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O'Donnell AT, Foran AM. The link between anticipated and internalized stigma and depression: A systematic review. Soc Sci Med 2024; 349:116869. [PMID: 38678910 DOI: 10.1016/j.socscimed.2024.116869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
Stigmatized groups may experience psychological distress. Yet, some studies show no significant relation between stigma and mental health outcomes. This systematic review investigates the link between anticipated and internalized stigma, and one mental health outcome, depression. We aimed to (1) determine whether anticipated and internalized stigma predict levels of depression, and (2) review the quality of evidence for this link. We searched PsycInfo, PubMed and EMBASE databases. Eighty-three studies (N = 34,705) met our inclusion criteria, across five stigma categories: Sexual and gender minorities; HIV/AIDS; Illness or disability-related (non-HIV); Weight, and Other. We reviewed evidence within each category and study design and developed a narrative synthesis. Sixty studies (72.3%) supported the proposed link, which varied across categories from 53.6% to 100%. Using the NIH quality assessment tool, most studies were of fair quality. Most cross-sectional studies (76.7%) straightforwardly supported the positive relation between internalized and/or anticipated stigma and depression, while only 40% of longitudinal studies did. Implications for the study of stigma and mental health outcomes are discussed.
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Affiliation(s)
- Aisling T O'Donnell
- Centre for Social Issues Research, Department of Psychology, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Aoife-Marie Foran
- Centre for Social Issues Research, Department of Psychology, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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El Ayadi AM, Obore S, Kirya F, Miller S, Korn A, Nalubwama H, Neuhaus J, Getahun M, Eyul P, Twine R, Andrew EVW, Barageine JK. Identifying opportunities for prevention of adverse outcomes following female genital fistula repair: protocol for a mixed-methods study in Uganda. Reprod Health 2024; 21:2. [PMID: 38178156 PMCID: PMC10768188 DOI: 10.1186/s12978-023-01732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Female genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000-2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence, and other morbidity may occur during fistula development. Women with fistula are stigmatized, limit social and economic engagement, and experience psychiatric morbidity. Improved surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events. This study aims to quantify these adverse risks and inform clinical and counseling interventions to optimize women's health and quality of life following fistula repair through: identifying predictors and characteristics of post-repair fistula breakdown and recurrence (Objective 1) and post-repair incontinence (Objective 2), and to identify feasible and acceptable intervention strategies (Objective 3). METHODS This mixed-methods study incorporates a prospective cohort of women with successful vesicovaginal fistula repair at approximately 12 fistula repair centers in Uganda (Objectives 1-2) followed by qualitative inquiry among key stakeholders (Objective 3). Cohort participants will have a baseline visit at the time of surgery followed by data collection at 2 weeks, 6 weeks, 3 months and quarterly thereafter for 3 years. Primary predictors to be evaluated include patient-related factors, fistula-related factors, fistula repair-related factors, and post-repair behaviors and exposures, collected via structured questionnaire at all data collection points. Clinical exams will be conducted at baseline, 2 weeks post-surgery, and for outcome confirmation at symptom development. Primary outcomes are fistula repair breakdown or fistula recurrence and post-repair incontinence. In-depth interviews will be conducted with cohort participants (n ~ 40) and other key stakeholders (~ 40 including family, peers, community members and clinical/social service providers) to inform feasibility and acceptability of recommendations. DISCUSSION Participant recruitment is underway. This study is expected to identify key predictors that can directly improve fistula repair and post-repair programs and women's outcomes, optimizing health and quality of life. Furthermore, our study will create a comprehensive longitudinal dataset capable of supporting broad inquiry into post-fistula repair health. Trial Registration ClinicalTrials.gov Identifier: NCT05437939.
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA.
| | - Susan Obore
- Department of Urogynecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Fred Kirya
- School of Health Sciences, Soroti University, Soroti, Uganda
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Monica Getahun
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Patrick Eyul
- Infectious Disease Research Collaboration, Kampala, Uganda
| | - Robert Twine
- Infectious Disease Research Collaboration, Kampala, Uganda
| | | | - Justus K Barageine
- Department of Urogynecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Kampala International University, Kampala, Uganda
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Bigley R, Barageine J, Nalubwama H, Neuhaus J, Mitchell A, Miller S, Obore S, Byamugisha J, Korn A, El Ayadi AM. Factors associated with reintegration trajectory following female genital fistula surgery in Uganda. AJOG GLOBAL REPORTS 2023; 3:100261. [PMID: 37719642 PMCID: PMC10502369 DOI: 10.1016/j.xagr.2023.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND A female genital fistula, primarily caused by prolonged obstructed labor or after cesarean delivery in resource-limited countries, affects 500,000 to 2,000,000 women worldwide. Fistula is preventable with timely access to high-quality obstetrical care. Access to surgical repair of a female genital fistula has greatly increased over time. However, research surrounding postrepair reintegration, the process of returning to an individual's normal life, remains limited, and further efforts are needed to understand the factors shaping women's ability to rebuild their relationships and lives following repair. OBJECTIVE This study aimed to characterize the 12-month reintegration trajectory after female genital fistula repair by participant sociodemographic and clinical characteristics. STUDY DESIGN This study analyzed quantitative survey and medical record data of women (N=60) participating in a longitudinal cohort study assessing recovery after genital fistula repair in Uganda, with baseline and 4 quarterly follow-up assessments in 12 months. The primary outcome of reintegration was assessed using a 19-item postfistula repair reintegration instrument (range, 0-100) where a higher score represents better reintegration. Predictors of interest included parity and living children, quality of life, depressive symptoms at baseline, self-esteem, stigma, trauma, physical symptoms, and social support. We described participant baseline characteristics using means and proportions and estimated a series of mixed-effects linear regression models, including interactions of characteristics with time to understand how these characteristics influence reintegration trajectory in the 12 months after repair. RESULTS The participants' physical and psychosocial morbidities at baseline were high; more than 80% of participants reported fistula-related physical symptoms, 82% of participants described their general health as poor, and measures of self-esteem, overall social support, and overall quality of life were low. The mean reintegration score at baseline was 33 (standard deviation, 20), which increased to 78 (standard deviation, 19) at 12 months after fistula repair. The participant sociodemographic characteristics statistically associated with reintegration included any living children (β, 1.08; 95% confidence interval, -0.08 to 2.23). Moreover, psychosocial factors significantly affected reintegration with steeper trajectories for women with depressive symptoms (β, 0.89; 95% confidence interval, 0.02-1.75) or women experiencing internalized stigma (β, 0.05; 95% confidence interval, -0.00 to 0.11) and less steep for those with higher self-esteem (β, -0.11; 95% confidence interval, -0.24 to 0.01), overall social support (β, -0.06; 95% confidence interval, -0.12 to -0.01), and partner support (β, -0.21; 95% confidence interval, -0.35 to -0.07). CONCLUSION Understanding the prominent factors associated with differences in reintegration trajectories across the year after genital fistula surgery has the potential to inform interventions that mitigate challenges and improve women's postrepair recovery experiences.
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Affiliation(s)
- Rachel Bigley
- University of California, San Francisco, School of Medicine, San Francisco, CA (Dr Bigley)
| | - Justus Barageine
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda (Drs Barageine, Ms Nalubwama, and Dr Byamugisha)
- Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda (Drs Barageine and Obore)
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda (Drs Barageine, Ms Nalubwama, and Dr Byamugisha)
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (Drs Neuhaus and El Ayadi)
| | - Ashley Mitchell
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA (Ms Mitchell)
| | - Suellen Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (Drs. Miller, Korn, and El Ayadi)
| | - Susan Obore
- Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda (Drs Barageine and Obore)
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda (Drs Barageine, Ms Nalubwama, and Dr Byamugisha)
| | - Abner Korn
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA (Ms Mitchell)
| | - Alison M. El Ayadi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (Drs Neuhaus and El Ayadi)
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA (Ms Mitchell)
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Boden-Albala B, Ding X, Ryan N, Goodman S, Wing J, Runnerstrom MG, Gutierrez D, Gibbs B, Robb JM, Drum E. Anti-Asian racism related stigma, racial discrimination, and protective factors against stigma: a repeated cross-sectional survey among university students during the COVID-19 pandemic. Front Public Health 2023; 11:958932. [PMID: 37771832 PMCID: PMC10524265 DOI: 10.3389/fpubh.2023.958932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
Background Since the onset of the COVID-19 pandemic in March 2020, reports of anti-Asian American or Pacific Islander (AAPI) hate have increased in the United States. Institutions of higher education provide a unique opportunity to examine COVID-19 related stigma and protective factors in AAPI young adults enrolled in college. Objective The goal of this research was to examine COVID-19 related stigma among a diverse college student population. We posited that AAPI students experience more racial discrimination, internalized stigma, and/or anticipated racial discrimination than other students. We also sought to identify protective behavioral factors against stigma. Methods This study includes data from a repeated cross-sectional survey that was administered among college students at a large public university in the United States in April (n = 1,359) and November 2020 (n = 1,196). All university enrolled students with an active email account were eligible to participate in the online survey, which included questions about COVID-19 stigma (anticipated, enacted, internalized), stigma resistance, sources of COVID-19 information, lifestyle behaviors, and sociodemographic information. Binary logistic regression models were utilized to assess differences in stigma between race and ethnic groups and to identify factors associated with stigma. Results AAPI students were more likely to experience all three types of stigma compared to other race and ethnic groups. AAPI students in both waves were at least 2 times more likely to experience enacted stigma and 7.3 times more likely to experience anticipated stigma in the earlier wave compared to non-Hispanic White students. Students who had experienced enacted stigma were more likely to experience anticipated stigma, and those who experienced enacted and anticipated stigma were more likely to experience internalized stigma. Higher education level, living with neighbors/roommates, maintaining a healthy lifestyle, and thinking positively about oneself may act as protective factors against different types of stigma. Conclusion AAPI students have a greater risk of experiencing COVID-19 stigma compared to those from other race and ethnic groups. Universities should combat anti-AAPI sentiments and COVID-19 stigma and promote public health efforts to build resistance against the negative effects of stigma.
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Affiliation(s)
- Bernadette Boden-Albala
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
- Department of Health, Society and Behavior, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
- Department of Epidemiology and Biostatistics, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
- Department of Neurology, School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
| | - Xueting Ding
- Department of Health, Society and Behavior, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
| | - Nessa Ryan
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
| | - Sara Goodman
- School of Medicine, Department of Pediatrics-Infectious Diseases, Stanford University, Stanford, CA, United States
| | - Jeffrey Wing
- College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Miryha Gould Runnerstrom
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, United States
| | - Desiree Gutierrez
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
| | - Brooke Gibbs
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
| | - John Michael Robb
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
| | - Emily Drum
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
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El Ayadi AM, Obore S, Kirya F, Miller S, Korn A, Nalubwama H, Neuhaus J, Getahun M, Eyul P, Twine R, Andrew EVW, Barageine JK. Identifying Opportunities for Prevention of Adverse Outcomes Following Female Genital Fistula Repair: Protocol for a Mixed-Methods Study in Uganda. RESEARCH SQUARE 2023:rs.3.rs-2879899. [PMID: 37205399 PMCID: PMC10187434 DOI: 10.21203/rs.3.rs-2879899/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Female genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000-2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence. Other gynecologic, neurologic and orthopedic morbidity may occur during fistula development. Women with fistula are stigmatized; limit engagement in social, economic, or religious activities; and report high psychiatric morbidity. Improved global surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events, protecting health and quality of life after surgery. This study seeks to identify predictors and characteristics of post-repair fistula breakdown and recurrence (Aim 1) and post-repair incontinence (Aim 2), and to identify feasible and acceptable intervention strategies (Aim 3). Methods This mixed-methods study incorporates a prospective cohort study of women with successful vesicovaginal fistula repair at approximately 12 fistula repair centers and affiliated care sites in Uganda (Aims 1-2) followed by qualitative inquiry among key stakeholders (Aim 3). Cohort participants will have a baseline visit at the time of surgery followed by data collection at 2 weeks, 6 weeks, 3 months and quarterly thereafter for 3 years. Primary predictors to be evaluated include patient-related factors, fistula-related factors, fistula repair-related factors, and post-repair behaviors and exposures, collected via structured questionnaire at all data collection points. Clinical exams will be conducted at baseline, 2 weeks post-surgery, and for outcome confirmation at symptom development. Primary outcomes are fistula repair breakdown or fistula recurrence and post-repair incontinence. In-depth interviews will be conducted with cohort participants (n ~ 40) and other key stakeholders (~ 40 including family, peers, community members and clinical/social service providers) to develop feasible and acceptable intervention concepts for adjustment of identified risk factors. Discussion Participant recruitment is underway. This study is expected to identify key predictors that can directly improve fistula repair and post-repair programs and women's outcomes, optimizing health and quality of life. Furthermore, our study will create a comprehensive longitudinal dataset capable of supporting broad inquiry into post-fistula repair health. Trial Registration ClinicalTrials.gov Identifier: NCT05437939.
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Affiliation(s)
| | - Susan Obore
- Mulago Specialized Women and Neonatal Hospital
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