The stigma of mental illness: Explanatory models and methods for change

Academic Success Among Master of Social Work Students with Clinical Depression: An Interpretive Phenomenological Analysis

PURPOSE

Little is known about depression's impact on Master of Social Work (MSW) students' academic success and career trajectory. This study explored the experiences of students living with clinical depression and enrolled in a MSW program at a singular large Midwestern University.

MATERIALS AND METHODS

Participants were recruited using convenience and purposive sample techniques. Data were transcribed and analyzed using an interpretive phenomenological analysis (IPA) framework, and the iterative processes associated with qualitative data analysis.

RESULTS

Participants addressed their depression by (a) recognizing, identifying, and addressing their childhood triggers, (b) finding healthy coping techniques to address their depression while also addressing previous negative behaviors, (c) incorporating intentional decision-making techniques to help them once they were enrolled in the MSW program, and (d) incorporating behavior change techniques learned in their classes to help them deal with their depression.

DISCUSSION

Students noted that classes presented opportunities to help them balance and address their triggers while also providing opportunities to holistically engage with academic demands. While there is no singular blueprint to ensure academic success, having clearly defined expectations within the academic setting (e.g. program expectations, studying for exams, course expectations, and personal responsibilities), helped to reduce stress, anxiety, and other unhealthy skills that may be correlated with their depressive symptoms and episodes.

CONCLUSION

Recommendations for faculty and students were made.

Disclosure costs: The impact of bipolar diagnosis and social desirability on stigma

BACKGROUND

The previous literature concerned with understanding stigma affecting patients with bipolar disorder relies predominantly on qualitative and survey approaches, and rarely contends with the potential role of social desirability on disclosure. The current project employs a 2 × 2 experimental approach to establish the presence of stigmatizing attitudes in a context with real social consequences (i.e., college housing decisions).

METHOD

Participants believed they were participating in a collaborative study with campus residential life. The project was designed to establish the presence of stigmatizing attitudes affecting patients with bipolar disorder compared to an unaffected control, as well as testing whether employing pressure to respond honestly (via bogus pipeline) affects stigma disclosure.

RESULTS

Study 1 results revealed that after reviewing a peer's housing application, stigma consequences were observable when a student disclosed a bipolar diagnosis at a large, public southeastern university (N = 182) across all outcomes (increased desire for social distance and perceived dangerousness, decreased relatability). In this sample social desirability did not appear to influence responding. In Study 2, at a small, private northeastern college (N = 168), stigma was observable on the dangerousness and relatability outcomes, but only demonstrable in terms of social distance under the conditions of the bogus pipeline.

DISCUSSION

Together, these findings contribute persuasive experimental evidence affirming the scope and impact of stigma in the lives of patients with bipolar disorder, and underscores the capacity for social desirability to mask the presence of stigma, which has significant implications for the interpretation of past stigma research.

Mental Health Literacy and Professional Psychological Help-Seeking Attitudes Among Primary Healthcare Workers: The Mediating Role of Social Support and Mental Illness Stigma

Background

Research highlights poor mental health among healthcare workers, but limited attention has been given to the mental health literacy and professional psychological help-seeking attitudes of primary healthcare workers.This study investigates the relationship between primary healthcare workers' mental health literacy and their attitudes toward professional psychological help-seeking. It also explores the chain mediating roles of social support and mental illness stigma in this relationship.

Methods

We conducted the study among primary healthcare workers in Shapingba District, Chongqing, China. The study utilized demographic questionnaires, the Multiple Mental Health Literacy Scale, Social Support Rating Scale, Perceived Devaluation-Discrimination Scale, and Attitudes Toward Seeking Professional Psychological Help Scale. We applied Pearson correlation, multiple linear regression, and structural equation modeling (SEM) for data analysis.

Results

Correlation analysis revealed positive associations between mental health literacy and help-seeking attitudes, while stigma negatively impacted these attitudes. The regression analysis demonstrated that mental health literacy, social support, and mental illness stigma significantly influenced attitudes toward professional psychological help-seeking, with the adjusted R square being 0.402. Specifically, social support and stigma acted as partial mediators in the relationship between mental health literacy and help-seeking attitudes. SEM confirmed a significant chain mediation effect, with social support and stigma jointly mediating the link between mental health literacy and help-seeking attitudes, explaining 27.46% of the variance.

Conclusion

This study underscores the critical role of mental health literacy, social support, and mental illness stigma in shaping primary healthcare workers' attitudes toward professional psychological help-seeking. Strengthening these factors can enhance their mental health outcomes and encourage more proactive help-seeking behavior. Implementing targeted interventions in training programs to reduce stigma and promote social support could improve help-seeking behaviors and overall mental health within healthcare settings.

Narrative enhancement and cognitive therapy for self-stigma among youth with bipolar disorder or multiple mental health conditions: protocol for a pilot randomised basket trial

INTRODUCTION

Self-stigma occurs when individuals internalise negative stereotypes about their mental health conditions. Self-stigma is common among those with serious mental illnesses, including youth, and is considered a major barrier to recovery through its impact on hope, self-esteem and self-identity. This patient-oriented protocol aims to assess the feasibility of conducting a future full-scale randomised controlled trial (RCT) of a youth-oriented adaptation of narrative enhancement and cognitive therapy for self-stigma among youth (NECT-Y).

METHODS AND ANALYSIS

This is a two-site, two-arm pilot basket RCT with 1:1 randomisation to NECT-Y or treatment as usual (TAU). Participants are youth, ages 16-29 diagnosed with bipolar disorder, any subtype (Basket 1) or with any two or more mental health conditions (Basket 2). After informed consent, we will conduct baseline assessments and randomisation, then either a 14-week NECT-Y group intervention or TAU. Diagnostic interviews will be used to confirm diagnosis at baseline. A range of self-report questionnaires will be administered at baseline, post-treatment and 3 month follow-up. The primary outcome is feasibility as indicated by the achievement of recruitment goals, retention and adherence, intervention fidelity and the absence of serious adverse events. Secondary outcomes include acceptability and the intervention's impact on self-stigma, wellness, symptomatology, treatment-seeking attitudes and other related constructs. A youth advisory group is informing all stages of the study process.

ETHICS AND DISSEMINATION

The Research Ethics Board for Centre for Addiction and Mental Health (#062/2024) has approved this study protocol. Ethics is also approved at London Health Sciences Centre (Western Health Sciences Research Ethics Board (HSREB) #125812). Results will be published in international peer-reviewed journals and presented at relevant conferences. Summaries will be provided to the funders of the study, as well as to lay audiences, including study participants.

TRIAL REGISTRATION NUMBER

NCT06672562.

"My Body is Betraying Me": Exploring the Stigma and Coping Strategies for Infertility Among Women Across Ethnic and Racial Groups

Female infertility remains a taboo and carries stigma across various ethnic/racial communities. Infertility-related stigma impairs women's mental well-being, strains their family relationships, and deters them from seeking treatment. In this article, we seek to understand the perceived/self-stigma of infertility and stigma management through in-depth interviews with 29 women (White, African American, and Hispanic) who were facing fertility challenges. Taking an intersectional approach, we focused on how these women's experience of infertility and their stigma coping were shaped by certain gendered, racial, and cultural ideologies deeply entrenched in contemporary U.S. society. Our findings uncovered shared stigmas and coping mechanisms as well as distinct variations that are specific to White, African American, and Hispanic women. The firsthand accounts from our participants revealed the distressing reality of marginalization and silencing of minority women's voices within their families, communities, and society at large. Furthermore, our study underscored how social interactions among women can foster competition, entrenching and bolstering hierarchical stigma power dynamics. This study contributes to the health disparity research by highlighting how women are stratified into different categories based on social class, ethnicity/race, and age. Such classifications ultimately result in differential access to health resources, perpetuating existing social inequality and division.

Decoding Prejudice: Understanding Patterns of Adolescent Mental Health Stigma

Background/Objectives: Mental health problems are a major cause of disability, impacting nearly 20% of adolescents. Nevertheless, they are hesitant to seek help because of stigma and fear of being labelled. Adolescents often have low mental health literacy and perceive mental health problems as personal failures. To address it, our study aimed to identify subgroups within the adolescent population based on mental health knowledge, social stigma, experiences of intergroup anxiety, and endorsement of stereotypes. Methods: This cross-sectional study included 182 adolescents (50.6% male) aged 10 to 17 years (M = 13.8, SD = 2.4). Participants completed an online survey comprising the Mental Health Knowledge Schedule, Attribution Questionnaire (AQ-8-C), Intergroup Anxiety Scale, and a scale regarding stereotypes towards people with mental health problems. Cluster analysis was used to identify the subgroups. Results: We identified three subgroups: (1) "Potential Advocates", showing high mental health knowledge, low social stigma, low intergroup anxiety, and moderate endorsement of stereotypes; (2) "Ambivalents", manifesting high mental health knowledge, moderate social stigma, heightened intergroup anxiety, and low endorsement of stereotypes; and (3) "Stigmatizers", revealing low mental health knowledge, pronounced social stigma, moderate intergroup anxiety, and tendency to endorse stereotypes. Conclusions: The results highlight the multiplicity of perceptions regarding mental health and the pivotal role of knowledge, stigma, intergroup dynamics, and stereotypes in shaping attitudes. Implications for interventions targeting mental health stigma and fostering positive attitudes among adolescents are discussed, underscoring the importance of customised strategies to address the multiple needs and experiences characteristic of this developmental stage.

Unmet Needs of Children and Young Adults With ADHD: Insights From Key Stakeholders on Priorities for Stigma Reduction

INTRODUCTION

Individuals with ADHD continue to face stigma, which can negatively impact their access to, adherence to, and quality of mental health services, as well as their overall wellbeing. Perspectives of various stakeholders regarding priorities for stigma reduction remain underexplored. This study explores young adult, parent, teacher, and mental health care professional perspectives on unmet needs of children and young adults with ADHD in the Netherlands, in the context of stigma reduction.

METHOD

A total of 24 respondents participated in seven small focus group discussions (FGDs). The FGDs facilitated in-depth discussions exploring stakeholder group perspectives on unmet needs of children and young adults with ADHD in educational, professional, and social settings. Data was analyzed using thematic content analysis.

RESULTS

Three thematic categories of unmet needs were identified: (1) a lack of awareness, knowledge, and understanding of ADHD; (2) insufficient personalized approaches in education and health care; and (3) limited accessibility of information and support services. Within theme 1, respondents primarily highlighted the importance of improving education for primary school teachers and mental health care professionals. Theme 2 underscored the need for increased capacity for personalization and attention to the sociopsychological factors of ADHD, alongside recognizing strengths. Theme 3 emphasized the need for easy access to reliable information and mental health care, including peer networks, as well as proper follow-up and continuity of care.

DISCUSSION AND CONCLUSION

Findings highlight the need for improving our understanding of ADHD as a complex biopsychosocial condition, which requires specific adjustments in education and mental health care. Interventions to improve support and disrupt stigmatization should meet diverse needs, incorporate multi-level strategies, and involve key stakeholders.

Dual pathways of aging stereotype threat at work: impacts on work behaviors of older workers

Aging stereotype threat is a significant issue in modern workplaces, affecting older workers' self-perceptions and work behaviors. Although research often highlights the negative impacts of aging stereotypes, the dual pathways by which these stereotypes influence negative and positive work behaviors remain underexplored. This study aims to address this gap by employing a dual mediation model, grounded in Uncertainty-Identity Theory and Psychological Reactance Theory, to explore the effects of aging stereotype threat on older workers' behaviors. Using structural equation modeling (SEM) with two-wave data from older employees in various industries, the study shows that aging stereotype threat significantly affects aging identity, which fully mediates its link to work withdrawal behaviors. In contrast, psychological reactance emerges as another mediator, leading to proactive work behaviors. The results also suggest that older workers with high self-efficacy exhibit a stronger relationship between stereotype threat and aging identity. This research adds to the literature by exploring how aging stereotype threat leads to both negative and positive behavioral outcomes. It provides valuable insights for organizations aiming to support older employees in the workplace.

Evaluation of health literacy and its predictive formative factors among Spanish military personnel

Health literacy (HL) is an aspect that has been widely studied. However, in the military population there are hardly any studies on the influence of educational variables. Knowing the level of health literacy of military professionals is important as it has an impact on adequate health decision making, avoids the abuse of health services and makes it possible to ask for help when needed, especially in aspects related to mental health. The aim of this study was to measure the level of literacy, as well as its association with other training variables in a sample of military personnel. The study was carried out in 695 military personnel of the Spanish Army. A cross-sectional observational design was used, using a survey with the HLS-EU-Q47 scale. Among the results, it stands out that the level of health literacy of the military is high compared to the rest of the population. The results showed that the level of HL does not seem to be influenced by the level of languages, nor by the degree they hold, nor by experiences abroad. On the other hand, it was observed that the performance of professional internships and work in multidisciplinary teams, extracurricular training, does influence the level of HL, especially in the dimension related to health promotion. This fact seems to mean that the military have learned during these experiences to keep abreast of health-related issues, to understand, to value and to form a considered opinion on health-related information.

WeARTolerance: Evaluating the impact of an arts-based program to reduce mental health-related stigma in young people

The stigma surrounding mental health remains a significant barrier to help-seeking and well-being in youth populations. The invisibility of mental health issues highlights the critical need for improved knowledge and stigma reduction, underscoring the urgency of tackling this issue. Arts-based interventions have shown promise in addressing stigma, yet comprehensive longitudinal studies in community settings are limited. This research evaluates the "WeARTolerance'' arts-based program in reducing mental health stigma among diverse youths. The program integrated psychoeducational and creative activities (e.g., visual arts, cinema, music, and theatre) to explore mental health themes, with 125 teenagers and young adult participants (M = 13.70; SD = 2.06). The present mixed-method study was split into two phases with complementary objectives: 1) evaluate quantitatively the program's impact in reducing social stigma and related outcomes; 2) explore in-depth qualitative feedback about the program. For the first phase, reliable self-report questionnaires were used to measure mental health knowledge, social stigma, intergroup anxiety, and social distance in pre-, post-, and 6-month follow-up periods. Participants' age and past psychiatric issues were fixed factors with random intercepts, and mixed effects models were used to analyze the attitudinal outcomes across time. In the second phase of this validation, nine teenagers aged between 12 and 16 participated in two focus groups conducted three months after the program. Its contents underwent thorough analysis using content analysis techniques. The quantitative results from Phase 1 demonstrated a decreasing trend in all primary outcomes. In phase 2, participants acknowledged the activities' relevance, reported overall satisfaction with the program, and showed great enthusiasm and willingness to learn more. Arts-based interventions like "WeARTolerance" are valuable for challenging stigma and fostering understanding in youth populations and provide an alternative and creative way to increase mental health literacy. The study proposes a program to reduce youth mental health stigma through arts-based elements, early intervention, and psychoeducation, involving collaborations between professionals and artists to promote youth engagement. Future studies should include indirect social contact and randomized controlled interventions.

"Validation of three scales for enhanced suicide prevention in Spanish-speaking populations: Suicidal ideation, stigma, and literacy"

BACKGROUND

Escalating suicide rates in Spain and Latin America underscore the critical need for accurate assessment and prevention tools tailored to these populations. This study aimed to culturally adapt and validate three essential scales: the Suicidal Ideation Attributes Scale (SIDAS), the Suicide Stigma Scale - Short Form (SOSS-SF), and the Suicide Literacy Scale - Short Form (LOSS-SF).

METHOD

A total of 678 participants (including 150 with suicidal ideation) completed an online survey. The scales underwent rigorous back-translation and adaptation by native speakers from Spain and Latin America. SIDAS and SOSS-SF were validated using Confirmatory Factor Analysis (CFA), with criteria including fit indices (e.g., RMSEA, CFI). LOSS-SF underwent validation through Item Response Theory (IRT). Additionally, gender invariance was assessed across all scales.

RESULTS

CFA confirmed the original factor structures of SIDAS and SOSS-SF, demonstrating good fit indices and internal consistency. The analysis of LOSS-SF required excluding two items, resulting in a final Spanish version with 10 items and an unifactorial structure. Gender invariance was established across all scales.

CONCLUSIONS

The culturally adapted and validated scales in this study demonstrate robust reliability and validity for assessing suicidal ideation, suicide stigma, and suicide literacy among Spanish-speaking populations. These validated tools have the potential to enhance clinical assessment, inform personalized interventions, monitor public health initiatives, educate communities about suicide, and advance research in suicide prevention and treatment.

Surviving and thriving: Assessing quality of life and psychosocial interventions in mental health of head and neck cancer patients

The quality of life of head and neck cancer patients is affected by various factors, including the disease itself, treatment side effects, and changes in appearance, leading to a range of mental health issues such as anxiety, depression, and adjustment disorders. These mental health problems not only reduce the patients' quality of life but may also negatively impact treatment outcomes and survival rates. Therefore, it is particularly important to assess and intervene in the mental health of head and neck cancer patients. This review focuses on the common mental health issues in these patients and emphasizes the importance of detailed assessment. By using various assessment tools, healthcare professionals can accurately identify patients' mental states and provide appropriate support and interventions. The article discusses various effective mental health interventions aimed at improving patients' psychological adaptation, reducing psychological stress, and enhancing quality of life. These interventions include cognitive-behavioral adjustments, family support, and mindfulness practices. In addition, the article mentions the potential of artificial intelligence technology in improving patients' quality of life, particularly in treatment planning, patient education, and mental health interventions. In summary, comprehensive management and intervention of the mental health of head and neck cancer patients are crucial to improving their quality of life and treatment outcomes. Future research needs to further explore effective psychological intervention methods and integrate them into the overall treatment plan for head and neck cancer patients.

Levels and Predictors of Suicide Literacy and Suicide Stigma in Spanish-Speaking Individuals

BACKGROUND

One of the obstacles to seeking help for suicide is its social stigma. The literature suggests that suicide knowledge could impact this stigma. The present study aims to examine levels and predictors of suicide stigma and suicide literacy among Spanish-speaking individuals from Spain and Latin America.

METHOD

A total of 678 adults completed an online survey conducted from December 2021 to May 2022. The survey assessed sociodemographic and clinical variables, including the Literacy of Suicide Scale (LOSS-SF) and Stigma of Suicide Scale (SOSS-SF).

RESULTS

Results showed the presence of stigmatization and a moderate level of suicide literacy. Latin Americans presented significantly more stigmatizing attitudes and lower levels of suicide literacy than Spaniards. Older age and stronger religious/spiritual beliefs were correlated with lower suicide literacy. Suicide stigma was regressed on lower suicide literacy, gender (men), stronger religious/spiritual beliefs, and lacking knowledge about how to find help. Furthermore, the region was significantly associated with the suicide glorification subscale, reporting Latin Americans' greater glorification.

CONCLUSIONS

By examining these factors, we aim to foster a deeper understanding of the attitudes and beliefs toward suicide. This understanding is crucial, as it may inform the development of effective interventions and prevention strategies that are culturally sensitive and tailored to diverse populations.

Factors associated with dementia-related stigma in British adolescents

BACKGROUND

Dementia-related stigma is a prominent barrier for people living with dementia, leading to poor well-being and social isolation. Adolescents are an under-researched group in society that may already have experience of dementia and are more susceptible to attitudinal change which makes them ideal targets for anti-stigma initiatives outlined by public health policy. For the development of evidence-based anti-stigma initiatives in adolescents, it is important to understand which socio-demographic groups are most likely to develop stigmatising attitudes and why. This study aims to identify factors of dementia-related stigma in adolescents.

METHODS

A total of 1,044 adolescents (aged 11-18 years) from across six regions of England were included in the analysis of this cross-sectional, survey-based study. Descriptive statistics and multiple regressions were employed to explore the association between demographic variables, modifiable factors of dementia-related stigma and the outcome of dementia-related stigma. A path analysis via a structural equation model was employed to test for direct and mediatory effects.

RESULTS

Multiple regression models revealed that younger adolescents, those with higher levels of contact with dementia, higher levels of empathy, higher levels of dementia knowledge, and higher affinity to older adults, are associated with more positive dementia attitudes in adolescents (p < 0.05). Within the accepted structural equation model, empathy, level of contact and dementia knowledge were key mediators of dementia-related stigma (p < 0.05).

CONCLUSION

This study highlights that modifiable factors such as level of contact, ageism, and empathy have a potentially important role in how dementia-related stigma may start to form in the adolescent years. Developing contact-based strategies that stimulate empathetic responses may be useful targets for stigma reduction initiatives for adolescents.

Interventions to decrease health students' stigma toward schizophrenia: A scoping review

BACKGROUND

Schizophrenia is heavily stigmatized among health professionals. Given that health professional students are future members of the workforce and will provide care for people with schizophrenia, it is essential to implement interventions aimed at reducing stigma among this group.

OBJECTIVE

This scoping review aimed to identify and synthesize existing literature on interventions to decrease schizophrenia stigma among health professional students, and to determine the possible gaps in the literature.

DESIGN

Nine electronic databases and gray literature were searched, including PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, MEDLINE, Web of Science, Scopus, China National Knowledge Infrastructure, WanFang, and Google on 5 May 2023. Two researchers independently conducted data screening, data extraction, and assessed study risks. A most updated search was also done on 22 May 2024. The Cochrane risk of bias tool version 2 for randomized trials and Risk of Bias in Non-randomized Studies were used to assess the studies' risk of bias. Data synthesis and analysis were conducted by two reviewers using a narrative approach. Reporting adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

RESULTS

This review included twenty-one studies with 2520 health professional students. The majority of included studies were non-randomized controlled trials (38 %) and pre-post studies (52 %). Most of the included studies were conducted in the United States (24 %). The participants in ten (48 %) studies were medical students. The number of intervention sessions ranged from one to 13, with an average of three. Seven (33 %) studies had an intervention duration of less than four weeks and 16 (76 %) studies had no follow-up. Various scales were used to assess the outcomes of schizophrenia stigma. Only two studies (10 %) indicated the intervention's ineffectiveness, with the majority of interventions led by psychiatry department faculty and individuals with schizophrenia.

CONCLUSIONS

Most studies (90 %) utilized various approaches, including face-to-face or online education, direct contact with individuals with schizophrenia, or a combination thereof, to diminish stigma among health professional students. However, none addressed cultural and empathy factors in their intervention designs, and the included studies lacked theoretical guidance. The review only comprised English quantitative studies with significant heterogeneity, with 17 studies (81 %) displaying serious or high risk of bias, limiting comprehensive discussions. These findings offer valuable insights for future systematic review.

TWEETABLE ABSTRACT

Studies on reducing health professional students' schizophrenia stigma need to address cultural and empathy factors.

Pilot evaluation of a brief training video aimed at reducing mental health stigma amongst emergency first responders (the ENHANcE II study)

BACKGROUND

First responders (i.e. police and ambulance staff) have increasingly become part of the mental health care system, often being the first port of call for those experiencing a crisis. Despite their frequent involvement in supporting those with mental health problems, there is evidence that mental health stigma is high amongst first responders.

AIMS

The aim of the present study was to evaluate a brief training video aimed at reducing mental health stigma amongst first responders.

METHODS

First responders watched a training video based on the cognitive behavioural model of mental health stigma, and involved contributions from people with lived experience, and first responders. Measures of mental health stigma were collected before and after viewing the training.

RESULTS

The training video produced small but significant improvements in mental health stigma, and these effects did not differ between police and ambulance staff. We were unable to determine what psychological constructs mediated this change in stigma. The feedback on the training video was generally positive, but also indicated some key areas for future development.

CONCLUSIONS

The present study provides encouraging evidence that levels of mental health stigma can be improved using a resource-light training intervention.

The role of personal recovery and internalised stigma on the expression of symptomatology in severe mental disorders: Mediating and moderating effects

OBJECTIVE

Given the relevance of internalised stigma in people suffering from a mental disorder, in the present study, the possible mediating and moderating role of self-stigma in the relationship between personal recovery and symptomatology has been studied.

METHOD

265 participants with severe mental disorder completed the following instruments: ISMI (self-stigma), REE (personal recovery) and HoNOS, CGI, GAF and EuroQol (symptomatology).

RESULTS

both the mediation and moderation analyses show significant results, which would indicate that internalised stigma has an effect on the relationship between personal recovery and symptomatology. Also, people with lower level of personal recovery and greater self-stigma have greater symptomatology than those who are in more advanced personal recovery processes and have a lower perception of internalised stigma.

DISCUSSION

the findings of this study suggest that self-stigma has an effect, and the improvement at personal recovery and symptomatology is accentuated when people with a severe mental disorder have a better management of internalised stigma. Therefore, it may be interesting to include this variable in recovery interventions.

Patients, colleagues, systems, and self: Exploring layers of physician emotions in caring for pregnant people who use substances and their newborns

INTRODUCTION

Pregnant people who use substances experience significant stigma, including in healthcare settings, where physicians make high-stakes decisions about treatment plans, resource allocation, and even a person's ability to parent. Previous psychology research has demonstrated the influence of emotions on decision-making, as well as on the development and expression of stigma. Yet the specific content of physician emotions, as well as approaches to processing these emotions, has been relatively under-examined. We sought to better understand the emotional experiences of physicians who practice in safety-net labor and delivery/inpatient settings to inform strategies to facilitate more humanizing, equitable care.

METHODS

From March 2021 to June 2022, the study team conducted semi-structured interviews with 24 San Francisco Bay Area-based physicians (obstetrics-gynecology, pediatrics, family medicine) caring for pregnant people who use substances and/or their newborns. We used deductive and inductive coding and identified themes regarding the nature, etiology, and processing of physician emotions.

RESULTS

Physicians described experiencing a range of emotions related to interpersonal (patients, colleagues), systems-level, and internal dynamics. Emotions such as anger, sadness, frustration, and helplessness resulted from their deep care and empathy for patients, witnessing stigmatizing colleague behaviors, disagreement with punitive systems, and recognition of their own limitations in effecting change. Few participants identified strategies for processing these emotions, and several described efforts to disengage from their emotional experience to preserve their sense of well-being and professionalism.

CONCLUSIONS

Physicians caring for pregnant people who use substances and their newborns experienced intense, multi-layered emotions. This study posits that additional efforts to support physician emotional processing and structural competency could improve healthcare experiences and outcomes for pregnant people who use substances.

Latent Profile Analysis of Self-Stigma Among Individuals With Schizophrenia and Its Relationship With Illness Perception

PURPOSE

To investigate self-stigma among individuals with schizophrenia, identify potential categories of self-stigma, and analyze the association between self-stigma categories and dimensions of disease perception.

METHOD

Convenience sampling was used to select individuals with schizophrenia (N = 216) in psychiatric hospitals. A General Demographic Information Questionnaire, the Internalized Stigma of Mental Illness Inventory, and Brief Illness Perception Questionnaire were used for data collection. A latent profile analysis was performed on self-stigma characteristics of participants, and potential categories of influencing factors and their relationship with illness perception were examined.

RESULTS

Participants were classified into three potential categories: low self-stigma-low resistance (19.4%), medium self-stigma (55.6%), and high self-stigma-high discrimination (25%). Compared with the low self-stigma-low resistance group, those with higher illness representation and illness understanding scores were more likely to be classified as medium self-stigma, and emotional representation was the strongest predictor for high self-stigma-high discrimination.

CONCLUSION

Self-stigma among participants was mostly medium to high. Self-stigma of individuals with schizophrenia demonstrates group heterogeneity; therefore, nurses should formulate targeted interventions based on the characteristics of each category to achieve precise interventions and reduce self-stigma. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Borderline personality disorder and stigma: Lived experience perspectives on helpful and hurtful language

Borderline personality disorder (BPD) is a severe mental health disorder that is subject to significant stigmatisation. With language being a key reinforcer of stigma, this co-produced study aims to explore the language use regarding BPD and its effect on those with BPD and carers. Recommendations to reduce stigmatisation are provided for both clinicians and researchers. Participants with BPD (consumer n = 33) and those supporting someone with BPD (carer n = 30) discussed their experience of hurtful and helpful language. Reflexive thematic analysis was used to analyse written and verbal responses into core conflictual relationship themes (CCRT) reflecting how different words were heard and experienced. All consumers and carers in the study reported experiences with stigmatising language. Feelings of inadequacy and frustration were common amongst consumers, specifically when they perceived others as trivialising their needs or not seeing them as a unique individual. Carers often reported feelings of frustration when they perceived others as blaming them or not acknowledging their needs. Both consumers and carers reported helpful language as being connecting, validating and accepting. Unhelpful communication patterns have negative consequences for the person's self-understanding (i.e., self-stigma) and their relationships with others, including the therapeutic alliance. A consideration of these communication patterns may foster the use of reflective positive language that is compassionate and hopeful.

Mental Health Stigma in the Workplace and its Association with Possible Actions of Managers to Prevent Sickness Absence of Employees with Mental Health Problems in the Swedish Private Sector: a Video Vignette Study

PURPOSE

Mental health problems (MHPs) are subjected to workplace stigma and can deteriorate into common mental disorders (CMDs) and sickness absence (SA). Research has shown that personal stigmatizing attitudes limit managers' efforts towards employees with MHPs, but knowledge is lacking regarding stigma in social contexts (contextual stigma) and different types of possible preventive actions. This study investigates personal stigmatizing attitudes and three contextual stigma layers (employee, collegial, organizational) and different types of possible actions to prevent SA of employees with MHPs.

METHOD

Survey data of 2769 Swedish managers working in the private sector were analysed. Personal stigmatizing attitudes were measured with the managerial stigma towards employee depression scale and supplemented with four additional items capturing contextual stigma. Managers watched video vignettes and assessed which preventive actions (n  = 20) were possible to use in their organization. A sum score was calculated reflecting the 'number of actions'. Principal component analysis revealed three action types: adapt tasks and setting, involve experts, and social support. A score reflecting the 'possibilities to implement actions' was calculated for each type. Multiple linear regression analyses were conducted with the four stigma layers as independent variables for each of the three action variables.

RESULTS

Personal stigmatizing attitudes and contextual stigma were significantly associated with both 'number of actions' and 'possibilities for implementing actions' relating to all action types. Patterns of associations with contextual stigma were significant but varied between the different action types.

CONCLUSION

This study substantiated the role of personal stigmatizing attitudes and contextual stigma in relation to possible actions of managers to prevent SA of employees with MHPs. The results emphasize the role of contextual stigma. Implications for practice and research are discussed.

Understanding Internalized Stigma's Role in Sex-Specific Suicidal Ideation among Individuals with Bipolar Disorder

Background: The experience of stigma can exert a profound impact on the mental health and well-being of individuals with bipolar disorder (BD). Our study explores which factors of internalized stigma are associated with suicidal ideation and how they differ between the two sexes in a clinical sample of BD patients. Methods: The study follows a cross-sectional study design, employing the Clinical Global Impression for Bipolar Patients (CGI-BP) to evaluate the overall severity of illness and the alteration in patients affected by bipolar disorder, the Internalized Stigma of Mental Illness (ISMI) assessing self-stigma among individuals experiencing mental disorders, and the Columbia Suicide Severity Rating Scale (C-SSRS) identifying and assessing individuals vulnerable to suicide. Descriptive analyses, analysis of variance (ANOVA), and logistic regression analysis were conducted, and 344 BD subjects were recruited. Results: Our ANOVA results revealed a significant association between sex and suicide across ISMI sub-items (p = 0.000). Logistic regression analysis comprised three phases: Discrimination was consistently significant across all phases (p < 0.001), while Alienation and Stereotype emerged as additional predictors of suicide in later phases of the analysis (p < 0.001). Conclusions: Our study contributes to the growing body of literature on internalized stigma, sex, and suicidality among individuals with bipolar disorder. Early intervention programs and prevention strategies are needed.

Measures Determining Dementia-Related Attitudes in Adolescents: A Scoping Review

Reducing stigma is a key benefit to intergenerational programs. However, little is known about the availability and suitability of measures that capture dementia-related attitudes in adolescents, thus limiting interpretations of the efficacy of such programs. The aim of this scoping review was to provide an overview of outcome measures used to capture dementiarelated attitudes in adolescents. Scoping review methodology was used to systematically identify relevant articles. Key search terms included dementia, attitudes, and adolescents. Fourteen studies met the inclusion criteria, of which 13 unique measures were identified. However, there are gaps in psychometric properties and a lack of underlying theoretical frameworks.

Stumbling Block in Providing Physical Activity Support Among Parents of Children with Autism Spectrum Disorder: A Moderated Mediation Analysis

Physical activity (PA) benefits children with autism spectrum disorder (ASD). Evidence suggests that some barriers impede parents from providing PA support for their children with ASD. Parental perceived stigma is one of these barriers. However, few studies have explored how parental perceived stigma influences parental PA support. This study aimed to investigate the relationship between parental perceived stigma and parental PA support, the mediating role of parental self-efficacy, and the moderating effect of having other typically developing children or not. A total of 274 participants were recruited to participate in the study. The results showed that parental self-efficacy mediated the association between parental perceived stigma and parental PA support and the moderating effect of having other typically developing children or not.

Comparing stigma between French people experiencing schizophrenia versus bipolar disorders

BACKGROUND

Among the multiple challenges that people experiencing mental illness in general, and schizophrenia or bipolar disorders in particular, have to face, stigma appears to be one of the most difficult to tackle. In France, the body of research about stigma regarding people experiencing schizophrenia or bipolar disorders is growing, but not as much as in other western countries.

AIMS

In this context, our study aims to explore and compare stigma in French people experiencing schizophrenia or bipolar disorders, along with their respective mental healthcare system experience, in order to better address them within public health policies.

METHODS

20 French mental health service users experiencing schizophrenia and 20 experiencing bipolar disorders answered the Stigma Scale, which assesses three dimensions of stigma (discrimination, difficulties of divulgation and lack of positive aspects). A semi-structured interview was used to collect information about the experience of the mental healthcare system (level of information, access to diagnosis, treatment, access to psychoeducation, etc.).

RESULTS

People experiencing schizophrenia and people experiencing bipolar disorders are different populations in terms of social impairment. However, they share a comparable negative experience of the mental healthcare system and a comparable level of information about their illness, to the exception of diagnosis divulgation, as people experiencing bipolar disorders have a better access to their diagnosis. People experiencing schizophrenia perceive a higher actual discrimination than people experiencing bipolar disorders.

CONCLUSIONS

Public health policies should take into account the strong perception of actual discrimination of people experiencing schizophrenia, with capitalizing on what seems beneficial for people experiencing bipolar disorders.

'Here, we describe them as forgetful, confused, and absent-minded': dementia knowledge, stigma, and care plan among Vietnamese adults in rural area

OBJECTIVES

This study aims to investigate dementia knowledge, dementia stigma, and self-rated importance of dementia plan, and their associated factors among Vietnamese adults in rural Vietnam.

METHODS

A total of 325 participants completed the survey. The first section presented two vignettes and related open-ended questions. Participants described what terms local people in their community use, and what potential disease they thought the persons in the vignettes may have. Conventional content analysis was used to search for the key categories. The second section of the survey consisted of closed-ended questions from different measures. Two multivariate regression models were performed on dementia stigma and prioritizing dementia care plan.

RESULTS

The study results show that participants held a moderate level of knowledge about dementia, yet they tended to use symptom- and stigma-connoted language to describe people with dementia. Their dementia stigma was reported at a middling level and was positively associated with age, number of older adults they have currently lived with, and anxiety about aging, and negatively associated with being married, knowing someone with dementia, and having greater Alzheimer's disease knowledge. Most participants prioritized a future dementia care plan. The odds of this intention increased among those who have known someone with dementia, worried about getting dementia and caring for someone with dementia in the future, and had a higher level of Alzheimer's disease knowledge.

CONCLUSION

The study results highlight the importance of dementia knowledge and exposure to people with dementia in reducing dementia stigma and increasing the chance for dementia care planning.

Measurement of perceived pressures in psychiatry: paper-and-pencil and computerized adaptive version of the P-PSY35 scale

PURPOSE

Formal coercion in psychiatry is widely studied yet much less is known about pressures patients may experience, partly because of the very few measures available. The goal of this study was to validate the P-PSY35 (Pressures in Psychiatry Scale) and provide a paper-and-pencil and a computerised adaptive test (CAT) to measure pressures experienced by patients in psychiatry.

METHODS

The P-PSY35 items were developed with users. Patients were evaluated during psychiatric hospitalisation or through an online survey. Mokken scale analysis and Item response theory (IRT) were used to select and estimate the items parameters. A Monte-Carlo simulation was performed to evaluate the number of items needed to transform the paper-and-pencil test into a reliable psychometric CAT.

RESULTS

A total of 274 patients were assessed. The P-PSY35 demonstrated good internal validity, internal consistency, convergent and divergent validity. The P-PSY35 could be substantially shortened while maintaining excellent reliability using the CAT procedure.

CONCLUSION

The P-PSY35 was developed in collaboration with users. It is a psychometrically rigorous tool designed to measure experienced pressures in French-language. The development and successful validation of the P-PSY35 represent a welcome step towards implementing and evaluating programs aimed at reducing negative consequences of coercion.

Mechanisms of mental illness anti-stigma messaging matter: Leveraging mental health communication inequities among Latinx populations to understand what works and what we can do better

BACKGROUND

Since 1950, public communication about the neurobiological-psychosocial basis of mental illness from the diathesis-stress model has promoted reception to treatment yet violent/dangerous stereotypes have increased during this period. Moreover, public mental health communication efforts have predominantly diffused in English-language media, excluding Spanish/Latinx media and its consumers from these efforts. To inform future mental health communication strategies, this study leverages high versus low diffusion of public mental health communication across English and Spanish/Latinx media to examine public mental health communication effects on stigma and treatment beliefs via neurobiological-psychosocial beliefs.

METHODS

A quota sample of 2058 U.S.-based Latinx residents ages 13-86 with diverse language/cultural media preferences was recruited to self-complete a survey about mental health information acquisition in 2021. Assessments ascertained frequency of Spanish/Latinx and English media use and mental health content scanning and seeking (α = 0.86-0.94); and items from the General Social Survey about mental illness neurobiological-psychosocial causal beliefs (α = 0.72)-genetics, brain chemistry, environment, stress; treatment beliefs-mental illness improves with treatment or on its own; and stigma beliefs-violent/dangerous and bad character stereotypes and unwillingness to socialize with a person with mental illness. Structural equation models estimated total, direct, and indirect effects of Spanish/Latinx and English media exposures on treatment and stigma beliefs via neurobiological-psychosocial beliefs, net individual/family factors.

RESULTS

Spanish/Latinx media reduced, while English media increased, neurobiological-psychosocial beliefs (p < 0.01). Neurobiological-psychosocial beliefs, in turn, increased treatment and stigma beliefs (p < 0.01), simultaneously. Indirect pathways were also significant (p < 0.05). Proportion mediated on treatment beliefs was one-third for Spanish/Latinx and two-thirds for English media. Proportion mediated on stigma beliefs for all media exposures averaged ≥1.

CONCLUSIONS

While consumers of Spanish/Latinx media report lower neurobiological-psychosocial knowledge that impedes treatment beliefs, consumers of English media report greater neurobiological-psychosocial and treatment knowledge and, consequently, more stigma. Innovation in public mental health communication is needed to counter stigma and health inequity.

Parents' illness representations of their child with anorexia nervosa: A systematic review of qualitative studies using the common-sense model

OBJECTIVE

Research indicates that parents experience distress while caring for a child with anorexia nervosa. Applying the Common Sense Model of Self-Regulation (CSM), a framework to describe responses to illness may help to understand the antecedents of parental distress, which could inform how to support parents in treatment. The aim of this systematic review was to synthesize outcomes from qualitative research in relation to parents' experiences of caring for a child with anorexia nervosa using the CSM.

METHOD

Systematic search of four electronic databases (psychINFO, MEDLINE, EMBASE, ProQuest Dissertation, and Theses Database) alongside a two-way screening process was used to identify eligible studies. Qualitative themes were synthesized using a "best fit" framework analysis and reported according to CSM dimensions of cognitive and emotional illness representations.

RESULTS

A total of 32 studies published between 1970 and 2023 were eligible for inclusion for review. Parents perceived their child's anorexia nervosa as a major health threat observable by illness representations that anorexia nervosa was uncontrollable, incomprehensible, chronic, and associated with negative consequences. The themes also suggested parents take responsibility for causing anorexia nervosa. These illness representations were linked with emotional representations of fear, anxiety, shame, guilt, loneliness, and depression.

CONCLUSIONS

The findings provide evidence of the utility of using the CSM to understand the antecedents of parents' distress and negative impacts of caring for a child with anorexia nervosa. Recommendations for future research and clinical practice are discussed emphasizing the need to understand parents' perceptions of their child's illness to putatively maximize treatment benefits for families.

PUBLIC SIGNIFICANCE

This review emphasizes the salience of understanding parents distress while caring for a child with anorexia nervosa. The findings present opportunities to best support parents in treatment, with a focus on addressing their cognitive and emotional representations of their child's illness. A multicomponent treatment regimen may be required to support parents if they present with illness representations that negatively affect their well-being and ability to cope with distress.

The mediating roles of depressive symptoms and social participation in the relationship between the effects of pain and cognitive function among Chinese older adults: A longitudinal study

Decline in cognitive function poses a substantial burden on individuals, families, and society. However, the longitudinal potential mechanism underlying the link of pain and cognitive function remains unclear. Using data of 4247 participants aged 60 years and over from the China Health and Retirement Longitudinal Study in 2011, 2013, 2018, and 2020, we discussed the longitudinal predictive effect of pain on cognitive function and the mediating effects of depressive symptoms and social participation. The longitudinal mediation model analysis revealed that pain could not directly influence cognitive function, but it could indirectly predict cognitive function through the independent mediation effects of depressive symptoms and social participation. Moreover, the association between pain and cognitive function was serially mediated by depressive symptoms and social participation. Diversified interventions aimed at relieving pain and depressive symptoms, and increasing social participation in older adults would be beneficial for their cognitive function.

Stigma of nursing students towards people with mental illness: Protocol of a mixed-method systematic review

Aims

To synthesize the influencing factors of the stigma of nursing students towards people with mental illness (PMI).

Background

The stigma of nursing students towards PMI may affect their career choices and negatively impact people seeking health services. While many studies have examined the educational aspects of mental health, they often overlook the multiple dimensions of possible factors influencing nursing students' perceptions.

Design

A mixed-method systematic review using the Framework Integrating Normative Influences on Stigma (FINIS).

Methods

We will search six databases, including PubMed, Web of Science, Cochrane Library, EMBASE, CINAHL and PsycINFO. The reference list of the included literature will be thoroughly examined to identify if any additional studies meet the criteria. Two authors will independently screen all titles, abstracts, full text and extract data. The Mixed-method Appraisal Tool will be used to assess quality. The extracted data will be disposed to different levels, including micro (demographic characteristics, disease characteristics), meso (social networks, treatment systems) and macro (media images, national context) to comply with the FINIS.

Expected results

This systematic review aims to comprehensively analyze the influencing factors of the stigma of nursing students towards PMI, providing a reference basis for anti-stigma intervention measures.Prospero registration number: CRD42022374419.

Experience and impact of stigma in people with chronic hepatitis B: a qualitative study in Asia, Europe, and the United States

BACKGROUND

People with chronic hepatitis B (CHB) commonly experience social and self-stigma. This study sought to understand the impacts of CHB-related stigma and a functional cure on stigma.

METHODS

Adults with CHB with a wide range of age and education were recruited from 5 countries and participated in 90-minute qualitative, semi-structured interviews to explore concepts related to CHB-associated stigma and its impact. Participants answered open-ended concept-elicitation questions regarding their experience of social and self-stigma, and the potential impact of reduced CHB-related stigma.

RESULTS

Sixty-three participants aged 25 to 71 years (15 from the United States and 12 each from China, Germany, Italy, and Japan) reported emotional, lifestyle, and social impacts of living with CHB, including prejudice, marginalization, and negative relationship and work experiences. Self-stigma led to low self-esteem, concealment of CHB status, and social withdrawal. Most participants stated a functional cure for hepatitis B would reduce self-stigma.

CONCLUSIONS

CHB-related social and self-stigma are widely prevalent and affect many aspects of life. A functional cure for hepatitis B may reduce social and self-stigma and substantially improve the health-related quality of life of people with CHB. Incorporating stigma into guidelines along with infectivity considerations may broaden the patient groups who should receive treatment.

Stigma and its impact on disclosure and mental health secrecy in young people with clinical depression symptoms: A qualitative analysis

BACKGROUND

Clinical depression ranks as a leading cause of disease and disability in young people worldwide, but it is widely stigmatized. The aim of this qualitative research was to gather young people's experiences of depression stigma and its impact on loneliness, social isolation, and mental health disclosure and secrecy. This novel information can then be used to guide psychosocial interventions for young people with depression.

METHODS

This qualitative study included N = 28 young people aged 18-25 years (Mage = 21.30). Participants were recruited from the community who had high symptoms of depression (assessed through a pre-screen using the Mood and Feelings Questionnaire (MFQ) with a benchmark score > 27) or had been recently diagnosed with depression by a medical professional. Semi-structured interviews were based on conceptual model drawings created by participants and analyzed using thematic analysis.

RESULTS

Four main themes emerged: 1) Depression secrecy: positive and negative aspects; 2) Depression disclosure: positive and negative aspects; 3) The solution is selective disclosure; and 4) Participants' recommendations do not align with personal preferences. In particular, the young people described non-disclosure as a way to be in control, but that secrecy prevented authentic engagement with others. Young people also described disclosure as eliciting more stigma but as necessary to gain help. Finally, the young people described struggling with knowing how much to disclose in relation to their mental health and with whom they could disclose.

CONCLUSIONS

This study provides new evidence of how young people with depression experience stigma and its effects on disclosure and mental health secrecy. Knowing how young people struggle with these issues can allow us to develop interventions to encourage them to come forward and discuss their mental health in order to receive appropriate support and treatment. We recommend young people be signposted and have access to mental health champions or nominated teachers in their schools or universities.

Factors associated with dementia attitudes in an adolescent cohort: Structural Equation Modelling

Objective

Dementia-related stigma is a key barrier to people living well with dementia, leading to social isolation and poor well-being. Adolescents represent an under-researched group that will become future carers and healthcare workers for the estimated 83.2 million people who will be living with dementia by 2030. Understanding the factors involved in dementia attitude formation in adolescents is useful for the development of evidence-based anti-stigma initiatives. This study aims to identify predictors of dementia attitudes in adolescents.

Methods

This is a cross-sectional study using secondary data analysis. 470 participants aged 12-15 years old from secondary schools in the Southeast of England, United Kingdom completed validated questionnaires relating to dementia attitudes (KIDS and Brief A-ADS) as well as demographic information. Multiple regressions were employed as well as a path analysis via a structural equation model to test for direct and mediatory effects.

Results

Multiple regression models revealed that being female, having higher levels of contact with dementia, and higher levels of empathy are positively associated with dementia attitudes in adolescents (p<0.05). Within the accepted structural equation model, empathy was a key mediator between contact and dementia attitudes.

Conclusion

This study highlights the pivotal role that contact with dementia can have in influencing dementia attitudes in adolescents with empathy serving as a mediator between contact and dementia attitudes. Interventions that use contact should consider how to stimulate empathetic responses to ultimately shape dementia attitudes.

Assessment tools for stigma in breast cancer patients based on COSMIN guidelines: a systematic review

OBJECTIVE

The objective of this study was to conduct a systematic review of the measurement properties and methodological quality of stigma assessment tools designed for breast cancer patients. The aim was to provide clinical medical staff with a foundation for selecting high-quality assessment tools.

METHODS

A comprehensive computer search was carried out across various databases, including SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database(VIP), Embase, PubMed, Web of Science, The Cochrane Library, and Scopus, which were searched from the inception of the databases until March 20, 2023. Literature screening and data extraction were performed independently by two researchers, adhering to predefined inclusion and exclusion criteria. The assessment tools were evaluated using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) systematic evaluation guidelines.

RESULTS

In the final analysis, a total of 9 assessment tools were included. However, none of these tools addressed measurement error, cross-cultural validity, criterion validity, and responsiveness. Following the COSMIN guidelines, BCSS and CSPDS were assigned to Class A recommendations, while the remaining tools received Class B recommendations.

CONCLUSION

The BCSS and CSPDS scales demonstrated comprehensive assessment in terms of their measurement characteristics, exhibiting good methodological quality, measurement attribute quality, and supporting evidence. Therefore, it is recommended to utilize these scales for evaluating breast cancer stigma. However, further validation is required for the remaining assessment tools.

People with mental illness stigmatize mental illness less: A comparison study between a hospital-based sample of people with mental illness and a non-clinical general population sample in urban India

Evidence shows that stigma negatively influences the quality of life of persons with severe mental illness. Nonetheless, stigma towards mental illness is lower among persons with a lived experience of mental illness compared to the rest of the population. Understanding the association between stigma of mental illness and the mental status of individuals living in urban India and whether this association is moderated by demographic factors opens a new avenue for prevention of social exclusion. Persons diagnosed with schizophrenia, bipolar disorder, or severe unipolar depression (cases, n  =  647) were recruited from among hospital patients in New Delhi between November 2011 and June 2012 and matched with non-psychiatric urban dwellers by age, sex, and location of residence (controls, n  =  649). Propensity score matching with multivariable linear regression was used to test whether stigma towards mental illness, measured by a 13-item Stigma Questionnaire, differed between cases and controls. Cases reported significantly lower stigma scores than controls (b  =  -0.50, p < 0.0001). The strength of the association between mental illness and stigma was not affected after controlling for age, caste, sex, education, and employment status, while wealth marginally reduced the strength of the association. These findings suggest individuals with a lived experience of mental illness, in New Delhi, India, may be more tolerant towards mental illness and support the need to involve persons with lived experience in the development and implementation of health promotional campaigns and programs aimed at reducing stigma towards mental illness.

Internalized stigma and self-stigma in people diagnosed with a mental disorder. One concept or two? A scoping review

BACKGROUND

In the literature on stigma, authors often use self-stigma or internalized stigma interchangeably to refer to this type of stigma. This results in a lack of conceptual clarity with negative repercussions for measurement and intervention.

AIMS

To identify how internalized stigma and self-stigma are conceptualized in people diagnosed with a mental disorder and establish similarities and differences between both concepts.

METHOD

A scoping review was conducted. Thirty-five studies that conceptualized internalized stigma or self-stigma were selected.

RESULTS

It was identified that the concepts are defined from nine components, and there are more conceptualizations that have points in common than those that consider some component of their own. To gain conceptual clarity, the use of the term internalized stigma is recommended, being a process made up of stages: acceptance of stereotypes and prejudices by people with mental disorders and their subsequent internalization. The latter leads to negative consequences for those affected, which can be understood as the personal impact of this process, which has a crucial socio-cultural component. Lines of research are proposed to provide solidity to studies on this type of stigma.

CONCLUSIONS

The term internalized stigma should be used when referring to the type of stigma that includes acceptance, internalization and personal impact for the subjects of the stigma. In contrast, self-stigma should be reserved to refer to stigma that is directed toward the 'self' and includes subtypes of stigma.

Examining the effect of discrimination and stigma on utilization of mental health services among college students

BACKGROUND

Even though onset of three-quarters of mental disorders occurs by age 25, few young adults seek help for their mental health needs. The objectives of this study are to examine the relationship of discrimination and stigma of mental illness on the help-seeking behavior for mental health among college students.

METHOD

Undergraduate students (N = 557) at a Midwestern university were surveyed online. Descriptive and logistic regression analysis was conducted using STATA15.

RESULTS

College students reporting higher discrimination were more likely to seek help for mental health services (OR = 1.04, CI = 1.01-1.06), after controlling for all covariates. Students with higher personal stigma reported lower odds of help-seeking behavior (OR = 89, CI = .80-.97). Students with higher perceived public stigma did not have an independent significant association on help-seeking behavior initially, but full model revealed a significantly association (OR = 1.02, CI = .99-1.05).

CONCLUSION

Developing targeted interventions addressing discrimination and stigma of mental illness is critical among college students.

Staying hidden: The burden of stigma in PD

BACKGROUND

Despite the myriad motor and non-motor challenges associated with Parkinson's disease (PD) diagnosis, the hidden issue of stigma may be among the most influential factors negatively affecting quality of life. A number of qualitative studies have been published assessing various aspects of stigma in PD, and quantitative studies assert that most people with PD experience stigma during the course of their disease. Stigma is associated with poorer mental and physical health, poorer quality of life, decreased levels of hope, self-esteem and self-efficacy. The resulting stigma can lead to social anxiety and isolation, reluctance to seek medical care, loneliness, depression and anxiety. Therefore, understanding what stigma is, where it comes from, and how it affects people living with PD may offer clinicians and care partners tools to help mitigate the negative effects.

FOCUS

Over the past few decades, we have seen a move away from simply focusing on the effects of a disease (medical model) toward a holistic biopsychosocial approach that considers the role of environmental factors (stigma) when assessing overall well-being. We review some proactive practical suggestions to help people living with PD effectively combat the negative effects of stigma.

CONCLUSION

The additional hidden burden of stigma from PD affects quality of life. Having a better understanding of the role of stigma and its impact may allow clinicians to provide proactive care and greater empathy for those living with the challenges of this disease.

The Role of Media in Addressing Opioid Use Disorder: Examining Causal Attributions and Emotions as Mediators of Media Influence on Stigma and Policy Support

This study examined the influence of media on stigma and public support for policy interventions that address opioid-related problems. Data from a survey of 997 U.S. adults indicate that media exposure to opioids and relevant topics significantly influenced stigma and support for punitive and public health-oriented policies, even after direct and indirect experiences with opioid misuse were controlled for. However, differences emerged in terms of what led people to endorse each type of policy intervention. When people attributed opioid misuse to individual-oriented causes after media exposure, they were more likely to support punitive policies. When people recognized pharmaceutical-oriented causes, they tended to support public health-related policies.In addition to causal attributions, emotions (fear, anger, and sympathy) served as mediators with different effects on stigma and policy support. Although exposure to opioid-related stories positively influenced all three emotions, media influence was most likely to elicit sympathy, which was negatively associated with social stigma. However, people who felt anger tended to stigmatize individuals with opioid use disorder and not to support either of the policy interventions. The overall findings suggest that communication efforts addressing the opioid situation should find frames that reduce social stigma and encourage support for public health-related policies.

New Community and Sociohealth Challenges Arising from the Early Diagnosis of Mild Cognitive Impairment (MCI)

Population aging increases the risk of developing neurodegenerative diseases that cause cognitive impairment. Advances in clinical practice and greater social awareness of the importance of cognitive impairment have led to an increase in the number of people with early diagnosis, predementia. Increasing access to biomarkers to assess whether Alzheimer's disease (AD) is the underlying cause of mild cognitive impairment (MCI) has undoubted clinical benefits (access to potentially disease-modifying treatments, among others) but is also responsible for new social-health care challenges. Understanding the psychosocial impact of a diagnosis of MCI due to AD or another neurodegenerative disease is essential to create future strategies to reduce the emotional overload of patients, their risk of discrimination and stigmatization, and to favor their social inclusion. We present a narrative review of the diagnostic process of mild cognitive impairment in clinical practice, with a holistic person-centered approach, and discuss the implications of such diagnosis (benefits and risks) and strategies on how to address them.

Self-Stigma of Stuttering: Implications for Communicative Participation and Mental Health

PURPOSE

The purpose of this study was to determine if self-stigma-related variables predicted communicative participation and mental health in adults who stutter. A progressive model of self-stigma was theorized and tested.

METHOD

Adults who stutter (N = 344) completed a survey that included measures of communicative participation, global mental health, and a variety of self-stigma-related variables including perceived enacted stigma, stigma awareness, anticipated stigma, felt stigma, stereotype agreement, and stigma application, in addition to demographic and speech-related variables. Hierarchical regression was performed to test whether self-stigma-related variables progressively explained significant variance in both communicative participation and global mental health.c Results: After controlling for demographic and speech-related variables, stigma-related variables were found to be significant predictors of both communicative participation and global mental health among adults who stutter. Most self-stigma-related variables entered later in the model predicted additional unique variance in the outcome variables than the self-stigma-related variables entered in previous steps, thus supporting the trickle-down and progressive nature of the self-stigma model theorized.

CONCLUSIONS

Accounting for self-stigma in the assessment and treatment of individuals who stutter may identify and ultimately reduce environmental and personal barriers to communicative functioning and well-being in people who stutter. The self-stigma terminology and model described in this study will help practitioners, researchers, and the public better understand the process of self-stigma and how it may be associated with adverse outcomes experienced by people who stutter.

Psychometric validation of the Reported and Intended Behaviour Scale (RIBS) in Hungary with a particular focus on 'Don't know' responses and further scoring recommendations

AIMS

Reported and Intended Behaviour Scale (RIBS) was designed to measure mental health stigma-related behaviors in the general public. We aimed to examine its psychometric properties and validate the scale in a Hungarian non-clinical community sample. The secondary aim of this study was to assess the appropriateness of the current scoring recommendations of 'Don't know' responses being coded as neutral, which had never been investigated before. In addition, we provide an overview of the results of already existing studies on the scale.

METHODS

Hungarian participants completed the RIBS within this cross-sectional online survey study and were considered non-clinical individuals based on a cut-off point of the Global Severity Index T score of 63 on the Symptom Checklist-90-Revised. Confirmatory factor analysis, reliability measures, and comparative analyses were performed.

RESULTS

Of the n = 5,701, n = 5,141 participants were included in the analysis. The mean age was 27.8 ± 11.1 years, and 89.2% (n = 4,587) of the sample were female. The unidimensional structure was supported by good model fit indices (RMSEA = 0.031, CFI = 0.999, TLI = 0.996, and WRMR = 0.006). Internal consistency of the RIBS and its test-retest reliability with a 5-month follow-up period were found to be good (Cronbach's alpha = 0.88 and ICC = 0.838). We found statistically significant differences between the total scores when the 'Don't know' responders were excluded from the sample or when they were coded as neutral as recommended by the scale authors (16 (IQR:13-18) vs. 15 (IQR:13-18) p < 0.0001). There were also statistically significant differences between 'Neither agree nor disagree' and 'Don't know' participants in several aspects of lived experiences of mental health problems.

CONCLUSIONS

The RIBS demonstrated good psychometric properties and can be transferred to the Hungarian context. It will be a valuable tool in assessing stigmatizing behavior and testing the efficacy of antistigma programs. Our results suggest that 'Neither agree nor disagree' and 'Don't know' responses bear different meanings, and coding should account for this.

The pursuit of intimacy: intimate relationship development for women with physical disabilities

Background and purpose

Understanding the barriers and facilitators to intimate relationship development among women with physical disabilities is crucial for promoting positive rehabilitation outcomes. This study investigates these factors using a Consensual Qualitative Research approach.

Methods

The research team utilized Consensual Qualitative Research. Consensual Qualitative Research is widely used in various social services to address limitations inherent limitations of other qualitative methods. Women with various physical disabilities (n=6) were identified and interviewed using a utilized a semi-structured interview. Their attitudes towards intimacy, outcome expectancy, and self-concept of women with physical disabilities were examined. The impact of physical disabilities, including disability stigma, on these factors was also assessed. Data was coded utilizing multiple researcher consensus as well as an auditor to consensually agree upon domains and core ideas while taking into account validity and trustworthiness, as per the methodology chosen.

Results

The study discovered general themes (100% representation) concerning core values and barriers to intimacy, societal barriers to intimate relationships, and hope for future relationships. Typical themes (50-83% representation) included non-romantic intimacy, physical barriers to intimacy, perceived limitations, and negative outcome expectancies. Across the board, the influence of disability limitations, identity, and societal attitudes became evident. The role of rehabilitation professionals in advocating for social skills development and self-confidence enhancement emerged as crucial.

Conclusions

The study illuminated barriers to intimacy among women with physical disabilities, such as societal stigma and self-concept associated with disability. The critical role of rehabilitation professionals in normalizing intimacy discussions and equipping individuals with necessary social skills and self-confidence was underscored. This focus could yield enhanced intimate relationship outcomes and improve the quality of life for women with physical disabilities.

Effects of mental health stigma on loneliness, social isolation, and relationships in young people with depression symptoms

BACKGROUND

Major depressive disorder (MDD) is the most prevalent affective disorder and the leading cause of illness and disability among young people worldwide. Besides being more susceptible to the onset of depression, young people have a higher risk of loneliness, and their personal and social development is impacted by social relationships during this time. It is thought that mental health stigma can undermine both help-seeking and longer-term outcomes for disorders like depression in young people. However, how stigma (i.e., related to depression) might affect young people's feelings of loneliness, social isolation, and relationships is unclear. Using qualitative research methods, this study aimed to explore the subjective experiences of public and internalized stigma and its effects on loneliness, social isolation, and relationship quality in young people with depression symptoms.

METHODS

We carried out in-depth, semi-structured interviews with N = 22 young people aged 17-25 (M_age = 22 years) who reported high symptoms of depression (Mood and Feelings Questionnaire (MFQ) score > 27) (i.e., community sample, N = 9) or had been previously diagnosed with depression by a medical professional (i.e., clinical sample, N = 13). Data were analysed using thematic analysis. We explored the subjective effects of depression stigma on loneliness, social isolation, and relationships.

RESULTS

Participants described both public stigma (i.e., initiated by others) and internalized stigma (i.e., self-imposed) as disrupting social relationships and eliciting loneliness, isolation, and depressive symptomology. Four main themes about young people's subjective experiences of stigma were identified: 1) Others' Misunderstanding of Mental Health Disorders and the Impact Misunderstanding has on Relationships; 2) Effects of Stigma on the Self and Wellbeing; 3) Stigma Fosters Secrecy Versus Disclosure; and 4) Stigma Increases Loneliness Driven by Avoidance of Social Contexts.

CONCLUSIONS

Young people's accounts revealed a wide range of consequences beyond their depression diagnosis. Participants often felt discriminated against, misunderstood, and judged by others as a result of public stigma; they discussed internalizing these attitudes. They suggested that a lack of understanding from others, for example from their partners, family, and peers, and unreliable and/or absent support systems resulted in increased feelings of loneliness and social isolation and reduced the quality and quantity of relationship formation, social bonds, and interactions. Stigma also reduced their self-esteem and confidence, which in turn fostered secrecy and a reluctance to disclose their depression. Despite depression's stigma, most participants reported having long-term goals and aspirations to reconnect with others. These goals stood in contrast to feeling hopeless and unmotivated during periods of depression. Overall, we reveal how stigma can impact feelings of loneliness, social isolation, and relationships among young people with depression, which could lead to targeted interventions to lessen the impact of stigma in this population.

Dimensionality and risk factors of the personal stigma of depression in adults aged 50 years and older at risk of depression

Objectives: Knowledge about the mechanism of the personal stigma of depression may inform strategies to reduce stigma and promote help-seeking. We examined the dimensionality and risk factors of the personal stigma of depression in older adults at risk of depression.Methods: Seven-hundred and one Hong Kong adults aged 50 years and older at risk of depression completed the personal stigma subscale of the depression Stigma Scale (DSS-personal) at two-time points. We used exploratory factor analysis (EFA) to explore the factor structure of DSS personal and confirmatory factor analysis to examine the model fit of the EFA-informed factor structure and structures proposed in previous studies. Regression analyses examined the relationships between risk factors and personal stigma dimensions.Results: Factor analyses identified a 3-factor structure of DSS-personal resembling the social-cognitive model consistent over time and included stereotype, prejudice, and discrimination (CFI = 0.95, TLI = 0.92, RMSEA = 0.05). Regression analyses indicated all stigma dimensions were associated with older age, less education, and no personal history of depression (B = -0.44 to 0.06); discrimination was also associated with more depressive symptoms (B = 0.10 to 0.12).Conclusion: Findings illustrated the potential theoretical underpinning of DSS-personal. Stigma reduction interventions could target and tailor to older adults with risk factors to enhance effectiveness and promote help-seeking.

Understanding stigma through the lived experiences of people with opioid use disorder

BACKGROUND

Stigma toward substance use disorders reduces treatment seeking and recovery efforts of persons who could most benefit from services. This is particularly true for opioid use disorder (OUD) stigma, which in recent years has likely fueled the overdose epidemic. Understanding the stigma surrounding OUD and stigma reduction efforts that can be implemented are needed to enhance treatment and recovery efforts. This project explores the lived experiences of persons who were in recovery from OUD or a family member of someone with OUD with a focus on stigma.

METHODS

We utilized a qualitative method to examine secondary data of published transcripts where people's (N = 30) experiences with stigma emerged through storytelling.

RESULTS

Thematic analysis found three overarching types of stigma that were described by participants, 1) Social stigma: misconceptions contributing to social stigma, labeling and associative stereotypes, persistence of stigma throughout recovery; 2) Self-stigma: internalized feelings due to stigma, concealing and continuing substance use, inadequacies of navigating recovery; and 3) Structural stigma: treatment and recovery resource barriers, challenges of reintegration.

CONCLUSIONS

The experiences described by participants highlight the multifaceted impact of stigma on the individual as well as society and add to our understanding of the lived experience of stigma. Future recommendations are discussed to improve the experience of individuals with lived experience of OUD; including implementing evidence-based strategies to reduce stigma such as using stigma-free or person first language, dispelling common myths, and supporting comprehensive recovery pathways.

The effects of emotion and juvenile diagnoses on parole release decisions: An experimental approach

Parole boards are often required to make many release recommendations after reviewing a substantial amount of information in a short timeframe. While making release decisions, parole board members might be motivated to sacrifice accuracy and, instead, use heuristics, such as their emotions. Emotions might increase the reliance on risk or threat related information, such as an inmate's mental illness status. The current study applies the appraisal tendency framework of emotion to assess the impact of emotion on parole decisions involving juvenile mental health diagnoses. Using a 3(emotion: anger, compassion, and control) x 4(mental illness: conduct disorder, oppositional defiant disorder, depression, and control) factorial design, this study examined the extent to which mock parole board members' emotions impacted evaluations of inmates with juvenile mental illness diagnoses and subsequent release decisions. Results indicated that there was no effect of emotion on parole decisions. However, the inmates' mental illnesses did play a role in parole release decisions. Specifically, parole candidates with depression were released on parole at higher rates compared to conduct disorder, oppositional defiant disorder, and the control condition. Policy implications are discussed.

Barriers and facilitators to access mental health services among people with mental disorders in Indonesia: A qualitative study

Background

The care and treatment management of people with mental health problems has become a prominent global concern in recent years that requires consistent attention. However, the literature suggests that only a small percentage of individuals with mental health problems in Indonesia receive the necessary mental health care. Therefore, it is crucial to explore this gap.

Objective

This study aimed to explore barriers and facilitators that affect access to mental health services among people with mental health disorders in Indonesia.

Methods

The study employed a qualitative descriptive design and focused on individuals with depression, anxiety, or bipolar disorder. Data were collected through in-depth interviews conducted via WhatsApp chat with 90 participants aged 18-32, who were purposively selected from Sumatra, Java, Kalimantan, and Papua Islands in Indonesia between January and June 2022. Thematic analysis was used to analyze the data.

Results

The barriers to accessing mental health services included: 1) uneasy access to mental healthcare facilities, 2) stigma, lack of social support, and delay in receiving proper treatment, and 3) expensive treatment costs without national health insurance membership. Importantly, the facilitators to access mental health services included: 1) national health insurance membership, 2) support from spouse, family, and closest friends and its association with mental health literacy, and 3) self-help.

Conclusion

The widespread distribution of mental health knowledge is recommended among healthcare providers, including public health practitioners and primary care nurses, to enhance their mental health literacy and competencies while rendering services to individuals with mental disorders. Additionally, efforts should be made to educate and promote awareness among caregivers and communities to reduce the stigma faced by those with mental disorders.