Stigma and multiple social comparisons in people with schizophrenia

A relational perspective of schizophrenia at work

Purpose

Despite a plethora of research on diversity and inclusion, workplace-related issues pertaining to individuals with schizophrenia (SCZ) remain grossly underexplored. This paper seeks to develop a relational, multilevel perspective of issues and challenges faced by individuals with SCZ in the work and career.

Design/methodology/approach

The research draws on the findings from in-depth, qualitative interviews with schizophrenic individuals, individuals’ family members, healthcare professionals and nongovernmental organization (NGO) representatives.

Findings

The findings highlight the interconnected nature of multilevel issues faced by schizophrenic individuals and indicate that at the societal level, social stigma, economic conditions and inadequate government policies are the key challenges faced by them. At the organizational level workplace support and job suitability and design affect individuals’ employment. At the individual level, self-stigma affects the employability in a negative way whereas personal motivation and resilience, family and social support and realization of illness are the facilitating factors.

Originality/value

The study adds to disability and diversity literature by developing a relational perspective that holistically captures the issues faced by schizophrenic individuals and suggests that the work and employment-related issues may be simultaneously addressed at multiple levels.

Passing as normal: Negotiating boundaries and coping with male breast cancer

BACKGROUND AND OBJECTIVE

Male breast cancer is a rare and understudied disease. In addition to coping with cancer, suffering from what is perceived as a "woman's disease" significantly burdens men's illness experience and can lead to stigmatization. The way men cope with these challenges has not been studied to date. Drawing on stigma, coping, and destigmatization theories, this study aims to explore how men experience and respond to the diagnosis of an illness typically associated with women.

METHODS

In-depth interviews were conducted with 16 Israeli men who were diagnosed with breast cancer within the past 10 years. Thematic analysis was performed, focusing on participants' references to experiencing and managing the psychosocial implications of being a male breast cancer patient.

RESULTS

Results demonstrated that participants faced stigmatizing situations both inside and outside healthcare settings. In addition, findings revealed four main responses to stigmatization: (1) selective disclosure, (2) concealment practices, (3) universalizing, and (4) making comparisons. Whereas the first two are strategic reactions to specific situations, the latter two are general conceptual destigmatizing responses.

CONCLUSIONS

Men's coping styles reveal their efforts to disengage from the discrediting attributes of male breast cancer, to distance themselves from female breast cancer, and to avoid emasculation. They manage stigmatizing situations using disengagement situational responses, such as concealment and selective disclosure, and negotiate group boundaries with the goal of destigmatizing male breast cancer. Beyond broadening the understanding of coping with male breast cancer, this study also illustrates the significant place of boundary work as a destigmatization practice about illness-related stigma.

State Authenticity as Fit to Environment: The Implications of Social Identity for Fit, Authenticity, and Self-Segregation

People seek out situations that "fit," but the concept of fit is not well understood. We introduce State Authenticity as Fit to the Environment (SAFE), a conceptual framework for understanding how social identities motivate the situations that people approach or avoid. Drawing from but expanding the authenticity literature, we first outline three types of person-environment fit: self-concept fit, goal fit, and social fit. Each type of fit, we argue, facilitates cognitive fluency, motivational fluency, and social fluency that promote state authenticity and drive approach or avoidance behaviors. Using this model, we assert that contexts subtly signal social identities in ways that implicate each type of fit, eliciting state authenticity for advantaged groups but state inauthenticity for disadvantaged groups. Given that people strive to be authentic, these processes cascade down to self-segregation among social groups, reinforcing social inequalities. We conclude by mapping out directions for research on relevant mechanisms and boundary conditions.

The psychological costs of comparisons: Parents' social comparison moderates the links between family management of epilepsy and children's outcomes

Parents play a key role in how children deal with epilepsy. When diagnosed with health conditions, people seek comparison information from fellow patients and families, and this information has consequences for how they evaluate their situation. This study examined the moderating role of parents' social comparison orientation in the associations between family management (parental perceptions of family life difficulties and child's daily life) and adaptation outcomes of children with epilepsy (HRQoL and perceived stigma). Participants included 201 dyads of children with epilepsy and either their mother or father. The results showed that when parents perceived higher difficulties managing their child's epilepsy and/or reported that their child was more affected by this condition, children reported higher perceived stigma and worse HRQoL only when parents had a higher social comparison orientation. Our results are innovative in showing that when parents have a higher social comparison orientation, their children may be at increased risk of poorer outcomes.

Psychometric properties of a Chinese version of the Stigma Scale: examining the complex experience of stigma and its relationship with self-esteem and depression among people living with mental illness in Hong Kong

BACKGROUND

Stigma of mental illness is a global public health concern, but there lacks a standardized and cross-culturally validated instrument for assessing the complex experience of stigma among people living with mental illness (PLMI) in the Chinese context.

AIM

This study examines the psychometric properties of a Chinese version of the Stigma Scale (CSS), and explores the relationships between stigma, self-esteem and depression.

METHODS

A cross-sectional survey was conducted with a community sample of 114 Chinese PLMI in Hong Kong. Participants completed the CSS, the Chinese Self-Stigma of Mental Illness Scale, the Chinese Rosenberg Self-Esteem Scale, and the Chinese Patient Health Questionnaire-9. An exploratory factor analysis was conducted to identify the underlying factors of the CSS; concurrent validity assessment was performed via correlation analysis.

RESULTS

The original 28-item three-factor structure of the Stigma Scale was found to be a poor fit to the data, whereas a revised 14-item three-factor model provided a good fit with all 14 items loaded significantly onto the original factors: discrimination, disclosure and positive aspects of mental illness. The revised model also displayed moderate to good internal consistency and good construct validity. Further findings revealed that the total stigma scale score and all three of its subscale scores correlated negatively with self-esteem; but only total stigma, discrimination and disclosure correlated positively with depression.

CONCLUSION

The CSS is a short and user-friendly self-administrated questionnaire that proves valuable for understanding the multifaceted stigma experiences among PLMI as well as their impact on psychiatric recovery and community integration in Chinese communities.

Disclosure of Psychiatric Disabilities in Vocational Rehabilitation

Vocational professionals aware of the stigma associated with psychiatric disability, generally exercise caution when disclosing psychiatric or disability related information to employers. However, few professionals directly address stigma or specify disclosure strategies in vocational rehabilitation plans. Integrated information tailored to vocational professionals is needed to guide this aspect of vocational rehabilitation practice. We review recent evidence with legal and ethical information relevant to vocational rehabilitation. Key elements of disclosure and stigma-countering strategies are identified which can be incorporated into the career planning, job preparation, job securing and job retaining phases of vocational rehabilitation plans.

Conceptualizing community: the experience of mental health consumers

In this article we describe a focus group study of the perspectives of diverse groups of mental health consumers on the concept of community. We identify the core domains that constitute the notion of community, and commonalities and differences in the perception of community along the lines of ethnicity and sexual orientation/gender identity. Seven focus groups were conducted with a total of 62 participants. Transcripts were analyzed using the grounded theory approach.Two domains-togetherness and community acceptance-emerged as common to four types of communities that were most frequently mentioned in the focus group discussion. Our findings show that identities other than those associated with mental illness and the role of service user are critical to the understanding of the psychological sense of community among persons with psychiatric disabilities. We suggest that mental health providers empower consumers to expand their "personal communities" beyond that of mental health clients using their diverse identities, and design interventions for addressing the stigma emanating from identities that are discriminated against by the wider society.

Injection drug users' strategies to manage perceptions of personal risk: how do IDUs see HIV as having affected them?

The U.S. public health community is in its 3rd decade of seeking to prevent and treat HIV/AIDS. Injection drug users (IDUs) are central to targeted HIV prevention interventions as approximately one third of new U.S. infections are attributable to injection drug use (Santibanez et al.,Journal of Urban Health, 83[1], 86-100, 2006). Targeted behavior change efforts are often explicitly built upon the risk perception of targeted individuals. In this article, we consider the efficacy of behavior change based on IDUs' perceptions of elevated risk. Our qualitative analysis of 28 interviews with HIV negative IDUs in inner city Baltimore suggests that participants did not see themselves as personally affected by HIV. Rather, respondents constructed accounts in which they differentiated themselves from the type of people who are so affected, thereby creating a less stigmatizing identity. We argue that effective HIV prevention should explicitly acknowledge and address the stigmatized IDU identity, rather than assuming readiness for behavior change.

Developing psychological perspectives of suicidal behaviour and risk in people with a diagnosis of schizophrenia: We know they kill themselves but do we understand why?

People with a diagnosis of schizophrenia are at increased risk of suicidal behaviour yet little is understood of the psychological underpinnings of this vulnerability. The biopsychosocial 'Cry of Pain' model [Williams, J.M.G. (1997). Cry of pain. Harmondsworth: Penguin.] provides a broad framework from which to understand suicidal behaviour. However, the utility of the model in relation to suicide in schizophrenia has not yet been explored. This was the primary goal of this paper. Six components of the 'Cry of Pain' model were identified and evaluated with respect to whether they contributed to i. common transdiagnostic factors underlying suicide, ii. factors relating to co-morbid depression which account for suicidal behaviour, or iii. factors which are specific to schizophrenia and underlie suicide risk. The potential for applying the model to clinical management of suicide in schizophrenia is illustrated.

The Stigma Scale: development of a standardised measure of the stigma of mental illness

BACKGROUND

There is concern about the stigma of mental illness, but it is difficult to measure stigma consistently.

AIMS

To develop a standardised instrument to measure the stigma of mental illness.

METHOD

We used qualitative data from interviews with mental health service users to develop a pilot scale with 42 items. We recruited 193 service users in order to standardise the scale. Of these, 93 were asked to complete the questionnaire twice, 2 weeks apart, of whom 60 (65%) did so. Items with a test-retest reliability kappa coefficient of 0.4 or greater were retained and subjected to common factor analysis.

RESULTS

The final 28-item stigma scale has a three-factor structure: the first concerns discrimination, the second disclosure and the third potential positive aspects of mental illness. Stigma scale scores were negatively correlated with global self-esteem.

CONCLUSIONS

This self-report questionnaire, which can be completed in 5-10 min, may help us understand more about the role of stigma of psychiatric illness in research and clinical settings.

Does chronic illness place constraints on positive constructions of identity? Temporal comparisons and self-evaluations in people with schizophrenia

It is often suggested that people in potentially threatening situations might engage in self-enhancing temporal comparisons that allow them to view themselves and their experience in a more positive light. Data from semi-structured interviews with 12 individuals in the UK diagnosed as having schizophrenia were content analyzed to explore patterns of temporal comparison. The study found that the onset of schizophrenic symptoms created a new baseline in participants' representations of their past, with different types of temporal comparisons occurring before and after this point. Although comparisons with past selves after onset supported the suggestion that people may select and construct their past in such a manner that permits them to see their present circumstances more positively and envisage a better future, comparisons with past selves before onset were more negative. The findings suggest that the Theory of Temporal Self-Appraisals (Ross & Wilson, 2000) needs to be elaborated to include people who have experienced major life changes.