval: 36.8, 49.0) for "I would be seen as weak." Nine studies found no association between anticipated stigma and help-seeking intentions/mental health service use and 4 studies found a positive association. One study found a negative association between self-stigma and intentions to seek help. Counterintuitively, those that endorsed high anticipated stigma still utilized mental health services or were interested in seeking help. We propose that these findings may be related to intention-behavior gaps or methodological issues in the measurement of stigma. Positive associations may be influenced by modified labeling theory. Additionally, other factors such as self-stigma and negative attitudes toward mental health care may be worth further attention in future investigation. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Emlet, Charles A; Brennan, David J; Brennenstuhl, Sarah; Rueda, Sergio; Hart, Trevor A; Rourke, Sean B
The purpose of this study was to examine the independent influence of age on levels of HIV-related stigma experienced by adults living with HIV/AIDS. To accomplish this, cross-sectional data from the Ontario HIV Treatment Network Cohort Study were used to determine whether older age is associated with overall stigma among HIV-positive adults living in Ontario, Canada (n = 960). The relationship was also tested for enacted, anticipated, and internalized stigma. Covariates included sociodemographic (e.g., gender, sexual orientation, race) and psychosocial variables (e.g., depression). Modifying effects of covariates were also investigated. Those 55 and older have significantly lower overall and internalized stigma than adults under age 40, even when accounting for gender, sexual orientation, income, time since diagnosis, depression, maladaptive coping, and social support. Age does not predict enacted or Anticipated Stigma when accounting for the demographic and psychosocial variables. A significant interaction between depression and age suggests that stigma declines with age among those who are depressed but increases to age 50 and then decreases in older age groups among those who are not depressed. Age matters when it comes to understanding stigma among adults living with HIV/AIDS; however, the relationship between age and stigma is complex, varying according to stigma type and depression level.
Colton, Matthew; And Others
Investigated the stigma attached to child welfare services in the Netherlands, United Kingdom, and Spain. Found that stigma continues to be part of the experience of using and delivering such services, despite positive determination of policies in all three countries that this should not be so. Also found that the experience of stigma can, with…
Patrinos, Harry Anthony; Shafiq, M. Najeeb
We introduce a simple empirical model that assumes a positive stigma (or norm) towards child labor that is common in some developing countries. We then illustrate our positive stigma model using data from Guatemala. Controlling for several child- and household-level characteristics, we use two instruments for measuring stigma: a child's indigenous…
Patrinos, Harry Anthony; Shafiq, M. Najeeb
The authors introduce a simple empirical model that assumes a positive stigma (or norm) toward child labor that is common in some developing countries. They illustrate the positive stigma model using data from Guatemala. Controlling for several child and household-level characteristics, the analysis uses two instruments for measuring stigma: a child's indigenous background and the househol...
Mburu, Gitau; Ram, Mala; Skovdal, Morten
Global scale up of antiretroviral therapy is changing the context of HIV-related stigma. However, stigma remains an ongoing concern in many countries. Groups of people living with HIV can contribute to the reduction of stigma. However, the pathways through which they do so are not well understood....
Larson, Jon E.; Corrigan, Patrick
Objective: This article describes family stigma, which is defined as the prejudice and discrimination experienced by individuals through associations with their relatives. Methods: The authors describe family stigma and present current research related to mental illness stigma experienced by family members. Research indicates this type of stigma…
Reeder, Glenn D.; Pryor, John B.
People with serious illness or disability are often burdened with social stigma that promotes a cycle of poverty via unemployment, inadequate housing and threats to mental health. Stigma may be conceptualized in terms of self-stigma (e.g., shame and lowered self-esteem) or public stigma (e.g., the general public's prejudice towards the stigmatized). This article examines two psychological processes that underlie public stigma: associative processes and rule-based processes. Associative proces...
Evans-Lacko, S; Brohan, E; Mojtabai, R; Thornicroft, G
Little is known about how the views of the public are related to self-stigma among people with mental health problems. Despite increasing activity aimed at reducing mental illness stigma, there is little evidence to guide and inform specific anti-stigma campaign development and messages to be used in mass campaigns. A better understanding of the association between public knowledge, attitudes and behaviours and the internalization of stigma among people with mental health problems is needed. This study links two large, international datasets to explore the association between public stigma in 14 European countries (Eurobarometer survey) and individual reports of self-stigma, perceived discrimination and empowerment among persons with mental illness (n=1835) residing in those countries [the Global Alliance of Mental Illness Advocacy Networks (GAMIAN) study]. Individuals with mental illness living in countries with less stigmatizing attitudes, higher rates of help-seeking and treatment utilization and better perceived access to information had lower rates of self-stigma and perceived discrimination and those living in countries where the public felt more comfortable talking to people with mental illness had less self-stigma and felt more empowered. Targeting the general public through mass anti-stigma interventions may lead to a virtuous cycle by disrupting the negative feedback engendered by public stigma, thereby reducing self-stigma among people with mental health problems. A combined approach involving knowledge, attitudes and behaviour is needed; mass interventions that facilitate disclosure and positive social contact may be the most effective. Improving availability of information about mental health issues and facilitating access to care and help-seeking also show promise with regard to stigma.
Wade, Tracey D; Wilksch, Simon M; Paxton, Susan J; Byrne, Susan M; Austin, S Bryn
The current study examined whether media internalization, found to mediate the relationship between selected prevention programs and outcomes, mediated the impact of two universal prevention programs that targeted risk factors for eating disorders and obesity, namely weight concern, and shape concern. Students randomized to a media literacy (Media Smart) program (N = 269, 65% females, mean age 12.97 years) and a healthy lifestyle (Life Smart) program (N = 347, 69% females, mean age 13.07 years) were included in the analyses. There were four waves of data (baseline, end of intervention, 6- and 12-month follow-up). Latent growth curve modeling was used to explore whether group assignment influenced levels of media internalization, and whether that in turn influenced change over time of our two outcome variables. Being randomly allocated to Media Smart as opposed to Life Smart resulted in less growth of both outcome variables through the influence on decreasing levels of media internalization. Findings provided support for the suggestion that media literacy programs exert an impact on outcomes related to eating disorder risk through changes to media internalization. Future research should examine whether these mechanisms of change differ between girls and boys. © 2017 Wiley Periodicals, Inc.
Rafacz, Jennifer D.
It has been proposed that the most effective way to combat mental illness stigma is to focus on power groups who have a direct impact on the lives of persons with serious mental illness. With the increase of violence and need for mental health services on college campuses, campus police officers are seen as an important power group for persons…
Full Text Available Objective: Self-stigma in overweight and obese individuals has strong associations with impairment in mental and global health. This study sought to explore self-compassion as a psychological resource in the self-stigma process. Methods: In a 2012 representative German population survey of N = 1,158 overweight and obese individuals, self-compassion was examined as a mediator between self-stigma and mental and physical health outcomes, including BMI (kg/m2, using structural equation modeling and controlling for sociodemographic factors. Results: Psychological variables were assessed using validated self-report questionnaires. Self-compassion partially mediated the relationships between self-stigma and depression, somatic symptoms, and health status / quality of life, lowering the predictive effect of self-stigma on the outcomes by approximately one-third. In contrast, self-compassion, because it was unrelated to BMI, did not mediate the association between self-stigma and BMI. Conclusion: Self-compassion has the potential to act as a buffer against the mental and global health detriments of self-stigma in overweight and obesity and could thus represent a target for interventions to reduce self-stigma and prevent these health impairments. In order to influence the association between self-stigma and BMI, self-compassion should conceptually be linked to weight management.
Full Text Available Controller tuning is the process of adjusting the parameters of the selected controller to achieve optimum response for the controlled process. For many of the control problems, a satisfactory performance is obtained by using PID controllers. One of the main problems with mathematical models of physical systems is that the parameters used in the models cannot be determined with absolute accuracy. The values of the parameters may change with time or various effects. In these cases, conventional controller tuning methods suffer when trying a lot to produce optimum response. In order to overcome these difficulties a fuzzy logic based Set- Point weighting controller tuning method is proposed. The effectiveness of the proposed scheme is analyzed through computer simulation using SIMULINK software and the results are presented. The fuzzy logic based simulation results are compared with Cohen-Coon (CC, Ziegler- Nichols (ZN, Ziegler – Nichols with Set- Point weighting (ZN-SPW, Internal Model Control (IMC and Internal model based PID controller responses (IMC-PID. The effects of process modeling errors and the importance of controller tuning have been brought out using the proposed control scheme.
Full Text Available Tannic acid (TA is a polyphenolic compound with a health-promoting potential for humans. It is hypothesised that TA effects on the relative weight of internal organs and biochemical blood indices are modified by dietary protein level in rats. The study involved 72 rats divided into 12 groups fed diets with 10 or 18% of crude protein (CP and supplemented with 0, 0.25, 0.5, 1, 1.5 or 2% of TA. After 3 weeks of feeding, the relative weight of the caecum was greater in rats fed TA diets, while feeding diets with 10% of CP increased the relative weight of the stomach, small intestine and caecum, but decreased that of kidneys and spleen. Albumin concentration was higher in rats fed 0.25% and 0.5% TA diets than in rats given the 2% TA diets. The 2% TA diets reduced creatine kinase (CK activity compared to non-supplemented diets and those with 0.5, 1 and 1.5% of TA. Rats fed the 10% CP diets had a higher activity of alkaline phosphatase, amylase, and γ-glutamyltransferase as well as the concentration of iron and cholesterol, but lower that of urea and uric acid. The interaction affected only cholinesterase activity. In conclusion, TA induced caecal hypertrophy and could act as a cardioprotective agent, as demonstrated by reduced CK activity, but these effects were not modified by dietary protein level.
Full Text Available Marie Ociskova,1,2 Jan Prasko,1 Dana Kamaradova,1 Ales Grambal,1 Zuzana Sigmundova1 1Department of Psychiatry, University Hospital in Olomouc, Faculty of Medicine and Dentistry, 2Department of Psychology, Faculty of Arts, Palacky University in Olomouc, Olomouc, Czech Republic Background: A number of psychiatric patients experience stigma connected to prejudices about mental disorders. It has been shown that stigma is most harmful when it is internalized. Most of the studies were performed on individuals either with psychoses or with mood disorders, and hence, there are almost no studies with other diagnostic categories. The goals of this research were to identify factors that are significantly related to self-stigma in patients with anxiety disorders and to suggest possible models of causality for these relationships.Methods: A total of 109 patients with anxiety disorders and possible comorbid depressive or personality disorders, who were admitted to the psychotherapeutic department participated in this study. All patients completed several psychodiagnostic methods, ie, the Internalized Stigma of Mental Illness Scale, Temperament and Character Inventory-Revised Version, Adult Dispositional Hope Scale, Dissociative Experiences Scale, Beck Anxiety Inventory, Beck Depression Inventory-Second Edition, and Clinical Global Impression (also completed by the senior psychiatrist.Results: The overall level of self-stigma was positively associated with a comorbid personality disorder, more severe symptomatology, more intense symptoms of anxiety and depression, and higher levels of dissociation and harm avoidance. Self-stigma was negatively related to hope, reward dependence, persistence, self-directedness, and cooperativeness. Multiple regression analysis showed that the most significant factors connected to self-stigma are harm avoidance, the intensity of depressive symptoms, and self-directedness. Two models of causality were proposed and validated. It
Oexle, N; Waldmann, T; Staiger, T; Xu, Z; Rüsch, N
Suicide rates are increased among unemployed individuals and mental illness stigma can contribute to both unemployment and suicidality. Persons with mental illness perceive negative attitudes among the general public and experience discrimination in their everyday life (=public stigma components) potentially leading to self-stigma and anticipated discrimination (=individual stigma components). Previous research found evidence for an association between aspects of mental illness stigma and suicidality, but has not yet clarified the underlying pathways explaining how different stigma components interact and contribute to suicidal ideation. Public and individual stigma components and their association with suicidal ideation were examined among 227 unemployed persons with mental illness. A path model linking public stigma components (experienced discrimination, perceived stigma) with suicidal ideation, mediated by individual stigma components (anticipated discrimination, self-stigma), was examined using structural equation modelling within Mplus. Our sample was equally split in terms of gender, on average 43 years old and about half reported no suicidal ideation during the past 30 days. In bivariate analyses all stigma components were significantly associated with suicidal ideation. In the path model and controlling for symptoms, the association between experienced discrimination and suicidal ideation was fully mediated by anticipated discrimination and self-stigma. Perceived stigma's contribution to suicidal ideation was fully mediated by anticipated discrimination, but not by self-stigma. In general, programmes addressing multiple stigma components seem to be most effective in improving suicide prevention. Besides interventions targeting negative attitudes and discriminating behaviours of the general public, programmes to support persons with mental illness in coping with perceived and experienced stigma could improve suicide prevention. Future studies should test
Throop, Elizabeth M; Skinner, Asheley Cockrell; Perrin, Andrew J; Steiner, Michael J; Odulana, Adebowale; Perrin, Eliana M
To determine the prevalence of obesity-related behaviors and attitudes in children's movies. A mixed-methods study of the top-grossing G- and PG-rated movies, 2006-2010 (4 per year) was performed. For each 10-min movie segment, the following were assessed: 1) prevalence of key nutrition and physical activity behaviors corresponding to the American Academy of Pediatrics obesity prevention recommendations for families; 2) prevalence of weight stigma; 3) assessment as healthy, unhealthy, or neutral; 3) free-text interpretations of stigma. Agreement between coders was >85% (Cohen's kappa = 0.7), good for binary responses. Segments with food depicted: exaggerated portion size (26%); unhealthy snacks (51%); sugar-sweetened beverages (19%). Screen time was also prevalent (40% of movies showed television; 35% computer; 20% video games). Unhealthy segments outnumbered healthy segments 2:1. Most (70%) of the movies included weight-related stigmatizing content (e.g., "That fat butt! Flabby arms! And this ridiculous belly!"). These popular children's movies had significant "obesogenic" content, and most contained weight-based stigma. They present a mixed message to children, promoting unhealthy behaviors while stigmatizing the behaviors' possible effects. Further research is needed to determine the effects of such messages on children. Copyright © 2013 The Obesity Society.
Wang, Shirley B; Lydecker, Janet A; Grilo, Carlos M
Overvaluation of shape and weight in binge-eating disorder (BED) is associated with greater eating-disorder psychopathology and greater weight-bias internalization, which are-in turn-associated with poorer mental and physical health. Little is known, however, about the significance of other cognitive processes, such as rumination, in BED. This study examined rumination and overvaluation of shape/weight with eating-disorder psychopathology and weight-bias internalization among 237 treatment-seeking patients with BED and comorbid obesity. Hierarchical multiple regressions indicated that rumination was associated with eating-disorder psychopathology and weight-bias internalization above and beyond the influence of overvaluation of shape/weight. Findings suggest that, among patients with BED/obesity, rumination is an important cognitive process associated with severity of eating-disorder psychopathology even after accounting for overvaluation of shape/weight. Patients with greater rumination might be more likely to dwell on weight-based discrimination experiences and internalize these negative attitudes. Additional controlled examination could determine whether rumination represents another potential target for BED/obesity treatment. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
Lewis, Sophie; Thomas, Samantha L; Blood, R Warwick; Castle, David J; Hyde, Jim; Komesaroff, Paul A
Obesity stigma exists within many institutions and cultural settings. Most studies suggest that stigmatising experiences have a negative impact on individuals' health and social behaviours and outcomes. However, some studies indicate that obesity stigma can motivate individuals to lose weight. Limited research has examined weight-based stigma from the perspective of obese individuals, including their perceptions of, and responses to, the different types of weight-based stigma they face in their daily lives. This study advances knowledge about weight-based stigma by documenting how obese adults (mostly female) described the different types of obesity stigma that they faced, how they responded to this stigma, and how different types of stigma impact on health and social wellbeing. Semi-structured, qualitative interviews were conducted between April 2008 and March 2009 with a diverse sample of 141 obese Australian adults. Guided by Link and Phelan's (2006) categorisation of different types of discrimination, participants' experiences could be grouped into three distinct types of stigma: 1) Direct (e.g. being abused when using public transport); 2) Environmental (e.g. not being able to fit into seats on planes); and 3) Indirect (e.g. people staring at the contents of their supermarket trolley). Participants described that more subtle forms of stigma had the most impact on their health and social wellbeing. However, it was the interaction between direct, environmental and indirect stigma that created a barrier to participation in health-promoting activities. Participants rarely challenged stigma and often blamed themselves for stigmatising experiences. They also avoided situations where they perceived they would be stigmatised and constantly thought about how they could find a solution to their obesity. Copyright © 2011 Elsevier Ltd. All rights reserved.
Kidd, Sean A.
Building upon previous exploratory qualitative research (Kidd S.A. (2003) "Child Adol. Social Work J." 20(4):235-261), this paper examines the mental health implications of social stigma as it is experienced by homeless youth. Surveys conducted with 208 youths on the streets and in agencies in New York City and Toronto revealed…
Wallhagen, Margaret I.
Purpose: To explore dimensions of stigma experienced by older adults with hearing loss and those with whom they frequently communicate to target interventions promoting engagement and positive aging. Design and Methods: This longitudinal qualitative study conducted interviews over 1 year with dyads where one partner had hearing loss. Participants…
Tsai, Alexander C; Hatcher, Abigail M; Bukusi, Elizabeth A; Weke, Elly; Lemus Hufstedler, Lee; Dworkin, Shari L; Kodish, Stephen; Cohen, Craig R; Weiser, Sheri D
The scale-up of effective treatment has partially reduced the stigma attached to HIV, but HIV still remains highly stigmatized throughout sub-Saharan Africa. Most studies of anti-HIV stigma interventions have employed psycho-educational strategies such as information provision, counseling, and testimonials, but these have had varying degrees of success. Theory suggests that livelihood interventions could potentially reduce stigma by weakening the instrumental and symbolic associations between HIV and premature morbidity, economic incapacity, and death, but this hypothesis has not been directly examined. We conducted a longitudinal qualitative study among 54 persons with HIV participating in a 12-month randomized controlled trial of a livelihood intervention in rural Kenya. Our study design permitted assessment of changes over time in the perspectives of treatment-arm participants (N = 45), as well as an understanding of the experiences of control arm participants (N = 9, interviewed only at follow-up). Initially, participants felt ashamed of their seropositivity and were socially isolated (internalized stigma). They also described how others in the community discriminated against them, labeled them as being "already dead," and deemed them useless and unworthy of social investment (perceived and enacted stigma). At follow-up, participants in the treatment arm described less stigma and voiced positive changes in confidence and self-esteem. Concurrently, they observed that other community members perceived them as active, economically productive, and contributing citizens. None of these changes were noted by participants in the control arm, who described ongoing and continued stigma. In summary, our findings suggest a theory of stigma reduction: livelihood interventions may reduce internalized stigma among persons with HIV and also, by targeting core drivers of negative attitudes toward persons with HIV, positively change attitudes toward persons with HIV held by
Huggett, Charlotte; Birtel, Michèle D; Awenat, Yvonne F; Fleming, Paul; Wilkes, Sophie; Williams, Shirley; Haddock, Gillian
Prior research has examined various components involved in the impact of public and internalized stigma on people with mental health problems. However, studies have not previously investigated the subjective experiences of mental health stigma by those affected in a non-statutory treatment-seeking population. An in-depth qualitative study was conducted using thematic analysis to investigate the experiences of stigma in people with mental health problems. Eligible participants were recruited through a local mental health charity in the North West of England. The topic of stigma was examined using two focus groups of thirteen people with experience of mental health problems and stigma. Two main themes and five subthemes were identified. Participants believed that (1) the 'hierarchy of labels' has a profound cyclical impact on several levels of society: people who experience mental health problems, their friends and family, and institutional stigma. Furthermore, participants suggested (2) ways in which they have developed psychological resilience towards mental health stigma. It is essential to utilize the views and experiences gained in this study to aid understanding and, therefore, develop ways to reduce the negative impact of public and internal stigma. People referred to their mental health diagnosis as a label and associated that label with stigmatizing views. Promote awareness and develop improved strategies (e.g., training) to tackle the cyclical impact of the 'hierarchy of labels' on people with mental health problems, their friends and family, and institutional stigma. Ensure the implementation of clinical guidelines in providing peer support to help people to combat feeling stigmatized. Talking about mental health in psychological therapy or health care professional training helped people to take control and develop psychological resilience. © 2018 The British Psychological Society.
White Hughto, Jaclyn M; Reisner, Sari L; Pachankis, John E
Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma. This critical review aims to integrate the literature on stigma towards transgender people in the U.S. This review demonstrates that transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of transgender people. The applied social ecological model employed here elucidates that transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in transgender populations. Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US transgender populations. Multi-level interventions to prevent stigma towards transgender people are warranted. Copyright © 2015 Elsevier Ltd. All rights reserved.
White Hughto, Jaclyn M.; Reisner, Sari L.; Pachankis, John E.
Rationale Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma. Objective This critical review aims to integrate the literature on stigma towards transgender people in the US. Results This review demonstrates that transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of transgender people. The applied social ecological model employed here elucidates that transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in transgender populations. Conclusion Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US transgender populations. Multi-level interventions to prevent stigma towards transgender people are warranted. PMID:26599625
Kim, Min Ah; Yi, Jaehee
Public stigma is a major source of stress for cancer survivors. However, factors that buffer or exacerbate the negative effects of public stigma on psychological distress have not been elucidated. This study examined how perceived public stigma affects psychological distress as mediated by cancer disclosure, internalized reactions to stigma, and social support availability. Cross-sectional study. The study was conducted in South Korea. The study sample was 223 adolescent and young adult survivors of childhood cancer diagnosed before the age of 19 and currently between 15 and 39 years old. Psychological distress was assessed using the Brief Symptom Inventory-18. Structural equation modeling was used with 1000 bootstrap samples. The goodness of model fit was acceptable. Public stigma perceived by cancer survivors influenced psychological distress via cancer disclosure, internalized shame, and social support availability. Higher levels of perceived public stigma predicted higher levels of internalized shame and self-blame and lower levels of social support availability, which subsequently increased psychological distress. Higher levels of perceived public stigma predicted lower levels of disclosure about cancer history and experiences. Cancer disclosure indirectly ameliorated psychological distress by reducing internalized shame. This study offers evidence that cognitive and social factors play important roles in mediating the effects of perceived public stigma on psychological distress in Korean cancer survivors. A greater understanding of factors that influence psychological distress may help psychosocial oncology service providers to identify childhood cancer survivors in need of psychosocial services and provide them with appropriate resources and interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.
Khan, Nashi; Kausar, Rukhsana; Khalid, Adeela; Farooq, Anum
Objective: This study aims to examine Gender Difference in the level of Discrimination and Stigma experienced by people diagnosed with Major Depressive Disorder in Pakistan. It was hypothesized that Women diagnosed with Depression are likely to be experiencing more Discrimination and Internalized Stigma in comparison to Men. Methods: This is a Cross Sectional Study. Thirty eight patients diagnosed with Major Depressive Disorder recruited from different Government Sector Hospitals of Lahore; w...
Goldberg, Abbie E.; Smith, JuliAnna Z.
This is the first study to examine change in depression and anxiety across the first year of adoptive parenthood in same-sex couples (90 couples: 52 lesbian, 38 gay male). Given that sexual minorities uniquely contend with sexual orientation-related stigma, this study examined how both internalized and enacted forms of stigma affect the mental health of lesbians and gay men during the transition to parenthood. In addition, the role of contextual support was examined. Higher perceived workplac...
Yang, Lawrence H; Singla, Daisy R
Indigenous interpretations of mental illness might negatively impact treatment adherence. However, psychiatric "labeling" potentially leads to stigma among Chinese groups, thus encouraging the use of indigenous idioms. We examined how relatives' use of indigenous labeling varied with the consumers' experience of illness and whether indigenous labeling protected relatives from internalized and experienced forms of stigma. Forty-nine relatives of Chinese-immigrant consumers with psychosis were sampled. Although consumers had progressed to the middle stages of psychosis, 39% of relatives used indigenous idioms to label psychosis. Indigenous labeling decreased when illness duration increased and when visual hallucinations were present. Indigenous labeling further predicted lower internalized stigma among relatives. Relatives who used indigenous labeling also reported fewer indirect stigma experiences, although not after controlling for illness severity. The frequency of direct discrimination among relatives did not differ by labeling. These forms of felt stigma might be embedded into relatives' psychoeducation programs to mitigate adverse consequences of psychiatric labeling.
Moore, Donna; Drey, Nicholas; Ayers, Susan
Perinatal mental illness is a global health concern; however, many women with the illness do not get the treatment they need to recover. Interventions that reduce the stigma around perinatal mental illness have the potential to enable women to disclose their symptoms to health care providers and consequently access treatment. There are many online forums for perinatal mental illness and thousands of women use them. Preliminary research suggests that online forums may promote help-seeking behavior, potentially because they have a role in challenging stigma. This study draws from these findings and theoretical concepts to present a model of forum use, stigma, and disclosure. This study tested a model that measured the mediating role of stigma between online forum use and disclosure of affective symptoms to health care providers. A Web-based survey of 200 women who were pregnant or had a child younger than 5 years and considered themselves to be experiencing psychological distress was conducted. Women were recruited through social media and questions measured forum usage, perinatal mental illness stigma, disclosure to health care providers, depression and anxiety symptoms, barriers to disclosure, and demographic information. There was a significant positive indirect effect of length of forum use on disclosure of symptoms through internal stigma, b=0.40, bias-corrected and accelerated (BCa) 95% CI 0.13-0.85. Long-term forum users reported higher levels of internal stigma, and higher internal stigma was associated with disclosure of symptoms to health care providers when controlling for symptoms of depression and anxiety. Internal stigma mediates the relationship between length of forum use and disclosure to health care providers. Findings suggest that forums have the potential to enable women to recognize and reveal their internal stigma, which may in turn lead to greater disclosure of symptoms to health care providers. Clinicians could refer clients to trustworthy and
Meyer-Bahlburg, Heino F L; Reyes-Portillo, Jazmin A; Khuri, Jananne; Ehrhardt, Anke A; New, Maria I
Stigma defined as "undesired differentness" (Goffman, 1963) and subtyped as "experienced" or "enacted," "anticipated," and "internalized" has been documented for patients with diverse chronic diseases. However, no systematic data exist on the association of stigma with somatic intersexuality. The current report concerns women with classical congenital adrenal hyperplasia (CAH), the most prevalent intersex syndrome, and provides descriptive data on CAH-related stigma as experienced in the general social environment (excluding medical settings and romantic/sexual partners) during childhood, adolescence, and adulthood. A total of 62 adult women with classical CAH [41 with the salt-wasting (SW) variant and 21 with the simple-virilizing (SV) variant] underwent a qualitative retrospective interview, which focused on the impact of CAH and its medical treatment on many aspects of women's lives. Deductive content analysis was performed on the transcribed texts. The women's accounts of CAH-related stigma were identified and excerpted as vignettes, and the vignettes categorized according to social context, stigma type, and the associated features of the CAH condition. Nearly two-thirds of women with either variant of CAH provided stigma vignettes. The vignettes included all three stigma types, and most involved some somatic or behavioral feature related to sex or gender. Stigma situations were reported for all ages and all social contexts of everyday life: family, peers, colleagues at work, strangers, and the media. We conclude that there is a need for systematic documentation of stigma in intersexuality as a basis for the development of improved approaches to prevention and intervention.
Chen, Emily S M; Chang, Wing Chung; Hui, Christy L M; Chan, Sherry K W; Lee, Edwin Ho Ming; Chen, Eric Y H
Stigma is a major factor causing delayed help-seeking and poor treatment adherence in patients with psychotic disorders. Previous research has mostly focused on chronic samples and the impact of culturally-relevant variables on both patients' and their caregivers' stigmatization is understudied. This study aimed to examine the relationships between various forms of stigma, "face concern", and clinical characteristics in a group of Chinese first-episode psychosis (FEP) patients and their caregivers. Forty-four Hong Kong Chinese aged 15-54 years presenting with FEP to psychiatric services and their caregivers were recruited. Assessments on self-stigma, affiliate stigma, perceived public stigma, "face concern", symptom severity and subjective quality of life (QoL) were conducted. Self-stigma of FEP patients was correlated with perceived public stigma, "face concern", insight and psychological health of QoL. Multiple regression analysis revealed that perceived public stigma and "face concern" independently predicted self-stigma. Mediation analysis further suggested that "face concern" partially mediated the relationship between perceived public stigma and self-stigma. Caregivers' affiliate stigma was significantly associated with higher levels of stress, and symptoms of depression and anxiety. Affiliate stigma did not correlate with perceived public stigma and "face concern". Our results indicate a critical role of perceived public stigma and fear of losing face in determining self-stigma in Chinese patients with FEP. Caregivers with greater degree of affiliate stigma experience increased stress and emotional distress. Our findings highlight the importance to examine culturally specific factors that may contribute to the development of self-stigma in first-episode populations of different ethnicities.
Ali, A; Kock, E; Molteno, C; Mfiki, N; King, M; Strydom, A
Studies have shown that individuals with intellectual disability (ID) are aware of stigma and are able to describe experiences of being treated negatively. However, there have been no cross-cultural studies examining whether self-reported experiences of stigma vary between ethnic groups. Participants with mild and moderate ID were recruited from a number of different settings in Cape Town, South Africa. Self-reported experiences of stigma in three ethnic groups were measured using the South African version of the Perceived Stigma of Intellectual Disability tool, developed by the authors. One-way anova was used to test whether there were differences in the total stigma score between the ethnic groups. Regression analysis was performed to identify factors associated with stigma. A total of 191 participants agreed to take part; 53 were Black, 70 were of mixed ethnicity and 68 were Caucasian. There were no differences in the levels of stigma reported by the three groups but the Black African ethnic group were more likely to report being physically attacked and being stared at, but were also more likely to report that they thought they were 'the same as other people'. There was an interaction effect between ethnicity and level of ID, with participants with mild ID from the Black African group reporting higher levels of stigma compared with those with moderate ID. Younger age was the only factor that was associated with stigma but there was a trend towards ethnicity, additional disability and socio-economic status being related to stigma. Interventions should target the Black African community in South Africa and should include the reduction of both public stigma and self-reported stigma. © 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.
Brewis, Alexandra A; Hruschka, Daniel J; Wutich, Amber
Obesity is understood as a major medical and public health challenge, but the stigma attached to it also creates extraordinary suffering. The pervasiveness of morally negative views toward the overweight and obese, such as laziness and lack of self-control, are undeniable in mainstream U.S. society, situated both institutionally (such as health care barriers or media stereotypes) and interpersonally (such as the negative comments of others). To test basic pathways related to the etiology of women's vulnerability to feeling "fat-stigma" in interpersonal relationships, we present a study conducted between August and November 2009 that combines social network, anthropometric, body image, and interview data for 112 women aged 18-45 years, living in Phoenix, Arizona, U.S., and linked follow-up interviews with 823 of their social ties. Based on the proposition that some social network characteristics should amplify the personal experience of stigma, and others should ameliorate it, we ask: what relationship qualities make women more sensitive to the judgments of others about their weight? We find that what others say about women has only a very limited influence on how women judge others' negative views of their weight once actual body size is taken into account, but that women are more influenced by the opinions of those they are closer to and interact with more often. Ultimately, the degree to which women perceive themselves to be judged by others regarding their weight is not well explained by the actual opinions of people in their networks, either known or unknown to them. The assumption that social network norms exert considerable influence on people's stigma experiences needs to be carefully evaluated, at least in the domain of overweight and obesity. Copyright © 2011 Elsevier Ltd. All rights reserved.
Shi, Ying; Wang, Shouqi; Ying, Jie; Zhang, Meiling; Liu, Pengcheng; Zhang, Huanhuan; Sun, Jiao
Epilepsy, one of the most common, serious chronic neurological diseases, is accompanied by different levels of perceived stigma that affects people in almost all age groups. This stigma can negatively impact the physical and mental health of people living with epilepsy (PLWE). Good knowledge of perceived stigma for PLWE is important. In this study, we conducted a meta-analysis to identify the correlates of perceived stigma for PLWE. Studies on factors associated with perceived stigma for PLWE, including sociodemographic, psychosocial, and disease-related variables, were searched in PubMed, PsychINFO, EMBASE, and Web of Science. Nineteen variables (k>1) were included in the meta-analysis. For sociodemographic characteristics, findings revealed that the significant weighted mean correlation (R) for "residence" and "poor financial status" were 0.177 and 0.286, respectively. For disease-related characteristics, all variables of significance, including "seizure severity," "seizure frequency," "number of medicines," and "adverse event" (R ranging from 0.190 to 0.362), were positively correlated with perceived stigma. For psychosocial characteristics, "depression" and "anxiety" with R values of 0.414 and 0.369 were significantly associated with perceived stigma. In addition, "social support," "quality of life (QOLIE-31,89)," "knowledge," and "attitude," with R values ranging from -0.444 to -0.200 indicating negative correlation with perceived stigma. The current meta-analysis evaluated the correlates of perceived stigma for PLWE. Results can serve as a basis for policymakers and healthcare professionals for formulating health promotion and prevention strategies. Copyright © 2017 Elsevier Inc. All rights reserved.
Owen, Jesse; Thomas, LeKeldric; Rodolfa, Emil
The current study examined the associations among clients' perceptions of self- and social stigma for seeking help, session outcomes, and working alliance. Ninety-one clients were treated by 26 therapists, at a large university counseling center. All clients were currently in therapy. We expected that clients' perceptions of self- and social…
Mikami, Amori Yee; Chong, Gua Khee; Saporito, Jena M; Na, Jennifer Jiwon
This study examined parents' perceptions/awareness and internalization of public courtesy stigma (affiliate stigma) about their children's inattentive and hyperactive/impulsive symptoms, and associations between parental affiliate stigma, parental negativity expressed toward the child, and child social functioning. Participants were families of 63 children (ages 6-10; 42 boys) with attention-deficit/hyperactivity disorder, assessed in a cross-sectional design. After statistical control of children's severity of inattentive and hyperactive/impulsive symptoms (as reported by parents and teachers), parents' self-reports of greater affiliate stigma were associated with more observed negative parenting. The associations between high parental affiliate stigma and children's poorer adult informant-rated social skills and greater observed aggression were partially mediated by increased parental negativity. As well, the positive association between children's adult informant-rated aggressive behavior and parental negativity was partially mediated by parents' increased affiliate stigma. Parental affiliate stigma about their children's inattentive and hyperactive/impulsive symptoms may have negative ramifications for parent-child interactions and children's social functioning. Clinical implications for parent training interventions are discussed.
Mak, Winnie W S; Cheung, Rebecca Y M
Self-stigma refers to the internalized stigma that individuals may have toward themselves as a result of their minority status. Not only can self-stigma dampen the mental health of individuals, it can deter them from seeking professional help lest disclosing their minority status lead to being shunned by service providers. No unified instrument has been developed to measure consistently self-stigma that could be applied to different concealable minority groups. The present study presented findings based on 4 studies on the development and validation of the Self-Stigma Scale, conducted in Hong Kong with community samples of mental health consumers, recent immigrants from Mainland China, and sexual minorities. Upon a series of validation procedures, a 9-item Self-Stigma Scale-Short Form was developed. Initial support on its reliability and construct validity (convergent and criterion validities) were found among 3 stigmatized groups. Utility of this unified measure was to establish an empirical basis upon which self-stigma of different concealable minority groups could be assessed under the same dimensions. Health-care professionals could make use of this short scale to assess potential self-stigmatization among concealable minorities, which may hamper their treatment process as well as their overall well-being.
Hutson, Sadie P; Darlington, Caroline K; Hall, Joanne M; Heidel, R Eric; Gaskins, Susan
The Appalachian South is disproportionately affected by HIV/AIDS. Partly due to the negative connotation that this disease carries in religiously conservative areas, HIV-related stigma remains a critical barrier to HIV care in the South. However, spirituality is a well-documented, effective coping mechanism among persons living with HIV/AIDS (PLWH). The purpose of this study was to examine the relationship between HIV-related stigma and spiritual well-being among a sample of PLWH (n = 216) in Appalachian counties of Tennessee and Alabama using the HIV Stigma Scale and the Spiritual Well-being Scale. Overall, disclosure of HIV status was the most highly reported stigma concern. Women reported higher levels of stigma and religious well-being than men. While existential well-being was negatively correlated with stigma, no significant overall correlation was found between religious well-being and stigma. Our findings reveal the importance of defining theology and differentiating between cultural religious conditioning and internalized beliefs.
Chang, Chih-Cheng; Su, Jian-An; Tsai, Ching-Shu; Yen, Cheng-Fang; Liu, Jiun-Horng; Lin, Chung-Ying
To examine the psychometrics of the Affiliate Stigma Scale using rigorous psychometric analysis: classical test theory (CTT) (traditional) and Rasch analysis (modern). Differential item functioning (DIF) items were also tested using Rasch analysis. Caregivers of relatives with mental illness (n = 453; mean age: 53.29 ± 13.50 years) were recruited from southern Taiwan. Each participant filled out four questionnaires: Affiliate Stigma Scale, Rosenberg Self-Esteem Scale, Beck Anxiety Inventory, and one background information sheet. CTT analyses showed that the Affiliate Stigma Scale had satisfactory internal consistency (α = 0.85-0.94) and concurrent validity (Rosenberg Self-Esteem Scale: r = -0.52 to -0.46; Beck Anxiety Inventory: r = 0.27-0.34). Rasch analyses supported the unidimensionality of three domains in the Affiliate Stigma Scale and indicated four DIF items (affect domain: 1; cognitive domain: 3) across gender. Our findings, based on rigorous statistical analysis, verified the psychometrics of the Affiliate Stigma Scale and reported its DIF items. We conclude that the three domains of the Affiliate Stigma Scale can be separately used and are suitable for measuring the affiliate stigma of caregivers of relatives with mental illness. Copyright © 2015 Elsevier Inc. All rights reserved.
Burmeister, Jacob M; Carels, Robert A
Binge eating has a complex etiology and is likely influenced by a wide range of biological, psychological, social, and environmental factors. Among the environmental and behavioral contributors, television use has been strongly linked to obesity and unhealthy eating behaviors. The current study tested whether television use predicts binge eating symptomatology in adults seeking behavioral weight loss treatment. Participants (N=116) were adults seeking weight loss treatment in group-based behavioral weight loss programs. Average body mass index was 38.5; average age was 45.3. They completed measures of binge eating symptomatology, television use, internalized weight stigma, depression, body satisfaction, and habitual physical activity. The amount of television participants watched per week was associated with binge eating symptomatology even after controlling for relevant covariates. Binge eating symptomatology was positively associated with television use, internalized weight stigma, depression, and decreased body satisfaction. The findings of the current study support the hypothesis that television use is a significant predictor of binge eating symptomatology for adults attempting weight loss. Determining the causal nature of the relationship and whether binge eating is occurring during television viewing will be important areas of future inquiry. © 2013.
Stevelink, S A M; van Brakel, W H; Augustine, V
Stigma is a common phenomenon worldwide and infectious diseases like HIV/AIDS and leprosy are often associated with high levels of stigma. Several studies have been conducted concerning the effects of stigma and the impact on social participation, but comparative studies are rare. The objective of this study was to identify differences and similarities between HIV/AIDS and leprosy-related stigma. From April till July 2009, 190 questionnaire-based interviews were conducted to assess the levels of internalized stigma (Internalized Stigma of Mental Illness scale), perceived stigma (Explanatory Model Interview Catalogue stigma scale) and social participation (Participation scale) in a cross-sectional sample of people affected by leprosy (PL) and people living with HIV/AIDS (PLHA). Respondents were selected from several hospitals, charity projects and during home visits in Vellore district, Tamil Nadu. Our results showed that both PLHA (n = 95) and leprosy-affected respondents (n = 95) faced a substantial burden of internalized and perceived stigma, with the former reporting a significantly higher level of stigma. As a result, PLHA faced more frequent and also more severe participation restrictions than PL. Especially, restrictions in work-related areas were reported by the majority of the respondents. In conclusion, PLHA faced a significantly higher level of stigma and participation restriction than PL. However, the latter also reported a substantial burden of stigma and participation restrictions. The study suggests that it may be possible to develop joint interventions based on the commonalities found. More research is needed to define these more precisely and to test the effectiveness of such joint interventions in reducing stigma and improving social participation.
Hall, Kelli Stidham; Manu, Abubakar; Morhe, Emmanuel; Harris, Lisa H; Loll, Dana; Ela, Elizabeth; Kolenic, Giselle; Dozier, Jessica L; Challa, Sneha; Zochowski, Melissa K; Boakye, Andrew; Adanu, Richard; Dalton, Vanessa K
Young women's experiences with sexual and reproductive health (SRH) stigma may contribute to unintended pregnancy. Thus, stigma interventions and rigorous measures to assess their impact are needed. Based on formative work, we generated a pool of 51 items on perceived stigma around different dimensions of adolescent SRH and family planning (sex, contraception, pregnancy, childbearing, abortion). We tested items in a survey study of 1,080 women ages 15 to 24 recruited from schools, health facilities, and universities in Ghana. Confirmatory factor analysis (CFA) identified the most conceptually and statistically relevant scale, and multivariable regression established construct validity via associations between stigma and contraceptive use. CFA provided strong support for our hypothesized Adolescent SRH Stigma Scale (chi-square p value < 0.001; root mean square error of approximation [RMSEA] = 0.07; standardized root mean square residual [SRMR] = 0.06). The final 20-item scale included three subscales: internalized stigma (six items), enacted stigma (seven items), and stigmatizing lay attitudes (seven items). The scale demonstrated good internal consistency (α = 0.74) and strong subscale correlations (α = 0.82 to 0.93). Higher SRH stigma scores were inversely associated with ever having used modern contraception (adjusted odds ratio [AOR] = 0.96, confidence interval [CI] = 0.94 to 0.99, p value = 0.006). A valid, reliable instrument for assessing SRH stigma and its impact on family planning, the Adolescent SRH Stigma Scale can inform and evaluate interventions to reduce/manage stigma and foster resilience among young women in Africa and beyond.
Internalizing stigma associated with mental illness: findings from a general population survey in Jamaica Interiorización del estigma asociado con las enfermedades mentales: resultados de una encuesta en población general en Jamaica
Roger Carl Gibson
Full Text Available OBJECTIVES: The culture of stigma associated with mental illness is particularly intense when persons who are normally victims of that stigmatization (mentally ill persons and their family members themselves act negatively toward others whom they associate with mental illness. We attempt to determine the extent of this internalization and assimilation of stigmatizing attitudes, cognitions, and behaviors in persons who are at risk for such stigmatization in Jamaica. METHODS: Data from a 2006 national survey on mental health were analyzed. Demographic variables, the presence or absence of mental illness in respondents and in their family members, and responses pertaining to behaviors and attitudes toward mentally ill persons were examined. Subsamples (respondents with mental illness, respondents with a family member with mental illness, respondents with neither were compared using the chi-square test. RESULTS: Respondents with family members with mental illness were less likely to demonstrate a number of different manifestations of stigmatization than others (P = 0.009-0.019. Respondents with mental illness showed no difference in the demonstration of a number of different manifestations of stigmatization from other respondents (P = 0.069-0.515. CONCLUSIONS: The small number of mentally ill respondents resulted in low statistical power for demonstrating differences between that subgroup and other respondents. The significantly more positive attitudes and behavior of respondents with family members with mental illness suggest that some benefit may be gained by creating more opportunities for the general public to interact with persons with mental illness.OBJETIVOS:La cultura del estigma asociado con las enfermedades mentales es especialmente intensa cuando las mismas personas que normalmente son víctimas de la estigmatización (personas con enfermedades mentales y los miembros de su familia actúan de forma negativa hacia otras personas a las que
Burke, Sara E.; Calabrese, Sarah K.; Dovidio, John F.; Levina, Olga S.; Uusküla, Anneli; Niccolai, Linda M.; Abel-Ollo, Katri; Heimer, Robert
Experiences of stigma are often associated with negative mental and physical health outcomes. The present work tested the associations between stigma and health-related outcomes among people with HIV who inject drugs in Kohtla-Järve, Estonia and St. Petersburg, Russia. These two cities share some of the highest rates of HIV outside of sub-Saharan Africa, largely driven by injection drug use, but Estonia has implemented harm reduction services more comprehensively. People who inject drugs were recruited using respondent-driven sampling; those who indicated being HIV-positive were included in the present sample (n=381 in St. Petersburg; n=288 in Kohtla-Järve). Participants reported their health information and completed measures of internalized HIV stigma, anticipated HIV stigma, internalized drug stigma, and anticipated drug stigma. Participants in both locations indicated similarly high levels of all four forms of stigma. However, stigma variables were more strongly associated with health outcomes in Russia than in Estonia. The St. Petersburg results were consistent with prior work linking stigma and health. Lower barriers to care in Kohtla-Järve may help explain why social stigma was not closely tied to negative health outcomes there. Implications for interventions and health policy are discussed. PMID:25703668
Wolitski, Richard J; Pals, Sherri L; Kidder, Daniel P; Courtenay-Quirk, Cari; Holtgrave, David R
HIV-related stigma negatively affects the lives of persons living with HIV/AIDS (PLWHA). Homeless/unstably housed PLWHA experience myriad challenges and may be particularly vulnerable to the effects of HIV-related stigma. Homeless/unstably housed PLWHA from 3 U.S. cities (N = 637) completed computer-assisted interviews that measured demographics, self-assessed physical and mental health, medical utilization, adherence, HIV disclosure, and risk behaviors. Internal and perceived external HIV stigma were assessed and combined for a total stigma score. Higher levels of stigma were experienced by women, homeless participants, those with a high school education or less, and those more recently diagnosed with HIV. Stigma was strongly associated with poorer self-assessed physical and mental health, and perceived external stigma was associated with recent non-adherence to HIV treatment. Perceived external stigma was associated with decreased HIV disclosure to social network members, and internal stigma was associated with drug use and non-disclosure to sex partners. Interventions are needed to reduce HIV-related stigma and its effects on the health of homeless/unstably housed PLWHA.
Burke, Sara E; Calabrese, Sarah K; Dovidio, John F; Levina, Olga S; Uusküla, Anneli; Niccolai, Linda M; Abel-Ollo, Katri; Heimer, Robert
Experiences of stigma are often associated with negative mental and physical health outcomes. The present work tested the associations between stigma and health-related outcomes among people with HIV who inject drugs in Kohtla-Järve, Estonia and St. Petersburg, Russia. These two cities share some of the highest rates of HIV outside of sub-Saharan Africa, largely driven by injection drug use, but Estonia has implemented harm reduction services more comprehensively. People who inject drugs were recruited using respondent-driven sampling; those who indicated being HIV-positive were included in the present sample (n = 381 in St. Petersburg; n = 288 in Kohtla-Järve). Participants reported their health information and completed measures of internalized HIV stigma, anticipated HIV stigma, internalized drug stigma, and anticipated drug stigma. Participants in both locations indicated similarly high levels of all four forms of stigma. However, stigma variables were more strongly associated with health outcomes in Russia than in Estonia. The St. Petersburg results were consistent with prior work linking stigma and health. Lower barriers to care in Kohtla-Järve may help explain why social stigma was not closely tied to negative health outcomes there. Implications for interventions and health policy are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.
Choi, Kyung-Hee; Steward, Wayne T; Miège, Pierre; Hudes, Esther; Gregorich, Steven E
The direct link between stigma against sexual minorities and psychological distress is well established. However, few studies have examined the potential mediating roles of avoidant and social support coping in the relationships between internalized and anticipated stigma associated with homosexuality and depressive symptoms and anxiety among Chinese men who have sex with men (MSM). We recruited a longitudinal sample of 493 MSM in Beijing, China from 2011 to 2012. Participants completed computer-based questionnaires at baseline, 6, and 12 months. We found significant indirect effects of anticipated MSM stigma on symptoms of both depression and anxiety via avoidant coping: anticipated MSM stigma at baseline was significantly associated with avoidant coping (B = 0.523, p stigma, avoidant coping had a significant positive effect on depressive symptoms and anxiety at 12 months (B = 0.069, p = 0.001 and B = 0.071, p = 0.014). In contrast, no significant indirect effects of anticipated MSM stigma on either psychological distress outcome via social support coping were found. No significant indirect effects of internalized MSM stigma via either avoidant or social support coping were found. These results underscore the need for interventions that address anticipations of stigma and the use of avoidant coping techniques to manage such anticipations.
Ha, Huy; Risser, Jan M H; Ross, Michael W; Huynh, Nhung T; Nguyen, Huong T M
This article examined the associations between three forms of homosexuality-related stigma (enacted, perceived, and internalized homosexual stigmas) with risky sexual behaviors, and to describe the mechanisms of these associations, among men who have sex with men (MSM) in Hanoi, Vietnam. We used respondent-driven sampling (RDS) to recruit 451 MSM into a cross-sectional study conducted from August 2010 to January 2011. Data were adjusted for recruitment patterns due to the RDS approach; logistic regression and path analyses were performed. Participants were young and single; most had attended at least some college. Nine out of ten participants engaged in sexual behaviors at moderate to high risk levels. Compared to those who had no enacted homosexual stigma, men having low and high levels of enacted homosexual stigma, respectively, were 2.23 times (95 % CI 1.35-3.69) and 2.20 times (95 % CI 1.04-4.76) more likely to engage in high levels of sexual risk behaviors. In addition, there was an indirect effect of perceived homosexual stigma and internalized homosexual stigma on sexual risk behaviors through depression and drug and alcohol use. Our study provides valuable information to our understanding of homosexual stigma in Vietnam, highlighting the need for provision of coping skills against stigma to the gay community and addressing drinking and drug use among MSM, to improve the current HIV prevention interventions in Vietnam.
Roe, David; Yamin, Amit
Research around the world has consistently shown that people with serious mental illness (SMI) are often subject to stronglyheld stigmatizing attitudes held by others in society (e.g., dangerousness, incompetence, inability to work). As a result, people with SMI often experience "internalized stigma" or "self-stigma" which reflects the process by which stigmatizing attitudes are internalized, leading to the loss of previously held or hoped for identities (e.g., self as student, self as worker, self as parent, etc.) and the adoption of identities based on stigmatizing views (e.g., self as dangerous, self as incompetent). In order to reduce the common devastating phenomenon of self-stigma, Narrative Enhancement and Cognitive Therapy (NECT) is a structured, groupbased treatment aimed to reduce self-stigma. It combines psychoeducation to help replace stigmatizing views about mental illness with empirical fndings, cognitive restructuring geared toward teaching skills to challenge negative beliefs about the self, and elements of narratology focused on enhancing one's ability to narrate one's life story. Since its development, nearly a decade ago, it has been implemented in fve different countries and fve languages and studied in three countries with results supporting its positive impact on decreasing self-stigma and improving other positive outcomes. In this paper we briefly review literature on stigma and self-stigma within the context of SMI, the need for treatment focused on decreasing self-stigma, the theoretical rational for the NECT, the format of the intervention and the existing published research.
Rood, E J J; Mergenthaler, C; Bakker, M I; Redwood, L; Mitchell, E M H
Tuberculosis (TB) stigma is thought to delay or prevent the decision to seek health care, but the strength of this association and the prevalence of anticipated TB stigma in the general population in most countries is unknown. To examine epidemiological, cultural and sociodemographic factors associated with TB courtesy stigma in 15 surveys across 13 countries, and its link to health seeking for cough in children under five. A multilevel survey weighted logistic regression model was used to analyse how individual characteristics and social contexts affect the occurrence of TB courtesy stigma. The same modelling approach was used to analyse associations between TB courtesy stigma and individual-level predictors of health-seeking behaviour of mothers for children with cough. TB courtesy stigma varies greatly among countries. TB courtesy stigma was negatively correlated with knowledge of TB's curability (adjusted OR [aOR] 0.82; 95%CI 0.78-0.86) and human immunodeficiency virus (HIV) accepting attitudes (proxy for HIV stigma) (aOR 0.15, 95%CI 0.15-0.16). Mothers' health-seeking behaviour for children under five with cough was found to be positively correlated with HIV accepting attitudes (OR 1.16, 95%CI 1.08-1.25), but was marginally affected by TB courtesy stigma (OR 0.99, 95%CI 0.98-1.00). Improving the general awareness of the effectiveness of anti-tuberculosis treatment will help to diminish TB courtesy stigma, and should be prioritised over expanding knowledge of mode of transmission. Efforts to reduce HIV and TB stigma may increase care seeking for childhood TB symptoms.
Campo-Arias, Adalberto; Herazo, Edwin
The concept stigma-discrimination complex associated with mental disorder (SDCAMD) is proposed to encompass the terms used in the attribution theory: stigma, stereotype, prejudice and discrimination. SDCAMD is one of the most frequent disorders worldwide. Internalized and perceived SDCAMD may explain a number of suicide cases. To update the factors that may explain the association between SDCAMD and suicide, and postulate possible underlying mechanisms. Articles were identified in MEDLINE using the descriptors for "stigma", "mental disorders" and "suicide" or "suicide rate". Articles published between January 2000 and June 2014 were included. Reviews and case studies were not considered. The two included studies showed that stigma increased the risk of suicidal behaviors. It was evident that people who meet criteria for mental disorder and reported high self-stigma made a greater number of suicide attempts, and countries with high stigma in the general population have a higher suicide rate. It was considered that the relationship between SDCAMD and suicide is established by a set of interrelated mechanisms. A "direct" mechanism involving perceived stigma and is configured as a barrier to access mental health services, and an "indirect" mechanism involving the self-stigma, which increases the vulnerability to depressive episodes and repeated self-injurious behaviors that ultimately end in suicide. The SDCAMD impacts negatively on the quality of life of people who meet criteria for mental disorders, and accounts for a significant number of suicides. One way is related to the perceived stigma that is configured as a barrier to access mental health services and, the second one includes repeated self-injurious behaviors that reduce self-esteem and increases perceived stress. Further research is required to increase the knowledge of this association. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.
Smith, Laramie R.; Earnshaw, Valerie A.; Copenhaver, Michael M.; Cunningham, Chinazo O.
Background Substance use disorders consistently rank among the most stigmatized conditions worldwide. Thus, substance use stigma fosters health inequities among persons with substance use disorders and remains a key barrier to successful screening and treatment efforts. Current efforts to measure substance use stigma are limited. This study aims to advance measurement efforts by drawing on stigma theory to develop and evaluate the Substance Use Stigma Mechanisms Scale (SU-SMS). The SU-SMS was designed to capture enacted, anticipated, and internalized substance use stigma mechanisms among persons with current and past substance use disorders, and distinguish between key stigma sources most likely to impact this target population. Methods This study was a cross-sectional evaluation of the validity, reliability, and generalizability of the SU-SMS across two independent samples with diverse substance use and treatment histories. Results Findings support the structural and construct validity of the SU-SMS, suggesting the scale was able to capture enacted, anticipated, and internalized stigma as distinct stigma experiences. It also further differentiated between two distinct stigma sources (family and healthcare providers). Analysis of these mechanisms and psychosocial metrics suggests that the scale is also associated with other health-related outcomes. Furthermore, the SU-SMS demonstrated high levels of internal reliability and generalizability across two independent samples of persons with diverse substance use disorders and treatment histories. Conclusion The SU-SMS may serve as a valuable tool for better understanding the processes through which substance use stigma serves to undermine key health behaviors and outcomes among persons with substance use disorders. PMID:26972790
Brent, Robert J
HIV-stigma is a major reason why HIV continues to be a global epidemic. Interventions targeting HIV-stigma are therefore necessary. To find an intervention that is worthwhile, a Cost-Benefit Analysis is needed which compares costs and benefits. There are many documented costs of HIV-stigma. What is missing is a valuation of the benefits of reducing HIV-stigma. The purpose of this paper is to present a general method that can be used to value the benefits of stigma reduction programs. The method involves estimating the marginal rate of substitution (MRS) between stigma and income in the utility function of older people with HIV. To illustrate how our framework can be used, we applied it to a sample of just over 900 people coming from the 2005-06 ROAH study (Research on Older Adults with HIV) in New York City. Copyright © 2016 Elsevier Ltd. All rights reserved.
Banks, Bahby; Jonas, Dan; Miles, Margaret Shandor; Smith, Giselle Corbie
We reviewed the literature to determine the effectiveness of HIV-related interventions in reducing HIV/AIDS stigma. Studies selected had randomized controlled trial (RCT), pretest–posttest with a non-randomized control group, or pretest–posttest one group study designs in which HIV-related interventions were being evaluated, and in which HIV/AIDS stigma was one of the outcomes being measured. A checklist was used to extract data from accepted studies, assess their internal validity, and overall quality. Data were extracted from 19 studies, and 14 of these studies demonstrated effectiveness in reducing HIV/ AIDS stigma. Only 2 of these 14 effective studies were considered good studies, based on quality, the extent to which the intervention focused on reducing HIV/AIDS stigma, and the statistics reported to demonstrate effectiveness. Future studies to reduce HIV/AIDS stigma could improve by designing interventions that pay greater attention to internal validity, use validated HIV/AIDS stigma instruments, and achieve both statistical and public health significance. PMID:21088989
Marlow, Laura A V; Wardle, Jane
Illness-related stigma has attracted considerable research interest, but few studies have specifically examined stigmatisation of cancer in the non-patient population. The present study developed and validated a Cancer Stigma Scale (CASS) for use in the general population. An item pool was developed on the basis of previous research into illness-related stigma in the general population and patients with cancer. Two studies were carried out. The first study used Exploratory factor analysis to explore the structure of items in a sample of 462 postgraduate students recruited through a London university. The second study used Confirmatory factor analysis to confirm the structure among 238 adults recruited through an online market research panel. Internal reliability, test-retest reliability and construct validity were also assessed. Exploratory factor analysis suggested six subscales, representing: Awkwardness, Severity, Avoidance, Policy Opposition, Personal Responsibility and Financial Discrimination. Confirmatory factor analysis confirmed this structure with a 25-item scale. All subscales showed adequate to good internal and test-retest reliability in both samples. Construct validity was also good, with mean scores for each subscale varying in the expected directions by age, gender, experience of cancer, awareness of lifestyle risk factors for cancer, and social desirability. Means for the subscales were consistent across the two samples. These findings highlight the complexity of cancer stigma and provide the Cancer Stigma Scale (CASS) which can be used to compare populations, types of cancer and evaluate the effects of interventions designed to reduce cancer stigma in non-patient populations.
Yanos, Philip T; Vayshenker, Beth; DeLuca, Joseph S; O'Connor, Lauren K
Mental health professionals who work with people with serious mental illnesses are believed to experience associative stigma. Evidence suggests that associative stigma could play an important role in the erosion of empathy among professionals; however, no validated measure of the construct currently exists. This study examined the convergent and discriminant validity and factor structure of a new scale assessing the associative stigma experiences of clinicians working with people with serious mental illnesses. A total of 473 clinicians were recruited from professional associations in the United States and participated in an online study. Participants completed the Clinician Associative Stigma Scale (CASS) and measures of burnout, quality of care, expectations about recovery, and self-efficacy. Associative stigma experiences were commonly endorsed; eight items on the 18-item scale were endorsed as being experienced "sometimes" or "often" by over 50% of the sample. The new measure demonstrated a logical four-factor structure: "negative stereotypes about professional effectiveness," "discomfort with disclosure," "negative stereotypes about people with mental illness," and "stereotypes about professionals' mental health." The measure had good internal consistency. It was significantly related to measures of burnout and quality of care, but it was not related to measures of self-efficacy or expectations about recovery. Findings suggest that the CASS is internally consistent and shows evidence of convergent validity and that associative stigma is commonly experienced by mental health professionals who work with people with serious mental illnesses.
Teh, Jen Lee; King, David; Watson, Bernadette; Liu, Shuang
People with mental illness (PWMI) often internalise negative beliefs (self-stigma) or anticipate external sources of stigma (perceived stigma). This study examines how the two types of stigma affect the willingness to communicate for help – such communication is a vital aspect of good patient care and treatment outcome. Seventy-two participants from different ethnic backgrounds who had experienced mental illness responded to an online survey about their level of agreement with statements refl...
Hamlington, Barbara; Ivey, Lauren E; Brenna, Ethan; Biesecker, Leslie G; Biesecker, Barbara B; Sapp, Julie C
A child's obesity is generally perceived by the public to be under the control of the child's parents. While the health consequences of childhood obesity are well understood, less is known about psychological and social effects of having an obese child on parents. We set out to characterize stigma and courtesy stigma experiences surrounding obesity among children with Bardet-Biedl syndrome (BBS), a multisystem genetic disorder, and their parents. Twenty-eight parents of children with BBS participated in semi-structured interviews informed by social stigmatization theory, which describes courtesy stigma as parental perception of stigmatization by association with a stigmatized child. Parents were asked to describe such experiences. Parents of children with BBS reported the child's obesity as the most frequent target of stigmatization. They perceived health care providers as the predominant source of courtesy stigma, describing interactions that resulted in feeling devalued and judged as incompetent parents. Parents of children with BBS feel blamed by others for their child's obesity and described experiences that suggest health care providers may contribute to courtesy stigma and thus impede effective communication about managing obesity. Health care providers may reinforce parental feelings of guilt and responsibility by repeating information parents may have previously heard and ignoring extremely challenging barriers to weight management, such as a genetic predisposition to obesity. Strategies to understand and incorporate parents' perceptions and causal attributions of their children's weight may improve communication about weight control.
Full Text Available A child's obesity is generally perceived by the public to be under the control of the child's parents. While the health consequences of childhood obesity are well understood, less is known about psychological and social effects of having an obese child on parents. We set out to characterize stigma and courtesy stigma experiences surrounding obesity among children with Bardet-Biedl syndrome (BBS, a multisystem genetic disorder, and their parents.Twenty-eight parents of children with BBS participated in semi-structured interviews informed by social stigmatization theory, which describes courtesy stigma as parental perception of stigmatization by association with a stigmatized child. Parents were asked to describe such experiences.Parents of children with BBS reported the child's obesity as the most frequent target of stigmatization. They perceived health care providers as the predominant source of courtesy stigma, describing interactions that resulted in feeling devalued and judged as incompetent parents.Parents of children with BBS feel blamed by others for their child's obesity and described experiences that suggest health care providers may contribute to courtesy stigma and thus impede effective communication about managing obesity. Health care providers may reinforce parental feelings of guilt and responsibility by repeating information parents may have previously heard and ignoring extremely challenging barriers to weight management, such as a genetic predisposition to obesity. Strategies to understand and incorporate parents' perceptions and causal attributions of their children's weight may improve communication about weight control.
Hamlington, Barbara; Ivey, Lauren E.; Brenna, Ethan; Biesecker, Leslie G.; Biesecker, Barbara B.; Sapp, Julie C.
Background A child’s obesity is generally perceived by the public to be under the control of the child’s parents. While the health consequences of childhood obesity are well understood, less is known about psychological and social effects of having an obese child on parents. We set out to characterize stigma and courtesy stigma experiences surrounding obesity among children with Bardet-Biedl syndrome (BBS), a multisystem genetic disorder, and their parents. Methods Twenty-eight parents of children with BBS participated in semi-structured interviews informed by social stigmatization theory, which describes courtesy stigma as parental perception of stigmatization by association with a stigmatized child. Parents were asked to describe such experiences. Results Parents of children with BBS reported the child’s obesity as the most frequent target of stigmatization. They perceived health care providers as the predominant source of courtesy stigma, describing interactions that resulted in feeling devalued and judged as incompetent parents. Conclusions Parents of children with BBS feel blamed by others for their child’s obesity and described experiences that suggest health care providers may contribute to courtesy stigma and thus impede effective communication about managing obesity. Health care providers may reinforce parental feelings of guilt and responsibility by repeating information parents may have previously heard and ignoring extremely challenging barriers to weight management, such as a genetic predisposition to obesity. Strategies to understand and incorporate parents’ perceptions and causal attributions of their children’s weight may improve communication about weight control. PMID:26473736
Stigma taints individuals with a spoiled identity and loss of status or discrimination. This article is the first to examine the stigma attached to abortion and surrogacy and consider how law may stigmatize women for failing to conform to social expectations about maternal roles. Courts should consider evidence of stigma when evaluating laws regulating abortion or surrogacy to determine whether these laws are based on impermissible gender stereotyping. © 2015 American Society of Law, Medicine & Ethics, Inc.
Full Text Available During the last two decades, there have been several conceptual developments in our understanding of pollen-stigma recognition and molecular mechanisms involved. The main models proposed are compared. Based on additional data a hypothesis to complete these models especially for pollen hydration and adhesion is proposed. After attachment of the pollen to the stigma surface a close interaction exists involving lipoproteic membrane-like compounds (pollenkitt and stigma pellicle and pollen agglutinating ability.
Chambers, Lori A.; Rueda, Sergio; Baker, D. Nico; Wilson, Michael G.; Deutsch, Rachel; Raeifar, Elmira; Rourke, Sean B.; Team, The Stigma Review
Background HIV-related stigma continues to negatively impact the health and well-being of people living with HIV, with deleterious effects on their care, treatment and quality of life. A growing body of qualitative research has documented the relationship between HIV-related stigma and health. This review aims to synthesize qualitative evidence that explored the intersections of stigma and health for people with HIV. Methods A thematic summary was conducted that was guided by the qualitative ...
Full Text Available In many health conditions, stigma is receiving increasing attention. Public stigmatization toward mental illness can affect particularly the patients and family memberships to help seeking behavior and treatment. These stigmatized persons in the society are deprived of rights and benefits. In this paper, reasons and consequences of stigma associated with mental illness are reviewed and combat against mental illnesses originated stigma are discussed. [TAF Prev Med Bull 2010; 9(1.000: 71-78
Rüsch, Nicolas; Angermeyer, Matthias C; Corrigan, Patrick W
Persons with mental illness frequently encounter public stigma and may suffer from self-stigma. We aim to clarify the concept of mental illness stigma and discuss important consequences for people with mental illness. A search of scientific literature on mental illness stigma was conducted with a focus on conceptually relevant empirical studies. After giving a conceptual overview of stigma, we elaborate on the consequences of stigma, focussing on self-stigma/empowerment, coping behaviour, fear of stigma as a barrier to using health services, and on structural discrimination. Main strategies to reduce stigma -- protest, education, and contact -- are discussed. Stigma is of central importance to persons with mental illness, both to how they experience their illness and its consequences and whether they use available health services. Well-designed anti-stigma initiatives will help to diminish the impact of mental illness stigma.
Corrigan, Patrick W; Morris, Scott B; Michaels, Patrick J; Rafacz, Jennifer D; Rüsch, Nicolas
Public stigma and discrimination have pernicious effects on the lives of people with serious mental illnesses. Given a plethora of research on changing the stigma of mental illness, this article reports on a meta-analysis that examined the effects of antistigma approaches that included protest or social activism, education of the public, and contact with persons with mental illness. The investigators heeded published guidelines for systematic literature reviews in health care. This comprehensive and systematic review included articles in languages other than English, dissertations, and population studies. The search included all articles from the inception of the databases until October 2010. Search terms fell into three categories: stigma, mental illness (such as schizophrenia and depression), and change program (including contact and education). The search yielded 72 articles and reports meeting the inclusion criteria of relevance to changing public stigma and sufficient data and statistics to complete analyses. Studies represented 38,364 research participants from 14 countries. Effect sizes were computed for all studies and for each treatment condition within studies. Comparisons between effect sizes were conducted with a weighted one-way analysis of variance. Overall, both education and contact had positive effects on reducing stigma for adults and adolescents with a mental illness. However, contact was better than education at reducing stigma for adults. For adolescents, the opposite pattern was found: education was more effective. Overall, face-to-face contact was more effective than contact by video. Future research is needed to identify moderators of the effects of both education and contact.
Rice, Whitney S; Logie, Carmen H; Napoles, Tessa M; Walcott, Melonie; Batchelder, Abigail W; Kempf, Mirjam-Colette; Wingood, Gina M; Konkle-Parker, Deborah J; Turan, Bulent; Wilson, Tracey E; Johnson, Mallory O; Weiser, Sheri D; Turan, Janet M
Attitudes and behavior that devalue individuals based upon their HIV status (HIV-related stigma) are barriers to HIV prevention, treatment, and wellbeing among women living with HIV. Other coexisting forms of stigma (e.g., racism, sexism) may worsen the effects of HIV-related stigma, and may contribute to persistent racial and gendered disparities in HIV prevention and treatment. Few studies examine perceptions of intersectional stigma among women living with HIV. From June to December 2015, we conducted 76 qualitative interviews with diverse women living with HIV from varied socioeconomic backgrounds enrolled in the Women's Interagency HIV Study (WIHS) in Birmingham, Alabama; Jackson, Mississippi; Atlanta, Georgia; and San Francisco, California. Interview guides facilitated discussions around stigma and discrimination involving multiple interrelated identities. Interviews were audio-recorded, transcribed verbatim, and coded using thematic analysis. Interviewees shared perceptions of various forms of stigma and discrimination, most commonly related to their gender, race, and income level, but also incarceration histories and weight. Women perceived these interrelated forms of social marginalization as coming from multiple sources: their communities, interpersonal interactions, and within systems and structures. Our findings highlight the complexity of social processes of marginalization, which profoundly shape life experiences, opportunities, and healthcare access and uptake among women living with HIV. This study highlights the need for public health strategies to consider community, interpersonal, and structural dimensions across intersecting, interdependent identities to promote the wellbeing among women living with HIV and to reduce social structural and health disparities. Copyright © 2018 Elsevier Ltd. All rights reserved.
Full Text Available Introduction The occurrence of mycotoxins in foods and feeds is a problem of major concern in all over the world. Profitability of poultry production can be greatly affected due to the frequency of feed contamination and the detrimental effects of these toxins on the performance. Aflatoxins, a group of closely related and biologically active mycotoxins, are produced by strains of Aspergillus flavus and Aspergillus parasiticus. They commonly occur as natural contaminant of poultry feeds. Domestic animal species such as chickens, ducks, cattle and turkeys consuming sublethal doses of aflatoxins for several days developed a toxic syndrome in which liver damage was the most significant change. The biological effects of aflatoxins could be categorized into two groups, long term and short term effects. Long term effects included chronic toxicity, cancer, birth defects and genetic alterations. Aflatoxins affected all poultry species, although they generally take relatively high levels to cause mortality, low levels can be detrimental if continually fed. Material and Methods This study was conducted to determine the efficacy of mineral, organic toxin absorbents, humic acid and yeast cell wall on performance and internal organs weight of broilers in experimental aflatoxicosis. This study was conducted in a completely randomize design with 432 Ross-308 broilers with 9 treatments, 4 replicates and 12 broilers in each replicate. Treatments included diet without aflatoxin, 2: diet contaminated with aflatoxin, 3: diet contaminated with aflatoxin and supplemented with 0.20 Humic acid, 4: diet contaminated with aflatoxin and supplemented with 0.40 Humic acid, 5: diet contaminated with aflatoxin and supplemented with 0.60 Humic acid, 5: diet contaminated with aflatoxin and supplemented with 0.80 Humic acid, 6: diet contaminated with aflatoxin and supplemented with 0.80 Humic acid, 7: diet contaminated with aflatoxin and supplemented with 1.00 Humic acid, 8: diet
Durso, Laura E; Latner, Janet D; Ciao, Anna C
Internalized weight bias has been previously associated with impairments in eating behaviors, body image, and psychological functioning. The present study explored the psychological correlates and psychometric properties of the Weight Bias Internalization Scale (WBIS) among overweight adults enrolled in a behavioral weight loss program. Questionnaires assessing internalized weight bias, anti-fat attitudes, self-esteem, body image concern, and mood symptoms were administered to 90 obese or overweight men and women between the ages of 21 and 73. Reliability statistics suggested revisions to the WBIS. The resulting 9-item scale was shown to be positively associated with body image concern, depressive symptoms, and stress, and negatively associated with self-esteem. Multiple linear regression models demonstrated that WBIS scores were significant and independent predictors of body image concern, self-esteem, and depressive symptoms. These results support the use of the revised 9-item WBIS in treatment-seeking samples as a reliable and valid measure of internalized weight bias. Copyright © 2016. Published by Elsevier Ltd.
Oexle, N; Ajdacic-Gross, V; Kilian, R; Müller, M; Rodgers, S; Xu, Z; Rössler, W; Rüsch, N
Whether the public stigma associated with mental illness negatively affects an individual, largely depends on whether the person has been labelled 'mentally ill'. For labelled individuals concealing mental illness is a common strategy to cope with mental illness stigma, despite secrecy's potential negative consequences. In addition, initial evidence points to a link between stigma and suicidality, but quantitative data from community samples are lacking. Based on previous literature about mental illness stigma and suicidality, as well as about the potential influence of labelling processes and secrecy, a theory-driven model linking perceived mental illness stigma and suicidal ideation by a mediation of secrecy and hopelessness was established. This model was tested separately among labelled and unlabelled persons using data derived from a Swiss cross-sectional population-based study. A large community sample of people with elevated psychiatric symptoms was examined by interviews and self-report, collecting information on perceived stigma, secrecy, hopelessness and suicidal ideation. Participants who had ever used mental health services were considered as labelled 'mentally ill'. A descriptive analysis, stratified logistic regression models and a path analysis testing a three-path mediation effect were conducted. While no significant differences between labelled and unlabelled participants were observed regarding perceived stigma and secrecy, labelled individuals reported significantly higher frequencies of suicidal ideation and feelings of hopelessness. More perceived stigma was associated with suicidal ideation among labelled, but not among unlabelled individuals. In the path analysis, this link was mediated by increased secrecy and hopelessness. Results from this study indicate that among persons labelled 'mentally ill', mental illness stigma is a contributor to suicidal ideation. One explanation for this association is the relation perceived stigma has with
Brown, I; Gould, J
There is a high non-attendance and dropout attrition from weight management interventions for adults with obesity. Patient dissatisfaction with consultations involving decisions about interventions may be a factor. A systematic review was undertaken of qualitative studies reporting perceptions, experiences, contexts and influences for adults facing, or reflecting on, weight management. The aim was to synthesize a generic model of influences on decision-making about weight management for adult patients. Electronic database and hand searches identified 29 qualitative studies involving 1387 participants (mean age 45.3 years; mean BMI 37.1 kg m(-2) ; 79.9% women). Seven overarching themes were inductively derived from extracted data spanning: cultural identity; social structures such as gender; responses to obesity stigma; previous weight loss experiences; personal motivators and barriers; social support; and practical resources. A model is presented in the paper. Improving decisions about weight management requires attention to how diffuse cultural and psycho-social factors, such as obesity stigma, influence patient choices. Reflection on experiences of previous attempts at weight loss is also essential, as are practical resource factors - particularly for less affluent groups. Considering these factors along with more established theories of individual psychological motivations and barriers may help to improve initial participation and retention within interventions. © 2011 The Authors. Clinical Obesity © 2011 International Association for the Study of Obesity.
Full Text Available In the current study, we tested the hypothesis that people who contracted HIV from "blameless" routes (e.g., blood transfusion, sex with stable partners are less stigmatized compared to people who contracted HIV from "blamable" routes (e.g., injection drug use, sex with sex workers. A cross-sectional study was conducted among 2,987 participants in Guangxi province, China, between 2012 and 2013. We employed both explanatory and predictive modeling strategy by using multivariate linear regression models. In the explanatory models, we assessed the association between routes of infection and three types of stigma (perceived, internalized, and enacted. From identified routes of infection that significantly contributed to higher stigma, we employed predictive modeling to explore predictors for the specific type of stigma. Multiple-imputation was employed for sensitivity analyses. Of the total sample, 63% were male and the average age was 42.9 years (ranged between 18 and 88. Multivariate regression models revealed that contraction from commercial sex increased the perceived (β = 0.46, 95%CI = 0.02, 0.90 and internalized stigma (β = 0.60, 95%CI = 0.09, 1.10, while injecting drug use increased the perceived (β = 0.65, 95%CI = 0.07, 1.22 and enacted stigma (β = 0.09, 95%CI = 0.02, 0.16 after controlling for confounders. Among PLWHA who were infected via commercial sex partners, social support was negatively associated with perceived (β = -0.47, 95%CI = -0.79, -0.14 and internalized stigma (β = -0.80, 95%CI = -1.24, -0.35. Among PLWHA who were infected via injecting drugs, no adherence to antiretroviral treatment (β = 0.41, 95%CI = 0.01, 0.82 was positively associated with perceived stigma, and disclosure of serostatus to others was negatively associated with enacted stigma (β = -0.20, 95%CI = -0.34, -0.05. Knowledge of the association between routes of infection and stigma can guide health professionals and policy makers to develop tailored
Suleiman MM, Ahmed; Sahal, Nagla; Sodemann, Morten
OBJECTIVE: To evaluate the prevalence of tuberculosis (TB) stigma and to determine the relation between socio-demographic characteristics and TB stigma among TB cases and their controls in Gezira State, Sudan. METHODS: A case-control study design was used. New smear-positive TB patients registere...
Avdibegović, Esmina; Hasanović, Mevludin
Stigma and recovery "from" and "in" mental illness are associated in many various ways. While recovery gives opportunities, makes person stronger, gives purpose and meaning to their lives and leads to social inclusion, in the same time stigma reduces opportunities, reduces self-esteem and self-efficacy, reduces the belief in own abilities and contributes to social exclusion through discrimination. The recovery of a person with mental illness means to get and keep hope, to understand their own possibilities and impossibilities, active living, to be autonomous, to have a social identity and to give meaning and purpose of our own lives. The care system, recovery-oriented, provides help and support to people with mental disorders in his/her recovery, which contributes to reduction of self-stigma, to the elimination of stigmatizing attitudes and beliefs in mental health services which consequently may have a positive reflection in reducing the stigma of mental illness in the community. It is important to look at the stigma and recovery from the perspective of individual experience of each person with a mental illness in the process of recovery. A support to the recovery concept and the development of a recovery-oriented system of care should be one of the key segments of any strategy to combat the stigma of mental illness. Also, the cultural and the social stigma aspects of stigma would be taken into account in the developing of the recovery concept and on the recovery-oriented care system.
Worona, Jay; Fletcher, Cynthia Plumb
This article, written by two lawyers, defines defamation, discusses the basic law of defamation and stigma, and focuses on recent case law on this topic. The cases are only a sample of the numerous cases that school districts across the nation face on the issues of defamation and stigma. The following topics are included in the legal review: the…
Saguy, Abigail C.; Ward, Anna
This paper examines the surprising case of women who "come out as fat" to test and refine theories about social change, social mobilization, stigma, and stigma resistance. First, supporting theories about "social movement spillover," we find that overlapping memberships in queer and fat activist groups, as well as networks between these groups,…
Perceived stigma and highly active antiretroviral treatment adherence among persons living with HIV/AIDS in the University of Port Harcourt Teaching Hospital. ... Data on socio-demographic characteristics, stigma and adherence to drug regimen were collected using a validated self-administered questionnaire. Data were ...
Watson, Amy C.; Fulambarker, Anjali; Kondrat, David C.; Holley, Lynn C.; Kranke, Derrick; Wilkins, Brittany T.; Stromwall, Layne K.; Eack, Shaun M.
Stigma is a significant barrier to recovery and full community inclusion for people with mental illnesses. Social work educators can play critical roles in addressing this stigma, yet little is known about their attitudes. Social work educators were surveyed about their general attitudes about people with mental illnesses, attitudes about practice…
their illness on the one side, and widespread stigma and discrimination on the other. Evidence from North America and paralleling findings from research in Western Europe suggest that stigma and discrimination are major problems in the community, with negative attitudes and behaviour towards people with mental illness ...
Meacham, Elizabeth; Orem, Jackson; Nakigudde, Gertrude; Zujewski, Jo Anne; Rao, Deepa
To understand the role of stigma in the delay of cancer service engagement by women with breast cancer in Kampala, Uganda. Women in Sub-Saharan African countries are twice as likely to die from cancer as women in high-income countries, which is largely attributable to late diagnosis. While breast cancer-related stigma has been identified in Sub-Saharan Africa, limited research focuses on how stigma impacts the behavior of breast cancer patients in Uganda. This qualitative study used a grounded theory approach to examine illness narratives from 20 breast cancer survivors in Uganda, gathered through semistructured interviews. Thematic analysis showed that perceived and internalized stigma associated with breast cancer influenced care engagement throughout illness, delaying engagement and inhibiting treatment completion. Women identified key factors for overcoming stigma including acceptance of diagnosis, social support, and understanding of breast cancer. The growing burden of mortality associated with breast cancer in Uganda can be mitigated by improving early detection and treatment engagement through interventions which account for key psychosocial barriers such as stigma. Copyright © 2016 John Wiley & Sons, Ltd.
Makowski, Anna Christin; Mnich, Eva E; von dem Knesebeck, Olaf
Objectives A better understanding of self-stigma facilitates the development and evaluation of anti-stigma measures. In this study, the Self-Stigma of Depression Scale (SSDS) is applied for the first time in Germany. The focus lies on feasibility and psychometric characteristics of the scale. Methods Data stem from a representative population survey in Germany (N = 2,013). The 16 items of the original SSDS are used to assess anticipated self-stigma in case of depression. Main component analysis is applied to analyze the factor structure. Results The original version of the SDSS could not be replicated in the German sample. Instead of four, three factors emerged in the German version. They are similar to three subscales of the original SSDS: "social inadequacy", "help-seeking inhibition" and "self-blame". The internal reliability of the total scale as well as of the first two subscales is acceptable. Conclusion SSDS is a multidimensional construct and can serve as an important instrument in research regarding self-stigma of depression in Germany. A further development of the German scale is recommended in order to gain greater insight into the nature of (anticipated) depression self-stigma. © Georg Thieme Verlag KG Stuttgart · New York.
Blais, Rebecca K; Renshaw, Keith D
Many U.S. Iraq/Afghanistan-era veterans return from deployment with posttraumatic stress (PTS) symptoms, but few veterans seek psychological help. Research on barriers to care is growing, but the link between stigma and help-seeking is understudied. The present study examined anticipated enacted stigma from military and nonmilitary sources, self-stigma, PTS, perceived likelihood of deploying again, marital status, and history of mental health care engagement as correlates of help-seeking intentions from a mental health professional or medical doctor/advance practice registered nurse (MD/APRN) in a sample of 165 combat veterans. Using structural equation modeling, results demonstrated that self-stigma was negatively associated with help-seeking intentions from a mental health professional and MD/APRN with small-to-medium effect sizes. Being married was positively associated with help-seeking intentions from a mental health professional and MD/APRN with small effect sizes. History of previous mental health care engagement was positively associated with help-seeking intentions from a mental health professional with a medium effect size, but unrelated to help-seeking intentions from a MD/APRN. Anticipated enacted stigma from any source, PTS, and greater perceived likelihood of deploying again were unrelated to help-seeking intentions from a mental health professional and MD/APRN. Implications for interventions aimed at decreasing self-stigma and increasing intention to seek help are discussed. Copyright © 2013 International Society for Traumatic Stress Studies.
Wood, Lisa; Burke, Eilish; Byrne, Rory; Enache, Gabriela; Morrison, Anthony P
Stigma is a significant difficulty for people who experience psychosis. To date, there have been no outcome measures developed to examine stigma exclusively in people with psychosis. The aim of this study was develop and validate a semi-structured interview measure of stigma (SIMS) in psychosis. The SIMS is an eleven item measure of stigma developed in consultation with service users who have experienced psychosis. 79 participants with experience of psychosis were recruited for the purposes of this study. They were administered the SIMS alongside a battery of other relevant outcome measures to examine reliability and validity. A one-factor solution was identified for the SIMS which encompassed all ten rateable items. The measure met all reliability and validity criteria and illustrated good internal consistency, inter-rater reliability, test retest reliability, criterion validity, construct validity, sensitivity to change and had no floor or ceiling effects. The SIMS is a reliable and valid measure of stigma in psychosis. It may be more engaging and acceptable than other stigma measures due to its semi-structured interview format. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.
Wesley, Kimberly M; Zhao, Mimi; Carroll, Yvonne; Porter, Jerlym S
Patients and families affected by various medical conditions report experiencing health-related stigma, which contributes to detrimental physical, psychological, and social outcomes. Sickle cell disease (SCD) is a genetic disorder that affects 89,000 individuals in the United States and is often associated with negative stereotypes and incorrect assumptions. The present study explored the perception of stigma as reported by caregivers of adolescents with SCD. Focus groups were conducted with 20 caregivers of patients with SCD. Focus groups were audio recorded and transcribed. The data were coded independently by two authors, and then reviewed conjointly until consensus was reached. Caregivers reported the perception of stigma in academic, medical, community, and family settings. They also reported internalized stigma including negative feelings toward having a child with SCD, feeling upset with others, and seeing negative emotions in their child due to SCD. Caregivers reported a general lack of knowledge about SCD across settings. These results demonstrated that stigma may affect individuals with SCD across multiple settings. These results also highlighted areas for intervention, with a focus on increasing communication and education toward medical providers, schools, and communities. Interventions can utilize technology, social media, and advertisement campaigns. Additionally, support groups for patients with SCD may help decrease stigma and validate patients' experiences. Copyright © 2016 Elsevier Inc. All rights reserved.
Puhl, Rebecca M; King, Kelly M
Despite significant attention to the medical impacts of obesity, often ignored are the negative outcomes that obese children and adults experience as a result of stigma, bias, and discrimination. Obese individuals are frequently stigmatized because of their weight in many domains of daily life. Research spanning several decades has documented consistent weight bias and stigmatization in employment, health care, schools, the media, and interpersonal relationships. For overweight and obese youth, weight stigmatization translates into pervasive victimization, teasing, and bullying. Multiple adverse outcomes are associated with exposure to weight stigmatization, including depression, anxiety, low self-esteem, body dissatisfaction, suicidal ideation, poor academic performance, lower physical activity, maladaptive eating behaviors, and avoidance of health care. This review summarizes the nature and extent of weight stigmatization against overweight and obese individuals, as well as the resulting consequences that these experiences create for social, psychological, and physical health for children and adults who are targeted. Copyright © 2013 Elsevier Ltd. All rights reserved.
Hargreaves, James R; Sprague, Laurel; Stangl, Anne L; Baral, Stefan D
Background The levels of coverage of human immunodeficiency virus (HIV) treatment and prevention services needed to change the trajectory of the HIV epidemic among key populations, including gay men and other men who have sex with men (MSM) and sex workers, have consistently been shown to be limited by stigma. Objective The aim of this study was to propose an agenda for the goals and approaches of a sexual behavior stigma surveillance effort for key populations, with a focus on collecting surveillance data from 4 groups: (1) members of key population groups themselves (regardless of HIV status), (2) people living with HIV (PLHIV) who are also members of key populations, (3) members of nonkey populations, and (4) health workers. Methods We discuss strengths and weaknesses of measuring multiple different types of stigma including perceived, anticipated, experienced, perpetrated, internalized, and intersecting stigma as measured among key populations themselves, as well as attitudes or beliefs about key populations as measured among other groups. Results With the increasing recognition of the importance of stigma, consistent and validated stigma metrics for key populations are needed to monitor trends and guide immediate action. Evidence-based stigma interventions may ultimately be the key to overcoming the barriers to coverage and retention in life-saving antiretroviral-based HIV prevention and treatment programs for key populations. Conclusions Moving forward necessitates the integration of validated stigma scales in routine HIV surveillance efforts, as well as HIV epidemiologic and intervention studies focused on key populations, as a means of tracking progress toward a more efficient and impactful HIV response. PMID:28446420
Earnshaw, Valerie A; Rosenthal, Lisa; Lang, Shawn M
Evidence demonstrates that HIV stigma undermines the psychological and physical health of people living with HIV (PLWH). Yet, PLWH describe engaging in HIV activism to challenge stigma, and research suggests that individuals may benefit from activism. We examine associations between experiences of HIV stigma and HIV activism, and test whether HIV activists benefit from greater well-being than non-activists. Participants include 93 PLWH recruited from drop-in centers, housing programs, and other organizations providing services to PLWH in the Northeastern USA between 2012 and 2013 (mean age = 50 years; 56% Black, 20% White, 18% Other; 61% non-Latino(a), 39% Latino(a); 59% male, 38% female, 3% transgender; 82% heterosexual, 15% sexual minority). Participants completed a cross-sectional written survey. Results of regression analyses suggest that PLWH who experienced greater enacted stigma engaged in greater HIV activism. Anticipated, internalized, and perceived public stigma, however, were unrelated to HIV activism. Moreover, results of a multivariate analysis of variance suggest that HIV activists reported greater social network integration, greater social well-being, greater engagement in active coping with discrimination, and greater meaning in life than non-activists. Yet, HIV activists also reported somewhat greater depressive symptoms than non-activists, suggesting that the association between HIV activism and well-being is complex. By differentiating between HIV stigma mechanisms, the current study provides a more nuanced understanding of which experiences of HIV stigma may be associated with HIV activism. It further suggests that engagement in activism may offer benefits to PLWH, while raising the possibility that activists could experience greater depressive symptoms than non-activists. Given the preliminary nature of this study, future research should continue to examine these complex associations between HIV stigma, activism, and well-being among PLWH
Aydemir, N; Kaya, B; Yıldız, G; Öztura, I; Baklan, B
The present study aimed to determine the level of felt stigma, overprotection, concealment, and concerns related to epilepsy in different life domains by using culturally-specific scales for Turkish individuals with epilepsy. Also, it aimed to detect relations among the study variables and to determine the variables which predict felt stigma. For this purpose, felt stigma scale, overprotection scale, concealment of epilepsy scale, and concerns of epilepsy scale were administered to two hundred adult persons with epilepsy (PWE). The results showed that almost half of the participants reported felt stigma, overprotection, concealment of epilepsy, concerns related to future occupation, and concerns related to social life. Almost all the study variables show correlations with each other. Concealment of epilepsy, concerns related to social life, and concerns related to future occupation were found as the predictors of felt stigma. Copyright © 2016 Elsevier Inc. All rights reserved.
Erkan Alpsoy; Yeşim Şenol; Aslı Bilgiç Temel; G. Özge Baysal; Ayşe Akman Karakaş
Backround and design. Internalized stigma involves endorsing negative feelings and beliefs such as insignificance, shame and withdrawal triggered by applying these negative stereotypes to one self. Internalized Stigma Scale has not been applied to psoriasis patients. We aimed to evaluate the reliability and validity of Internalized Stigma Scale in psoriasis patients. Materials and Methods. 100 consecutive, volunteer psoriasis patients (48 female, 52 male; aged, 40.59±15.44 years) were enro...
Vilhauer, Ruvanee P
Voice hearing experiences, or auditory verbal hallucinations, occur in healthy individuals as well as in individuals who need clinical care, but news media depict voice hearing primarily as a symptom of mental illness, particularly schizophrenia. This article explores whether, and how, public perception of an exaggerated association between voice hearing and mental illness might influence individuals' need for clinical care. A narrative literature review was conducted, using relevant peer-reviewed research published in the English language. Stigma may prevent disclosure of voice hearing experiences. Non-disclosure can prevent access to sources of normalizing information and lead to isolation, loss of social support and distress. Internalization of stigma and concomitantly decreased self-esteem could potentially affect features of voices such as perceived voice power, controllability, negativity and frequency, as well as distress. Increased distress may result in a decrease in functioning and increased need for clinical care. The literature reviewed suggests that stigma has the potential to increase need for care through many interrelated pathways. However, the ability to draw definitive conclusions was constrained by the designs of the studies reviewed. Further research is needed to confirm the findings of this review.
Full Text Available ObjectiveThe concept of stigma refers to problems of knowledge (ignorance, attitudes (prejudice, and behavior (discrimination. Stigma may hinder access to care, housing, and work. In the context of implementation of programs such as “housing first” or “individual placement and support” in French speaking regions, validated instruments measuring stigma are necessary. “Attitudes to Mental Illness 2011” is a questionnaire that includes three scales measuring stigma through these three dimensions. This study aimed to translate, adapt, and validate these three scales in French.MethodsThe “Attitudes to Mental Illness 2011” questionnaire was translated into French and back-translated into English by an expert. Two hundred and sixty-eight nursing students completed the questionnaire. Content validity, face validity, internal validity, and convergent validity were assessed. Long-term reliability was also estimated over a three-month period.ResultsExperts and participants found that the questionnaire’s content validity and face validity were appropriate. The internal validities of the three scales were also considered adequate. Convergent validity indicated that the scales did indeed measure what they were supposed to. Long-term stability estimates were moderate; this pattern of results suggested that the construct targeted by the three scales is adequately measured but does not necessarily represent stable and enduring traits.ConclusionBecause of their good psychometric properties, these three scales can be used in French, either separately, to measure one specific dimension of stigma, or together, to assess stigma in its three dimensions. This would seem of paramount importance in evaluating campaigns against stigma since it allows measures to be adapted according to campaign goals and the target population.
Rüsch, Nicolas; Zlati, Alina; Black, Georgia; Thornicroft, Graham
Mental disorders are associated with suicidality and with stigma. Many consequences of stigma, such as social isolation, unemployment, hopelessness or stress, are risk factors for suicidality. Research is needed on the link between stigma and suicidality as well as on anti-stigma interventions and their effects on suicidality. Royal College of Psychiatrists.
Robertson, John A
Stigma marks both surrogacy and abortion. Legal change lessens stigma but may not remove it altogether. Post-legalization regulation may reinstall stigma by surrounding a legalized practice with barriers that make exercise of that right more difficult. As a result, law may reenact stigma even as it purports to take it away. © 2015 American Society of Law, Medicine & Ethics, Inc.
Martin, Benjamin A.; Dula, Chris S.
Previous research indicates stigmas can produce feelings of fear, isolation, and discrimination, and that negative stigma has been and still is, associated with tattooing. Due to the rise in tattoo popularity, a method to analyze stigma against tattooed individuals is needed. The Martin Stigma Against Tattoos Survey (MSATS), was created, taken by…
Macintyre, K; Bakker, M I; Bergson, S; Bhavaraju, R; Bond, V; Chikovore, J; Colvin, C; Craig, G M; Cremers, A L; Daftary, A; Engel, N; France, N Ferris; Jaramillo, E; Kimerling, M; Kipp, A; Krishnaratne, S; Mergenthaler, C; Ngicho, M; Redwood, L; Rood, E J J; Sommerland, N; Stangl, A; van Rie, A; van Brakel, W; Wouters, E; Zwerling, A; Mitchell, E M H
Crucial to finding and treating the 4 million tuberculosis (TB) patients currently missed by national TB programmes, TB stigma is receiving well-deserved and long-delayed attention at the global level. However, the ability to measure and evaluate the success of TB stigma-reduction efforts is limited by the need for additional tools. At a 2016 TB stigma-measurement meeting held in The Hague, The Netherlands, stigma experts discussed and proposed a research agenda around four themes: 1) drivers: what are the main drivers and domains of TB stigma(s)?; 2) consequences: how consequential are TB stigmas and how are negative impacts most felt?; 3) burden: what is the global prevalence and distribution of TB stigma(s) and what explains any variation? 4): intervention: what can be done to reduce the extent and impact of TB stigma(s)? Each theme was further subdivided into research topics to be addressed to move the agenda forward. These include greater clarity on what causes TB stigmas to emerge and thrive, the difficulty of measuring the complexity of stigma, and the improbability of a universal stigma 'cure'. Nevertheless, these challenges should not hinder investments in the measurement and reduction of TB stigma. We believe it is time to focus on how, and not whether, the global community should measure and reduce TB stigma.
Butler-Barnes, Sheretta T; Martin, Pamela P; Hope, Elan C; Copeland-Linder, Nikeea; Lawrence Scott, Marquisha
This study examined how having a relationship with God served as a protective factor between racial stigma beliefs and psychological well-being. A church sample of African American adolescent girls (N = 117, M age = 15) completed measures on racial stigma, psychological well-being, and reports on having a relationship with God. After controlling for adolescent age, family income, and church attendance, positive racial beliefs and having a relationship with God were associated with a healthier psychological well-being. Findings also revealed that having a relationship with God and internalizing healthier racial beliefs were associated with a healthier psychological well-being, whereas reporting higher levels of having a relationship with God served as a protective factor for African American girls when internalizing moderate levels of racial stigma. Overall, results suggest that having a relationship with God can serve as a coping mechanism and promote a healthier psychological well-being for African American adolescent girls.
Parfene, Cristina; Stewart, Tracie L; King, Tricia Z
In the first experimental study of epilepsy-based discrimination in the workplace, we examined the influence of stigmatization on the workplace outcomes of hypothetical employees who were associated with epilepsy, but who did not have epilepsy themselves (stigma by association). Participants (40 women, 16 men), acting as employers, evaluated one of six randomly assigned employee work portfolios that were identical except that the employee was either male or female and had taken leave during the past year to care for a child with either epilepsy or asthma, or for whom no leave was mentioned. They then evaluated the employee and made recommendations concerning the employee's workplace rewards (promotion, raise) and penalties (job termination). Work quality evaluation was similar across conditions. However, parents of a child with epilepsy received fewer workplace rewards and greater workplace penalties than did employees in the other conditions. Implications for mental health and antibias interventions are discussed.
Omori, Yoshimi; Mori, Chizuru; White, Ann H
This study aimed to clarify the phenomenon and definition of self-stigma in schizophrenia. Self-stigma in schizophrenia affects patients' well-being and attitudes to treatment. Although stigma and self-stigma have interactive and different characteristics, theses definitions are not clearly distinguished. Mental illnesses may have different stereotypes but are treated equally in some studies. Lack of awareness of illness is a common feature in schizophrenia but has not been focused in self-stigma studies. Further studies are needed to clarify the phenomenon of self-stigma in people with schizophrenia and to develop interventions targeted at reducing self-stigma. © 2014 Wiley Periodicals, Inc.
Full Text Available Introduction: A deaf child creates a feeling of stigma in many hearing parents. Stigma in mothers can have a negative impact on a child’s treatment and rehabilitation process. Therefore, this study was conducted to evaluate the extent of stigma in mothers with deaf children. Materials and Methods: This descriptive, cross-sectional study was conducted in 2013 among 90 mothers with deaf children. The data-collection instrument included the stigma scale in the mothers of children with disabilities. The reliability and validity of the instrument were confirmed through content validity and Cronbach’s alpha coefficient (α=86%, respectively. Data were analyzed using SPSS-15 software. Results: Results showed that most mothers suffer from stigma due to having a deaf child. The mean stigma score was 96.48 ±27.72. In total, 24.4% of mothers reported that they had received strange and mocking looks; 72.2% regarded child deafness as a sign of divine retribution; and 33.3% felt ashamed of their child’s deafness. There was an inverse relationship between the mother’s level of education and mean stigma scores (P
Burt, S. Alexandra; O’Connor, Shannon; Thompson, J. Kevin; Klump, Kelly L.
Affiliation with weight conscious peer groups is theorized to increase thin-ideal internalization through socialization processes. However, selection effects could contribute if genetic and/or environmental predispositions lead to affiliation with weight conscious peers. Co-twin control methodology was used to examine socialization and selection effects in 614 female twins (ages 8–15) from the Michigan State University Twin Registry (MSUTR). Thin-ideal internalization and peer group characteristics were assessed via self-report questionnaires. Results suggested the presence of both socialization and selection effects. In terms of socialization, twins who reported increased exposure to weight conscious peers relative to their co-twins had elevated thin-ideal internalization scores, regardless of zygosity. However, associations between weight conscious peers and thin-ideal internationalization within twin pairs were attenuated, suggesting that genetic and shared environmental selection effects also contribute. Findings significantly extend previous work by confirming the presence of socialization processes and highlighting selection processes to be examined in future longitudinal research. PMID:26859605
Earnshaw, Valerie; Smith, Laramie; Copenhaver, Michael
Experiences of stigma from others among people with a history of drug addiction are understudied in comparison to the strength of stigma associated with drug addiction. Work that has studied these experiences has primarily focused on stigma experienced from healthcare workers specifically even though stigma is often experienced from other sources…
Lewis, Sophie; Thomas, Samantha L; Hyde, Jim; Castle, David J; Komesaroff, Paul A
To investigate obese men's health behaviors and strategies for change. Qualitative interviews with 36 men (BMI 30 and over). All men felt personally responsible for their weight gain. Sedentary lifestyles, stress, lack of worklife balance and weight-based stigma were all significant causes of weight gain and barriers to weight loss. These factors also contributed to men's unwillingness to seek help for their over-weight. Addressing the self-blame and stigma associated with obesity is important in developing strategies to improve the health and well-being of obese men.
Results: Results showed that most mothers suffer from stigma due to having a deaf child. The mean stigma score was 96.48 ±27.72. In total, 24.4% of mothers reported that they had received strange and mocking looks; 72.2% regarded child deafness as a sign of divine retribution; and 33.3% felt ashamed of their child’s deafness. There was an inverse relationship between the mother’s level of education and mean stigma scores (P
The purpose of this study was to determine whether siblings of people with Down syndrome face courtesy stigma, a stigma acquired as a result of an association with a person from a stigmatized group. The central hypothesis was that the majority of people who have a sibling with Down syndrome face courtesy stigma during both adolescence and adulthood. The data supports this hypothesis, showing that 76% of respondents reported courtesy stigma as adolescents and 62% reported courtesy stigma as ad...
Barker, David H; Swenson, Rebecca R; Brown, Larry K; Stanton, Bonita F; Vanable, Peter A; Carey, Michael P; Valois, Robert F; Diclemente, Ralph J; Salazar, Laura F; Romer, Daniel
HIV-related stigma has been shown to impede HIV-antibody testing and safer sexual practices in adults. Less is known about its effects on prevention programs among at-risk youth. This study examined the longitudinal relationships between HIV-stigma and HIV-knowledge following completion of a validated group-based intervention. Data were provided by 1,654 African-American adolescents who participated in a large multi-city prevention trial (Project iMPACCS). Participants were randomly assigned to an empirically-validated skill-based intervention or a general health promotion control group. Both stigma and knowledge were assessed at baseline and post-intervention. Results suggested that adolescents participating in the intervention showed improvements in knowledge and decreases in stigma when compared to controls. Improvements in stigma appeared to be partly driven by improvements in knowledge. Higher baseline stigma was shown to reduce gains in knowledge in both the treatment and control groups. Results suggest that HIV-stigma can interfere with how youth identify with and internalize messages from group-based prevention trials.
Jen Lee Teh
Full Text Available People with mental illness (PWMI often internalise negative beliefs (self-stigma or anticipate external sources of stigma (perceived stigma. This study examines how the two types of stigma affect the willingness to communicate for help – such communication is a vital aspect of good patient care and treatment outcome. Seventy-two participants from different ethnic backgrounds who had experienced mental illness responded to an online survey about their level of agreement with statements reflecting self- and perceived stigma and their willingness to disclose to various help sources. Face-to-face interviews with 17 of these respondents provided a deeper understanding of how stigma affected their help-seeking communication. The quantitative results seemed to suggest that self-stigma has a stronger negative correlation with willingness to seek help. Respondents preferred disclosing to friends above family members and health professionals. The results highlight the importance of building resilience to reduce self-stigma and thereby increase help seeking. Given the different ethnic backgrounds of the participants, there emerged some multicultural issues that would seem to contribute to persisting mental illness stigma. These and any cultural differences are discussed.
Gaddis, S Michael; Ramirez, Daniel; Hernandez, Erik L
Scholars suggest that public mental health stigma operates at a meso-level and is associated with severity of symptoms, disclosure, self-esteem, and treatment-seeking behavior. However, the operationalization of public stigma nearly always comes from an individual-level generalization of what others believe. Using data from over 60,000 students on 75 U.S. college and university campuses between 2009 and 2015, we contextualize public stigma by creating a school-level measure of students' individual-level endorsed mental health treatment stigma. We present multilevel logistic regression models for 21 different dependent variables. We find that even after controlling for individual-level stigma scores, school-level stigma is negatively associated with self-reports of suicidal ideation and self-injury, although not associated with screens for depression or anxiety. Moreover, school-level stigma is negatively associated with medication use, counseling and therapy visits, and to a lesser degree, informal support. We suggest that future research should continue to examine the contextual environment of public stigma, while policymakers may be able to implement changes to significantly reduce stigma at this level. Copyright © 2017 Elsevier Ltd. All rights reserved.
Hing, Nerilee; Russell, Alex M T; Gainsbury, Sally M; Nuske, Elaine
Problem gambling attracts considerable public stigma, with deleterious effects on mental health and use of healthcare services amongst those affected. However, no research has examined the extent of stigma towards problem gambling within the general population. This study aimed to examine the stigma-related dimensions of problem gambling as perceived by the general public compared to other health conditions, and determine whether the publicly perceived dimensions of problem gambling predict its stigmatisation. A sample of 2000 Australian adults was surveyed, weighted to be representative of the state population by gender, age and location. Based on vignettes, the online survey measured perceived origin, peril, concealability, course and disruptiveness of problem gambling and four other health conditions, and desired social distance from each. Problem gambling was perceived as caused mainly by stressful life circumstances, and highly disruptive, recoverable and noticeable, but not particularly perilous. Respondents stigmatised problem gambling more than sub-clinical distress and recreational gambling, but less than alcohol use disorder and schizophrenia. Predictors of stronger stigma towards problem gambling were perceptions it is caused by bad character, is perilous, non-recoverable, disruptive and noticeable, but not due to stressful life circumstances, genetic/inherited problem, or chemical imbalance in the brain. This new foundational knowledge can advance understanding and reduction of problem gambling stigma through countering inaccurate perceptions that problem gambling is caused by bad character, that people with gambling problems are likely to be violent to other people, and that people cannot recover from problem gambling.
Pedersen, Eric R.; Paves, Andrew P.
Perceived public stigma regarding seeking mental health treatment seeking can be a barrier to accessing services for young adults. While factors associating with personal stigma regarding how one would view and treat others have been identified, the discrepancies between perceived and personal stigma has received less research attention. We designed the current study to expand on previous research and examine the discrepancies between perceived public stigma and personal stigma among a sample...
Full Text Available Michaela Holubova,1,2 Jan Prasko,1 Radovan Hruby,3 Klara Latalova,1 Dana Kamaradova,1 Marketa Marackova,1 Milos Slepecky,4 Terezia Gubova2 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacký University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic; 2Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic; 3Private Psychiatric Practice, Martin, Slovak Republic; 4Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, Slovak Republic Background: Maladaptive coping strategies may adversely disturb the overall functioning of people with mental disorders. Also, self-stigma is considered a maladaptive psychosocial phenomenon that can affect many areas of patient life. It has a negative impact on self-image, and may lead to dysphoria, social isolation, reduced adherence, using of negative coping strategies, and lower quality of life. The objective of this study was to determine the relationship between coping strategies and self-stigma among persons with schizophrenia and related psychotic disorders.Subjects and methods: A total of 104 clinically stable outpatients with chronic schizophrenia-spectrum disorders were enrolled in a cross-sectional study. Sociodemographic and clinical data were recorded. Patients were examined by psychiatrists with the Stress Coping Style Questionnaire, the Internalized Stigma of Mental Illness scale, and the Clinical Global Impression scale. Correlation and multiple-regression analyses were performed to discover contributing factors to self-stigma.Results: Positive coping strategies were used by patients with schizophrenia-spectrum disorders to the same extent as in the healthy population. Negative coping strategies were overused by these patients. There were significant associations between self-stigma, severity of the disorder, and coping strategies in schizophrenia. The ability to use positive coping
Psychometric properties of a Chinese version of the Stigma Scale: examining the complex experience of stigma and its relationship with self-esteem and depression among people living with mental illness in Hong Kong.
Ho, Andy H Y; Potash, Jordan S; Fong, Ted C T; Ho, Vania F L; Chen, Eric Y H; Lau, Robert H W; Au Yeung, Friendly S W; Ho, Rainbow T H
Stigma of mental illness is a global public health concern, but there lacks a standardized and cross-culturally validated instrument for assessing the complex experience of stigma among people living with mental illness (PLMI) in the Chinese context. This study examines the psychometric properties of a Chinese version of the Stigma Scale (CSS), and explores the relationships between stigma, self-esteem and depression. A cross-sectional survey was conducted with a community sample of 114 Chinese PLMI in Hong Kong. Participants completed the CSS, the Chinese Self-Stigma of Mental Illness Scale, the Chinese Rosenberg Self-Esteem Scale, and the Chinese Patient Health Questionnaire-9. An exploratory factor analysis was conducted to identify the underlying factors of the CSS; concurrent validity assessment was performed via correlation analysis. The original 28-item three-factor structure of the Stigma Scale was found to be a poor fit to the data, whereas a revised 14-item three-factor model provided a good fit with all 14 items loaded significantly onto the original factors: discrimination, disclosure and positive aspects of mental illness. The revised model also displayed moderate to good internal consistency and good construct validity. Further findings revealed that the total stigma scale score and all three of its subscale scores correlated negatively with self-esteem; but only total stigma, discrimination and disclosure correlated positively with depression. The CSS is a short and user-friendly self-administrated questionnaire that proves valuable for understanding the multifaceted stigma experiences among PLMI as well as their impact on psychiatric recovery and community integration in Chinese communities. Copyright © 2014 Elsevier Inc. All rights reserved.
Ebrahimi, Hossein; Mohammadi, Eissa; Mohammadi, Mohammad Ali; Pirzadeh, Akbar; Mahmoudi, Hamzeh; Ansari, Ismail
A deaf child creates a feeling of stigma in many hearing parents. Stigma in mothers can have a negative impact on a child's treatment and rehabilitation process. Therefore, this study was conducted to evaluate the extent of stigma in mothers with deaf children. This descriptive, cross-sectional study was conducted in 2013 among 90 mothers with deaf children. The data-collection instrument included the stigma scale in the mothers of children with disabilities. The reliability and validity of the instrument were confirmed through content validity and Cronbach's alpha coefficient (α=86%), respectively. Data were analyzed using SPSS-15 software. Results showed that most mothers suffer from stigma due to having a deaf child. The mean stigma score was 96.48 ±27.72. In total, 24.4% of mothers reported that they had received strange and mocking looks; 72.2% regarded child deafness as a sign of divine retribution; and 33.3% felt ashamed of their child's deafness. There was an inverse relationship between the mother's level of education and mean stigma scores (P<0.033). The stigma score was higher in mothers who were living independently of their relatives (P<0.029). The mean stigma score in mothers of children with a cochlear implant was lower than that of mothers of children with earphones (86.70 vs. 99.64), and this difference tended towards significance (P=0.057). This study showed that half of all mothers with deaf children were scorned and felt ashamed of having a deaf child in the family because of the stigma. The majority of mothers with deaf children felt stigmatized, and only their education and residency status affected this issue. The mothers of cochlear-implanted children perceived less stigma. Due to the various social and psychological problems caused by hearing impairment, it is necessary to consider the emotional health and psychological state of the mothers in addition to rehabilitation programs and standard services for the children themselves.
Holzemer, William L; Uys, Leana R; Chirwa, Maureen L; Greeff, Minrie; Makoae, Lucia N; Kohi, Thecla W; Dlamini, Priscilla S; Stewart, Anita L; Mullan, Joseph; Phetlhu, René D; Wantland, Dean; Durrheim, Kevin
This article describes the development and testing of a quantitative measure of HIV/AIDS stigma as experienced by people living with HIV/AIDS. This instrument is designed to measure perceived stigma, create a baseline from which to measure changes in stigma over time, and track potential progress towards reducing stigma. It was developed in three phases from 2003-2006: generating items based on results of focus group discussions; pilot testing and reducing the original list of items; and validating the instrument. Data for all phases were collected from five African countries: Lesotho, Malawi, South Africa, Swaziland and Tanzania. The instrument was validated with a sample of 1,477 persons living with HIV/AIDS from all of the five countries. The sample had a mean age of 36.1 years and 74.1% was female. The participants reported they knew they were HIV positive for an average of 3.4 years and 46% of the sample was taking antiretroviral medications. A six factor solution with 33 items explained 60.72% of the variance. Scale alpha reliabilities were examined and items that did not contribute to scale reliability were dropped. The factors included: Verbal Abuse (8 items, alpha=0.886); Negative Self-Perception (5 items, alpha=0.906); Health Care Neglect (7 items, alpha=0.832); Social Isolation (5 items, alpha=0.890); Fear of Contagion (6 items, alpha=0.795); and Workplace Stigma (2 items, alpha=0.758). This article reports on the development and validation of a new measure of stigma, HIV/AIDS Stigma Instrument - PLWA (HASI-P) providing evidence that supports adequate content and construct validity, modest concurrent validity, and acceptable internal consistency reliability for each of the six subscales and total score. The scale is available is several African languages.
Background The stigma of mental illness among medical students is a prevalent concern that has far reaching negative consequences. Attempts to combat this stigma through educational initiatives have had mixed results. This study examined the impact of a one-time contact-based educational intervention on the stigma of mental illness among medical students and compared this with a multimodal undergraduate psychiatry course at the University of Calgary, Canada that integrates contact-based educational strategies. Attitudes towards mental illness were compared with those towards type 2 diabetes mellitus (T2DM). Method A cluster-randomized trial design was used to evaluate the impact of contact-based educational interventions delivered at two points in time. The impact was assessed by collecting data at 4 time points using the Opening Minds Scale for Health Care Providers (OMS-HC) to assess changes in stigma. Results Baseline surveys were completed by 62% (n=111) of students before the start of the course and post-intervention ratings were available from 90 of these. Stigma scores for both groups were significantly reduced upon course completion (p mental illness and interest in a psychiatric career was increased at the end of the course. Stigma towards mental illness remained greater than for T2DM at all time points. Conclusions Psychiatric education can decrease the stigma of mental illness and increase student confidence. However, one-time, contact-based educational interventions require further evaluation in this context. The key components are postulated to be contact, knowledge and attention to process, where attending to the student’s internal experience of working with people with mental illness is an integral factor in modulating perceptions of mental illness and a psychiatric career. PMID:24156397
Whitehead, J; Shaver, John; Stephenson, Rob
Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and "outness," and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals' demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients' disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.
Papish, Andriyka; Kassam, Aliya; Modgill, Geeta; Vaz, Gina; Zanussi, Lauren; Patten, Scott
The stigma of mental illness among medical students is a prevalent concern that has far reaching negative consequences. Attempts to combat this stigma through educational initiatives have had mixed results. This study examined the impact of a one-time contact-based educational intervention on the stigma of mental illness among medical students and compared this with a multimodal undergraduate psychiatry course at the University of Calgary, Canada that integrates contact-based educational strategies. Attitudes towards mental illness were compared with those towards type 2 diabetes mellitus (T2DM). A cluster-randomized trial design was used to evaluate the impact of contact-based educational interventions delivered at two points in time. The impact was assessed by collecting data at 4 time points using the Opening Minds Scale for Health Care Providers (OMS-HC) to assess changes in stigma. Baseline surveys were completed by 62% (n=111) of students before the start of the course and post-intervention ratings were available from 90 of these. Stigma scores for both groups were significantly reduced upon course completion (p mental illness and interest in a psychiatric career was increased at the end of the course. Stigma towards mental illness remained greater than for T2DM at all time points. Psychiatric education can decrease the stigma of mental illness and increase student confidence. However, one-time, contact-based educational interventions require further evaluation in this context. The key components are postulated to be contact, knowledge and attention to process, where attending to the student's internal experience of working with people with mental illness is an integral factor in modulating perceptions of mental illness and a psychiatric career.
To report on the analysis of the concept of the stigma of mental illness within the Haitian American community. Mental illness is a highly stigmatized condition within certain communities making it challenging for individuals to seek effective treatment. The consequences of such stigma can have lifelong corollaries for the individuals, the families and the communities. The concept of stigma is not fully developed in nursing; clarity of the concept of stigma of mental illness is still needed in the nursing literature. In order to assist patients in accessing mental health services, the concept of stigma must first be clarified. The method used for this concept analysis was that of Walker and Avant. Five attributes were identified, creating the following definition: labelling, stereotype, negative attitude, emotional response, and discrimination. The antecedents for stigma of mental illness are lack of knowledge about mental illness, emotional state and cultural beliefs and values. The origins of stigmatization of mental illness among Haitian Americans need to be understood. Mental health illnesses are stigmatized within the Haitian culture, which presents as a barrier to accessing help for many Haitian American women suffering from mental illness. The defining attributes can be used to develop tools to help clinicians identify patients being stigmatized. Once stigma is recognized, nurses can develop strategies and policies that can mitigate the effects of stigmatization of mental illness among this patient population. Further research is essential to examine the ways in which this concept impacts the Haitian American community, as well as effective strategies to help minimize its effects. © 2016 International Council of Nurses.
Full Text Available Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers.LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and "outness," and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals' demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas.Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men.The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients' disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.
Whitehead, J.; Shaver, John; Stephenson, Rob
Background Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. Methodology LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Results Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. Conclusions The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas. PMID:26731405
Yadavaia, James E.; Hayes, Steven C.
This study evaluated the effectiveness of 6 to 10 sessions of Acceptance and Commitment Therapy (ACT) for self-stigma around sexual orientation linked to same-sex attraction (what has generally been referred to as internalized homophobia; IH) in a concurrent multiple-baseline across-participants design. Three men and 2 women showed sizeable…
This paper begins by highlighting the disadvantage that EAL (English as an Additional Language) writers experience in international publishing. It then explores Goffman's (1959, 1968) ideas on stigma and illustrates how, subject to certain caveats, what he has to say provides important insights into understanding the situation of EAL scholars.…
Cheon, Bobby K.; Chiao, Joan Y.
Culture shapes how individuals perceive and respond to others with mental illness. Prior studies have suggested that Asians and Asian Americans typically endorse greater stigma of mental illness compared to Westerners (White Europeans and Americans). However, whether these differences in stigma arise from cultural variations in automatic affective reactions or deliberative concerns of the appropriateness of one’s reactions to mental illness remains unknown. Here we compared implicit and expli...
Goldenberg, Tamar; Vansia, Dhrutika; Stephenson, Rob
suggest that there is a need to address intragroup stigma within MSM communities. The representation of biases and intragroup stigma on Craigslist may result from internalized stigma among MSM while also perpetuating further internalization of stigma for men who read the sex ads. Understanding patterns in the perpetuation of intragroup stigma can help to better target messages aimed at making cultural and behavioral shifts in the perpetration of intragroup stigma within MSM communities.
Thayyil, Sudhin; Schievano, Silvia; Robertson, Nicola J.; Jones, Rodney; Chitty, Lyn S.; Sebire, Neil J.; Taylor, Andrew M.
Magnetic resonance (MR) imaging allows minimally invasive autopsy, especially when consent is declined for traditional autopsy. Estimation of individual visceral organ weights is an important component of traditional autopsy. Objective: To examine whether a semi-automated can be used for non-invasive internal organ weight measurement using post-mortem MR imaging in fetuses, newborns and children. Methods: Phase 1: In vitro scanning of 36 animal organs (heart, liver, kidneys) was performed to check the accuracy of volume reconstruction methodology. Real volumes were measured by water displacement method. Phase 2: Sixty-five whole body post-mortem MR scans were performed in fetuses (n = 30), newborns (n = 5) and children (n = 30) at 1.5 T using a 3D TSE T2-weighted sequence. These data were analysed offline using the image processing software Mimics 11.0. Results: Phase 1: Mean difference (S.D.) between estimated and actual volumes were -0.3 (1.5) ml for kidney, -0.7 (1.3) ml for heart, -1.7 (3.6) ml for liver in animal experiments. Phase 2: In fetuses, newborns and children mean differences between estimated and actual weights (S.D.) were -0.6 (4.9) g for liver, -5.1 (1.2) g for spleen, -0.3 (0.6) g for adrenals, 0.4 (1.6) g for thymus, 0.9 (2.5) g for heart, -0.7 (2.4) g for kidneys and 2.7 (14) g for lungs. Excellent co-correlation was noted for estimated and actual weights (r 2 = 0.99, p < 0.001). Accuracy was lower when fetuses were less than 20 weeks or less than 300 g. Conclusion: Rapid, accurate and reproducible estimation of solid internal organ weights is feasible using the semi-automated 3D volume reconstruction method.
Full Text Available Mental illness stigma has been the focus of increasing attention in the past few years, with an exponential increase in scientific publications on the subject. This phenomenon is a source of suffering for the patient undermining the achievement of personal goals and full social integration. In this article, the authors present a selective review of the literature on mental illness stigma, going through its definition, origins, repercussions, patients’ subjective experiences and strategies to challenge stigma. The literature presents stigma as being a complex phenomenon, whose definitions derive from different epis- temological roots (sociology, psychology and psychiatry. Its impact on the lives of people with a mental illness is well acknowledged and seems to translate into decreased opportunities, loss of self-esteem and self-concept, decreased quality of life, social support and empowerment, thus limiting the adoption or performance of regular social roles. Stigma has also been shown to compromise access to health care, not only psychiatric treatment but also general medical care, thus increasing the morbidity and mortality in this vulnerable population. A considerable amount of effort has been put into the comprehension of this phenomenon and to designing strategies for fighting stigma, which also include promoting health-care professionals’ awareness of the topic in order to improve clinical practice and global quality of care.
Full Text Available Introduction and Context: Stigma associated with psychiatric disorders and few somatic disorders such as sexually transmitted diseases (STDs, tuberculosis and leprosy, adversely effects treatment seeking behavior, leads to concealment, and poor compliance with treatment. In busy outpatient departments (OPDs, the issue of stigma is likely to be overlooked. Materials and Methods: We carried out a cross-sectional study collecting data on an 8-item stigma scale from patients attending psychiatry and other OPDs of a Tertiary Care Teaching Hospital in an industrial township. Information was collected by face to face interview from 400 patients attending psychiatry OPD and 401 patients attending other OPDs. Validations of the scale were done by face, content, and construct validity. Reliability was appraised by Cronbach′s alpha and Guttmann split-half coefficients. Significant differences in answers to the 8-item questionnaire were explored by Chi-square test for individual responses and Kruskal-Wallis test for difference in total stigma score. Results: Patients attending psychiatry OPD consistently gave responses indicating a greater degree of perceived stigma than those attending OPD for somatic disorders. This difference was almost 3-4 times more on most of the items (P < 0.001. Among somatic disorders, stigma was highest (even higher than psychiatric disorders among STDs, tuberculosis and leprosy patients among these and psychiatric disorders the score was almost 3 times more compared to other somatic disorders (P < 0.001. The scale demonstrated good face, content, and construct validity. Reliability was also very high with Cronbach′s alpha coefficient and Guttmann split-half reliability coefficient 0.932 and 0.901 indicating very good internal consistency of the 8-item scale. Conclusion: Stigma was higher among STD patients, tuberculosis, leprosy, and psychiatry patients as compared to patients suffering from somatic disorders. Assessment of
Shamos, Sara; Hartwig, Kari A; Zindela, Nomsa
To explore how gender differentially affects the stigma experiences of people living with HIV (PLHIV) in Swaziland, the extent and dimensions of HIV-related felt and enacted stigma and social support were analyzed. Thirty-seven semistructured, face-to-face interviews were conducted with PLHIV in Swaziland between 2004 and 2006. Through the process of conceptual analysis, themes, including felt stigma, information management, enacted stigma, and social support, were explored, coded, and analyzed in the contexts of partner and familial relationships, and workplace and neighborhood settings. Findings revealed that there were high levels of felt stigma in all contexts, yet fewer than anticipated accounts of enacted stigma in family, work, and neighborhood contexts compared to their expressions of felt stigma. The amount and characteristics of felt and enacted stigma and social support differed based on gender, as women often experienced more felt and enacted stigma than men, and had less definite financial or emotional support.
Kalichman, Seth; Katner, Harold; Banas, Ellen; Kalichman, Moira
AIDS stigmas delay HIV diagnosis, interfere with health care, and contribute to mental health problems among people living with HIV. While there are few studies of the geographical distribution of AIDS stigma, research suggests that AIDS stigmas are differentially experienced in rural and urban areas. We conducted computerized interviews with 696 men and women living with HIV in 113 different zip code areas that were classified as large-urban, small-urban, and rural areas in a southeast US state with high-HIV prevalence. Analyses conducted at the individual level (N = 696) accounting for clustering at the zip code level showed that internalized AIDS-related stigma (e.g., the sense of being inferior to others because of HIV) was experienced with greater magnitude in less densely populated communities. Multilevel models indicated that after adjusting for potential confounding factors, rural communities reported greater internalized AIDS-related stigma compared to large-urban areas and that small-urban areas indicated greater experiences of enacted stigma (e.g., discrimination) than large-urban areas. The associations between anticipated AIDS-related stigma (e.g., expecting discrimination) and population density at the community-level were not significant. Results suggest that people living in rural and small-urban settings experience greater AIDS-related internalized and enacted stigma than their counterparts living in large-urban centers. Research is needed to determine whether low-density population areas contribute to or are sought out by people who experienced greater AIDS-related stigma. Regardless of causal directions, interventions are needed to address AIDS-related stigma, especially among people in sparsely populated areas with limited resources.
Oliveira, Sandra E H; Esteves, Francisco; Carvalho, Helena
Some mental illnesses and certain mental health care environments can be severely stigmatizing, which seems to be related to decreased self-esteem and a deterioration of the quality of social relationships for people with mental illness. This study aims to identify clinical profiles characterized by clinical diagnoses more strongly associated with the treatment settings and related to internalized stigma, self-esteem and satisfaction with social relationships. It also aimed to analyze associations between clinical profiles and socio-demographic indicators. Multiple correspondence analysis and cluster analysis were performed on a sample of 261 individuals with schizophrenia and mood disorders, from hospital-based and community-based facilities. MCA showed four distinct clinical profiles allowing a differentiation among levels of: internalized stigma, social relationship satisfaction and self-esteem. Overall, results revealed that internalized stigma remains a pervasive problem for some people with schizophrenia and mood disorders. Particularly, internalized stigma and social relationships dissatisfaction and associated socio-demographic indicators appear to be a risk factor for social isolation for individuals with schizophrenia, which may worsen the course of the disorder. Our findings highlight the importance to develop structured interventions aimed to reduce internalized stigma, and exclusion of those who suffer the loss of their social roles and networks. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Hüls, Anke; Ickstadt, Katja; Schikowski, Tamara; Krämer, Ursula
For the analysis of gene-environment (GxE) interactions commonly single nucleotide polymorphisms (SNPs) are used to characterize genetic susceptibility, an approach that mostly lacks power and has poor reproducibility. One promising approach to overcome this problem might be the use of weighted genetic risk scores (GRS), which are defined as weighted sums of risk alleles of gene variants. The gold-standard is to use external weights from published meta-analyses. In this study, we used internal weights from the marginal genetic effects of the SNPs estimated by a multivariate elastic net regression and thereby provided a method that can be used if there are no external weights available. We conducted a simulation study for the detection of GxE interactions and compared power and type I error of single SNPs analyses with Bonferroni correction and corresponding analysis with unweighted and our weighted GRS approach in scenarios with six risk SNPs and an increasing number of highly correlated (up to 210) and noise SNPs (up to 840). Applying weighted GRS increased the power enormously in comparison to the common single SNPs approach (e.g. 94.2% vs. 35.4%, respectively, to detect a weak interaction with an OR ≈ 1.04 for six uncorrelated risk SNPs and n = 700 with a well-controlled type I error). Furthermore, weighted GRS outperformed the unweighted GRS, in particular in the presence of SNPs without any effect on the phenotype (e.g. 90.1% vs. 43.9%, respectively, when 20 noise SNPs were added to the six risk SNPs). This outperforming of the weighted GRS was confirmed in a real data application on lung inflammation in the SALIA cohort (n = 402). However, in scenarios with a high number of noise SNPs (>200 vs. 6 risk SNPs), larger sample sizes are needed to avoid an increased type I error, whereas a high number of correlated SNPs can be handled even in small samples (e.g. n = 400). In conclusion, weighted GRS with weights from the marginal genetic effects of the
Almohanna, Amal; Conforti, Frank; Eigel, William; Barbeau, William
Objective: This study was conducted to determine the impact of dietary acculturation on the health status of newly arrived international students at Virginia Tech in Fall 2010. Participants: Thirty-five international students, 18-36 years of age, completed the study. Methods: Data were collected at 3 different time periods (V1, V2, and V3)…
Loh, Morrison N; Kirsch, Louise; Rothwell, John C; Lemon, Roger N; Davare, Marco
When grasping and lifting different objects, visual cues and previously acquired knowledge enable us to prepare the upcoming grasp by scaling the fingertip forces according to the actual weight of the object. However, when no visual information is available, the weight of the object has to be predicted based on information learned from previous grasps. Here, we investigated how changes in corticospinal excitability (CSE) and grip force scaling depend on the presence of visual cues and the weight of previously lifted objects. CSE was assessed by delivering transcranial magnetic stimulation (TMS) at different times before grasp of the object. In conditions in which visual information was not provided, the size of motor evoked potentials (MEP) was larger when the object lifted was preceded by a heavy relative to a light object. Interestingly, the previous lift also affected MEP amplitude when visual cues about object weight were available but only in the period immediately after object presentation (50 ms); this effect had already declined for TMS delivered 150 ms after presentation. In a second experiment, we demonstrated that these CSE changes are used by the motor system to scale grip force. This suggests that the corticospinal system stores a "sensorimotor memory" of the grasp of different objects and relies on this memory when no visual cues are present. Moreover, visual information about weight interacts with this stored representation and allows the corticospinal system to switch rapidly to a different model of predictive grasp control.
Loh, Morrison N; Kirsch, Louise; Rothwell, John C; Lemon, Roger N; Davare, Marco
When grasping and lifting different objects, visual cues and previously acquired knowledge enable us to prepare the upcoming grasp by scaling the fingertip forces according to the actual weight of the object. However, when no visual information is available, the object’s weight has to be predicted based on information learned from previous grasps. Here, we investigated changes in corticospinal excitability (CSE) and grip force scaling depending on the presence of visual cues and the weight of previously lifted objects. CSE was assessed by delivering transcranial magnetic stimulation (TMS) at different times before grasp of the object. In conditions where visual information was not provided, the size of motor evoked potentials (MEP) was larger when the object lifted was preceded by a heavy relative to a light object. Interestingly, the previous lift also affected MEP amplitude when visual cues about object weight were available, but only in the period immediately after (50 ms) object presentation; this effect had already declined for TMS delivered 150 ms after presentation. In a second experiment, we demonstrated that these CSE changes are used by the motor system to scale grip force. This suggests that the corticospinal system stores a ‘sensorimotor memory’ of the grasp of different objects and relies on this memory when no visual cues are present. Moreover, visual information about weight interacts with this stored representation and allows the corticospinal system to switch rapidly to a different model of predictive grasp control. PMID:20484640
Pescosolido, Bernice A; Martin, Jack K; Olafsdottir, Sigrun; Long, J Scott; Kafadar, Karen; Medina, Tait R
The WHO's International Studies of Schizophrenia conclude that schizophrenia may have a more benign course in "developing" societies than in the West. The authors focus on this finding's most common corollary: cultural schemata are shaped by the transition from agrarian to industrial society. Developing societies are viewed as traditional, gemeinschaft cultures lacking the stigmatizing beliefs about persons with mental illness held in modern, gesellschaft cultures of developed societies. The Stigma in Global Context-Mental Health Study formalized the cultural myth of public stigma (CMPS) with propositions linking level of development to intolerant, exclusionary, and individualistic attitudes. In 17 countries, the authors find no support for the corollary; where support is found, the findings are opposite expectations, with developed societies reporting lower stigma levels. Reconceptualizing of the cultural landscape on more specific dimensions also produces null or contrary findings. This correction to nostalgic myths of cultural context in developing societies thwarts misguided treatment, policy, and stigma-reduction efforts.
Full Text Available Congenital deafness is one of the most common childhood disorders and every year many children are born with permanent hearing loss. The present study was carried out to understand the experience of mothers with deaf children. This study was conducted with a qualitative approach. The participants were 35 mothers of children with congenital deafness who were selected by purposive sampling. The data was collected through semi structured indepth interviews and analyzed using thematic analysis introduced by Braun and Clarke. Data analysis revealed 3 themes and 9 sub-themes including social stigma (prying eyes, pity aversion, feeling of discrimination, taunt from people, internalized stigma (feeling of inferiority, feeling of shame and embarrassment, and reaction to stigma(turning to concealment, cautious disclosure, and marginalization. Shame and stigma were the major experiences of Iranian mothers of deaf children that shadowed their lives. These experiences lead mainly to ineffective coping mechanisms such as avoidance of using hearing aids and concealment of the child’s hearing loss. In addition, to cope with perceived stigma, mothers isolate and marginalize themselves and pursue secrecy strategies. Therefore, our findings are important for health professionals who are working with families having children with hearing loss. They need to aware of the problems faced by the families and should advocate necessary support.
Tao, Jun; Wang, Lijuan; Kipp, Aaron M; Qian, Han-Zhu; Yin, Lu; Ruan, Yuhua; Shao, Yiming; Lu, Hongyan; Vermund, Sten H
Little is known about the relationship between HIV stigma and depression among newly diagnosed HIV-infected men who have sex with men (MSM). We measured HIV-related stigma and current depression using standard scales among 367 Chinese MSM who had been diagnosed very recently with HIV infection, analyzing key associations with multivariable ordinal logistic regression. Current depression prevalence was 36 %. Median scores for felt, vicarious, and internalized stigma were 17, 2, and 5, respectively, each on a 0-30 scale. A one-point increase in the total stigma score was associated with a 4 % increase in the odds of current depression [adjusted odds ratio (aOR) = 1.04, 95 % confidence interval (CI) 1.03-1.05]. Internalized stigma had the strongest association with depression (aOR = 1.09, 95 % CI 1.07-1.12). Effective interventions to address coping with HIV-related stigma immediately following HIV-diagnosis might help reduce depression, improve long-term mental health, and improve engagement in their care.
Holubova, Michaela; Prasko, Jan; Ociskova, Marie; Marackova, Marketa; Grambal, Ales; Slepecky, Milos
Self-stigma is a maladaptive psychosocial phenomenon that can affect many areas of patients' lives and have a negative impact on their quality of life (QoL). This study explored the association between self-stigma, QoL, demographic data, and the severity of symptoms in patients with depressive disorder. Patients who met the International Classification of Diseases, 10th revision, research criteria for depressive disorder were enrolled in this cross-sectional study. All outpatients completed the following measurements: the Quality of Life Enjoyment and Satisfaction Questionnaire, the Internalized Stigma of Mental Illness Scale, demographic questionnaire, and the objective and subjective Clinical Global Impression-Severity scales that measure the severity of disorder. A total of 81 depressive disorder patients (with persistent affective disorder - dysthymia, major depressive disorder, or recurrent depressive disorder) and 43 healthy controls participated in this study. Compared with the healthy control group, a lower QoL was observed in patients with depressive disorder. The level of self-stigma correlated positively with total symptom severity score and negatively with QoL. Multiple regression analysis revealed that the overall rating of objective symptom severity and score of self-stigma were significantly associated with QoL. This study suggests a lower QoL in patients with depressive disorder in comparison with healthy controls and a negative impact of self-stigma level on QoL in patients suffering from depressive disorders.
Wagner, Glenn J; Aunon, Frances M; Kaplan, Rachel L; Karam, Rita; Khouri, Danielle; Tohme, Johnny; Mokhbat, Jacques
This qualitative study sought to explore sexual identity development among men who have sex with men in Beirut, Lebanon; the stigma experienced by these men; and how their psychological well-being and social engagement are shaped by how they cope with this stigma. Semi-structured interviews were conducted with 31 men who have sex with men and content analysis was used to identify emergent themes. While many men reported feeling very comfortable with their sexual orientation and had disclosed their sexual orientation to family, most men struggled at least somewhat with their sexuality, often because of perceived stigma from others and internal religious conflict about the immorality of homosexuality. Most participants described experiencing verbal harassment or ridicule or being treated as different or lesser than in social relationships with friends or family. Mechanisms for coping with stigma included social avoidance (trying to pass as heterosexual and limiting interaction with men who have sex with men to the internet) or withdrawal from relationships in an attempt to limit exposure to stigma. Findings suggest that effective coping with both internal and external sexual stigma is central to the psychological well-being and social engagement of men who have sex with men in Beirut, much as has been found in Western gay communities.
Dadun,; Peters, Ruth M. H.; Van Brakel, Wim H.; Lusli, Mimi; Damayanti, Rita; Irwanto, A.; Bunders- Aelen, J.G.F.
Background: There is a need for comprehensive, valid and reliable instruments to assess leprosy-related stigma. This paper presents the process of the cross-cultural validation of an instrument in Cirebon District, Indonesia initiated by the Stigma Assessment and Reduction of Impact (SARI) project.
Ali, Afia; Hassiotis, Angela; Strydom, Andre; King, Michael
People with intellectual disability are one of the most stigmatised groups in society. Despite this, research in this area has been limited. This paper provides a review of studies examining self stigma in people with intellectual disability, and courtesy and affiliate stigma in family carers. An electronic search of studies published between 1990…
Pescosolido, Bernice A; Martin, Jack K; Lang, Annie; Olafsdottir, Sigrun
A resurgence of research and policy efforts on stigma both facilitates and forces a reconsideration of the levels and types of factors that shape reactions to persons with conditions that engender prejudice and discrimination. Focusing on the case of mental illness but drawing from theories and studies of stigma across the social sciences, we propose a framework that brings together theoretical insights from micro, meso and macro level research: Framework Integrating Normative Influences on Stigma (FINIS) starts with Goffman's notion that understanding stigma requires a language of social relationships, but acknowledges that individuals do not come to social interaction devoid of affect and motivation. Further, all social interactions take place in a context in which organizations, media and larger cultures structure normative expectations which create the possibility of marking "difference". Labelling theory, social network theory, the limited capacity model of media influence, the social psychology of prejudice and discrimination, and theories of the welfare state all contribute to an understanding of the complex web of expectations shaping stigma. FINIS offers the potential to build a broad-based scientific foundation based on understanding the effects of stigma on the lives of persons with mental illness, the resources devoted to the organizations and families who care for them, and policies and programs designed to combat stigma. We end by discussing the clear implications this framework holds for stigma reduction, even in the face of conflicting results.
Chen, Chih-Hsuan; Wang, Ying-Ting; Shu, Bih-Ching
People who suffer from disease frequently experience disease-related stigmas. Stigma presents in daily life during normal human interactions. The stereotypes promoted by the media often impact public opinion significantly. Moreover, healthcare professionals may exacerbate stigmatization due to their misunderstanding of patients and their disease issues. Therefore, the reflection on stigma of healthcare professionals cannot be ignored. The present article illustrates the issue of stigmas held by healthcare professionals, their related stigmas, and their self-awareness. It is hoped that all healthcare professionals may cooperate to develop an anti-stigma strategy and to become true spokespersons for their patients.
Murray, S M; Augustinavicius, J; Kaysen, D; Rao, D; Murray, L K; Wachter, K; Annan, J; Falb, K; Bolton, P; Bass, J K
Sexual violence is associated with a multitude of poor physical, emotional, and social outcomes. Despite reports of stigma by sexual violence survivors, limited evidence exists on effective strategies to reduce stigma, particularly in conflict-affected settings. We sought to assess the effect of group Cognitive Processing Therapy (CPT) on stigma and the extent to which stigma might moderate the effectiveness of CPT in treating mental health problems among survivors of sexual violence in the Democratic Republic of Congo. Data were drawn from 405 adult female survivors of sexual violence reporting mental distress and poor functioning in North and South Kivu. Women were recruited through organizations providing psychosocial support and then cluster randomized to group CPT or individual support. Women were assessed at baseline, the end of treatment, and again six months later. Assessors were masked to women's treatment assignment. Linear mixed-effect regression models were used to estimate (1) the effect of CPT on feelings of perceived and internalized (felt) stigma, and (2) whether felt stigma and discrimination (enacted stigma) moderated the effects of CPT on combined depression and anxiety symptoms, posttraumatic stress, and functional impairment. Participants receiving CPT experienced moderate reductions in felt stigma relative to those in individual support (Cohen's D = 0.44, p = value = 0.02) following the end of treatment, though this difference was no longer significant six-months later (Cohen's D = 0.45, p = value = 0.12). Neither felt nor enacted stigma significantly moderated the effect of CPT on mental health symptoms or functional impairment. Group cognitive-behavioral based therapies may be an effective stigma reduction tool for survivors of sexual violence. Experiences and perceptions of stigma did not hinder therapeutic effects of group psychotherapy on survivors' mental health. ClinicalTrials.gov NCT01385163.
Background Illness-related stigma has attracted considerable research interest, but few studies have specifically examined stigmatisation of cancer in the non-patient population. The present study developed and validated a Cancer Stigma Scale (CASS) for use in the general population. Methods An item pool was developed on the basis of previous research into illness-related stigma in the general population and patients with cancer. Two studies were carried out. The first study used Exploratory factor analysis to explore the structure of items in a sample of 462 postgraduate students recruited through a London university. The second study used Confirmatory factor analysis to confirm the structure among 238 adults recruited through an online market research panel. Internal reliability, test-retest reliability and construct validity were also assessed. Results Exploratory factor analysis suggested six subscales, representing: Awkwardness, Severity, Avoidance, Policy Opposition, Personal Responsibility and Financial Discrimination. Confirmatory factor analysis confirmed this structure with a 25-item scale. All subscales showed adequate to good internal and test-retest reliability in both samples. Construct validity was also good, with mean scores for each subscale varying in the expected directions by age, gender, experience of cancer, awareness of lifestyle risk factors for cancer, and social desirability. Means for the subscales were consistent across the two samples. Conclusions These findings highlight the complexity of cancer stigma and provide the Cancer Stigma Scale (CASS) which can be used to compare populations, types of cancer and evaluate the effects of interventions designed to reduce cancer stigma in non-patient populations. PMID:24758482
Hawke, Lisa D; Parikh, Sagar V; Michalak, Erin E
Psychiatric stigma is pervasive injustice that complicates the course of illness and reduces quality of life for people with mental illnesses. This article reviews the research examining stigma towards bipolar disorder (BD) with a view to guiding the development of stigma reduction initiatives and ongoing research. PsychInfo, Medline, and Embase databases were searched for peer-reviewed studies addressing stigma in BD. Stigma is a serious concern for individuals with BD and their families. Stigma occurs within affected individuals, families, social environments, work and school environments, and the healthcare industry. With stigma often come a loss of social support and occupational success, reduced functioning, higher symptom levels and lower quality of life. BD stigma is comparable to that of other severe mental illnesses, such as schizophrenia. Few interventions are available to specifically target stigma against BD. Most studies have used explicit, attitude-based measures of stigma without controlling for social desirability, which may not translate into real-world stigmatizing behaviors. Furthermore, many studies have not clearly delineated results in a manner consistent with the conceptual framework of stigmatization. Stigma toward BD is ubiquitous and has insidious consequences for affected individuals and their families. Stigma reduction initiatives should target individuals living with BD, their families, workplaces, and the healthcare industry, taking into account the experiences and impacts of BD stigma to improve social support, course of illness, and quality of life. Copyright © 2013 Elsevier B.V. All rights reserved.
Ditchman, Nicole; Werner, Shirli; Kosyluk, Kristin; Jones, Nev; Elg, Brianna; Corrigan, Patrick W
Individuals with intellectual disabilities (ID) and individuals with mental illness are consistently found to be among the most socially excluded populations and continue to face substantial health, housing, and employment disparities due to stigma. Although this has spurred extensive research efforts and theoretical advancements in the study of stigma toward mental illness, the stigma of ID has received only limited attention. In this article we explore the application of mental illness stigma research for ID. We carefully reviewed the existing research on mental illness stigma as a foundation for a parallel summary of the empirical literature on attitudes and stigma related to ID. Based on our review, there has not been a systematic approach to the study of stigma toward ID. However, multilevel conceptual models of stigma have received much attention in the mental illness literature. These models have been used to inform targeted interventions and have application to the study of the stigma process for individuals with ID. Nonetheless, there are indeed key differences between-as well as substantial variability within-the ID and mental illness populations that must be considered. Stigma is an issue of social justice impacting the lives of individuals with ID, yet there remains virtually no systematic framework applied to the understanding of the stigma process for this group. Future research can draw on the stigma models developed in the mental illness literature to guide more rigorous research efforts and ultimately the development of effective, multilevel stigma-change strategies for ID.
Chung, Eva Yin-Han; Lam, Gigi
The World Health Organization has asserted the importance of enhancing participation of people with disabilities within the International Classification of Functioning, Disability and Health framework. Participation is regarded as a vital outcome in community-based rehabilitation. The actualization of the right to participate is limited by social stigma and discrimination. To date, there is no validated instrument for use in Chinese communities to measure participation restriction or self-perceived stigma. This study aimed to translate and validate the Participation Scale and the Explanatory Model Interview Catalogue (EMIC) Stigma Scale for use in Chinese communities with people with physical disabilities. The Chinese versions of the Participation Scale and the EMIC stigma scale were administered to 264 adults with physical disabilities. The two scales were examined separately. The reliability analysis was studied in conjunction with the construct validity. Reliability analysis was conducted to assess the internal consistency and item-total correlation. Exploratory factor analysis was conducted to investigate the latent patterns of relationships among variables. A Rasch model analysis was conducted to test the dimensionality, internal validity, item hierarchy, and scoring category structure of the two scales. Both the Participation Scale and the EMIC stigma scale were confirmed to have good internal consistency and high item-total correlation. Exploratory factor analysis revealed the factor structure of the two scales, which demonstrated the fitting of a pattern of variables within the studied construct. The Participation Scale was found to be multidimensional, whereas the EMIC stigma scale was confirmed to be unidimensional. The item hierarchies of the Participation Scale and the EMIC stigma scale were discussed and were regarded as compatible with the cultural characteristics of Chinese communities. The Chinese versions of the Participation Scale and the EMIC
Full Text Available AIDS-related stigma and mental disorders are the most common conditions in people living with HIV (PLHIV. We therefore conducted this study to examine the association of AIDS-related stigma and discrimination with mental disorders among PLHIV in Cambodia.A two-stage cluster sampling method was used to select 1,003 adult PLHIV from six provinces. The People Living with HIV Stigma Index was used to measure stigma and discrimination, and a short version of general health questionnaire (GHQ-12 was used to measure mental disorders. Multivariate logistic regression analysis was conducted.The reported experiences of discrimination in communities in the past 12 months ranged from 0.8% for reports of being denied health services to 42.3% for being aware of being gossiped about. Internal stigma was also common ranging from 2.8% for avoiding going to a local clinic and/or hospital to 59.6% for deciding not to have (more children. The proportions of PLHIV who reported fear of stigma and discrimination ranged from 13.9% for fear of being physically assaulted to 34.5% for fear of being gossiped about. The mean score of GHQ-12 was 3.2 (SD = 2.4. After controlling for several potential confounders, higher levels of mental disorders (GHQ-12≥ 4 remained significantly associated with higher levels of experiences of stigma and discrimination in family and communities (AOR = 1.9, 95% CI = 1.4-2.6, higher levels of internal stigma (AOR = 1.7, 95% CI = 1.2-2.3, and higher levels of fear of stigma and discrimination in family and communities (AOR = 1.5, 95% CI = 1.1-2.2.AIDS-related stigma and discrimination among PLHIV in Cambodia are common and may have potential impacts on their mental health conditions. These findings indicate a need for community-based interventions to reduce stigma and discrimination in the general public and to help PLHIV to cope with this situation.
Carrasco, Maria Augusta; Nguyen, Trang Q; Barrington, Clare; Perez, Martha; Donastorg, Yeycy; Kerrigan, Deanna
Evidence indicates that social cohesion is a successful strategy to improve consistent condom use (CCU) among female sex workers. However, the individual and layered or combined effect that various types of overlapping stigmas may have on CCU between female sex workers living with HIV and their clients and steady partners has not been analyzed. Drawing on the Abriendo Puertas cohort of female sex workers living with HIV in the Dominican Republic, we used structural equation modeling to test the hypothesis that both HIV stigma and sex work stigma mediate the association between social cohesion and CCU and that they have a layered effect. The results indicated that HIV stigma mediated the association between social cohesion and CCU with clients and partners, while sex work-related stigma did not. There was no evidence of a layered HIV stigma and sex work stigma effect, which may be due to methodological limitations to handle highly correlated latent variables. Findings highlight the need to address internalized HIV stigma within the context of community-based approaches to enhance their HIV prevention impact. This will help to reduce the risk of HIV re-infection with a new distinct HIV viral strain, STI infection, and onward HIV transmission among female sex workers living with HIV.
Abdoli, Samereh; Abazari, Parvaneh; Mardanian, Leila
Empowerment of people with diabetes means integrating diabetes with identity. However, others' stigmatization can influence it. Although diabetes is so prevalent among Iranians, there is little knowledge about diabetes-related stigma in Iran. The present study explored diabetes-related stigma in people living with type 1 diabetes in Isfahan. A conventional content analysis was used with in-depth interview with 26 people with and without diabetes from November 2011 to July 2012. A person with type 1 diabetes was stigmatized as a miserable human (always sick and unable, death reminder, and intolerable burden), rejected marriage candidate (busy spouse, high-risk pregnant), and deprived of a normal life [prisoner of (to must), deprived of pleasure]. Although, young adults with diabetes undergo all aspects of the social diabetes-related stigma; in their opinion they were just deprived of a normal life. It seems that in Isfahan, diabetes-related stigma is of great importance. In this way, conducting an appropriate intervention is necessary to improve the empowerment process in people with type 1 diabetes in order to reduce the stigma in the context.
Corrigan, Patrick W; Schmidt, Annie; Bink, Andrea B; Nieweglowski, Katherine; Al-Khouja, Maya A; Qin, Sang; Discont, Steve
Given the egregious effect of public stigma on the lives of people with mental illness, researchers have sought to unpack and identify effective components of anti-stigma programs. We expect to show that continuum messages have more positive effect on stigma and affirming attitudes (beliefs that people with mental illness recover and should be personally empowered) than categorical perspectives. The effect of continuum beliefs will interact with contact strategies. A total of 598 research participants were randomly assigned to online presentations representing one of the six conditions: three messages (continuum, categorical, or neutral control) by two processes (education or contact). Participants completed measures of continuum beliefs (as a manipulation check), stigma and affirming attitudes after viewing the condition. Continuum messages had significantly better effect on views that people with mental illness are "different," a finding that interacted with contact. Continuum messages also had better effects on recovery beliefs, once again an effect that interacted significantly with contact. Implications of these findings for improving anti-stigma programs are discussed.