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

Dementia education and training for the general public: A scoping review

The lack of public awareness and understanding of dementia affects the experiences of people living with dementia and their families. Dementia education and training for the general public have been gradually disseminated. We conducted a systematic scoping review guided by PRISMA-ScR to map existing evidence and identify dementia education and training available to the general public. From the four electronic databases, 41 articles were identified. Dementia education has three main purposes: dementia friendliness (n = 25), early diagnosis/help-seeking (n = 10), and prevention (n = 6). Education aimed at dementia friendliness was delivered in the community (n = 6), schools/universities (n =14), workplaces (n = 2), and online (n = 3). Interventions aimed at early diagnosis and prevention were often conducted in communities with middle-aged and older people or specific ethnic groups. Eleven dementia-friendliness studies reported on the interaction with people living with dementia to reduce stigma. Dementia knowledge, attitudes, and preventive behaviors were assessed as outcomes. Though randomized controlled trials were conducted in early diagnosis and prevention studies via e-learning, they were not performed in dementia-friendliness studies. Therefore, there is a need to further accumulate evidence of dementia education for each of these purposes.

The Personal Suicide Stigma Questionnaire (PSSQ): Relation to Self-Esteem, Well-Being, and Help-Seeking

Two studies are reported that extend the evidence base for use of the Personal Stigma of Suicide Questionnaire (PSSQ). In the first study (N = 117), the Rosenberg Self-Esteem Scale, the WHO-5 measure of well-being, as well as measures of suicidality were examined in relation to the PSSQ. A self-selected sub-sample (N = 30) completed the PSSQ after an interval of two months. In line with the stigma internalization model, when demographic variables and suicidality were accounted for, the PSSQ self-blame subscale was the most significant predictor of self-esteem. As for well-being, the rejection subscale was involved as well as self-blame. The retest stability of the PSSQ for the sub-sample was 0.85 and coefficient alpha for the total sample was 0.95, indicating both good stability and internal consistency for the scale. In the second study (N = 140), PSSQ was studied in relation to intention to seek help from four sources in the case of suicidal ideation. The strongest relationship with PSSQ was with intention not to seek help from anyone (r = 0.35). When other variables were included in the prediction of help-seeking from a general medical practitioner, family or friends, or from nobody, the only significant PSSQ correlate was minimization. For help-seeking from a psychologist or psychiatrist, the most significant predictor was judged helpfulness of prior contact with them. The results from these studies strengthen previous findings of the construct validity of the PSSQ and point to its utility in understanding barriers to help-seeking among those experiencing suicidality.

A scoping review of psychosocial interventions to reduce internalised shame

Internalised shame has been linked to psychopathology and consistently identified as a predictor of poor treatment outcomes and premature therapy termination. We conducted a scoping review of therapist-delivered psychosocial interventions to reduce internalised shame to learn how to improve outcomes for individuals experiencing shame.

Six bibliographical databases were searched for studies measuring internalised shame pre- and post-treatment. We screened 6846 abstracts; 42 full-text manuscripts were retrieved, with 16 studies meeting the inclusion criteria. Of these, 10 studies examined between- and within-subject effects, and 6 studies exclusively examined within-subject effects.

Twelve of the sixteen included studies reported small to moderate within-group reductions in internalised shame. Between group analyses showed that shame interventions may be more effective than no treatment or treatment as usual, but not more effective than an active comparator.

Successful treatments often involved psychoeducation, experiential exercises, and techniques to increase social support and emotional expression; however, study quality was weak to moderate and the importance of each of these techniques for reducing internalised shame was not determined.

Stigma as a barrier to early intervention among youth seeking mental health services in Ontario, Canada: a qualitative study

BACKGROUND

Stigma associated with mental health challenges is a major barrier to service seeking among youth. Understanding how stigma impacts service-seeking decisions from the perspectives of youth remains underexplored. Such research is necessary to inform effective stigma reduction.

OBJECTIVE

This study aims to understand how stigma influences service seeking among youth with mental health challenges.

METHODS

Qualitative inquiry was taken using youth engagement, underpinned by pragmatism. Data were collected via 4 virtual focus groups with 22 purposively selected youth participants with lived experience of mental health challenges in Ontario, Canada. Focus group guides were developed collaboratively among research team members, including youth co-researchers. Data were analyzed inductively using reflexive thematic analysis.

RESULTS

Three main themes were constructed from the data: point of entry into the system, being biomedicalized or trivialized, and paving the way for non-stigmatizing services. Initial contact with the mental healthcare system was seen to be affected by stigma, causing participants to delay contact or be refused services if they do not fit with an expected profile. Participants described a constant negotiation between feeling 'sick enough' and 'not sick enough' to receive services. Once participants accessed services, they perceived the biomedicalization or trivialization of their challenges to be driven by stigma. Lastly, participants reflected on changes needed to reduce stigma's effects on seeking and obtaining services.

CONCLUSION

A constant negotiation between being 'sick enough' or 'not sick enough' is a key component of stigma from the perspectives of youth. This tension influences youth decisions about whether to seek services, but also service provider decisions about whether to offer services. Building awareness around the invisibility of mental health challenges and the continuum of wellness to illness may help to break down stigma's impact as a barrier to service seeking. Early intervention models of care that propose services across the spectrum of challenges may prevent the sense of stigma that deters youth from accessing and continuing to access services.

A Review on Mental Illness and Stigma

The concept of stigma is a universal problem that has been the subject of many studies. The phenomenon of stigmatization in psychiatric disorders is also an issue that should be particularly emphasized. Studies have reported that the diagnostic groups most exposed to stigmatization are psychotic disorders, bipolar disorders, depressive disorders, anxiety disorders, and substance use disorders. The stigma process is shaped especially by the clinical features of psychiatric disorders and the society’s attributions to the causes of psychiatric disorders. IIn order for interventions to be developed to prevent stigmatization to be effective, the causes of stigmatization must first be understood.. Therefore, in this study, it is aimed to review the stigmatization processes separately according to the types of psychiatric disorders.

Self-stigma in people living with dementia in Chile: A qualitative exploratory study

BACKGROUND

Self-stigma is a dimension of stigma concerning how individuals internalize negative attributes and discriminate against their own selves. Dementia is a stigmatizing condition, and there is a paucity of research exploring the manifestations and implications of self- stigma in people living with dementia in various contexts.

AIM

To examine how self-stigma manifests in the experiences of people living with early-stage dementia in Santiago, Chile.

PARTICIPANTS

Six men and five women living with early-stage dementia of the Alzheimer's type, aged between 64 and 82 years old (mean = 70).

METHODS

One-on-one interviews were conducted, focusing on the experience of people living with early-stage dementia to provide insights on how self-stigma manifests. Interviews were analyzed with a qualitative content analysis approach using Corrigan's social cognitive model of self-stigma (2016).

RESULTS

Self-stigma manifested as devaluation and blame at a cognitive level, and as restriction of participation at a behavioral level. Families and dementia education emerged as contextual elements that influenced the internalization of negative attributes in the participants' experiences.

CONCLUSIONS

Consistent with previous qualitative research, we found that self-stigma has negative consequences as it concerns emotions, self-prejudices, and self-discrimination. This study provides distinctive insights on the process of internalization of stigma and the influence of external elements. Self-stigma remains an understudied but important feature of the dementia experience, an understanding of which can lead to developing and testing supportive approaches upon diagnosis to minimize its adverse effects.

Development of Junior High School Students to Secondary Vocational Students Stigma Scale

BACKGROUND AND AIM

It is particularly obvious that vocational and technical education (VTE) has been stigmatized for a long time in the field of secondary vocational education. The severe stigma that secondary vocational students suffer from may negatively affect junior high school students' choice to attend secondary vocational schools and become such students. This study aims to develop the junior high school students to Secondary Vocational Students Stigma Scale (SVSSS) and to test its reliability and validity.

METHODS

The initial questionnaire was formed following an open-ended questionnaire and expert review based on the conceptual model of stigma as a theoretical framework. A total of 316 junior high school students (sample 1) were administered with the resulting data subjected to item analysis and exploratory factor analysis (EFA). And a total of 416 junior high school students (sample 2) were administered with the data applied for validity, reliability, and cross-group invariance test.

RESULTS

It was revealed in the EFA that the SVSSS consists of 20 items in total, including three dimensions, namely negative labeling, social isolation, and devaluation and discrimination. Favorable structural validity of the questionnaire was demonstrated in confirmatory factor analysis (CFA) (x 2/df=2.907, RMSEA=0.068, RFI=0.925, CFI=0.956, NFI=0.934, IFI=0.956, PNFI=0.816, PCFI=0.835). The aggregate scores of the SVSSS, exhibiting cross-gender invariance, were significantly negatively associated with willingness to choose secondary vocational education and positively correlated with academic performance. Cronbach's α coefficient of the SVSSS and each dimension ranged from 0.815 to 0.963, with split-half reliability from 0.777 to 0.969.

CONCLUSION

Featuring favorable reliability and validity, the SVSSS was found to be an effective tool for the measurement of the secondary vocational education stigma among junior high school students, with its measurement invariance across genders.

The clinical and psychosocial correlates of self-stigma among people with schizophrenia spectrum disorders across cultures: A systematic review and meta-analysis

BACKGROUND

Individuals with schizophrenia spectrum disorders (SSD) are at heightened risk of experiencing self-stigma, and some cultures are more stigmatizing towards SSD than others. The first purpose of this review is to provide an estimate of the relationship between self-stigma and clinical and psychosocial outcomes. The second purpose is to examine how these relationships vary across cultures.

METHOD

Studies reporting correlations between self-stigma and outcome variable(s) were identified through electronic database searches from June 1, 2021, to January 2, 2022. Mean effect sizes were calculated using Fisher's r-to-Z-transformation.

RESULTS

Sixty-three articles (N = 8925, 22 countries) were included in the systematic review and fifty-three articles (N = 7756) were included in the meta-analysis. For the most studied clinical correlates, self-stigma had a moderate, positive correlation with depressive symptoms (r = 0.49, p < .001), a moderate, negative correlation with functioning (r = -0.39, p < .001), and a positive, small correlation with severity of psychotic symptoms (r = 0.29, p < .001), negative symptoms (r = 0.18, p < .001) and positive symptoms (r = 0.13, p = .01). For the most studied psychosocial correlates, self-stigma had a strong, negative correlation with quality of life (r = -0.52, p < .001) and self-esteem (r = -0.55, p < .001). The correlates of self-stigma were similar across cultures.

DISCUSSION

Self-stigma shows strong to small correlations with clinical and psychosocial variables similarly across cultures. More research is needed to examine underlying mechanisms to develop effective interventions.

Effectiveness of an educational program for reducing mental illness stigma targeting family medicine trainees in Tunisia: A quasi-experimental study

Reducing stigma among mental health and health professionals has been an ultimate priority in many countries worldwide. This study aimed to evaluate the effectiveness of a four-session educational intervention for reducing stigma of mental illness targeting family medicine trainees in Tunisia. A quasi-experimental design was adopted with an intervention group (N = 51) and a control group (N = 56). Pre-intervention data were collected using an online survey. A four-session seminar series was implemented and organized. Post-intervention data were collected immediately after the end of the intervention then 2 months thereafter. Instruments included Attribution Questionnaire (AQ-27), Self-Determination Scale (SDS), Empowerment Scale (ES), and Recovery Scale (RS). Repeated measures analysis of covariance and multiple analysis of covariance tests were carried out. Results revealed that the intervention had moderate effects on the AQ-27 score and on six of its stigma factors including factors of the dangerousness model. The intervention improved SDS score, but not ES or RS scores. Positive effects were observed immediately after the intervention and 2 months thereafter. Regular implementation of educational programs in clinical practice would be beneficial. Developing other anti-stigma methods is needed to address the concepts of recovery and responsibility of patients with mental illness.

Exploring Local Values and Beliefs to Develop School-based Mental Health Anti-Stigma: A Phenomenology Study

BACKGROUND: Students in middle-income countries frequently experience stigma related to mental disorders (MDs). Those with MDs are stereotyped as incompetent, uncontrollable, uncooperative, and dangerous. Stereotypes are predominantly formed and disseminated due to culture and beliefs. Therefore, it is essential to investigate, comprehend, and apply the local values and beliefs to increase the effectiveness of school-based anti-stigma programs. AIM: This study aims to investigate the local values and beliefs related to mental health anti-stigma as early initiation of school-based anti-stigma development. METHODS: This is an exploratory phenomenological study. A total of 30 informants were interviewed personally or participated in focus group discussions. Content analysis was performed to identify related sub-themes and themes. RESULTS: This study identified seven themes and 15 sub-themes. The seventh theme included the importance of school-based anti-stigma, school-based anti-stigma approach, school-based anti-stigma method, media dissemination of school-based anti-stigma information, design of school-based anti-stigma information, the target group of school-based anti-stigma, and collaboration partners of school-based anti-stigma. CONCLUSION: Adolescents in middle school frequently experience stigma regarding their mental health from their peers. Using both Islamic and mental health approaches, integrating internal and external stakeholders, dispelling unfavorable misconceptions and stereotypes, encouraging students to understand and empathize with others, and reducing the harmful effects of mental health stigma were found to help reduce the stigma of mental illness.

Creating a hierarchy of mental health stigma: testing the effect of psychiatric diagnosis on stigma

BACKGROUND

Levels of mental health stigma experienced can vary as a function of the presenting mental health problem (e.g. diagnosis and symptoms). However, these studies are limited because they exclusively use pairwise comparisons. A more comprehensive examination of diagnosis-specific stigma is needed.

AIMS

The aim of our study was to determine how levels of mental health stigma vary in relation to a number of psychiatric diagnoses, and identify what attributions predict levels of diagnosis-specific stigma.

METHOD

We conducted an online survey with members of the public. Participants were assessed in terms of how much stigma they had, and their attributions toward, nine different case vignettes, each describing a different mental health diagnosis.

RESULTS

We recruited 665 participants. After controlling for social desirability bias and key demographic variables, we found that mental health stigma varied in relation to psychiatric diagnosis. Schizophrenia and antisocial personality disorder were the most stigmatised diagnoses, and depression, generalised anxiety disorder and obsessive-compulsive disorder were the least stigmatised diagnoses. No single attribution predicted stigma across diagnoses, but fear was the most consistent predictor.

CONCLUSIONS

Assessing mental health stigma as a single concept masks significant between-diagnosis variability. Anti-stigma campaigns are likely to be most successful if they target fearful attributions.

Measuring professional stigma towards patients with a forensic mental health status: protocol for a Delphi consensus study on the design of a questionnaire

INTRODUCTION

Negative attitudes towards individuals with a mental illness and/or criminal background are widely studied, but empirical interest in the attitudes towards patients with a forensic mental health status is lacking. Negative attitudes among mental healthcare (MHC) professionals can have a significant impact on treatment outcomes and hence, affect patients' rehabilitation. This study will elaborate an instrument to assess stigmatising attitudes among community MHC professionals towards patients with a forensic mental health status.

METHODS AND ANALYSIS

The instrument will be developed by means of a Delphi study and depart from pre-existing instruments that assess public and professional stigma towards individuals with a mental illness and/or criminal background. Relevant instruments were identified through a targeted literature review. A longlist of items has been selected for the Delphi survey. Five expert panels (ie, academic experience in stigma or forensic MHC, clinical experience in community or forensic MHC or patient experience in forensic and community MHC) will be asked to score the relevance of each item on a 7-point Likert scale and to agree on the wording (yes/no). Participants will be provided with the option to suggest additional items or alternative wording. Adapted Delphi methodology will be applied with an expectation of at least three rounds to achieve consensus: ≥60% of the participants of at least four of five expert panels rank the item in the top three (inclusion) or bottom three (exclusion). Items will be reworded for a consecutive round based on a 'yes minus no' score and participants' suggestions.

ETHICS AND DISSEMINATION

This study has been approved by the ethics committee of Fundación Sant Joan de Déu. Dissemination of results will be through peer-reviewed publications, presentations and (inter-)national academic conferences. A summary of the results will be shared with the participants and key persons in community and forensic MHC.

Is it time to change the approach of mental health stigma campaigns? An experimental investigation of the effect of campaign wording on stigma and help-seeking intentions

Introduction

Mental health stigma causes a range of diverse and serious negative sequelae. Anti-stigma campaigns have largely aligned with medical theories and categorical approaches. Such campaigns have produced some improvements, but mental health stigma is still prevalent. The effect of alternative theoretical perspectives on mental health within anti-stigma campaigns has not been tested. Moreover, we do not know their effect on help-seeking intentions.

Methods

We conducted an online experimental pre-post study comparing the effects of two anti-stigma campaign posters on mental health stigma and help-seeking intentions. One poster adhered to the medical, categorical approach to mental health, whereas the other poster portrayed mental health problems in line with a non-categorical, continuous perspective.

Results

After controlling for familiarity with the campaign poster, country of residence and pre-test scores, we found no significant between-group differences in terms of help-seeking intentions and all stigma attitudes except for danger-related beliefs. That is, those who viewed the non-categorical poster reported an increased perception that people with mental health problems are dangerous.

Discussion

Our largely null findings may suggest the equivalence of these posters on stigma and help-seeking intentions but may also reflect the brevity of the intervention. Our findings concerning danger beliefs may reflect a Type I error, the complexities of stigma models, or the adverse effects of increased perceived contact. Further research is needed to test the effects of differing mental health paradigms on stigma and help-seeking intentions over a longer duration.

Patient Toward Physician Occupational Stigma Scale: Development of the Chinese Version

BACKGROUND/OBJECTIVE

Physicians' occupational stigma could eradicate physician-patient trust, threatening physicians' social status and occupational reputation. Hitherto, there has been no scale obtaining good psychometric properties to assess patients' stigma toward physicians. The present study aimed to develop the Patient toward Physician Occupational Stigma Scale (PPOSS) and examine its reliability and validity.

METHODS

The questionnaire comprising sociodemographic information and the PPOSS were employed to survey 645 Chinese patients in two phases. In Sample 2, the Wake Forest Physician Trust Scale (WFOTS), the Intolerance of Uncertainty Scale-12 (IUS-12), and the Brief Illness Perception Questionnaire (BIPQ) were tested.

RESULTS

The PPOSS includes 19 items subsumed into three dimensions of stereotype, discrimination, and prejudice. According to the results of confirmatory factor analysis (CFA), the three-factor model fitted well (χ2/df=2.065, RMSEA=0.057, SRMR=0.045, RFI=0.904, CFI=0.956, IFI=0.956, PNFI=0.779, PCFI=0.811). The PPOSS was significantly negatively correlated with the WFOTS, and significantly positively correlated with the IUS-12 and the BIPQ. The Cronbach's alpha coefficients for the total scale and each dimension were between 0.87 and 0.94, and the split-half reliability coefficients were between 0.84 and 0.93. Besides, the PPOSS had the measurement invariance across gender.

CONCLUSION

With its satisfactory psychometric properties, the PPOSS can be used as an effective instrument to assess patients' stigma toward physicians.

The association between comorbidities and stigma among breast cancer survivors

This study aimed to explore the association between types and numbers of comorbidities and stigma among breast cancer survivors (BCSs). A cross-sectional study was conducted among 937 BCSs in Shanghai Cancer Rehabilitation Club. All participants were asked to fill in an online questionnaire including Stigma Scale for Chronic Illnesses 8-item version (SSCI-8) and questions on sociodemographic characteristics and health status. Multivariate linear regression was used to analyze the association between comorbidities and stigma, adjusting for confounding factors. Results showed that nearly 70% of the participants had one or more comorbidities. The participants with stroke, digestive diseases or musculoskeletal diseases had significantly higher stigma than those without the above comorbidities. In addition, stigma was higher among survivors in the group with a greater number of comorbidities. Thus, it is important to strengthen the management of stigma in BCSs, especially for those with comorbidities.

Stigma and Chronic Pain

Stigma is defined by the World Health Organization (WHO) as "a mark of shame, disgrace or disapproval that results in an individual being rejected, discriminated against and excluded from participating in a number of different areas of society". Extensive literature searches have documented stigma in the context of health. Among the physical health conditions that are associated with stigma, chronic pain deserves particular attention. Stigma experienced by individuals with chronic pain affects their entire life. Literature identifies multiple dimensions or types of stigma, including public stigma, structural stigma and internalized stigma. Recent literature supports the biopsychosocial model of pain, according to which biological, psychological and sociocultural variables interact in a dynamic manner to shape an individual's response to chronic pain. Chronic pain affects a higher proportion of women than men around the world. There is an inadequate education of health care professionals regarding pain assessment and their insecurity to manage patients with chronic pain. A first-line intervention strategy could be to promote pain education and to expand knowledge and assessment of chronic pain, as recently highlighted for headache disorders, paradigmatically for resistant or refractory migraine, whose diagnosis, without an adequate education to understand the possible fluctuations of the disease, may have profound psychological implications with the idea of insolvability and contribute to stigmatizing the patient.

Perspectives of Nursing Students towards Schizophrenia Stigma: A Qualitative Study Protocol

Aim: This study aims to explore fourth-year nursing students’ knowledge of schizophrenia and their attitudes, empathy, and intentional behaviours towards people with schizophrenia. Design: This will be a descriptive qualitative study using focus-group interviews. Methods: Fourth-year nursing students on clinical placement in a hospital in Hunan province will be invited for focus-group interviews. Snowball and purposive sampling will be used to recruit nursing students for this study. Five focus-group interviews, each including six participants, will be conducted to explore participants’ knowledge, attitudes, intentional behaviours, and empathy towards schizophrenia. The interview will be conducted through the online Tencent video conference platform and the interview data will be collected through the same platform. All interviews will be recorded and transcribed verbatim and analysed with the approach of the content analysis supported by NVivo 12. Simultaneous data collection and analysis will be performed, and the interviews will be continued until data saturation is met. The findings of this study will be helpful in developing effective interventions to decrease the stigma toward schizophrenia among nursing students and those who study healthcare disciplines.

Internalized stigma in obsessive compulsive disorder: Correlates and associations with quality of life

In the present study we aimed to measure IS among outpatients with OCD, and to assess its relationship with clinical and sociodemographic variables, and quality of life. Out of 100 patients assessed, 79 patients with OCD were included in the study. Each patient was assessed using the SCID-5 CV, Y-BOCS, ISMI Scale, and WHOQOL-BREF. There was a strong correlation of IS with lower QoL and severity of OCD symptoms. Avoidance behavior, psychological health and social relationship domains emerged as independent factors related to IS in the regression analysis. There is a need for further studies on a larger samples to identify the specifics of the development and impact of IS in people with OCD.

Stigma and Peer-Led Interventions: A Systematic Review and Meta-Analysis

Purpose

The main purpose of our systematic review was to investigate the effect of peer-led intervention on self-stigma in individuals with mental health problems. Secondary purpose was investigating the impact of peer intervention on clinical symptoms, recovery-related outcomes, and disclosure-related outcomes.

Methods

Five electronic databases were searched from 1975 to 2021. Literature databases were searched for randomized controlled trials. From the perspective of key outcomes, a meta-analysis of the effects of peer-led interventions on changing stigma was conducted.

Results

A meta-analysis of randomized controlled trials targeting different target groups with mental health problems (e.g., adolescents, college students, family members of mentally ill persons, unemployed persons, etc.) was conducted. It was found that, at the end of the intervention, intervention had a positive effect on main outcomes such as self-stigma and stress from stigma. As for secondary outcomes, there was no significant influence on clinical symptoms. There was a positive effect on rehabilitation and empowerment, but without a statistical significance. There was a statistically significant effect on self-efficacy and professional help seeking. There was a statistically significant effect on confidentiality and disclosure-related distress in the Honest Open Proud (HOP) subgroup. There was no significant influence on confidentiality and withdrawal in the non-HOP subgroup.

Conclusion

Peer-led intervention can reduce self-stigma and stigma pressure and might improve recovery and empowerment. It increases self-efficacy and willingness to seek professional help, but has no significant effect on clinical symptoms and withdrawal. HOP intervention has positive effects on disclosure-related confidentiality and pain.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021287584.

Association of stigmatizing attitudes with people’s opinion of depression as a valid reason for sickness absence: A Swedish vignette study

BACKGROUND: Depression is a common cause of sickness absence (SA) and also highly associated with stigma. Few studies have addressed the role of stigma in relation to SA. OBJECTIVE: To investigate if attitudes to depression were associated with the public’s opinion of depression as a valid reason of SA. METHODS: The study population (n = 2413) originated from a web-based panel of citizens. The survey included a short vignette describing a person with symptoms of depression and the person’s work tasks, followed by a question on recommendation of SA. Negative attitudes were measured by the Depression Stigma Scale. Logistic regressions were used to estimate the odds ratios (OR) for the likelihood of not recommending SA, controlling for individual and work-related co-variates. RESULTS: The crude association between negative attitudes and not recommending SA was OR 2.15 (95% CI, 1.76–2.62). In the fully adjusted model the OR was 1.76 (95% CI, 1.40 –2.21) for not recommending SA. CONCLUSIONS: Participants with negative attitudes to depression were more likely to not consider depression as a valid reason of sickness absence. The study supports theories on layered stigma; attitudes from one arena are related to other arenas. Future studies are needed to confirm our findings.

The magnitude and correlates of internalized stigma among people with mental illness attending the outpatient department of Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia

Introduction

Internalized stigma is an ongoing process of psychological assimilation of the community labels towards mental illness, in which people with mental illness (PWMI) gradually lose their current positive belief and confidence in themselves and their future wishes. It affects the treatment and help-seeking behavior which leads to poor drug adherence, social marginalization, unemployment, socio-economic devastation, and poor quality of life for PWMI. Therefore, the current study aimed to determine the magnitude and correlates of high internalized stigma among People with Mental Illness (PWMI) attending the outpatient department of Amanuel mental specialized hospital, Addis Ababa, Ethiopia.

Methods

Institution based cross-sectional study was conducted from March 03 to March 28, 2019. A consecutive sampling technique was used to select an estimated 406 study participants. Internalized stigma was assessed using a 29 Item Internalized Stigma of Mental Illness (ISMI-29) tool. Data were entered and analyzed using SPSS 22 software. A Binary logistic regression model was fitted to identify correlates of internalized stigma. An adjusted odds ratio (AOR) with a 95% confidence interval was computed to determine the strength of association and the level of significance was declared with a p-value <0.05.

Result

Of the total study participants, 388 respondents agreed to participate in the study giving a response rate of 96%. The magnitude of high internalized stigma among the study participants was 61.3% (95% CI: 58.2, 64.4). Poor social support (AOR = 1.973; 95%CI = 1.189, 3.27) and being unemployed (AOR = 2.87, 95% CI = 1.192–6.931) were significant correlates of high internalized stigma among PWMI.

Conclusion

Overall, around three in five PWMI experienced high internalized stigma. Poor social support and being unemployed were significant correlates of high internalized stigma. Large scale community-based study supplemented by qualitative design is highly recommended to identify additional correlates of internalized stigma and understand perspectives of PWMI.

Stigma experienced by people with mental illness in South America: an integrative review

Introduction

People with mental illness are highly stigmatized by populations around the world and are perceived to be a burden on society. As a result of stigma, many people with mental illness are discriminated against, which leads to limited life opportunities. Given that beliefs about mental illness can vary based on culture, religion, nationality and ethnicity, it is important to understand the different types of mental illness-related stigma experienced around the world.

Materials and Methods

Whittemore and Knafl's (2005) methodology for integrative reviews was used to analyze 18 studies about lived experiences of mental illness-related stigma in South America.

Results

Findings suggest that certain types of stigma in South America are based on gender and social norms, such as the social position of men and women in society. This leads to discrimination, isolation and violence from family, intimate partners, friends, society and health professionals. Employment is also limited for South Americans with mental illness. Other consequences, such a self-stigma, also impact the lives of people with mental illness in many South American contexts.

Discussion

Family, friendship and social relationships, including health professionals, can involve processes that lead to the stigma experienced by people with mental illness.

Conclusion

This integrative review highlights how mental illness related-stigma impacts individuals in South America.

Internalized stigma among people with schizophrenia: Relationship with socio-demographic, clinical and medication-related features

BACKGROUND

People with schizophrenia are at high risk of suffering from stigma and internalizing it. Recently, a better understanding of the stigma process has shifted the attention from public stigma to self-stigma, which is deeply debilitating. This study aimed to assess factors associated to self-stigma by evaluating socio-demographic, clinical and treatment-related variables in a group of subjects diagnosed with schizophrenia and to identify predictors of high internalized stigma.

METHODS

Ninety-four inpatients accessing rehabilitative centers with a diagnosis of schizophrenia were included in this cross-sectional study. Measures included both patient-rated scales, assessing internalized stigma, attitude toward medications, side effects experience and subjective well-being, and clinician-rated scales, assessing schizophrenia symptoms and global clinical severity and antipsychotic-related side effects.

RESULTS

Twenty-one patients (22.3%) showed high internalized stigma while 73 (77.7%) did not. Patients experiencing more medication adverse effects and worse subjective well-being were more likely to suffer from internalized stigma according to a logistic regression analysis. Extrapyramidal, psychic and some autonomic reactions also emerged as individual predictors of self-stigma in a separate regression analysis.

CONCLUSIONS

Self-stigma and subjective medication side effects perception represent a relevant issue in patients' life and should be carefully taken into account in clinical practice.

The role of moral explanations and structural inequalities in experiences of mental illness stigma in Northern Minas Gerais, Brazil

The process of stigmatization within different cultural contexts has long been viewed as essential in understanding the course and outcomes of mental illness. However, little research has examined which cultural constructs and categories are used to explain mental illness, and how they contribute to the way people with mental illness experience stigma and social exclusion, as well as how these beliefs affect healthcare practices. This study examines meanings ascribed to mental illness and experiences of stigma among four groups in urban settings of Minas Gerais, Brazil: persons with mental illness; their families; members of the lay public; and health professionals working at an alternative community-based psychosocial treatment service or a local university hospital. Qualitative methods, including semi-structured interviews and participant observation, were conducted with a purposive sample of 72 participants. Data were analyzed through content analysis. The findings suggest that stigma and discrimination are intrinsically rooted in a systemic process of social exclusion generated by meanings ascribed to mental illness and the structural vulnerabilities of the mental healthcare system. The findings further suggest that structural inequality is a powerful factor behind lay concepts of mental illness and that this is particularly harmful because it reinforces personal blame attributions instead of addressing the hidden structural forces that contribute to mental illness. The study highlights the subtle interrelations between cultural beliefs and structural vulnerabilities that should be addressed in mental health policy in order to diminish the effects of stigma on people with mental illnesses.

Mental Illness of Management Educators: Does Holding Multiple Academic Jobs Play a Role? A Qualitative Study

Through addressing management educators in four public business schools in Egypt, the authors of this paper aim to uncover the impact of holding multiple academic jobs on the mental health of management educators. The paper asserts that management educators do not perceive the holding of multiple academic roles as a stimulant of any form of mental illness (e.g., anxiety, depression, stress) if it is accompanied by a sense of autonomy (proper teaching loads, rational time for supervising theses, reasonable requests for research production) a feeling of competence (relevant monthly salary, available training and learning opportunities) and a sense of relatedness (feeling of involvement, flexible work hours, option to work from home).

More than Mental Illness: Experiences of Associating with Stigma of Mental Illness for Chinese College Students

From existing empirical research, we identified that Chinese college students commonly experience stigma surrounding mental illness and found some factors that support them in resisting the stigma and achieving psychological health. However, less research provides qualitative data involving individual experiences and insights on mental illness within this group of college students. This study, based on Linking Hearts (an internationally cooperative research-sharing project between China and Canada), was conducted in Shandong, Jinan, and aims to promote the mental health of college students by empowering interdisciplinary professionals and students. Through the research project, this study analyzed the materials from 24 focus groups, explored the understanding of mental illness and prevalence of mental illness stigma in Chinese colleges at the present time, administered a background questionnaire, and provided statistical support for some revealed themes. The final themes are as follows: mental illness is stereotyped as "severe, pathetic, and complicated"; the misconception of "visiting a psychological counselor is scary"; from public stigma to self-stigma; barriers deterring students from seeking help or accessing services; two sides of the same coin: peer support versus peer pressure.

Barriers and facilitators to changing drinking and receiving alcohol-related care: Interviews with Veterans Health Administration primary care patients who indicated interest but did not enroll in an alcohol care management intervention trial

Background: Most people with alcohol use disorder do not receive treatment, and primary care (PC)-based management of alcohol use disorder is a key strategy to close this gap. Understanding PC patients' perspectives on changing drinking and receiving alcohol-related care is important for this goal, particularly among those who decline alcohol-related care. This study examined perspectives on barriers and facilitators to changing drinking and receiving alcohol-related care among Veterans Health Administration (VA) PC patients who indicated interest but did not enroll in the Choosing Healthier drinking Options In primary CarE trial (CHOICE), which tested a PC-based alcohol care management intervention. Methods: VA PC patients with frequent heavy drinking who indicated interest in CHOICE but did not enroll were invited to participate. Twenty-seven patients completed in-person, semi-structured interviews. Interview transcripts were analyzed using iterative deductive and inductive content analysis. Results: Participants were mostly men (96%) and White (59%), and the mean age was 48. Seventy-four percent met criteria for alcohol use disorder, and the median number of past-week standard drinks was 41.5. Participants reported fewer alcohol-related problems, lower importance of/readiness to change drinking, and higher confidence in their ability to change than patients who enrolled in the CHOICE trial. Barriers fell into 5 domains: drinking fulfills need(s); reducing drinking or treatment is not needed; treatment is not effective/not acceptable; alcohol-related stigma; and practical barriers. Facilitators fell into 4 domains: reasons to change drinking; social support; treatment is acceptable/meets patients' needs; and practical facilitators. Participants discussed how Veteran identity and military experiences impacted drinking and willingness to receive care, which amplified multiple barriers/facilitators. Conclusions: This study identified barriers and facilitators to changing drinking and receiving alcohol-related care among VA PC patients who indicated interest but did not enroll in an alcohol care management trial. Findings can inform patient-centered interventions and support clinicians in engaging patients in care.

How Do Children of Parents With Mental Illness Experience Stigma? A Systematic Mixed Studies Review

Stigma can have devastating health and wellbeing impacts, not just on people with mental health problems, but on people associated with the stigmatized person. This is called stigma-by-association. Children whose parents have mental health problems are a particularly vulnerable group, and stigma acts as a mechanism, contributing to the transgenerational transmission of mental disorders. The current study is a systematic mixed studies review, synthesizing knowledge about how this group of children experience stigma-by-association. Overall, 32 studies were included, after a systematic search including quantitative, qualitatative, and mixed methods studies. The methodological quality was assessed and qualitative content analysis undertaken. We grouped children's stigma experiences into four dimensions, i.e., experienced stigma, anticipated stigma, internalized stigma, and structural discrimination. Results show that stigma is an important factor in those children's lives, and needs further investigation in qualitative and quantitative research. The current study emphasizes the importance of anti-stigma interventions and campaigns.

Exploring mental health stigma among chinese-english bilinguals: Dual-process model of emotional competence, flipped learning readiness, and academic performance in Mainland Chinese Universities

Due to severe global competition and performance-related academic challenges, Chinese students are compelled to learn English and become bilinguals despite their non-English majors. Consequently, these students frequently experience psychological issues, including mental health stigma. Hence, the present study aims to explore the psychological factors associated with the academic performance of Chinese-English bilinguals as an outcome of their emotional competence, flipped learning readiness, and mental health stigma. Drawing on data from 448 Chinese-English bilingual students in universities in mainland China, the results based on structural equation modeling (SEM) indicated that their academic performance, flipped learning readiness, and emotional competence are negatively influenced by their mental health stigma. Moreover, the findings also validate that both flipped learning readiness and emotional competence significantly mediate the indirect effects of mental health stigma on the academic performance of bilinguals. The study's implications offer new and compelling evidence on the primary issue of mental health stigma among Gen Z bilingual students to raise deterrence against this psychological menace through collaboration across policymakers, academics, and mental healthcare providers.

Estigma hacia personas con enfermedad mental en estudiantes y profesores de terapia ocupacional,

Resumen Introducción Las personas con enfermedad mental experimentan actitudes estigmatizadoras desde la población general, incluyendo profesionales y estudiantes de la salud. Estudios internacionales han estimado el estigma en estudiantes de terapia ocupacional hacia personas con enfermedad mental como moderado. Objetivo Describir el estigma hacia personas con enfermedad mental en estudiantes y profesores de terapia ocupacional en una universidad chilena. Método Estudio descriptivo transversal con docentes y estudiantes en 1er y 4° año de terapia ocupacional en una universidad en Santiago de Chile, año 2020. Se aplicó formato online de cuestionario Opening Minds Stigma Scale for Health Care Providers (OMS-HC), versión adaptada a Chile, y formulario de datos sociodemográficos. Se calculó puntajes promedio para cuestionario de 20 ítems y ajustado a tres dimensiones con 15 ítems. Se usó pruebas de UMann-Whitney y t student para diferencias entre grupos. Los datos sociodemográficos fueron analizados mediante estadística descriptiva. Resultados Muestra de 87 personas, edad promedio 27 años (18-58), 81 (93%) mujeres, 41 (47%) estudiantes de 4to año, 28 (24%) estudiantes de 1er año, y 22 (25%) docentes. Puntaje promedio OMS-HC para muestra total fue 42,2 puntos (28-57), indicando nivel moderado-bajo de actitudes estigmatizadoras. Estudiantes de 1er año obtuvieron mayores puntajes, pero diferencias no fueron significativas. Conclusión Los resultados son consistentes con literatura previa refiriendo nivel moderado-bajo de actitudes estigmatizadoras hacia personas con enfermedades mentales. Las diferencias incipientes entre estudiantes de 1er y 4to año hacen pertinentes nuevos estudios con mayor tamaño muestral y en otros contextos.

Stigma and coping experiences in Latinx individuals at clinical high-risk for psychosis

AIM

The experiences of culturally diverse individuals at clinical high-risk for psychosis (CHR) is not well studied. Exploratory research needs to examine whether differences exist between racial/ethnic groups within the CHR population. Understanding experiences of Latinx patients is of importance, as the Latinx population represents the most rapidly growing paediatric population in the United States and they face significant barriers to mental health treatment. Because Latinx persons experience high rates of mental illness-based stigma and discrimination in their communities, they may face additional stigma-based barriers to CHR treatment.

METHOD

Twenty-six participants (15 Latinx, 11 non-Latinx white/NLW) who met CHR criteria based on the Structured Interview for Psychosis-Risk Syndromes (SIPS) were interviewed regarding stigma associated with CHR identification and symptoms. Using a consensus-based open-coding thematic analysis approach, data were analysed for stigma, discrimination, and coping responses.

RESULTS

Instances of internalization of stereotypes appeared to be more salient to NLW participants than Latinx participants, and Latinx participants reported seemingly more anticipated rejection from stereotypes than NLW participants. Experiences of discrimination also appeared to be more salient to Latinx participants than NLW participants. Moreover, Latinx participants reported evidently greater instances of discrimination across anticipated, individual, and structural discrimination. Finally, while covering strategies appeared to be more salient to NLW's, Latinx clients more often described using secrecy as well as a greater range of coping responses, including empowerment.

CONCLUSION

While the experience of anticipated rejection appeared to be more salient to Latinx CHR participants and they seemingly report more secrecy than NLW, they also engaged in empowerment-related coping strategies. Future research should continue to explore the roles of cultural values in influencing coping strategies among CHR individuals.

Implicit and Explicit Attitudes of Employers Toward Hiring People Who Have Experienced Depression

Purpose Depression is the most common mental disorder worldwide, yet many individuals with this disorder still face labor market marginalization. To our knowledge, this study is the first to explore both implicit and explicit attitudes of human resources directors/employers regarding potential employees who have experienced depression. Methods 219 human resources directors/employers answered a semi-structured interview, as well as self-report questionnaires, assessing their implicit and explicit attitudes on hiring people who have experienced depression. Explicit attitudes were assessed with self-report measures (questionnaire), whereas implicit attitudes were measured by qualitatively rating automatic mental associations (free associations). Qualitative and quantitative analyses were conducted on implicit and explicit attitudes. Results For implicit attitudes, both stereotypes and normalization attitudes were mentioned by employers. In order to ensure the validity of the explicit attitudes measure, a confirmatory factor analysis was conducted, and revealed that employers and HR's attitudes were, as expected, described by the 12 items spread out on three conceptual dimensions-Stereotypes, Organizational Burden, and Normalization, with satisfactory alpha coefficients for all subscales. ANOVA results showed that implicit and explicit attitudes of employers were not related. Finally, ANOVA results on employers' implicit attitudes showed that hiring apprehensions regarding depression were higher for employers depicting more stereotypes, whereas regression analysis on explicit attitudes showed that Organizational Burden and Normalization were only the significant predictors of employers' hiring apprehensions. Conclusion The results were consistent with previous findings from the general population underlying the ambivalence of attitudes associated with depression. Indeed, stereotypes, organizational burden, and normalization attitudes appear as distinct and complementary facets of depression stigma at work. We suggest anti-stigma training targeting employers' hiring apprehensions and encompassing both explicit and implicit attitudes regarding depression.

Validity of the Personal Suicide Stigma Questionnaire in a Community Sample

Abstract. The Personal Suicide Stigma Questionnaire (PSSQ) is a new scale assessing the experience of stigma in those who have been suicidal. This study examined the construct validity of the scale using a sample of participants from the general community who reported being suicidal at some point in their lives ( N = 3,947). The Distress Questionnaire – 5 and the Suicidal Ideation Attributes Scale were used to assess the severity of distress and suicidality. Confirmatory factor analysis (CFA) showed a three-factor model (Rejection, Minimization, Self-Blame) with one general Personal Stigma factor influencing the three first-order factors, which best fit the data. Scalar invariance was reached for both age and gender. The same factor structure was maintained when the format of the scale was altered for a subsample to provide a “not applicable” option for each item. PSSQ total score remained a significant predictor of distress after suicidality and demographic variables were accounted for. The PSSQ and its subscales can be used for the assessment of personal suicide stigma.

Changing Attitudes Towards Voice Hearers: A Literature Review

Auditory verbal hallucinations, or voice hearing, is increasingly understood as a common experience. Despite this, voice hearers still experience a great deal of stigma, which can have serious negative impacts on the person's experience of their voices, and their recovery. Research has demonstrated that healthcare professionals may be a major source of the stigma surrounding voice hearing, with service-level implications for the development and delivery of evidence-based interventions. Therefore, reducing this stigma is a critical intervention target. The purpose of this narrative review is to examine evidence for interventions aimed at reducing stigma towards people who hear voices, in populations of healthcare professionals, students, and the general public. The available evidence supports the use of anti-stigma interventions based around direct contact with voice hearers and education about voice hearing. However, further research is necessary in this area to confirm these findings.

Stigmatizing attitudes toward psychiatric disorders: A cross-sectional population-based survey

BACKGROUND

Stigmatizing attitudes against individuals diagnosed with mental illness could increase the severity of psychiatric symptoms, lead to delay in getting medical support, and decrease adherence to treatments. Identifying the groups most associated with stigmatization could orientate actions to reduce this prejudice and improve patients' prognosis.

OBJECTIVE

To investigate variables associated with stigmatization toward psychiatric disorders in Brazil.

METHODS

A Web-based survey was sent out to assess the sociodemographic characteristics of the respondents and their perception of mental illness. Included participants were composed of Brazilians aged 18 years or over, with access to the internet and social networks. The questionnaire was available from June to August 2018 on Facebook.

RESULTS

A total of 2414 respondents were included. The majority were female, white, aged between 18 and 29 years, and had more than 10 years of study. The variables associated with stigma were male sex, fewer years of education, lower household income, the presence of a psychiatric disorder in a first-degree relative, and internalized stigma.

CONCLUSIONS

The present study identified variables associated with the stigma against psychiatric disorders. Future studies should propose intervention strategies, such as to foster education about mental illness and to promote the importance of seeking help from a mental health professional, to address this problem in Brazil.

Stigma toward individuals with mental illness: validation of the Arabic version of the Attribution Questionnaire in a university student population

Purpose

This study aims to examine the reliability and validity of the Arabic version of the attribution questionnaire (AQ).

Design/methodology/approach

The AQ is designed to assess attitudes, affects and behavioral intentions related to a hypothetical person diagnosed with schizophrenia. The original English version was translated into Literary Arabic. A total of 310 students registered in different universities, with medical and paramedical establishments excluded completed the Arabic version of AQ. Reliability was tested using Cronbach’s alpha coefficients. Structural equation modeling was used to test hypothesized paths. Correlations among exogenous (e.g. responsibility) and endogenous (e.g. help) variables in the path were examined. Fit indicators were then examined for equations that were identified.

Findings

The results revealed that the Arabic version of AQ showed acceptable psychometric properties in the assessment of stigma in the Tunisian population. All factors of this Arabic version showed Cronbach’s alpha values equal to or greater than 0.72. Structural equation models for the responsibility and dangerousness models were mostly supported. The Arabic version of AQ is valid and reliable for the assessment of stigma in Tunisian and Arabic-speaking populations.

Practical implications

The Arabic version of AQ may be used to promote research on stigma toward people with mental illness in larger and more representative Tunisian and Arabic-speaking populations, which will help to further address the complex and multifaceted phenomenon of stigma toward people with mental illness.

Originality/value

This is the first validated stigma measure in the Tunisian socio-cultural context.

Perfectionism, Power, and Process: What We Must Address to Dismantle Mental Health Stigma in Medical Education

In this commentary, the authors draw on 2 personal accounts of mental illness published by Kirk J. Brower, MD, and Darrell G. Kirch, MD, in this issue to consider how and why mental health stigma is maintained in medical education. In particular, they explore how perfectionism, power differentials, and structural forces drive mental illness stigma in medical education. They argue that mental health stigma in medical education, while deeply embedded in the physician archetype and medical culture, is not inevitable and that dismantling it will require individual courage, interpersonal acceptance, and institutional action.

What's in a Name? Evaluating the Public Stigma of Gambling Disorder

Public stigma of gambling disorder has negative effects on the mental health and functioning of affected individuals and impedes treatment-seeking. One factor thought to be implicated in stigma is the label used to describe the condition. The aims of this research were to: (1) evaluate whether different labels for problematic gambling behavior influence public stigma; and (2) compare public stigma of gambling disorder to other health conditions. Separate samples of university student (Study 1) and general population (Study 2) participants were randomly assigned to label conditions and completed questionnaires assessing stigma and attitudes towards the assigned label. In Study 1, the eight conditions included four gambling labels (problem gambling, pathological gambling, gambling disorder, and gambling addiction) and four psychiatric or health comparison labels (depression, obsessive-compulsive disorder, alcohol use disorder, and asthma). In Study 2, compulsive buying disorder was added as a fifth psychiatric comparison for a total of nine conditions. The results indicated that the four gambling label conditions elicited similar attitudes and stigma. Those conditions were also more stigmatized than the depression, obsessive-compulsive disorder, and asthma conditions. The gambling conditions elicited similar stigmatizing attitudes as alcohol use disorder but were slightly more stigmatized than compulsive buying disorder, with these conditions showing both similarities and differences across the stigma-related outcomes. The results were largely consistent across both samples and contribute to knowledge of the nature and origins of gambling-related stigma.

Magnitude of internalised stigma and associated factors among people with bipolar disorder at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional study

OBJECTIVES

To assess the magnitude of internalised stigma and associated factors among patients with bipolar disorder attending the outpatient department of Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.

DESIGN

Institution-based cross-sectional study design.

SETTING

Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.

PARTICIPANTS

We recruited about 418 participants using systematic sampling technique for an interview during the study period.

MEASUREMENT

Data were collected by face-to-face interviews. Internalized Stigma of Mental Illness scale was used to measure internalised stigma. The Rosenberg Self-Esteem Scale and the Oslo-3 Social Support were instruments used to assess the associated factors. Bivariate and multivariate logistic regressions were performed to identify factors associated with the outcome variable. ORs with 95% CI were computed to determine the level of significance.

RESULTS

The magnitude of internalised stigma was 24.9% (95% CI: 21.2% to 28.9%). In the multivariate analysis, unemployed (adjusted OR (AOR)=2.3, 95% CI: 1.0 to 5.0), unable to read and write (AOR=3.3, 95% CI: 1.05 to 10.7), poor social support (AOR=5.3, 95% CI: 1.9 to 15.0), ≥4 previous hospitalisations due to bipolar disorder (AOR=2.6, 95% CI: 1.1 to 6.1) and low self-esteem (AOR=2.4, 95% CI: 1.1 to 5.1) had a significant association with internalised stigma.

CONCLUSIONS

One in four patients with bipolar disorder reported high internalised stigma. Unemployment, low educational status, low self-esteem, poor social support and being hospitalised more than three times before were significantly associated with internalised stigma. Thus, a stigma-reduction programme focusing on self-esteem improvement and psychological health of patients to increase their stigma resistance to counteracting effects of internalised stigma is essential.

Perceived Suicide Stigma and Associated Factors in Chinese College Students: Translation and Validation of the Stigma of Suicide Attempt Scale and the Stigma of Suicide and Suicide Survivors Scale

This study aims to translate and validate two perceived suicide stigma scales, including the Stigma of Suicide Attempt Scale (STOSA) and the Stigma of Suicide and Suicide Survivor Scale (STOSASS) into Chinese language, examining the factor structure, and assessing the correlation between suicide stigma and a series of variables. After translating and back translating the STOSA and STOSASS, an online survey was administrated to 412 college students in China. These two scales were tested for their dimensionality in a series of confirmatory factor analyses. A series of regression analyses were conducted to examine the factors that are associated with perceived and public suicide stigma, including demographics, psychological distress, suicidality, suicide exposure, and perceived entitativity of suicide ideators, decedents, and survivors. The results showed that the two translated scales, STOSA and STOSASS, were reliable (Cronbach’s α = 0.79~0.83) and valid in Chinese contexts and it can be treated as unidimensional scales. Suicidality, exposure to suicide, and perceived entitativity of suicide-related persons were significantly associated with higher endorsement of public suicide stigma (SOSS Stigma, p < 0.03), but not perceived stigma (STOSA, STOSASS). Higher levels of psychological distress were associated with both higher perceived and public suicide stigma (p < 0.05).

Exorcising memories of internalised stigma: The demons of lived experience

Public stigma and self-stigma impact negatively on the lives of people with mental health issues. Many people in society stereotype and discriminate against people with mental ill-health, and often this negative process of marginalisation is internalised by people with lived experiences. Thus, this negative internalisation leads to the development of self-stigma. In this article, I reflect on my own experiences of shame and self-stigma as a person with mental ill-health socially bullied by peers from my community and social groups. I present a personal narrative of both public and self-stigmatisation which I hope will enable me to exorcise memories of internalised stigma, which are encountered as my demons of lived experience. Using reflexivity, a process used widely in health and social care fields, I consider how social bullying shattered my fragile confidence, self-esteem, and self-efficacy in the early days of my recovery; the impact of associative stigma on family members is also explored. Following this, the potential to empower people who experience shame and stigma is explored alongside effective anti-stigma processes which challenge discrimination. I connect the concept of recovery with the notion of empowerment, both of which emphasise the importance of agency and self-efficacy for people with mental ill-health. Finally, I consider how the concepts of empowerment and recovery can challenge both the public stigma held by peers in the community and the self-stigma of those with lived experiences.