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- Community-based participatory research (CBPR), stigma, and health.
- Abstract: The goal of Stigma and Health is to advance research about the pernicious effects of prejudice and discrimination on the lives of people with stigmatized health conditions. Community-based participatory research (CBPR) is becoming an essential set of principles and practices for important research on these topics. CBPR is an activist approach to science recognizing that only an empowered community is able to fully understand and act on challenges of that community (Wallerstein, Duran, Oetzel, & Minkler, 2018). Research that promotes empowerment is especially important when the topic of interest essentially disempowers a group. CBPR is a strengths-based approach believing that solutions lie as much in describing the resources a group might call on to address a problem as description of the problem alone. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
PubDate: Mon, 20 Apr 2020 04:00:00 GMT
- PrEP stigma, HIV stigma, and intention to use PrEP among women in New York
City and Philadelphia.- Abstract: Stigma is an important contributor to the continued HIV epidemic in the United States. In 2016, women made up nearly 1 in 5 of all new infections. cHIV prophylaxis (PrEP) is a medication that can be taken to prevent HIV acquisition; however, PrEP is significantly underutilized by women at risk for infection. How PrEP stigma relates to PrEP initiation among women is not well understood. Surveys were completed by 160 PrEP-eligible women aged 18–55 years in Philadelphia, Pennsylvania, and New York City, New York. Associations between PrEP stigma, HIV stigma, and PrEP initiation intention were modeled using multinomial logistic regression, controlling for sociodemographic and theoretically relevant variables. Participants ranged in age from 18 to 55 years (M = 40.2; SD = 11.78). Most (79%) identified as Black or African American and/or Latina and 36% had completed high school or less. Higher PrEP stigma was significantly associated with lower PrEP initiation intention while controlling for other theoretically relevant and sociodemographic variables. HIV stigma was not related to PrEP initiation intention. HIV prevention interventions seeking to increase PrEP initiation among PrEP-eligible, urban women need to address the role that PrEP stigma plays in PrEP uptake. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
PubDate: Thu, 31 Oct 2019 04:00:00 GMT
- Reducing mental-illness stigma via high school clubs: A matched-pair,
cluster-randomized trial.- Abstract: We examined the effectiveness of a student-initiated and guidebook-supported high school club program aimed at reducing mental-illness stigma via humanization—largely through contact—hypothesizing that stigma measures would improve across a school year and as a function of the timing of club initiation. Forty-two Northern California high schools (731 students) participated from 2015–2017. Stigma measures (Knowledge, Attitudes, Social Distance, and Positive Actions) were collected in the fall (Time 1 [T1]), winter (Time 2 [T2]), and spring (Time 3 [T3]). Schools were matched on student-body demographics, then randomized into either an immediate (23 clubs at T1) or delayed (19 clubs at T2) start. The sample was diverse regarding race/ethnicity and class standing. Across both randomized groups, measures of stigma significantly improved from beginning to end of the school year; effect sizes ranged from small to medium (d = .22–.56). The hypothesized pattern of change was partially supported: the immediate group showed significant increases from T1–T2 for Attitudes and Positive Actions; the delayed group showed a stronger increase from T2-T3 for Knowledge. Ceiling effects at baseline were salient. Baseline stigma measures were in a more positive direction than in a prior, quasi-experimental study of the same club model 5 years earlier, with effect sizes ranging from d = .32 to .88, suggesting secular trends regarding lower stigma levels. Findings support the importance of school-based interventions for reducing mental-illness stigma, particularly via student-initiated, contact-based efforts. It is possible that youth mental-illness stigma has decreased in recent years, with more sensitive measures needed in future trials. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
PubDate: Thu, 03 Oct 2019 04:00:00 GMT
- Weight-based discrimination, interpersonal needs, and suicidal ideation.
- Abstract: Body mass index (BMI) has been an inconsistent predictor of suicidal thoughts and behaviors. One reason for this inconsistency may be that weight, per se, does not increase risk; rather, we argue that negative treatment associated with weight is a more critical predictor of suicidal thoughts and behaviors. Thus, the goal of the present research was to examine weight-based discrimination as a predictor of suicidal ideation through the lens of the interpersonal theory of suicide. Two samples of community-dwelling adults (N = 254 and 306, respectively) completed online surveys assessing weight-based discrimination, depression, belongingness and perceived burdensomeness. Participants also reported on their height, weight, and a variety of known risk factors for suicidal ideation (e.g., education, income). As predicted, weight-based discrimination was associated with increased suicidal ideation. This effect was mediated by depression and perceived burdensomeness; contrary to predictions, belongingness was not a significant mediator. This pattern of results was robust to controlling for BMI as well as established risk factors for suicidal ideation. Weight-based discrimination is associated with suicidal ideation, and this relationship may be due in part to increased depression and perceived burdensomeness. The present studies extend our understanding of the mental health outcomes of weight-based discrimination to suicidal ideation and advance the understanding of possible explanatory mechanisms linking discrimination to suicidal ideation. However, these findings should be considered tentative until they are replicated in highly powered and preregistered future research. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
PubDate: Thu, 26 Sep 2019 04:00:00 GMT
- “Every time I get gendered male, I feel a pain in my chest”:
Understanding the social context for gender dysphoria.- Abstract: The present study aimed to expand current understandings of gender dysphoria by explicating the social context in which it is experienced and by centering the analysis on the lived experience of trans individuals. Data were collected online from a nonclinical sample composed of 610 transgender participants. Participants answered 2 open-ended prompts to describe their gender dysphoria as experienced in a social context. Thematic analysis was used to code the data and determine main themes. Four socially salient themes emerged regarding gender dysphoria: 1) External Triggers; 2) Internal Processing; 3) Interruption of Social Functioning; and 4) Moderated by Transition. When describing their experiences, participants identified external triggers for dysphoria that were social in nature as well as internal processes that occurred in response to those triggers. Often this led to an interruption of social functioning. For some of our participants, gender dysphoria was moderated by transition. Results of the present study suggest that trans individuals’ experience of gender dysphoria is greatly impacted by social context. Discussion focuses on the way the present findings may be best understood in relation to the literature on minority stress. Consideration of gender dysphoria as a proximal stressor may help to conceptually disaggregate gender dysphoria from psychological stress in the way we frame mental health considerations for trans individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
PubDate: Thu, 19 Sep 2019 04:00:00 GMT
- Stigma, health, and psychosocial functioning among transgender active duty
service members in the U.S. military.- Abstract: Transgender persons face frequent instances of stigma that may make them vulnerable to adverse mental and physical health outcomes. To date, however, few studies have assessed gender identity–related stigma and its psychosocial correlates among active duty transgender military personnel. To assess the associations of stigma with psychosocial functioning and health, U.S. military personnel self-identifying as transgender completed anonymous online measures of stigmatizing situations within the military, health, psychosocial functioning, eating pathology, risk behaviors, and coping strategies. Participants also described their worst experience of gender identity–related stigma within the military. In total, 174 service members (28.8 ± 6.3 years, 50.6% transmale, 71.3% non-Hispanic White, 7.8 ± 5.5 years in service) completed the survey. The majority (93%) reported at least 1 instance of gender identity–related stigma in the military, including bullying and barriers to obtaining gender-affirming services. Although service members reported generally good health and psychosocial functioning, stigma in the military was significantly associated with poorer overall mental health and greater depression, anxiety, and stress, after adjusting for age, gender identity, race, and service rank. Stigma was unrelated to self-reported physical health. Of 14 different coping behaviors assessed, only positive reframing was associated with better mental health. The current study indicates that stigma within the military is reported by the majority of service members self-identifying as transgender and is associated with poor mental health, above and beyond the contribution of relevant covariates. Additional research is needed to identify those at greatest risk for the adverse effects of stigma. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
PubDate: Thu, 22 Aug 2019 04:00:00 GMT
- Weight stigma among pregnant and postpartum women: A new context of
stigmatization.- Abstract: Weight stigma is now well studied, but very little research has examined it in the context of pregnancy. This gap is problematic because weight gain is necessary for healthy pregnancies, and many women begin pregnancy already considered overweight or obese. Social responses to weight gain during pregnancy may not always be positive, and stigmatization may therefore be common during this time. A sample of 501 pregnant and postpartum women reported on pregnancy-related weight stigma, including on sources of weight-stigmatizing experiences, frequency of experiences, and examples. Results include basic findings along with associations of body mass index (BMI) and self-perceived weight with weight-stigmatizing experiences. Nearly two thirds of participants reported experiencing weight stigma from at least one source. Experiences occurred, on average, between “a few times a month” and “at least once a week.” Participants reported experiencing weight stigma from the media multiple times a week, making it the most frequently occurring source. Additionally, women of all prepregnancy BMIs reported experiencing weight stigma. Self-perceived weight mediated the relationship between prepregnancy BMI and weight stigma. These findings reveal that pregnant and postpartum women experience weight stigma from multiple sources. Moreover, experiencing weight stigma is not limited to those with prepregnancy obesity. Considering that sources of stigma vary, intervening to reduce weight stigma targeted at pregnant and postpartum women may require focusing both on perpetrators and on building resilience among targets. This work lays a foundation for future work investigating pregnancy-related weight stigma. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
PubDate: Thu, 22 Aug 2019 04:00:00 GMT
- Shooter mental illness status and language use in online articles about
mass shootings.- Abstract: Studies of a variety of media have found a negative slant in portrayals of individuals with mental illness. These portrayals may contribute to harmful public stigma. As consumers shift focus to online sources of news, it is important to understand whether negative portrayals are also found online. The current study analyzed language use and other coverage choices in online articles (N = 811) about mass shooting events as a function of the mental illness status of the shooter. Regression analyses controlling for relevant crime characteristics showed that less angry language was used and more positive details about the shooter were included when the shooter had a mental illness. The number of victim fatalities, location of and motive for the crime, and shooter age were also related to language use and coverage choices. Whereas the current results do not align with prior findings of overtly negative media portrayals of individuals with mental illnesses, it is not clear whether this reflects a modern improvement in media portrayals or whether it is perhaps a more subtle sign of continued bias toward associating mental illness with dangerousness and lack of responsibility for committing violent acts. Future work should focus on the impact of online information sources on public attitudes and stigma toward individuals with mental illness. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
PubDate: Thu, 22 Aug 2019 04:00:00 GMT
- Social vulnerabilities and reported discrimination in health care among
HIV-positive medical case management clients in New York City.- Abstract: We aimed to investigate the extent to which social vulnerabilities correlated with lifetime experience of discrimination in health care among people with HIV receiving services to improve treatment adherence and viral suppression. Individuals (N = 687) enrolled in a Ryan White Part A medical case management program were surveyed about discrimination experienced in health care settings, reasons for any discrimination faced, and self-reported health. We merged data from the survey with data from the New York City HIV Surveillance Registry and a programmatic database to obtain client sociodemographic and clinical characteristics and reported history of social vulnerabilities. Thirty-nine percent of participants reported lifetime experience of discrimination in health care settings; individuals with a history of at least 3 social vulnerabilities (mental health diagnosis, incarceration, substance use, and/or housing instability) had more than twice the odds of reporting discrimination than individuals who did not report any of these social vulnerabilities (adjusted odds ratio = 2.33 [95% confidence interval = 1.43, 3.83]). Among individuals who reported discrimination in health care, those who cited HIV status or substance use as reasons for discrimination were significantly more likely to report a higher number of social vulnerabilities (p = .04 and p = .009, respectively), with discrimination because of HIV status most strongly associated with a mental health diagnosis. These findings underscore the importance of acknowledging life experience and psychosocial barriers in provider interactions with people with HIV. They also highlight a need for monitoring provider attitudes and behaviors regarding intersectional stigmas related not only to factors such as race and sexual orientation but also to social vulnerabilities. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
PubDate: Mon, 12 Aug 2019 04:00:00 GMT
- Honest, open, proud–college: Effectiveness of a peer-led small-group
intervention for reducing the stigma of mental illness.- Abstract: Although many college students face mental health challenges, the rate of mental health service utilization among students is low. Stigma complicates the experience of mental health problems, and interferes with students’ likelihood of pursuing needed services. This randomized controlled trial examines the effectiveness of a peer-led group-based intervention for students living with mental illness. Honest, Open, Proud–College (HOP-C) aims to reduce the stigma of mental illness and help participants make informed decisions about whether and how to disclose their mental health status. In a sample of 118 students across 3 campuses, randomized to HOP-C or a waitlist, the intervention evidenced significant benefits for (a) self-stigma about mental illness (particularly, harm from self-applied stereotypes), (b) appraisals of perceived resources to cope with stigma-related distress (but not appraisals of stigma as a stressor), and (c) self-efficacy about disclosure of their mental health status (but not self-efficacy about keeping mental health status a secret). Exploratory analysis did not support HOP-C as improving participants’ symptoms of depression or anxiety. HOP-C has promise for addressing the prevalent challenges of mental health stigma, which in turn may help students receive needed services to improve their mental health and associated life outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
PubDate: Thu, 01 Aug 2019 04:00:00 GMT
- Risk factors for self-stigma among incarcerated women with alcohol use
disorder.- Abstract: Alcohol use disorder (AUD) is a highly stigmatized condition, often associated with negative stereotypes such as being morally weak, incompetent, unpredictable, and aggressive. People with AUD are at risk of experiencing self-stigma, a social-cognitive experience in which people think others hold negative stereotypes about them, expect to be treated unfairly, and/or believe that negative stereotypes are personally accurate. Women in the criminal justice system with AUD in particular are at risk of experiencing self-stigma because of intersecting sources of disadvantage. Given that self-stigma can lead to treatment avoidance and dropout, it is important to understand risk factors for self-stigma to inform prevention and intervention efforts in the justice system. Incarcerated women with AUD (n = 185) completed measures of alcohol self-stigma as well as a variety of theoretically relevant risk factors including sociodemographics, baseline levels of stress and depression, and alcohol-related factors (i.e., length of drinking history, frequency/amount of use, consequences of use, physician advice to stop, belief that legal involvement is related to alcohol use, alcohol-related charges, self-efficacy to quit, readiness for treatment, pressures to enter treatment, and factors that influence treatment) and other stigmatized conditions (drug use, exchanging sex, and homelessness). Results showed that experiencing more consequences of alcohol use, pressures to enter treatment, and perceived stress were associated with internalized stigma and anticipated/enacted stigma. This study begins to identify which incarcerated women with AUD are most at risk of experiencing self-stigma that may interfere with alcohol treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
PubDate: Thu, 25 Jul 2019 04:00:00 GMT
- How stigma interferes with symptom awareness: Discrepancy between
objective and subjective cognitive performance in currently untreated
persons with mental health problems.- Abstract: Stigma has been shown to interfere with self-identification as having a mental illness, perceived need, and help-seeking, but it is unclear whether it also impairs awareness of symptoms of mental illness. Objective and subjective cognitive deficits are common in mental illness, but the concordance of these assessments is generally weak. The present study aimed at investigating the role of stigma in explaining this discrepancy. A sample of 187 currently untreated persons with mental health problems was studied. Concentration performance was measured via the d2-R (i.e., the revision of the Concentration Endurance Test [d2 Test of Attention]) and subjectively (self-report). Measure discrepancy was quantified using a sensitivity score. Stigma was measured as personal stigmatizing attitudes, stigma awareness, and stigma stress. The association of stigma and sensitivity was examined via multiple regression analysis. In unadjusted regression models, stronger negative attitudes were significantly associated with overestimating, and higher stigma-stress was associated with underestimating one’s cognitive performance. These associations were reduced to a near-significant trend or disappeared when controlling for demographic variables. Subgroup analyses revealed that specific stigmatizing attitudes (i.e., differentness, untreatability) were associated with lower sensitivity in persons without prior contact to a person with mental illness, whereas in individuals without personal treatment experience, higher stigma stress was associated with greater symptom sensitivity. Interventions reducing stigmatizing attitudes may help facilitate the accurate recognition of cognitive deficits as possible first signs of a mental illness. Strengthening resources for coping with public stigma may prevent worsening of both symptoms and psychosocial functioning. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
PubDate: Thu, 27 Jun 2019 04:00:00 GMT
- Stigma and anxiety disorders: A systematic review.
- Abstract: This article provides a systematic review of the research examining the individual associations of public, personal, and self-stigma for anxiety disorders and a range of demographic and cultural factors impacting on help-seeking processes in the context of stigma. An extensive search of the literature was conducted with 18 studies (N = 17,066), examining mainly social and generalized anxiety disorder identified as satisfying the inclusion criteria. Key findings revealed endorsement of weak-not-sick attitudes were strongest for public stigma, increased awareness of anxiety disorders and mental health literacy were associated with reduced negative personal stigma attitudes, and high levels of self-stigma were associated with poorer treatment outcomes. For public stigma, younger age and geographical rurality were revealed as relevant correlates, whereas gender and cultural differences were each identified as factors influencing personal stigma. This is the first systematic review examining anxiety disorders and stigma, with future research needed to continue investigating this understudied relationship and the related variables that ultimately impact on help-seeking processes. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
PubDate: Thu, 20 Jun 2019 04:00:00 GMT
- Predictors of neighbors’ attitudes toward persons with mental illness
and therapeutic residential services in Brazil.- Abstract: As a result of the psychiatric deinstitutionalization in Brazil, the care provided to persons with mental illness was transferred to community mental health services and residential settings called Therapeutic Residential Services (TRS). Positive attitudes of people toward them, especially those of neighbors, became important to facilitating their social reintegration and reducing stigma. This study is pioneering, as no quantitative study addressing the neighbors’ attitudes of TRS has been previously conducted in Brazil. There is only a Brazilian study validating the scale Community Attitudes toward the Mentally Ill (CAMI-BR; Abelha et al., 2015). In order to identify predictors of positive attitudes toward persons with mental illness and TRS, a stratified random sample of 110 neighbors from a medium-sized city in Minas Gerais was interviewed using the CAMI-BR scale and a questionnaire addressing sociodemographic and mental health information. Multivariate analysis revealed, as predictors of neighbors’ positive attitudes, the variables concerning higher educational level, and information and contact with mental illness and information about a TRS installation near one’s home. Consistent with the literature, these results indicate a need to develop strategies to educate the population about mental illness and community mental health services and to promote contact with them to reduce stigma, increase positive attitudes. and improve their reintegration into the community. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
PubDate: Mon, 17 Jun 2019 04:00:00 GMT
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