Reducing the stigma associated with anorexia nervosa: An evaluation of a social consensus intervention among Australian and Chinese young women

Mediating role of resilience in the relationship between COVID-19 related stigma and mental health among COVID-19 survivors: a cross-sectional study

BACKGROUND

The global coronavirus disease 2019 (COVID-19) has caused many negative effects on physical and mental health of patients who have survived COVID-19. Apart from some long-lasting physical sequelae, those COVID-19 survivors are also suffering stigma and discrimination at different levels around the world. The current study aims to assess the role resilience played in stigma and mental disorders among COVID-19 survivors.

METHODS

The cross-sectional study was carried out among former COVID-19 patients in Jianghan District (Wuhan, China) from June 10 to July 25, 2021. The demographic questions, the Impact of Events Scale-Revised, the Generalized Anxiety Disorder Questionnaire, the Patient Health Questionnaire, the Resilience Style Questionnaire and the Short Version of COVID-19 Stigma Scale of 12 items were used to collect relevant information of the participants. Descriptive analyses, Pearson correlation analysis and Structural Equation Modeling were used to make data description and analysis.

RESULTS

A total of 1541 out of 1601 COVID-19 survivors (887 females and 654 males) were included in the analysis. Perceived stigma of those COVID-19 survivors correlates significantly with anxiety (r = 0.335, P < 0.001), depression (r = 0.325, P < 0.001) and post-traumatic stress disorder (PTSD) (r = 0.384, P < 0.001). It has a direct effect on COVID-19 survivors' anxiety (β = 0.326, P < 0.001), depression (β = 0.314, P < 0.001), PTSD (β = 0.385, P < 0.001) and their resilience (β = - 0.114, P < 0.01). Resilience partially mediated the association between perceived stigma and anxiety (β = 0.020, P < 0.01), depression (β = 0.020, P < 0.01), and PTSD (β = 0.014, P < 0.01) among COVID-19 survivors.

CONCLUSION

Stigma has a significant negative impact on mental health, while resilience plays a mediator role in the relationship between stigma and mental health among COVID-19 survivors. Based on our study, we suggested that when designing psychological interventions for COVID-19 survivors, consideration should be taken into account to reduce stigma and improve resilience.

Stigmatization and attitudes toward eating disorders: a comparison between native German adolescents, Turkish immigrant adolescents in Germany, and native Turkish adolescents

BACKGROUND AND AIMS

The purpose of this study was to investigate the attitudes toward eating disorders in native German adolescents (Germans), adolescents with Turkish migration background in Germany (Immigrants), and native Turkish adolescents (Turks).

METHOD

A total of 507 adolescents (N = 139 Germans; N = 126 Immigrants; N = 242 Turks) read a vignette describing a 16-year-old female with bulimic symptoms. Participants completed questionnaires on mental health literacy, stigmatization, desirability of eating disorder-related behaviors and acquaintance with bulimic symptoms.

RESULTS

Adolescents living in Germany were more likely to recognize the vignette as an eating disorder than Turks. Immigrants were more similar to Germans in mental health literacy of eating disorders than Turks. However, in terms of stigmatizing attitudes, immigrants blamed more than Germans, Turks being intermediate on this variable. In Turks, higher desirability of eating disorder-related behaviors was associated with an increased acquaintance with bulimic symptoms and decreased evaluations of impairment. Higher mental health literacy was associated with less blame in Germans.

CONCLUSIONS

Migration background was associated with increased mental health literacy of eating disorders but did not result in reduced stigma. Differences in attitudes toward eating disorders indicate the need for differential interventions across the groups.

Real women have (just the right) curves: investigating anti-thin bias in college women

BACKGROUND

Weight stigma is associated with negative mental and physical health outcomes across the body mass index (BMI) continuum. However, few studies have examined discrimination experienced by people with low body weights.

OBJECTIVES

This study explored the presence of anti-thin bias, defined as the belief that individuals at lower body weights have undesirable personality characteristics, in young adult women. Additionally, we examined perceived etiology of weight for women with underweight.

METHOD

Participants (N =295 women, age 18.84 ± 2.32) were randomly assigned to read one of the six vignettes about women who differed by race (White and Black) and BMI status (slightly underweight, average weight, and slightly overweight).

RESULTS

Negative personality characteristics were more likely to be ascribed to vignette characters with under- or overweight BMIs, compared to characters with average weight BMIs. Participants were more likely to attribute underweight characters' body weight to an eating disorder (ED) compared with average or overweight characters.

CONCLUSION

Results suggest that women with under- or overweight BMIs experience greater stigmatization for their body weight than women with average BMIs, underscoring the need for research to investigate weight discrimination across the weight spectrum.

LEVEL OF EVIDENCE

Level I, experimental study.

Core components of mental health stigma reduction interventions in low- and middle-income countries: a systematic review

AIMS

To identify and categorise core components of effective stigma reduction interventions in the field of mental health in low- and middle-income countries (LMICs) and compare these components across cultural contexts and between intervention characteristics.

METHODS

Seven databases were searched with a strategy including four categories of terms ('stigma', 'mental health', 'intervention' and 'low- and middle-income countries'). Additional methods included citation chaining of all papers identified for inclusion, consultation with experts and hand searching reference lists from other related reviews. Studies on interventions in LMICs aiming to reduce stigma related to mental health with a stigma-related outcome measure were included. All relevant intervention characteristics and components were extracted and a quality assessment was undertaken. A 'best fit' framework synthesis was used to organise data, followed by a narrative synthesis.

RESULTS

Fifty-six studies were included in this review, of which four were ineffective and analysed separately. A framework was developed which presents a new categorisation of stigma intervention components based on the included studies. Most interventions utilised multiple methods and of the 52 effective studies educational methods were used most frequently (n = 83), and both social contact (n = 8) and therapeutic methods (n = 3) were used infrequently. Most interventions (n = 42) based their intervention on medical knowledge, but a variety of other themes were addressed. All regions with LMICs were represented, but every region was dominated by studies from one country. Components varied between regions for most categories indicating variation between cultures, but only a minority of studies were developed in the local setting or culturally adapted.

CONCLUSIONS

Our study suggests effective mental health stigma reduction interventions in LMICs have increased in quantity and quality over the past five years, and a wide variety of components have been utilised successfully - from creative methods to emphasis on recovery and strength of people with mental illness. Yet there is minimal mention of social contact, despite existing strong evidence for it. There is also a lack of robust research designs, a high number of short-term interventions and follow-up, nominal use of local expertise and the research is limited to a small number of LMICs. More research is needed to address these issues. Some congruity exists in components between cultures, but generally they vary widely. The review gives an in-depth overview of mental health stigma reduction core components, providing researchers in varied resource-poor settings additional knowledge to help with planning mental health stigma reduction interventions.

Stigma reduction interventions for children and adolescents in low- and middle-income countries: Systematic review of intervention strategies

Stigmatisation and discrimination are common worldwide, and have profound negative impacts on health and quality of life. Research, albeit limited, has focused predominantly on adults. There is a paucity of literature about stigma reduction strategies concerning children and adolescents, with evidence especially sparse for low- and middle-income countries (LMIC). This systematic review synthesised child-focused stigma reduction strategies in LMIC, and compared these to adult-focused interventions. Relevant publications were systematically searched in July and August 2018 in the following databases; Cochrane, Embase, Global Health, HMIC, Medline, PsycINFO, PubMed and WorldWideScience.org, and through Google Custom Search. Included studies and identified reviews were cross-referenced. Three categories of search terms were used: (i) stigma, (ii) intervention, and (iii) LMIC settings. Data on study design, participants and intervention details including strategies and implementation factors were extracted. Within 61 unique publications describing 79 interventions, utilising 14 unique stigma reduction strategies, 14 papers discussed 21 interventions and 10 unique strategies involving children. Most studies targeted HIV/AIDS (50% for children, 38% for adults) or mental illness (14% vs 34%) stigma. Community education (47%), individual empowerment (15%) and social contact (12%) were most employed in child-focused interventions. Most interventions were implemented at one socio-ecological level; child-focused interventions mostly employed community-level strategies (88%). Intervention duration was mostly short; between half a day and a week. Printed or movie-based material was key to deliver child-focused interventions (37%), while professionals most commonly implemented adult-focused interventions (53%). Ten unique, child-focused strategies were all evaluated positively, using a diverse set of scales. Children and adolescents are under-represented in stigma reduction in LMIC. More stigma reduction interventions in LMIC, addressing a wider variety of stigmas, with children as direct and indirect target group, are needed. This systematic review is registered under International Prospective Register of Systematic Reviews PROSPERO, reference number #CRD42018094700.

Reducing anorexia nervosa stigma: an exploration of a social consensus intervention and the moderating effect of blameworthy attributions

Background: Research suggests that blameworthy attributions towards individuals with anorexia nervosa are common, which in turn elicit more stigmatising attitudes towards those with the disorder. The social consensus approach has been found to reduce stigmatising attitudes in various domains and, as such, is a promising avenue to pursue for ameliorating stigma in anorexia nervosa.Aims: The present study primarily sought to investigate the effectiveness of a social consensus approach in reducing stigma towards individuals with anorexia nervosa. The study also examined if blameworthy attributions were associated with change in stigma.Method: An experimental design was employed, where female undergraduate students (N= 126) completed self-report measures that assessed anorexia nervosa stigma at baseline (Time 1) and 6-10 days after allocation to one of two conditions: social consensus and control (Time 2).Results: The social consensus intervention was more effective than the control condition in reducing stigmatising attitudes on measures assessing affective reactions (p= 0.025) and characteristics attributed to a target with anorexia nervosa (p < 0.001). Level of blame-based attributions did not moderate change in stigma.Conclusions: Results suggest that a social consensus intervention is promising irrespective of the endorsement of blameworthy attributions.

When are anti-fat attitudes understood as prejudice versus truth? An experimental study of social influence effects

BACKGROUND/OBJECTIVES

If people who hold anti-fat attitudes believe these attitudes to be true, then anti-prejudice appeals are likely to be unsuccessful, if only because the targets will not see their attitudes as in need of change. The current study examined processes that may lead people to see their anti-fat attitudes as 'truth' or as 'prejudice'.

SUBJECTS/METHODS

Participants (N = 482) read anti-fat statements and were then presented with an interpretation of these statements as 'truth' or 'prejudice'. The source of this interpretation was either an (i) in-group or out-group member and (ii) expert or non-expert. Participants' judgements of the statements were expected to vary such that in-group others and experts would exert more influence than would out-group others and non-experts.

RESULTS

Participants aligned their own interpretations of an anti-fat statement with those of an expert, but not with those of a non-expert, F(1,466) = 8.97, p < 0.05, ηp 2 = 0.02. The group membership variable had no effect on judgements of 'truth' or 'prejudice' of the anti-fat statement.

CONCLUSION

The expressions that people believe constitute anti-fat prejudice versus truth about people described as overweight are influenced by exposure to expert opinion (in this case, by medical doctors). Implications for the success of weight-based anti-prejudice appeals and for healthcare provision are discussed.