Exploring stigmatization in digital newspaper coverage of substance use disorder

Substance use disorder is a global health issue that profoundly affects both individuals and societies. Social stigma acts as a significant barrier to treatment motivation. Mass media plays a substantial role in shaping societal perceptions. This study aims to identify stigmatizing attitudes in news narratives concerning substance use disorder as portrayed in digital newspapers. We examined news articles from the top eight national digital newspapers published during 2022 by using quantitative and retrospective content analysis. Following the review, we collected 1.233 news articles, removed 480 articles which were irrelevant or duplicate, and analyzed the remaining 753 articles using quantitative content analysis methods on SPSS 26.0. The majority of news articles depict substance use disorder in a negative consideration. The analysis revealed that nearly all news sources were news agencies and only 11% of the articles offered potential solutions. Alarmingly, 69.7% of the articles contained stigmatizing content, while 53.1% directly impacted the social lives of individuals with substance use disorder. Furthermore, 44.1% of the articles reinforced a dangerous perception associated with individuals with substance use disorder. To address these issues, we recommend a more empathetic portrayal of substance use disorder, support for help-seeking behavior, and advocacy for effective solutions in news coverage.

Internal stigmatization in patients with chronic migraine and medication overuse headache

OBJECTIVES

Internalized stigma can have profound effects on how individuals with migraines and other primary headache disorders see themselves and their quality of life. We aimed to investigate internalized stigma in patients with chronic migraines and medication overuse headaches.

METHODS

A total of 57 patients (52 women, 5 men) were included in the study, 26 of these patients were affected by chronic migraine, 31 of them were affected by medication overuse headache and chronic migraine. The Internalized Stigma Scale in Mental Illness (Ristsher's stigmatization scale) and General Health Questionnaire were applied to all patients.

RESULTS

In Ristsher's stigmatization scale, which measures internalization of stigma, internalized stigmatization was more significant in patients with medication overuse headache than in patients with chronic migraine compared to groups (p:0.05). The subtitle of alienation was statistically significant when the groups were compared to all subscales in the form of alienation, confirmation of stereotypes, perceived discrimination, social withdrawal and resistance to stigma (p:0.05).

DISCUSSION

Although internal stigmatize has been observed in chronic migraine patients, medication overuse headache is also a type of headache with intense stigma. In addition, this internal stigma perhaps plays an active role in the transformation of chronic migraine patients to medication overuse headaches patient.

[The German Center for Mental Health : Innovative translational research to promote prevention, targeted intervention and resilience]

BACKGROUND

Due to the high disease burden, the early onset and often long-term trajectories mental disorders are among the most widespread diseases with growing significance. The German Center for Mental Health (DZPG) was established to enhance research conditions and expedite the translation of clinically relevant findings into practice.

OBJECTIVE

The aim of the DZPG is to optimize mental healthcare in Germany, influence modifiable social causes and to develop best practice models of care for vulnerable groups. It seeks to promote mental health and resilience, combat the stigmatization associated with mental disorders, and contribute to the enhancement of treatment across all age groups.

MATERIAL AND METHODS

The DZPG employs a translational research program that accelerates the translation of basic research findings into clinical studies and general practice. University hospitals and outpatient departments, other university disciplines, and extramural research institutions are working together to establish a collaboratively coordinated infrastructure for accelerated translation and innovation.

RESEARCH PRIORITIES

The research areas encompass 1) the interaction of somatic and mental risk and resilience factors and disorders across the lifespan, 2) influencing relevant modifiable environmental factors and 3) based on this personalized prevention and intervention.

CONCLUSION

The DZPG aims to develop innovative preventive and therapeutic tools that enable an improvement in care for individuals with mental disorders. It involves a comprehensive integration of experts with experience at all levels of decision-making and employs trilogue and participatory approaches in all research projects.

Identifying the mental health burden in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients in Switzerland: A pilot study

Background

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating chronic disease of significant public health and clinical importance. It affects multiple systems in the body and has neuro-immunological characteristics. The disease is characterized by a prominent symptom called post-exertional malaise (PEM), as well as abnormalities in the immune-inflammatory pathways, mitochondrial dysfunctions and disturbances in neuroendocrine pathways. The purpose of this study was to evaluate the impact of ME/CFS on the mental health and secondary psychosocial manifestations of patients, as well as their coping mechanisms.

Method

In 2021, a descriptive cross-sectional study was conducted in Switzerland. A self-administered paper questionnaire survey was used to gather data from 169 individuals diagnosed with ME/CFS.

Results

The majority of the patients (90.5%) reported a lack of understanding of their disease, resulting in patients avoiding talking about the disease due to disbelief, trivialization and avoidance of negative reactions. They felt most supported by close family members (67.1%). Two thirds of the patients (68.5%) experienced stigmatization. ME/CFS had a negative impact on mental health in most patients (88.2%), leading to sadness (71%), hopelessness for relief (66.9%), suicidal thoughts (39.3%) and secondary depression (14.8%). Half of the male patients experienced at least one suicidal thought since clinical onset. Factors significantly associated with depression were the lack of cure, disabilities associated with ME/CFS, social isolation and the fact that life was not worth anymore with ME/CFS. The three main factors contributing to suicidal thoughts were (i) being told the disease was only psychosomatic (89.5%), (ii) being at the end of one's strength (80.7%) and (iii) not feeling being understood by others (80.7%).

Conclusion

This study provided first time significant insights into the mental and psychological well-being of ME/CFS patients in Switzerland. The findings highlight the substantial experiences of stigmatization, secondary depression and suicidal thoughts compared to other chronic diseases, calling for an urgent need in Switzerland to improve ME/CFS patient's medical, psychological and social support, in order to alleviate the severe mental health burden associated with this overlooked somatic disease.

Experiences of appearance conversations among young people living with a visible difference

Stigmatisation surrounding having a visible difference to the face or body may have a marked impact on how young people communicate about appearance. The aim of our study was therefore to explore the experiences of appearance conversations among young people living with a visible difference. Interviews were conducted with 32 young people (mean age 14.1 years; 67.7% girls), with a condition resulting in a visible difference (e.g., craniofacial condition or scarring). Using reflexive thematic analysis, we identified three themes. Importance of Safety and Understanding reflects the importance of feeling safe in order to be able to talk about appearance. Participants described appearance conversations as often originating in their need for emotional support or practical assistance when encountering difficulties (Conversations When in Need of Support), but appearance was also experienced as a sensitive topic that was difficult to talk about (Avoiding Appearance Conversations). Our results highlight the importance of creating spaces where young people with a visible difference feel safe to bring up the topic of appearance when in need of support. Elements that facilitate such conversations include others having knowledge about the condition and having one's feelings and experiences validated instead of minimised.

A Narrative Review of the Dichotomy Between the Social Views of Non-Monogamy and the Experiences of Consensual Non-Monogamous People

Monogamy is deeply rooted in most Western societies, shaping how people construe and behave in romantic relationships. These normative views facilitate the emergence of negative perceptions and evaluations when people choose not to adhere to mononormativity. Even though people in consensual non-monogamous (CNM) relationships are targets of stigmatization, research shows a dichotomy between these negative views and the relational experiences of CNM people. Indeed, people in CNM and monogamous relationships have comparable relationship functioning and quality and struggle with similar relationship problems. One of the differences is that CNM relationships afford people to explore their sexuality and fulfill their needs with multiple partners, without agreed-upon extradyadic behavior being perceived as infidelity or having deleterious consequences to relationship maintenance. These positive experiences notwithstanding, CNM people are continuously pressured by mononormativity and stigmatization, increasing the risk of internalized CNM negativity and worse personal and relational outcomes. One possible way to counteract CNM stigmatization and improve the lives of CNM people is by changing discourses surrounding non-monogamy and improving acceptance, not only in professional settings but also in the general population. Another strategy is to understand how the relationship beliefs and scripts of younger generations can help promote more inclusive and diverse societies.

Can equity in care be achieved for stigmatized patients? Discourses of ideological dilemmas in perioperative care

BACKGROUND

In the perioperative care of individuals with obesity, it is imperative to consider the presence of risk factors that may predispose them to complications. Providing optimal care in such cases proves to be a multifaceted challenge, significantly distinct from the care required for non-obese patients. However, patients with morbidities regarded as self-inflicted, such as obesity, described feelings of being judged and discriminated in healthcare. At the same time, healthcare personnel express difficulties in acting in an appropriate and non-insulting way. In this study, the aim was to analyse how registered nurse anaesthetists positioned themselves regarding obese patients in perioperative care.

METHODS

We used discursive psychology to analyse how registered nurse anaesthetists positioned themselves toward obese patients in perioperative care, while striving to provide equitable care. The empirical material was drawn from interviews with 15 registered nurse anaesthetists working in a hospital in northern Sweden.

RESULTS

Obese patients were described as "untypical", and more "resource-demanding" than for the "normal" patient in perioperative care. This created conflicting feelings, and generated frustration directed toward the patients when the care demanded extra work that had not been accounted for in the schedules created by the organization and managers.

CONCLUSIONS

Although the intention of these registered nurse anaesthetists was to offer all patients equitable care, the organization did not always provide the necessary resources. This contributed to the registered nurse anaesthetists either consciously or unconsciously blaming patients who deviated from the "norm".

Psychosocial Burden in People with Atopic Dermatitis: Effects of a Substance-Free Basic Skincare in a Randomized Health Care Study

INTRODUCTION

Atopic dermatitis (AD) is a physical, emotional, and social burden for patients. Most suffer from itching, pain, and dry skin as well as sleep disturbances, experienced stigmatization, anxiety, or depression. Therefore, it is important to consider the psychosocial well-being and also stigmatization in the treatment of people with AD. The aims of this study were to compare clinical and psychosocial parameters between patients with a different severity of AD and to analyse the effect of an omega-6-fatty-acid-skin therapy.

METHODS

Adult patients with clinically confirmed AD were asked about quality of life, stigmatization, and well-being after dermatological diagnosis. A second examination took place after 2-5 weeks. Meanwhile, after randomization, half of the patients used an omega-6-fatty-acid-skin therapy.

RESULTS

Seventy-nine patients were included in the study. The use of omega-6-fatty-acid-skin therapy resulted in a significant reduction in the severity of xerosis cutis compared to patients using another basic therapy. In addition, the health-related quality of life of all patients improved significantly in both groups (F = 7.56; p = 0.008), and no significant difference was found between the groups over time in the patient-reported outcomes.

CONCLUSION

Basic therapy for AD leads to relevant improvements in clinical status as well as quality of life. Patients using omega-6-fatty-acid-skin therapy experience greater improvement in xerosis cutis compared to free-choice basic therapy.

Leaving the stigma to the patients? Frequency of crisis experiences among mental health professionals in Berlin and Brandenburg and how they cope with it

BACKGROUND

Although mental health professionals' mental health problems are gaining increased attention, there is little systematic research on this topic.

AIMS

This study investigated the frequency of crisis experiences among mental health professionals and examined how they approach these experiences in terms of their personal and social identities.

METHODS

An online survey was conducted among mental health professionals in 18 psychiatric hospital departments in the German federal states of Berlin and Brandenburg (N = 215), containing questions about personal crisis experiences, help sought, service use, meaningfulness of lived experiences, causal beliefs of mental illness and psychotherapeutic orientation. Social identification was assessed via semantic differential scales derived from preliminary interview studies. To investigate relationships between the variables, explorative correlation analyses were calculated.

RESULTS

Results showed a high frequency rate of crisis experiences, substantial rates of suicidal ideation and incapacity to work and high service use. Most participants regarded their experiences as meaningful for their personal identity. Meaningfulness was positively related to a psychosocial causation model of mental illness, to psychodynamic psychotherapeutic orientation and to a high degree of disidentification with users and crisis experienced colleagues.

CONCLUSION

The (paradoxical) disintegration of personal and social identity of may be understood as a strategy to avoid stigmatization. A more challenging coping style among professionals is discussed.

Why do transgender individuals experience discrimination in healthcare and thereby limited access to healthcare? An interview study exploring the perspective of German transgender individuals

BACKGROUND

Transgender individuals experience limited access to healthcare. This results not least from experiences of discrimination to which they are exposed in the health system. These contribute to transgender individuals having poorer health than cis individuals, i.e. individuals whose sex assigned at birth is in line with their gender identity. It is an ethical duty to take effective measures to minimize inequalities in medical care. At best, such measures should also be assessed as appropriate from the perspective of those affected in order to be accepted and thus effective. It is therefore important to know whether measures touch on the subjectively assumed reasons for experiences of discrimination. Hence, to be able to take appropriate measures, it is important to identify the reasons that transgender individuals see as causal for their experiences of discrimination in healthcare.

METHODS

We conducted semi-structured interviews with 14 German transgender individuals and asked them about their own experiences of discrimination in healthcare and their assumptions on the reasons for discrimination. We analyzed the responses using the method of structured qualitative content analysis.

RESULTS

13 transgender individuals reported experiences of discrimination in healthcare. These emanated from different professional groups and took place in trans-specific as well as general medical settings. We were able to identify a total of 12 reasons that transgender individuals see as causal for their experiences of discrimination: (1) internalized trans-hostility and "protection" of cis individuals, (2) lack of knowledge/uncertainties regarding transition, (3) "protection" of a binary worldview, (4) binary worldview in medicine, (5) structural deficits, (6) asymmetric interactions with specialists, (7) current political debate, (8) view of transgender individuals as a "burden for society", (9) objectification, (10) homophobia, (11) misogyny/androcentrism and (12) discrimination as reaction to discrimination.

CONCLUSIONS

German transgender individuals have a very differentiated picture regarding their subjective reasons for experiencing discrimination in healthcare. Overall, disrespect regarding gender identity and a confrontation with foreignness seems to be seen as the decisive factor. Thus, it is not enough to focus only on measures that aim to remedy the information deficit on the part of medical providers. Measures must be taken that can create a granting and respectful attitude towards transgender individuals.

Experiences of adults living with refractory epilepsy and their views and expectations on receiving results from whole genome sequencing

INTRODUCTION

Researchers, clinicians and patients are turning to new innovations in research and clinical practice to further their knowledge in the genetic domain and improve diagnostics or treatment. However, with increased knowledge in genetics, societal issues may arise. Being conscious of these issues is crucial in order to implement standardized and efficient testing on a wider scale that is accessible to a greater number of individuals while simultaneously returning test results, including incidental findings, in a timely manner.

METHODS

Within the framework of a genomics research project, we invited 20 participants who suffer from refractory epilepsy to provide insight on their personal experiences with epilepsy, as well as their thoughts on receiving Whole Genome Sequencing (WGS) results and with whom they would feel comfortable sharing these results with.

RESULTS

All participants had their own unique experience with epilepsy, such as how they handled their diagnosis, their struggles following the diagnosis, the healthcare services they received, how they shared their diagnosis with others, and how they managed stigmatization from others. Most participants would be eager to know their WGS results, whether the results be related to epilepsy (n = 19), response to pharmaceutical drugs including AEDs (n = 16), comorbidities (n = 19) and incidental findings (n = 15).

CONCLUSION

Our findings reinforce the need to improve access to genetic testing for epilepsy patients in clinical settings. Furthermore, while acquiring more genetic knowledge (i.e. WGS) about epilepsy can provide answers for the affected population, it also requires the simultaneous involvement of several medical disciplines, with greater emphasis on genetic and psychological counseling.

Perceived stigma in burn survivors: Associations with resourcefulness and alexithymia

OBJECTIVE

Burn survivors often have severe scarring and distorted body image, and they are commonly given new perceptions and even receive a variety of negative labels from individuals, families and society. This study aimed to explore the association between stigma, resourcefulness and alexithymia, and identifies whether resourcefulness in burn survivors is mediating the relationship between resourcefulness and alexithymia.

METHOD

This correlational study was conducted from December 2021 to July 2022 in a comprehensive tertiary Grade A hospital in Ningxia, China. A convenience sample of 159 burn survivors was recruited. Data were collected using demographics, Social Impact Scale(SIC),Toronto Alexithymia Scale, and Resourcefulness Scale (RS). Descriptive analysis, Hierarchical Regression analysis, Pearson Correlation analysis, and Mediation analysis were used for data analysis.

RESULTS

Finally, a data set of 148 responses was determined for analysis. The effective rate was 95.9%. We found significant correlation between stigma, resourcefulness and alexithymia. Sociodemographic characteristics (gender, spouse states), clinical characteristics (body surface burned area, scar areas), resourcefulness and alexithymia of burn survivors were significant predictors of stigma among burn survivors. The mediating effect of resourcefulness between stigma and alexithymia in burns survivors accounted for 36.03% of the total effect.

CONCLUSION

Resourcefulness partially mediates the relationship between stigma and alexithymia. These findings suggest medical staff should strengthen the management of the mental health of burn survivors and eliminate the negative cognition and tendency of burn survivors by regularly promoting stigma counseling measures based on cognitive behavioral therapy. Based on the resourcefulness theory, psychological counseling and intervention are carried out in various ways to fully mobilize their internal factors for positive emotional regulation and enhance the ability of individuals to cope with adversity. In addition, an attempt was made to establish an "anti-stigma coalition" or "peer support group" for burn survivors to provide networked information support and emotional support to facilitate further the smooth return of patients to their families and society.

Value of gym-based group exercise versus usual care for young adults receiving antipsychotic medication: study protocol for the multicenter randomized controlled Vega trial

BACKGROUND

Exercise is recommended to protect physical health among people with severe mental illness and holds the potential to facilitate long-term recovery. An inclusive exercise community provides an opportunity for life skill training and social connectedness and may reduce the experience of loneliness and internalized stigmatization which together may improve personal recovery. Using a pragmatic randomized design, we aim to examine the effectiveness of a gym-based exercise intervention tailored to young adults in antipsychotic treatment (i.e., Vega Exercise Community) compared to usual care. It is hypothesized that the Vega Exercise Community will be superior to usual care for personal recovery at four months.

METHODS

The trial will be conducted at four sites in Denmark from which 400 participants, aged 18 to 35 years, who are in current treatment with antipsychotic medications for the management of schizophrenia spectrum or affective disorders, will be recruited. Participants will be randomized (2:1) to Vega Exercise Community or usual care. Vega Exercise Community includes three weekly group-based exercise sessions hosted in commercial functional training centers delivered by certified Vega instructors. After four months, participants in Vega Exercise Community will be randomized (1:1) to minimal versus extended support with regards to sustained physical activity. Data will be collected at baseline, four, six and 12 months. The primary outcome is personal recovery assessed by Questionnaire about the Process of Recovery at four months. Behavioral symptoms, health-related quality of life, metabolic health, and program costs will be evaluated to further determine the effectiveness and cost-effectiveness of the Vega Exercise Community. Finally, the quality of life and physical and mental health of the participants' primary relative will be evaluated.

DISCUSSION

The results of this trial may have important implications for health, sustained physical activity, and recovery for individuals in treatment with antipsychotics. Given the pragmatic design, positive results may readily be implemented by mental health care professionals to promote exercise as an integrated part of treatment of severe mental illness.

TRIAL REGISTRATION

Clinical Trials.gov (NCT05461885, initial registration June 29th, 2022). WHO Universal Trial Number (UTN): U1111-1271-9928.

Brief cognitive behavior therapy for stigmatization, depression, quality of life, social support and adherence to treatment among patients with HIV/AIDS: a randomized control trial

OBJECTIVE

Individuals living with HIV/AIDs are at a high risk of many problems like depression, stigma, quality of life, decreased adherence to treatment, and lack of social support. The present study aimed to investigate the impact of brief-cognitive behavior therapy (B-CBT) on reducing depression and stigma and improving treatment adherence, quality of life, and social support among patients with HIV/AIDS attending antiretroviral therapy (ART).

MATERIALS AND METHODS

This randomized clinical trial was conducted at ART Clinic in the Tehsil Headquarters Hospital Shahkot Nankana Sahib from July 2021 to October 2021. After baseline screening, 126 patients met the eligibility criteria and 63 were allocated to the experimental group (EXPg = 63) and 63 to waitlist-control group (WLCg = 63). Participants' age range was from 20 to 55 years. Participants who were taking ART treatment were enrolled for the CBT treatment. Before this, all the participants completed a baseline assessment to ensure a level of severity and diagnosis. A total of eight CBT based therapeutic sessions were conducted individually with EXPg. To assess the outcomes among patients receiving ART, we used Demographic form, Patient health questionnaire, HIV stigma scale, General medication adherence scale, Multidimensional scale of perceived social support, and WHOQOL BREF scale.

RESULTS

Findings suggest that B-CBT significantly reduced the level of depression (i.e. F (1, 78) = 101.38, p < .000, η2 = .599), and social stigma (i.e. F (1, 78) = 208.47, p < .000, η2 = .787) among patients with HIV/AIDS. Furthermore, CBT substantially improved the level of adherence to treatment (i.e. F(1,78) = 24.75, p < .000, η2 = .503), social support (i.e. F (1, 78) = 128.33, p < .000, η2 = .606), and quality of life (i.e. F (1, 78) = 373.39, p < .000, η2 = .837) among patients with HIV/AIDS. Significant mean difference M(SD) on PHQ at post-analysis in the EXPg vs. WLCg was seen 1.22(0.47) vs. 2.30(0.68) and similarly, on MPSS at a post-analysis in the EXPg vs. WLCg 2.85(0.36) vs. 1.70(0.51) which indicates sound therapeutic outcomes.

CONCLUSIONS

Cognitive behavioral therapy effectively decreases the level of depression and stigma and enhances the level of social support, quality of life, and adherence to treatment among HIV/AIDS patients. It is concluded that cognitive behavior therapy is an effective treatment approach for patients with HIV/AIDS.

TRIAL REGISTRATION

Thai clinical trial registry (i.e. TCTR =  TCTR20210702002 ).

An acceptance-based, intersectional stigma coping intervention for people with HIV who inject drugs-a randomized clinical trial

Background

People with HIV who inject drugs experience intersecting forms of stigma that adversely impact care access. This RCT aimed to evaluate effects of a behavioral intersectional stigma coping intervention on stigma and care utilization.

Methods

We recruited 100 participants with HIV and past-30-day injection drug use at a non-governmental harm reduction organization in St. Petersburg, Russia, and randomized them 1:2 to receive usual services only or an additional intervention of three weekly 2-h group sessions. Primary outcomes were change in HIV and substance use stigma scores at one month after randomization. Secondary outcomes were initiation of antiretroviral treatment (ART), substance use care utilization, and changes in frequency of past-30-days drug injection at six months. The trial was registered as NCT03695393 at clinicaltrials.gov.

Findings

Participant median age was 38.1 years, 49% were female. Comparing 67 intervention and 33 control group participants recruited October 2019-September 2020, the adjusted mean difference (AMD) in change in HIV and substance use stigma scores one month after baseline were 0.40, (95% CI: -0.14 to 0.93, p = 0.14) and -2.18 (95% CI: -4.87 to 0.52, p = 0.11), respectively. More intervention participants than control participants initiated ART (n = 13, 20% vs n = 1, 3%, proportion difference 0.17, 95% CI: 0.05-0.29, p = 0.01) and utilized substance use care (n = 15, 23% vs n = 2, 6%, proportion difference 0.17, 95% CI: 0.03-0.31, p = 0.02). The adjusted median difference in change in injecting drug use frequency 6 months after baseline was -3.33, 95% CI: -8.51 to 1.84, p = 0.21). Five not intervention-related serious adverse events (7.5%) occurred in the intervention group, one (3.0%) serious adverse event in the control group.

Interpretation

This brief stigma-coping intervention did not change stigma manifestations or drug use behaviors in people with HIV and injection drug use. However, it seemed to reduce stigma's impact as an HIV and substance use care barrier.

Funding

R00DA041245, K99DA041245, P30AI042853.

Stigmatization, a social perception which may have a debilitating impact on hidradenitis suppurativa patients: an observational study

Hidradenitis suppurativa (HS) is a debilitating disease and patients are prone to feelings of stigmatization. In our cohort, we assessed how feelings of stigmatization may relate to patient quality of life (QOL), depression, and social anxiety. Participants completed the Dermatology Life Quality Index (DLQI) to assess QOL, Patient Health Questionnaire 9 (PHQ-9) to assess depression, the Brief Fear of Negative Evaluation (BFNE) to assess social anxiety, and an adapted version of the Feelings of Stigmatization (FoS) to assess stigmatization. The FoS also correlated with DLQI (R = 0.68), PHQ-9 (R = 0.42), and BFNE (R = 0.52). Participants with greater FoS were also more likely to have worse QOL (18.1), higher levels of depression (11.1), and higher social anxiety (30.1), as compared to those with less FoS (6.7, P < 0.001; 4.9, P < 0.001; 23.2, P < 0.001, respectively). HS is a chronic disease with no definitive treatment. Effective screening protocols, coupled with pharmacological and nonpharmacological interventions, may help patients with HS's psychosocial burden.

Stigmatization, panic disorder, and death anxiety among patients of Covid-19: Fourth wave of pandemic in Pakistan

BACKGROUND

In Pakistan, the fourth wave of COVID-19 is causing an increasing number of positive cases. This fourth wave may be a risky aspect of mental health issues for COVID-19 patients. This quantitative study is designed to understand the stigmatization, and panic disorder and to explore the mediating role of death anxiety among patients of COVID-19 during the fourth wave of novel coronavirus.

METHODS

The study was conducted using a correlational research design. The survey was carried out by utilizing a questionnaire with a convenient sample technique. The sample of the study was comprised of 139 patients with COVID-19. Data were collected through Stigma Scale for Chronic Illnesses (SSCI), The Panic Disorder Severity Scale (PDSS), and Death Anxiety Inventory.

RESULTS

Results show that stigma is significantly positively related to panic disorder and death anxiety. Furthermore, panic disorder is also significantly positively related to death anxiety. Results also indicate that stigmatization is a significant positive predictor for death anxiety and panic disorder. Moreover, results indicate that death anxiety has a mediating role in the relationship between stigmatization and panic disorder with age and gender as covariates.

CONCLUSION

This study would be helpful for people around the world to understand this threatening contagious virus so they wouldn't stigmatize infected ones. Additional research is required for the sustainable improvement of anxiety over time.

[Current recommendations for congenital melanocytic nevi]

Congenital melanocytic nevi are pigmented birthmarks, some of which have a considerable size. In some cases, not only the skin but also the brain or spinal cord are affected. Many aspects about how to manage this disease have been reconsidered and partly changed over the last 20 years. This article summarizes the current state of knowledge and treatment recommendations.

Exploring the emotional costs of abortion travel in the United States due to legal restriction

OBJECTIVES

Pregnant people have traveled across state and national borders for the purpose of abortion since at least the 1960s. Scholarship has robustly documented the financial and logistical costs associated with travel, but less work has examined the emotional costs of abortion travel. We investigate whether abortion travel has emotional costs and, if so, how they come about.

STUDY DESIGN

We conducted in-depth interviews with 30 women who had to travel across state borders in the United States for abortion care because of their gestation. We analyzed findings thematically.

RESULTS

Interviewees described having to travel to obtain abortion care as emotionally burdensome, causing distress, stress, anxiety, and shame. Because they had to travel, they were compelled to disclose their abortion to others and obtain care in an unfamiliar place and away from usual networks of support, which engendered emotional costs. Additionally, travel induced feelings of shame and exclusion because it stemmed from a law-based denial of in-state abortion care, which some experienced as marking them as deviant or abnormal.

CONCLUSIONS

People who have to travel for abortion care experience emotional costs alongside financial and logistical costs. The circumstances of that travel-specifically, being forced to travel because of legal restriction and service unavailability-are foundational to the ensuing emotional burdens. Findings add to the emerging literature on how laws and other structures produce the stigmatization of abortion at interpersonal and individual levels.

IMPLICATIONS

With abortion bans following the overturning of the right to abortion and existing gestational limits in the US, more people will have to travel for abortion care. Attention to the emotional costs of abortion travel can help providers understand what their patients may be experiencing when they present for care.

Stigmatization in the context of the COVID-19 pandemic: a survey experiment using attribution theory and the familiarity hypothesis

BACKGROUND

The COVID-19 pandemic has created a global health crisis, leading to stigmatization and discriminatory behaviors against people who have contracted or are suspected of having contracted the virus. Yet the causes of stigmatization in the context of COVID-19 remain only partially understood. Using attribution theory, we examine to what extent attributes of a fictitious person affect the formation of stigmatizing attitudes towards this person, and whether suspected COVID-19 infection (vs. flu) intensifies such attitudes. We also use the familiarity hypothesis to explore whether familiarity with COVID-19 reduces stigma and whether it moderates the effect of a COVID-19 infection on stigmatization.

METHODS

We conducted a multifactorial vignette survey experiment (2⁸-design, i.e., N_Vignettes = 256) in Germany (N_Respondents = 4,059) in which we experimentally varied signals and signaling events (i.e., information that may trigger stigma) concerning a fictitious person in the context of COVID-19. We assessed respondents' cognitive (e.g., blameworthiness) and affective (e.g., anger) responses as well as their discriminatory inclinations (e.g., avoidance) towards the character. Furthermore, we measured different indicators of respondents' familiarity with COVID-19.

RESULTS

Results revealed higher levels of stigma towards people who were diagnosed with COVID-19 versus a regular flu. In addition, stigma was higher towards those who were considered responsible for their infection due to irresponsible behavior. Knowing someone who died from a COVID infection increased stigma. While higher self-reported knowledge about COVID-19 was associated with more stigma, higher factual knowledge was associated with less.

CONCLUSION

Attribution theory and to a lesser extent the familiarity hypothesis can help better understand stigma in the context of COVID-19. This study provides insights about who is at risk of stigmatization and stigmatizing others in this context. It thereby allows identifying the groups that require more support in accessing healthcare services and suggests that basic, factually oriented public health interventions would be promising for reducing stigma.

Psychosocial Impact of the Implementation of COVID-19 Protocols

BACKGROUND

The COVID-19 pandemic has spread globally since the first case was diagnosed in Wuhan, China in December 2019 and we are now experiencing the fourth wave. Several measures are being taken to care for the infected and to curtail the spread of this novel infectious virus. The psychosocial impact of these measures on patients, relatives, caregivers, and medical personnel also needs to be assessed and catered for.

METHODS

This is a review article on the psychosocial impact of the implementation of COVID-19 protocols. The literature search was done using Google Scholar, PubMed, and Medline.

DISCUSSION

Modalities of transportation of the patient to isolation and quarantine centres have led to stigma and negative attitudes towards such individuals. When diagnosed with the infection, fear of dying from COVID-19, fear of infecting family members and close associates, fear of stigmatization, and loneliness are common among COVID-19 patients. Isolation and quarantine procedures also cause loneliness and depression, and the person is at risk of post-traumatic stress disorder. Caregivers are continually stressed out and have the constant fear of contracting SARS-CoV-2. Despite clear guidelines to help with closure for family members of people dying from COVID-19, inadequate resources make this unrealistic.

CONCLUSION

Mental and emotional distress resulting from fear of SARS-Cov-2 infection, the mode of transmission, and consequences have a tremendous negative impact on the psychosocial well-being of those affected, their caregivers, and relatives. There is a need for the government, health institutions, and NGOs to establish platforms to cater to these concerns.

"They talked to me rudely". Women perspectives on quality of post-abortion care in public health facilities in Kenya

BACKGROUND

Access to safe abortion is legally restricted in Kenya. Therefore, majority women seeking abortion services in such restrictive contexts resort to unsafe methods and procedures that result in complications that often require treatment in health facilities. Most women with abortion-related complications end up in public health facilities. Nevertheless, evidence is limited on the quality of care provided to patients with abortion complications in public health facilities in Kenya.

METHODS

Data for this paper are drawn from a qualitative study that included interviews with 66 women who received post-abortion care in a sample of primary, secondary and tertiary public health facilities in Kenya between November 2018 and February 2019. The interviews focused on mechanisms of decision-making while seeking post-abortion care services, care pathways within facilities, and perceptions of patients on quality of care received including respect, privacy, confidentiality, communication and stigma.

FINDINGS

The participants' perceptions of the quality of care were characterized as either "bad care" or "good care", with the good care focusing on interpersonal aspects such as friendliness, respect, empathy, short waiting time before receiving services, as well as the physical or functional aspects of care such as resolution of morbidity and absence of death. Majority of participants initially reported that they received "good care" because they left the facility with their medical problem resolved. However, when probed, about half of them reported delays in receiving care despite their condition being an emergency (i.e., severe bleeding and pain). Participants also reported instances of abuse (verbal and sexual) or absence of privacy during care and inadequate involvement in decisions around the nature and type of care they received. Our findings also suggest that healthcare providers treated patients differently based on their attributes (spontaneous versus induced abortion, single versus married, young versus older). For instance, women who experienced miscarriages reported supportive care whereas women suspected to have induced their abortions felt stigmatized.

CONCLUSION

These findings have far reaching implications on efforts to improve uptake of post-abortion care, care seeking behaviors and on how to assess quality of abortion care. There should be emphasis on interventions meant to enhance processes and structural indicators of post-abortion care services meant to improve patients' experiences throughout the care process. Moreover, more efforts are needed to advance the tools and approaches for assessing women experiences during post-abortion care beyond just the overriding clinical outcomes of care.

Attitudes toward depression among Ecuadorian physicians using the Spanish-validated version of the Revised Depression Attitude Questionnaire (R-DAQ)

PURPOSE

Depression is inadequately recognized and managed, and physicians' attitudes toward this condition and its treatment may play a part in this. This study aimed to assess Ecuadorian physicians' attitudes toward depression.

METHODS

This was a cross-sectional study conducted using the validated Revised Depression Attitude Questionnaire (R-DAQ). The questionnaire was delivered to Ecuadorian physicians, and the response rate was 88.8%.

RESULTS

76.4% of participants had never received previous training in depression, and 52.1% of them indicated neutral or limited professional confidence when dealing with depressed patients. More than two-thirds of the participants reported an optimistic attitude toward the generalist perspective of depression.

CONCLUSION

Overall, physicians in Ecuador's healthcare settings were optimistic and held positive attitudes toward patients with depression. However, a lack of confidence in the management of depression and a need for ongoing training were found, especially among medical professionals who are not in daily contact with patients with depression.

[Stigmatisation of patients with mental disorders by medical interns specialising in general practice: A national survey]

OBJECTIVES

The objective was to assess the level of stigmatisation of psychiatric patients by medical interns specialising in general practice (GP), and to assess the influencing factors of stigmatisation.

METHODS

A national survey was carried out among interns in general practice (GP) contacted through their local associations from December 10, 2019 to March 9, 2020. An online questionnaire was diffused. The validated French version of the Mental Illness Clinicians' Attitudes (MICA) was used to measure stigmatising attitudes towards psychiatry and persons with psychiatric disorder by the interns. This 16-item scale is designed to measure attitudes of health care professionals towards people with mental illness with scores ranging from 16 to 96 (the most stigmatizing). Several covariates were collected: socio-demographics, personal experiences with mental health, and mental health trainings during medical studies. All questionnaires were strictly anonymized. Comparative analyses of the MICA score by group were performed using Student's tests.

RESULTS

A total of 389 interns responded. The majority of respondents were female (n=277; 71%) and the mean age was 27years [standard deviation (SD)±2.39]. The mean MICA rate was 40.64 (SD±8.09) for a neutral score of 56, reflecting low overall stigmatizing attitudes. MICA scores were significantly lower among female interns (40.11 vs. 41.95; P=0.042), those who had benefited from personal psychological or psychiatric support (38.70 vs. 41.61; P=0.001), and those who had completed a psychiatric externship (39.47 vs. 42.16; P=0.001).

CONCLUSIONS

GP interns had an attitude that is generally not very stigmatizing even if its improvement should still be sought. This is particularly verified among those who have completed a psychiatric internship during their externship. This suggested association should be supported by other studies. The stakes are high for the future management of patients since stigmatisation by a physician is strongly implied in the worse healthcare management of patients with psychiatric disorders, leading them to a shorter lifespan.

Stigmatized experience is associated with exacerbated pain perception in depressed patients

Patients with depression not only have to cope with depressive and physical symptoms but also face stigmatization due to mental illness. Pain is a clinical symptom of many patients with depression. However, it is unclear whether stigmatized experience associated with mental illness directly affects depressed patients' pain perception. Here, using the event reflection task, Study 1 (N = 95) examined whether stigmatized experiences due to depression would affect patients' self-reported pain assessment. Study 2 (N = 43) further employed thermal stimuli at different intensities to examine whether stigmatization would affect patients' evoked pain. We found that patients with depression who experienced stigmatization based on mental illness reported higher pain catastrophizing and performed increased pain perception for noxious stimuli than those who did not. Our studies provide first-hand experimental evidence of the effect of stigmatized experiences on depressed patients' pain perception. The findings contribute insights for improving clinical treatment, suggesting that interventions should minimize stigmatization associated with mental illness to help patients maintain healthier physical and psychological states.

HIV, substance use, and intersectional stigma: Associations with mental health among persons living with HIV who inject drugs in Russia

HIV stigma is associated with negative physical and mental health outcomes. Intersectional stigma among persons living with HIV (PLHIV) results from interrelated, synergistic impacts of experiencing multiple stigma forms. Its relation with mental health outcomes is still an emerging area of study in this key population. This study aimed to evaluate associations of intersectional stigma, defined as endorsing high levels of HIV and substance use stigmas, with depressive and anxiety symptoms in a cohort of 111 PLHIV who inject drugs in St. Petersburg, Russia. Over a third of participants (37%) reported experiencing intersectional stigma (i.e., both stigma scores above the median). In adjusted analysis, lower Patient Health Questionnaire depression scale (PHQ-9) scores (beta (β=-4.31, 95% CI: -7.11 - -1.51, p = 0.003) and Generalized Anxiety Disorders Scale (GAD-7) scores (β=-3.64, 95% CI: -5.57 - -1.71, p < 0.001) were associated with having low scores for both HIV and substance use stigmas. Lower PHQ-9 scores (β=-3.46, 95% CI: -5.72 - -1.19, p = 0.003) and GAD-7 scores (β=-3.06, 95% CI: -4.62 - -1.50, p < 0.001) were also associated with high stigma on either HIV or substance use stigma scales. Controlling for demographics, depressive symptoms approximately linearly increased from both forms of stigma low to experiencing either form of stigma high to experiencing intersectional stigma, while levels of anxiety symptoms were comparable among participants with both types of stigma low and one stigma high. Participants who experienced intersectional stigma reported the greatest severity of both depressive and anxiety symptoms, as compared to individuals who endorsed low stigma scores (i.e., low stigma on both HIV and substance use stigma scales) or high scores of only one form of stigma. This suggests that intersectional stigma in this population of PLHIV who inject drugs in Russia is linked with worsened mental health outcomes, exceeding the effects of experiencing one form of stigma alone. Interventions to help people cope with intersectional stigma need to consider affective symptoms and tailor coping strategies to address impacts of multiple forms of mental health distress.

The emotional well-being of Long COVID patients in relation to their symptoms, social support and stigmatization in social and health services: a qualitative study

BACKGROUND

Long COVID patients have experienced a decline in their quality of life due to, in part but not wholly, its negative emotional impact. Some of the most prevalent mental health symptoms presented by long COVID patients are anxiety, depression, and sleep disorders. As such, the need has arisen to analyze the personal experiences of these patients to understand how they are managing their daily lives while dealing with the condition. The objective of this study is to increase understanding about the emotional well-being of people diagnosed with long COVID.

METHODS

A qualitative design was created and carried out using 35 patients, with 17 participants being interviewed individually and 18 of them taking part in two focus groups. The participating patients were recruited in November and December 2021 from Primary Health Care (PHC) centers in the city of Zaragoza (Northern Spain) and from the Association of Long COVID Patients in Aragon. The study topics were emotional well-being, social support networks, and experience of discrimination. All an inductive thematic content analyses were performed iteratively using NVivo software.

RESULTS

The Long COVID patients identified low levels of self-perceived well-being due to their persistent symptoms, as well as limitations in their daily lives that had been persistent for many months. Suicidal thoughts were also mentioned by several patients. They referred to anguish and anxiety about the future as well as a fear of reinfection or relapse and returning to work. Many of the participants reported that they have sought the help of a mental health professional. Most participants identified discriminatory situations in health care.

CONCLUSIONS

It is necessary to continue researching the impact that Long COVID has had on mental health, as well as to provide Primary Health Care professionals with evidence that can guide the emotional treatment of these patients.

Reliability and validity of the post COVID-19 condition stigma questionnaire: A prospective cohort study

BACKGROUND

Many of the 10-20% percent of COVID-19 survivors who develop Post COVID-19 Condition (PCC, or Long COVID) describe experiences suggestive of stigmatization, a known social determinant of health. Our objective was to develop an instrument, the Post COVID-19 Condition Stigma Questionnaire (PCCSQ), with which to quantify and characterise PCC-related stigma.

METHODS

We conducted a prospective cohort study to assess the reliability and validity of the PCCSQ. Patients referred to our Post COVID-19 Clinic in the Canadian City of Edmonton, Alberta between May 29, 2021 and May 24, 2022 who met inclusion criteria (attending an academic post COVID-19 clinic; age ≥18 years; persistent symptoms and impairment at ≥ 12 weeks since PCR positive acute COVID-19 infection; English-speaking; internet access; consenting) were invited to complete online questionnaires, including the PCCSQ. Analyses were conducted to estimate the instrument's reliability, construct validity, and association with relevant instruments and defined health outcomes.

FINDINGS

Of the 198 patients invited, 145 (73%) met inclusion criteria and completed usable questionnaires. Total Stigma Score (TSS) on the PCCSQ ranged from 40 to 174/200. The mean (SD) was 103.9 (31.3). Cronbach's alpha was 0.97. Test-retest reliability was 0.92. Factor analysis supported a 6-factor latent construct. Subtest reliabilities were >0.75. Individuals reporting increased TSS occurred across all demographic groups. Increased risk categories included women, white ethnicity, and limited educational opportunities. TSS was positively correlated with symptoms, depression, anxiety, loneliness, reduced self-esteem, thoughts of self-harm, post-COVID functional status, frailty, EQ5D5L score, and number of ED visits. It was negatively correlated with perceived social support, 6-min walk distance, and EQ5D5L global rating. Stigma scores were significantly increased among participants reporting employment status as disabled.

INTERPRETATION

Our findings suggested that the PCCSQ is a valid, reliable tool with which to estimate PCC-related stigma. It allows for the identification of patients reporting increased stigma and offers insights into their experiences.

FUNDING

The Edmonton Post COVID-19 Clinic is supported by the University of Alberta and Alberta Health Services. No additional sources of funding were involved in the execution of this research study.

The Pervasive Impact of the Stigmatization of Gastrointestinal Diseases-A Patient's Perspective

Stigma is a centuries-old phenomenon that pervades chronic digestive diseases, regardless of classification. Patients with gastrointestinal (GI) illness perceive others hold stigmatizing beliefs about them and their illness, including from medical professionals, and may go on to internalize or believe these negative stereotypes as true. These perceptions seem to be based on the thought that the public views GI diseases negatively. The effects of GI stigma are substantial and influence quality of life, psychological distress, treatment adherence, disease severity, and health-care utilization. These realities underscore the need for stigma to be addressed by the GI community and measures taken to mitigate its impacts.

Outpatient Therapists' Perspectives on Working With Persons Who Are Sexually Interested in Minors

Minor-attracted persons (MAPs; i.e., people who are sexually interested in children and adolescents below the age threshold of legal consent for sexual activity) exhibit high psychological distress but report difficulties finding therapeutic help and are reluctant to start treatment due to fears of therapist stigmatization. This research sought to elucidate the link between outpatient therapists' stigmatizing attitudes toward non-offending versus offending MAPs and therapists' willingness to treat MAPs as well as how stigmatization was related to treatment-relevant aspects such as perceived MAP treatment needs, treatment barriers, and specific MAP treatment skills. Results from a brief, anonymous online survey conducted among N = 427 Swiss outpatient therapists working in the primary healthcare system are reported. Although therapists were less stigmatizing than the general public, considerable individual differences in the stigmatization of non-offending MAPs emerged. Stigmatizing attitudes toward non-offending MAPs and a perceived lack of specific treatment competences were negatively related to therapists' willingness to treat MAPs. A network analysis revealed direct links between subjectively perceived MAP treatment competence and treatment willingness and between treatment willingness and social distance attitudes. Other stigmatizing attitudes were only indirectly linked to treatment willingness through preferred social distance. It is a paradox that therapists believe that MAPs should greatly benefit from secondary prevention but many are unwilling to provide therapy (45% in case of non-offending MAPs vs. 63% in case of offending MAPs) or do not feel competent to provide MAPs with professional help (47% with and 88% of therapists without previous MAP treatment experience). Implications for increasing therapists' treatment willingness are discussed.

Stigmatization of Consensual Non-Monogamous Partners: Perceived Endorsement of Conservation or Openness to Change Values Vary According to Personal Attitudes

Studies have shown that romantic partners in consensual non-monogamous (CNM) relationships are targets of stigmatization. However, little is known about the underlying mechanisms and the conditions under which such stigmatization occurs. In two experimental studies (combined N = 772), we asked participants to read the description of two partners in a relationship (monogamous vs. open relationship vs. polyamorous) and make a series of judgments about those partners. Overall results showed that CNM (vs. monogamous) partners were perceived as less trustworthy and as having more sexual health concerns (Studies 1 and 2), and as being less committed and less sexually satisfied (Study 2). Results from a conditional mediation analysis (Study 2) further showed that participants with negative attitudes toward consensual non-monogamy perceived CNM (vs. monogamous) partners as having less conservation and more openness to change values, which was then associated with more stigmatization. In contrast, participants with positive attitudes toward consensual non-monogamy perceived CNM (vs. monogamous) partners as having more openness to change values, which was then associated with less stigmatization. Taken together, these results extended the literature focused on prejudice, discrimination, and stigmatization of minority groups and highlighted key elements that can be used to buffer stigmatization.

The effect of stigmatization education on the social distancing of nursing students toward patients with a diagnosis of schizophrenia

PURPOSE

To assess the effect of a program designed to reduce nursing students' social distancing from individuals diagnosed with schizophrenia.

METHOD

This experimental study was designed using a pretest, a posttest, and a control group. All participants were nursing students, of which 25 were included in the intervention group and 23 were placed in the control group. A 13-week program was offered to the intervention group. The measuring instruments consisted of a personal information form and the Social Distance Scale. Data were analyzed using the two-way repeated measures analysis of variance.

FINDINGS

A significant difference was found between the two groups.

CONCLUSION

The Education Program on Stigmatization in Schizophrenia is an effective intervention that reduces the social distance of nursing students from individuals diagnosed with schizophrenia.

A public health framework for reducing stigma: the example of weight stigma

We examine stigma and how it operates, then develop a novel framework to classify the range of positions that are conceptually possible regarding how stigma ought to be handled from a public health perspective. In the case of weight stigma, the possible positions range from encouraging the intentional use of weight stigma as an obesity prevention and reduction strategy to arguing not only that this is harmful but that weight stigma, independent of obesity, needs to be actively challenged and reduced. Using weight stigma as an illustrative example, we draw on prior theoretical work on stigma mechanisms and intervention strategies to develop a framework for improving the understanding, evaluation, and planning of anti-stigma interventions. This framework has the potential to help public health actors to map out how protest, contact, education, and regulation strategies can be used to reduce direct discrimination, structural discrimination, and internalized stigma (self-stigma).

Recovered but Constrained: Narratives of Ghanaian COVID-19 Survivors Experiences and Coping Pathways of Stigma, Discrimination, Social Exclusion and Their Sequels

BACKGROUND

Research about the coronavirus disease 2019 (COVID-19), its epidemiology and socio-economic impact on populations worldwide has gained attention. However, there is dearth of empirical knowledge in low- and middle-income settings about the pandemic's impact on survivors, particularly the tension of their everyday life arising from the experiences and consequences of stigma, discrimination and social exclusion, and how they cope with these behavioral adversities.

METHODS

Realist qualitative approach drawing data from people clinically diagnosed positive of COVID-19, admitted into therapy in a designated treatment facility, and subsequently recovered and discharged for or without follow-up domiciliary care. In-depth interviews were conducted by maintaining a code book for identifying and documenting thematic categories in a progression leading to thematic saturation with 45 participants. Data were transcribed and coded deductively for broad themes at the start before systematically nesting emerging themes into the broad ones with the aid of NVivo 12 software.

RESULTS

Everyday lived experiences of the participants were disrupted with acts of indirect stigmatization (against relatives and family members), direct stigmatization (labeling, prejudices and stereotyping), barriers to realizing full social life and discriminatory behaviors across socio-ecological structures (workplace, community, family, and social institutions). These behavioral adversities were associated with self-reported poor health, anxiety and psychological disorders, and frustrations among others. Consequently, supplicatory prayers, societal and organizational withdrawal, aggressive behaviors, supportive counseling, and self-assertive behaviors were adopted to cope and modify the adverse behaviors driven by misinformation and fearful perceptions of the COVID-19 and its contagious proportions.

CONCLUSION

In the face of the analysis, social campaigns and dissemination of toolkits that can trigger behavior change and responsible behaviors toward COVID-19 survivors are proposed to be implemented by health stakeholders, policy and decision makers in partnership with social influencers, the media, and telecoms.

Comparison of In-Person vs. Video Directly Observed Therapy (VDOT) on Stigma Levels in Tuberculosis Patients

INTRODUCTION

To investigate the effect of video directly observed therapy (VDOT) on stigma levels in tuberculosis (TB) patients.

METHODS

Thirty TB patients (36.5%) receiving directly observed therapy (DOT) and 52 receiving VDOT (63.4%) between 15.08.2021 and 15.10.2021 in Samsun, Turkey, were included in this study (n = 82). All the participants completed the Stigma Scale in Patients with Tuberculosis (SSTB), and their demographic and disease characteristics were investigated.

RESULTS

The mean age of the participants was 50.0 ± 17.8 years, 64 were married (78.8%), and 38 were women (46.3%) in the study group. Sixty patients had pulmonary TB (73.1%), and duration of disease was less than 6 months in 64 (82.9) patients. The mean SSTB score was 84.2 ± 12.3, the DOT group exhibiting higher SSTB scores then the VDOT group (t = 2.524, P = .006). The VDOT group had lower mean SSTB subdimension mean scores (perceived stigma, self-perception internalized stigma, and family/friend relations) (P < .05). Linear regression models identified VDOT and male gender as independent factors for increased total SSTB scores (P < .05). VDOT was also identified as an independent factor for total SSTB subdimension scores in the linear regression models (P < .05).

CONCLUSION

Our results confirm that TB patients who receive VDOT has less stigmata compared with homecare DOT.

Mental distress before and during the COVID-19 pandemic: A longitudinal study among communities affected by Ebola virus disease in the DR Congo

BACKGROUND

Associated with high mortality rate, fear, and anxiety, Ebola Virus Disease (EVD) is a significant risk factor for mental distress. This longitudinal study aims to investigate the prevalence and predictors associated with mental distress among populations affected by EVD outbreaks in the Province of Equateur in DR Congo.

METHODS

Surveys were administered in zones affected by the 2018 EVD outbreak in Equateur Province with a 16-month interval. Measures assessed sociodemographic characteristics, mental distress (GHQ-12), COVID-19 and EVD exposure and related stigmatization, and Resilience. Models of logistic regression and path analysis were used to estimate factors related to mental distress outcomes.

RESULTS

Prevalence of mental distress decreased from Wave 1 to Wave 2 (Mental distress_T1= 57.04%, Mental distress_T2= 40.29%, x²= 23.981, p<.001). Clinical mental distress score at follow-up was predicted by greater levels of exposure to Ebola at baseline (B= .412, p<.001) and at Wave 2 (B= .453, p<.001) as well as Ebola stigmatization at baseline (B= .752, p<.001), and Protestant religion (B= .474, p=.038). Clinical mental distress score at follow-up was significantly associated with higher levels of exposure to COVID-19 (B= .389, p=.002) and COVID-19 related stigmatization (B= .480, p<.001). COVID-19 related stigmatization partially mediated the association between exposure to EVD (Time 1) and mental distress (B= .409, p<.001).

CONCLUSIONS

Although a decrease in mental distress symptoms was observed, its prevalence remains high. The results show that mental health programs need to develop better health and education communication strategies to reduce stigmatization.

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.

Functional Neurological Disorders in the medical education: An urgent need to fill the gaps

BACKGROUND

FND is a disabling disease that accounts for 5 to 10% of the reason for consultation in neurology. However, young physicians often say they have little or no training in their management.

AIM

The aim of the present study was to assess whether French junior neurologists, psychiatrists and physical and rehabilitation medicine (PRM) specialists received teaching on FND during their medical studies, including the residency, and to evaluate their knowledge and perception of the disorder.

METHODS

The survey was distributed by the means of a Google form questionnaire to specialist registrars and young specialists with the help of resident's organizations.

RESULTS

568 respondents from the 3 specialties were included in the study. Most respondents (72.4%) were specialists registrars. Almost half of the respondents (45.5%) answered they never received any teaching on FND, and only 20.5% of them knew the Hoover's sign, a positive sign specific of functional weakness. A large majority of respondents felt they were not sufficiently trained in FND (87.9%), and they did not have sufficient knowledge of these disorders (85.3%).

DISCUSSION

Better training would allow clinicians to make a diagnosis earlier, to better explain it to patients, and to limit the costs associated with diagnosis delays. A better training of clinicians about FND would also improve the prognosis of patients, as early diagnosis and good explanation is associated with a better prognosis.

CONCLUSION

This survey shows that there is a gap about FND in the training programs in the medical studies and during the specialization training of young doctors in France.

The professed effect of stigma on community psychiatric nurses in the Greater Accra region of Ghana

BACKGROUND

Stigma is a major factor that inhibits Mental Health Nurses work, especially Community Psychiatric Nurses, in terms of productivity. Even though mental health services have improved drastically, because of decentralization of mental health care, a lot more people still have reservations when it comes to mental health nurses particularly Community Psychiatric Nurses. The purpose of the study was to explore the professed effects of stigma on CPNs in the Southern part of Ghana.

METHODS

The study was carried out in three district hospitals (Ga South, Ga Central and Okaikoi) all in the Accra Metropolis. The aim of the study was to describe how stigma affects Community Psychiatric Nurses. A qualitative descriptive exploratory design was adopted for the study. The purposive sampling technique was used to recruit participants. Data was saturated with 12 participants, aged between 25 and 40 years. The audio-taped interviews were transcribed verbatim and afterwards analyzed using thematic and content analysis.

RESULTS

The findings gathered from participants revealed that Community Psychiatric Nurses experienced various effects of stigma, such as low productivity, depression, and anger. Most of the participants recounted how stigmatization had affected their work both in the hospital setting and in their communities.

CONCLUSION

The study showed that Community Psychiatric Nurses carried out their activities with much difficulty, because of their poor image. They stressed the need for recognition and support from employers, stakeholders and the general community so as to boost confidence and morale with the resultant effect of better healthcare delivery.

Covid-19 stigmatization: A systematic literature review

Covid-19 has severe implications for the emergence of negative stigmatization of specific individuals and community groups. Due to labeling and discrimination, mental attacks cause psychological distress so seriously that it requires proper handling. Therefore, this study aims to conduct a systematic literature review on articles on COVID-19 stigmatization. This paper used descriptive analysis that 248 articles are from the Scopus database obtained by keyword Covid-19 stigmatization in the 2020–2021 time span were then processed and visualized using the Vosviewer software. The results reveal the three most dominant concepts studied: anxiety, isolation, and knowledge. The Covid-19 stigma arises due to low public knowledge, widespread Covid-19 disinformation, and lack of trust in the government. This research contributes to a description of the root causes and adverse effects of stigmatization during Covid-19 to help formulate recommendations for preventive and treatment actions that can be taken. Meanwhile, the limitation of this research is that the articles reviewed are only sourced from Scopus, so they do not have comparative data. Therefore, future studies require using a comparative analysis approach that uses a Web of Science (WoS) database.

Stigmatization related COVID-19 and PTSD among Chinese graduates

BACKGROUND

Since COVID-19 broke out worldwide, it had caused extensive public health concerns and psychological distress, including PTSD and stigmatization towards recovered patients and people from high-risk areas. However, the association between PTSD, stigmatization and certain related factors have not been confirmed.

METHODS

Through cluster random sampling, 946 Chinese graduates were investigated from 5 universities in Shanghai at three months after China lifted its coronavirus lockdown. PTSD symptoms were evaluated with PCL-5. Demographic and disease-related characteristics including stigmatization, educational attainment and working position were collected to assess their association with PTSD.

RESULTS

12.4% graduates were reported significant PTSD symptoms in PCL-5 screening with a cut-off of 33. Graduates with a Master's degree (P = 0.02) or working position like "looking for a job" and "planning to go abroad" (P = 0.038) showed severer stigmatization related to COVID-19. Stigmatization towards both patients recovering from COVID-19 and people from high-risk areas had significant association with PTSD symptoms. Multivariate linear regression analysis showed that stigmatization can explain 5% of variation of PCL-5 scores after controlling gender, age, educational attainments and working position.

CONCLUSION

Graduates who were looking for jobs or preparing to go abroad showed more stigmatization related to COVID-19. There was a positive correlation between stigma against COVID-19 and PTSD symptoms. More attention should be paid to the mental health status of graduates who are preparing to go abroad or looking for jobs.

Ethical implications of epigenetics in the era of personalized medicine

Given the increasing research activity on epigenetics to monitor human diseases and its connection with lifestyle and environmental expositions, the field of epigenetics has attracted a great deal of interest also at the ethical and societal level. In this review, we will identify and discuss current ethical, legal and social issues of epigenetics research in the context of personalized medicine. The review covers ethical aspects such as how epigenetic information should impact patient autonomy and the ability to generate an intentional and voluntary decision, the measures of data protection related to privacy and confidentiality derived from epigenome studies (e.g., risk of discrimination, patient re-identification and unexpected findings) or the debate in the distribution of responsibilities for health (i.e., personal versus public responsibilities). We pay special attention to the risk of social discrimination and stigmatization as a consequence of inferring information related to lifestyle and environmental exposures potentially contained in epigenetic data. Furthermore, as exposures to the environment and individual habits do not affect all populations equally, the violation of the principle of distributive justice in the access to the benefits of clinical epigenetics is discussed. In this regard, epigenetics represents a great opportunity for the integration of public policy measures aimed to create healthier living environments. Whether these public policies will coexist or, in contrast, compete with strategies reinforcing the personalized medicine interventions needs to be considered. The review ends with a reflection on the main challenges in epigenetic research, some of them in a technical dimension (e.g., assessing causality or establishing reference epigenomes) but also in the ethical and social sphere (e.g., risk to add an epigenetic determinism on top of the current genetic one). In sum, integration into life science investigation of social experiences such as exposure to risk, nutritional habits, prejudice and stigma, is imperative to understand epigenetic variation in disease. This pragmatic approach is required to locate clinical epigenetics out of the experimental laboratories and facilitate its implementation into society.

Schizophrenia on Turkish Twitter: an exploratory study investigating misuse, stigmatization and trivialization

PURPOSE

This study aims to investigate use and misuse of the word 'schizophrenia' and its derivatives to assess the prevalence of stigmatizing and trivializing attitudes and the meanings attributed to the condition on Turkish Twitter.

METHODS

Using R programming language, we collected Turkish Twitter posts containing the terms used for schizophrenia in Turkish through Twitter's Search API over a 47-day period between July and June 2019. After removing retweets, we randomly sampled 3000 tweets and manually categorized them in three dimensions: use type (metaphorical/non-metaphorical), topic and attitude. Qualitative analysis on representative tweets were performed and word frequencies were calculated.

RESULTS

In total 44,266 tweets were collected and after removing retweets, 24,529 tweets were obtained. Overwhelming majority of the tweets (91.7%) used the terms metaphorically and the majority displayed stigmatizing (68.3%) and trivializing (23%) attitudes. Politics was the most common topic (58.2%) followed by everyday/social chatter (28.5%). Only a small number of tweets were part of awareness campaigns (0.2%) or displayed a supportive attitude (0.8%). Terms were often used metaphorically in a stigmatizing manner as personal or political insults, while in everyday/social contexts, they were used in a trivializing manner to label eccentricity, oddness, overthinking and suspiciousness. Popularity and reach metrics show that these tweets were extensively retweeted, liked and reached millions of users.

CONCLUSION

This is the first study investigating attitudes towards schizophrenia on Turkish Twitter. Significantly higher rates of stigmatizing attitudes demonstrate the urgent need for public health and social awareness campaigns targeting stigma surrounding schizophrenia in Turkey.

Self-disgust in Patients with Dermatological Diseases

BACKGROUND

Dermatological diseases can be associated with symptoms such as oozing pus, weeping, and/or bleeding, which represent primary disgust elicitors. This study examined the role of self-disgust in people with different skin conditions (e.g., hidradenitis suppurativa, psoriasis, lichen sclerosus).

METHODS

A self-selected sample of 200 dermatology patients completed questionnaires for the assessment of self-disgust, experienced stigmatization, symptoms of depression, anxiety, and somatization. Multiple regression analysis and mediation analysis were computed to examine the relationship between self-disgust and the other selected variables.

RESULTS

Sixty-four percent of the patients reported elevated self-disgust. Sex, age, depression, and perceived stigmatization were predictors of self-disgust. Depression mediated the relationship between stigmatization (e.g., staring by others) and self-disgust.

CONCLUSIONS

This study points to the important role of self-disgust in dermatological conditions. Public health programs to counteract stigmatization of patients with skin diseases as well as therapy approaches that help decrease patients' self-disgust and increase self-acceptance are urgently needed.

Public Perceptions of Child Pornography and Child Pornography Consumers

Understanding the public's perceptions of child pornography helps identify gaps in awareness and knowledge, impacts legislative decision making, quantifies stigmatization, and provides a baseline for identifying differences between lay and offender populations for clinical purposes. This research provides a comprehensive public survey assessing these issues. An Internet-based sample of 524 adults (mean age = 47 years, 51% female) within the USA were asked about their understanding and beliefs related to child pornography and individuals who view child pornography. The questions covered three topic areas-general perceptions of child pornography, endorsement of child pornography beliefs, and opinions related to the legality of various forms of child pornography as well as the decision making related to sentencing and sex offender registration for child pornography consumers. The research found that the public viewed these offenses as more severe than most other crimes and that there was an overestimation by the public of risks related to recidivism and contact offending. Additionally, the research found that there was support for most of the current sentencing guidelines in the USA, including sex offender registration, and that there was limited support for treatment over incarceration.

Prejudices against people with epilepsy as perceived by affected people and their families

PROBLEM

Prejudices can impair social participation of people with epilepsy.

METHODS

From 2019 to 2020, we invited people with epilepsy and their relatives across Germany to fill in a questionnaire.

RESULTS

Two hundred and thirty people with epilepsy (PWE, median age: 40 years; min./max.: 19/83; 66% female) and 103 relatives (REL, median age: 42 years; min./max. 23/70; 83% female) took part in the survey. 44% PWE and 40% REL said prejudices against PWE had not declined in recent years. Of PWE, 64% reported they had experienced prejudices themselves. In an open question with multiple answers possible, 71% of the PWE described concrete prejudices against PWE, 62% of the REL did so. The reported prejudices concerned symptoms of epilepsy (37% PWE; 23% REL), academic or occupational performance (47% PWE; 38% REL), social or family life (27% PWE, 29% REL), and other topics (7% PWE, 4% REL). Of PWE, 88% said all or almost all relatives knew about their condition, 74% stated this applied to all or almost all friends, and 48% told all or almost all colleagues about their epilepsy. Of PWE, 94% would want to know if a relative had epilepsy, 87% would like to know about a friend's epilepsy, 70% about a colleague's epilepsy. Fear of stigmatization was a reason for not always communicating the condition according to 20% PWE and 63% REL. None of PWE and 16% of REL named shame as a reason.

CONCLUSION

People with epilepsy still experience prejudices and fear of stigmatization hinders an open communication about the condition.

An Assessment of Perceived Stigmatization of Patients Infected with COVID-19 in the Nation's Epicenter of the Pandemic: A Cross-Sectional Study of Residents of Agege, Lagos, Nigeria

BACKGROUND

In some parts of Africa, the patients and those who survived COVID-19 are stigmatized and this has impeded the response activities put in place to control the pandemic. In spite of this, most efforts in preventing COVID-19 were geared towards the use of non-pharmacologic measures without corresponding measures to dissipate stigmatization in the community. Therefore, this study assessed the factors associated with perceived stigmatization of patients with COVID-19 among residents of Agege local government, Lagos State, Nigeria.

METHODS

We conducted a cross-sectional survey among 333 consenting residents recruited from Agege local government area (LGA) using a multi-stage sampling technique. A semistructure, interviewer-administered questionnaire adapted from the People Living with Human Immunodefiency Virus (PLHIV) Stigma Index was used to collect data on socio-demographic characteristics, knowledge of COVID-19 and perceived stigmatization. Bivariate analysis was done using Chi-square and binary logistic regression was used to identify the determinants of perceived stigmatization at 5% level of significance.

RESULTS

The mean age of the respondents was 35.7 ± 13.6 years. Awareness about COVID-19 outbreak was 95.2%. Television (43.5%) and radio (36.9%) were the two major sources of information on COVID-19 infection and prevention. The proportions of the respondents who had poor knowledge and perceived stigmatization of COVID-19 patients were 50.0% and 47.7% respectively. A higher likelihood of perceived stigmatization was found among those aged 25 - 49 years (aOR= 3.1, 95% CI = 1.4 - 6.7), > 50 years (aOR= 2.1, 95% CI = 1.1 - 3.9) and married respondents (aOR= 1.8, 95% CI = 1.1 - 2.9).

CONCLUSION

The study highlights the poor knowledge about COVID-19 and a high level of stigmatization. Hence, targeted health educational interventions are urgently needed for the residents of Agege, most especially among married respondents as well as the adults.

Effect of human library intervention on mental health literacy: a multigroup pretest-posttest study

BACKGROUND

Mental health literacy (MHL) is an evolving concept encompassing knowledge of mental illness, help-seeking options, perceived stigma, and discrimination. This study aimed to test the effectiveness of a human library intervention at enhancing MHL. A human library intervention was adopted to enhance MHL in this study. The human library intervention aims to establish a positive framework and safe space for dialogue between readers and a 'human book'. It works to promote dialogue, reduce prejudice, and encourage understanding of people who are regarded as disadvantaged or in a minority group.

METHODS

An experimental approach with a multigroup pretest-posttest design was adopted. Forty-five participants aged between 18 and 23 years were recruited and randomly assigned to the experimental group (human library intervention), comparison group (didactic teaching session), or control group (no intervention). Adapted vignette-based MHL scale scores were used as the outcome measures. The overall and subscale scores were included in the analysis.

RESULTS

The human library intervention group showed a significant improvement in overall MHL compared with the other two groups. In a multivariate analysis of the variance in subscale scores, the intervention was shown to significantly reduce stigma and preferred social distance, but had no significant effect on knowledge acquisition.

CONCLUSIONS

The human library intervention is effective at enhancing overall MHL and reducing stigma and preferred social distance. Further studies are suggested to further develop the MHL construct, human library interventions, and the MHL scales for consolidating evidence-based practice.

Implications of WHO COVID-19 interim guideline 2020.5 on the comprehensive care for infected persons in Africa Before, during and after clinical management of cases

The novel coronavirus disease 2019 (COVID-19) is one of the biggest public health crises globally. Although Africa did not display the worst-case scenario compared to other continents, fears were still at its peak since Africa was already suffering from a heavy load of other life-threatening infectious diseases such as HIV/AIDS and malaria. Other factors that were anticipated to complicate Africa's outcomes include the lack of resources for diagnosis and contact tracing along with the low capacity of specialized management facilities per capita. The current review aims at assessing and generating discussions on the realities, and pros and cons of the WHO COVID-19 interim guidance 2020.5 considering the known peculiarities of the African continent. A comprehensive evaluation was done for COVID-19-related data published across PubMed and Google Scholar (date of the last search: August 17, 2020) with emphasis on clinical management and psychosocial aspects. Predefined filters were then applied in data screening as detailed in the methods. Specifically, we interrogated the WHO 2020.5 guideline viz-a-viz health priority and health financing in Africa, COVID-19 case contact tracing and risk assessment, clinical management of COVID-19 cases as well as strategies for tackling stigmatization and psychosocial challenges encountered by COVID-19 survivors. The outcomes of this work provide links between these vital sub-themes which may impact the containment and management of COVID-19 cases in Africa in the long-term. The chief recommendation of the current study is the necessity of prudent filtration of the global findings along with regional modelling of the global care guidelines for acting properly in response to this health threat on the regional level without exposing our populations to further unnecessary adversities.