[Italian contribute to the CIASS validation]

OBJECTIVES

Interpersonal relationships contribute to the psychological adjustments to chronic disease, directly affecting health and, more generally, life satisfaction of patients. Those factors are often threatened by the fear of becoming target of prejudices and discrimination from those who share their daily life with. Thus, this study proposes a contribution to the Italian adaptation and validation of the Chronic Illness Anticipated Stigma Scale (CIASS), a brief questionnaire (12 items) that aims to assess perceived stigma of chronic illness patients in family, work and health care contexts.

METHODS

279 chronic illness patients have completed the questionnaire, comparing the scores with those obtained in depression (BDI-II), anxiety (STAI), and internalized stigma scales.

RESULTS

Confirmatory factor analysis (CFA) on the Italian sample has shown the same structure of the original questionnaire, composed by three dimensions of anticipated stigma, experienced with family and friends, work colleagues and health care providers. Correlation analyses confirm the relation between scores of anticipated stigma and other mental health indicators as anxiety and depression.

CONCLUSIONS

Italian version of CIASS demonstrates to be a valid and reliable instrument, considering it both as an indicator of person's state of health and a promising marker of the specific kind of perceived discrimination in family, care and working contexts.

The class politics of prejudice: Brexit and the land of no-hope and glory

The debates relating to social class and whether it is still a useful concept in describing a lived reality of the British population has never been far away from media, political and academic dispute. Thatcher's Britain throughout the 1980s attempted to dilute class meaning with what was called 'a home owning democracy' and thus end class collective politics through easily available credit for the working class while simultaneously attacking trade union organization, recruitment and political action. During the late 1990s and into the noughties a 'New Labour' administration attempted to exacerbate the end of class politics through an agenda of a 'cultural distinction' to class identity. Class struggle, class politics and class identity is embedded deep within the cultural norms practices, and history of British democracy. Consequently it is difficult if not impossible to prise class inequality in the UK away from and out of national, local and personal politics (Savage et al. 2015: 393-8). This paper focuses upon the sense that class politics, and cultural class distinction, within the UK had the biggest influence in determining a working-class 'Leave Vote' in the 2016 referendum within the UK. This paper explores accounts and narratives from working-class 'leave' voters though an ethnographic study of the political and social viewpoints of working-class communities of East London, and of ex-mining towns of Nottinghamshire. Framing into fuller context the anger and apathy of being 'left out', arguing that being 'left out' has been part of working-class political narratives for over 30 years. Going beyond frustration and apathy, a significant part of the narrative of working people was of 'not existing', suggesting certain important linkages with ongoing debates about new ways of conceptualizing class differences and class structures.

Religious anti-gay prejudice as a predictor of mental health, abuse, and substance use

Anti-gay, or homonegative, prejudice is generally considered harmful to the wellbeing of sexual minority individuals. However, the origins or nature of such prejudice may vary. Despite a sizable body of literature suggesting homonegative prejudice is frequently religious-based, the psychological impact of exposure to religious anti-gay prejudice remains largely undetermined. Addressing this research gap, the authors examined whether opposition to same-sex sexuality on religious grounds predicted detrimental outcomes among same- and both-sex attracted individuals, as well as their heterosexual counterparts. A nationwide U.S. sample of 1600 individuals-recruited using contemporary online crowd-sourcing techniques designed to limit selection bias-completed a novel inventory assessing interpersonal exposure to religious (as well as nonreligious) homonegative disapproval. Outcome variables assessed included a number of clinically relevant measures spanning general mental health, social support, suicidality, abuse, and substance use. Analyses revealed that greater exposure to religious anti-gay prejudice predicted higher levels of anxiety, stress, and shame; more instances of physical and verbal abuse; and more problematic alcohol use. Furthermore, while sexual minority individuals tended to fare more poorly than their heterosexual counterparts on almost every outcome measure assessed, homonegative prejudice predicted poorer outcomes among all respondents regardless of their sexual orientation or religious identification. Hence, results are among the first to demonstrate that anti-gay religious exposure is associated with substantial threats to wellbeing, and that such effects may be observed beyond religious sexual minorities. Overall, findings imply that homonegative religious social conditions may be of broader health and mental health concern than is conventionally recognized. (PsycINFO Database Record

It is not Black and White: Discrimination and distress in Hawai'i

OBJECTIVE

This study investigates whether the strength of the relationship between perceived discrimination and psychological distress varies by race/ethnicity, gender, and the number of years of residence in Hawai'i.

METHOD

Our sample consisted of 1,036 undergraduate students at a university in Hawai'i and the survey was conducted in 2012-2013. The sample was composed of 55% women and the average age was 21. The students reported their racial/ethnic backgrounds as White (19%), Japanese (21%), Filipino (16%), Chinese (10%), Native Hawaiian (14%), Pacific Islander (4%), other Asian (6%), and other race/ethnicity (10%).

RESULTS

Interaction effect results revealed that Whites who had experienced everyday discrimination had higher levels of psychological distress than racial ethnic minorities. Women who had experienced everyday discrimination were more distressed than men and more distressed by a lower threshold level of discrimination. Furthermore, those who had lived in Hawai'i for a longer duration and experienced everyday discrimination were more distressed.

CONCLUSIONS

Our findings draw attention to how the psychological effects of discrimination vary by racial/ethnic group, gender, and location in the United States. The relationship between everyday discrimination and higher levels of psychological distress especially among those who have lived in Hawai'i longer, women, and Whites indicates that targeted medical and social interventions are needed to protect the mental health of college students. (PsycINFO Database Record

A deeper look at implicit weight bias in medical students

The Implicit Relational Assessment Procedure (IRAP, Barnes-Holmes et al. in Psychol Rec 60:527-542, 2010) was utilized as a relatively new tool to measure implicit weight bias in first- and third-year medical students. To date, only two studies (Miller et al. in Acad Med 88:978-982, 2013; Phelan et al. in Med Educ 49:983-992, 2015) have investigated implicit weight bias with medical students and both have found pro-thin/anti-fat implicit attitudes, on average, using the Implicit Association Test (IAT, Greenwald and Banaji in Psychol Rev 102:4-27, 1995) as the assessment tool. The IRAP, however, allows for a deeper analysis of implicit attitudes with respect to both thin and fat in isolation, and it was found that medical students are, on average, actually both pro-thin and pro-fat, and on average are more pro-thin than pro-fat, as opposed to anti-fat. Additionally, it was found that medical students' implicit weight bias against fat/obese individuals improved over the first 2 years of medical training, and this improvement was specifically driven by improved implicit attitudes toward overweight and obese, while implicit attitudes toward thin remained constant over that time. The implications of more sensitive implicit bias assessment and specific changes in bias over time are discussed within the context of medical education curriculum development.

Challenging mental health related stigma in China: Systematic review and meta-analysis. II. Interventions among people with mental illness

People with mental illness often face different types of mental illness stigma that may affect their lives, including perceived stigma, self-stigma, harmful coping strategies and poor quality of life. Although anti-stigma interventions for people with mental illness from Western countries have been identified by recent systematic reviews, their efficacy in China is unknown. This review evaluates the efficacy of anti-stigma interventions among people with mental illness in Mainland China, Hong Kong, Taiwan and Macau. A systematic search of 8 electronic databases in English and Chinese yielded 17 randomized and non-randomized controlled trials. Standardized mean differences (SMDs) were calculated wherever possible. Psychoeducation was the most commonly used intervention. SMDs were large and significant for perceived/experienced/anticipated stigma, self-prejudice and coping with stigma, as well as for depression and anxiety symptoms and quality of life. Both Cognitive Behavioral Therapy and psychoeducation had positive effects on perceived/experienced/anticipated stigma. The quality of studies was modest and heterogeneity across studies was high. Anti-stigma interventions demonstrated promise to reduce stigma's negative impact on people with mental illness in China, but more high-quality intervention research is needed.

Gender differences and similarities in medical students' experiences of mistreatment by various groups of perpetrators

BACKGROUND

Mistreatment of medical students during medical education is a widespread concern. Studies have shown that medical students report the most mistreatment compared to students of other study programs and that the prevalence of mistreatment peaks during clinical training. For this reason, a study was conducted to assess prevalence of mistreatment among medical students committed by various groups of people. The focus was to identify whether gender was associated with the experience of mistreatment. Additionally, students' perception of university climate for reporting sexual harassment was assessed.

METHOD

In the study 88 medical students (45 women, 43 men) participated. A modified version of the Questionnaire on Student Abuse was used to assess students' experience of various types of mistreatment and associated distress during medical education. To explore factors that could be associated with this experience the organizational climate for reporting sexual harassment was assessed with the Psychological Climate for Sexual Harassment.

RESULT

The most often cited perpetrators of mistreatment were strangers (79.5%), friends (75.0%) and university staff (68.2%). Strangers mostly committed psychological mistreatment and sexual harassment, whereas friends additionally engaged in physical mistreatment of medical students. The most common form of mistreatment conducted by university staff was humiliation of students. These kinds of psychological mistreatment were reported to be distressing (43%). Gender differences were found in the prevalence of mistreatment. Women experienced more sexual harassment and humiliation than did men. On the other hand, men experienced more physical mistreatment than did women. Women reported experiencing more distress from mistreatment experiences than did men and also more often reported being mistreated by university staff than did men. Women perceived a greater risk in reporting sexual harassment to the organization than did men.

CONCLUSION

Mistreatment of female and male students should be focused on using a gender perspective because types of mistreatment can differ by gender. Additionally, interventions should include the societal level as there was a high prevalence of mistreatment perpetrated by strangers. Also the issue of trust in the university needs to be addressed and the organization is called on to visibly demonstrate that it represents and protects its students as well as its staff.

Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model

HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and "pop-up" street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team's experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related "space" as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming.

Prime and prejudice: The effect of priming context and prejudicial attitudes on post-traumatic stress disorder symptoms following immigrant violence

The recent arrival of immigrants into many western countries has become common. Clashes between immigrants and local residents may produce acts of violence. In two studies we assessed post-traumatic stress disorder (PTSD) symptoms in local residents exposed to immigrant violence, while addressing possible effects of priming context and prejudicial attitudes. In Study 1, context was either reminiscent/non-reminiscent of experiencing African immigrant violence (researcher with same/different ethnic origin to that of perpetrators). In Study 2, context was manipulated as a negative ("illegal-migrant") or neutral ("working-immigrant") framing for African immigrants. We also examined if effects of context on trauma symptoms are moderated by prejudicial attitudes towards African immigrants. As expected, higher PTSD symptom levels were evident in the presence of traumatic (Study 1) and negative (Study 2) context, yet only in residents with high prejudicial attitudes. Results suggest that both contexts and prejudice play a role in assessment of PTSD stemming from cultural conflicts. Theoretical implications of the data in terms of PTSD memory theories, are discussed including the notion of a PTSD context theory. Practical implications pertaining to the potential compatibility of researchers and therapists with trauma victims are also addressed.

Evidence for arrogance: On the relative importance of expertise, outcome, and manner

Arrogant behavior is as old as human nature. Nonetheless, the factors that cause people to be perceived as arrogant have received very little research attention. In this paper, we focused on a typical manifestation of arrogance: dismissive behavior. In particular, we explored the conditions under which a person who dismissed advice would be perceived as arrogant. We examined two factors: the advisee's competence, and the manner in which he or she dismissed the advice. The effect of the advisee's competence was tested by manipulating two competence cues: relative expertise, and the outcome of the advice dismissal (i.e., whether the advisee was right or wrong). In six studies (N = 1304), participants made arrogance judgments about protagonists who dismissed the advice of another person while the advisees' relative expertise (compared to the advisor), their eventual correctness, and the manner of their dismissal were manipulated in between-participant designs. Across various types of decisions and advisee-advisor relationships, the results show that less expert, less correct, and ruder advisees are perceived as more arrogant. We also find that outcome trumps expertise, and manner trumps both expertise and outcomes. In two additional studies (N = 101), we examined people's naïve theories about the relative importance of the aforementioned arrogance cues. These studies showed that people overestimate the role of expertise information as compared to the role of interpersonal manner and outcomes. Thus, our results suggest that people may commit arrogant faux pas because they erroneously expect that their expertise will justify their dismissive behavior.

Far from fairness: Prejudice, skin color, and psychological functioning in Asian Americans

OBJECTIVES

We explored the moderating role of observed skin color in the association between prejudice and concurrent and lagged psychological functioning (i.e., depression, ingroup/outgroup psychological connectedness). We further aimed to understand gender differences in these processes.

METHOD

Data from 821 Asian American undergraduate students (57.5% female and 42.5% male) were drawn from the National Longitudinal Survey of Freshman. Cross-sectional and longitudinal regression-based moderation models were conducted with PROCESS 2.13 for SPSS.

RESULTS

Lighter skin color nullified the association between prejudice and recent depression for Asian American females. This moderating effect did not hold over time with regards to depression symptoms 1 year later. Additionally, prejudice predicted psychological distance to other Asian students 1 year later among females rated as lighter in skin color, whereas prejudice was tied to psychological closeness for females with darker skin ratings.

CONCLUSIONS

Results highlight skin color as a pertinent factor relevant to the short-term and long-term mental health and social experiences of Asian American women in particular. (PsycINFO Database Record

When does activating diversity alleviate, when does it increase intergroup bias? An ingroup projection perspective

The question how intergroup bias can be alleviated is of much theoretical and practical interest. Whereas diversity training and the multiculturalism ideology are two approaches prominent in practice, most theoretical models on reducing intergroup bias are based on social-identity theory and self-categorization theory. This social-identity perspective assumes that similar processes lead to intergroup bias in very different intergroup contexts if people identify with the respective social groups. A recent prominent model based on these theories is the ingroup-projection model. As this model assumes, an ingroup’s norms and standards are applied to outgroups included in a common superordinate category (this is called ingroup projection). Intergroup bias results because the outgroup fulfils these norms and standards less than the ingroup. Importantly, if the diversity of the superordinate category is induced as the norm, ingroup projection and thus intergroup bias should be reduced. The present research delineates and tests how general this process is. We propose that ingroup prototypicality is not only an outcome variable, as the ingroup-projection model originally assumes, but can also be an important moderator. We hypothesize that for members considering their ingroup highly prototypical (“pars pro toto”, large majorities), the superordinate group’s diversity may question their ingroup’s position and thus elicit threat and intergroup bias. In contrast, for members who consider their group as less prototypical (one among several, or “una inter pares” groups), activating diversity should, as originally assumed in the ingroup-projection model, reduce intergroup bias. Three experiments (total N = 345) supported these predictions in the contexts of groups defined by gender or nationality. Taken together, the ingroup-projection model can explain under which conditions activating superordinate-category diversity induces tolerance, and when it may backfire. We discuss in how far the ingroup-projection model can integrate conflicting findings on the multiculturalism ideology.

Empathy and moral emotions in post-apartheid South Africa: an fMRI investigation

Moral emotions elicited in response to others' suffering are mediated by empathy and affect how we respond to their pain. South Africa provides a unique opportunity to study group processes given its racially divided past. The present study seeks insights into aspects of the moral brain by investigating behavioral and functional MRI responses of White and Black South Africans who lived through apartheid to in- and out-group physical and social pain. Whereas the physical pain task featured faces expressing dynamic suffering, the social pain task featured victims of apartheid violence from the South African Truth and Reconciliation Commission to elicit heartfelt emotion. Black participants' behavioral responses were suggestive of in-group favoritism, whereas White participants' responses were apparently egalitarian. However, all participants showed significant in-group biases in activation in the amygdala (physical pain), as well as areas involved in mental state representation, including the precuneus, temporoparietal junction (TPJ) and frontal pole (physical and social pain). Additionally, Black participants reacted with heightened moral indignation to own-race suffering, whereas White participants reacted with heightened shame to Black suffering, which was associated with blunted neural empathic responding. These findings provide ecologically valid insights into some behavioral and brain processes involved in complex moral situations.

Demographic Differences in PrEP-Related Stereotypes: Implications for Implementation

Qualitative interviews about pre-exposure prophylaxis (PrEP) stereotypes were conducted with a subsample of 160 MSM who participated in a PrEP messaging study. Negative stereotypes about PrEP users were identified by 80 % of participants. Two types of stereotypes were most common: PrEP users are HIV-infected (and lying about it), and PrEP users are promiscuous and resistant to condom use. Participants' identification of these stereotype categories differed significantly by demographic factors (i.e., race/ethnicity, education). Expanding access to PrEP requires recognizing potential differences in the experience or anticipation of PrEP-related stereotypes that might impact willingness to discuss PrEP with providers, friends, or partners.

Looking the part (to me): effects of racial prototypicality on race perception vary by prejudice

Less racially prototypic faces elicit more category competition during race categorization. Top-down factors (e.g. stereotypes), however, affect categorizations, suggesting racial prototypicality may enhance category competition in certain perceivers. Here, we examined how prejudice affects race category competition and stabilization when perceiving faces varying in racial prototypicality. Prototypically low vs high Black relative to White faces elicited more category competition and slower response latencies during categorization (Experiment 1), suggesting a pronounced racial prototypicality effect on minority race categorization. However, prejudice predicted the extent of category competition between prototypically low vs high Black faces. Suggesting more response conflict toward less prototypic Black vs White faces, anterior cingulate cortex activity increased toward Black vs White faces as they decreased in racial prototypicality, with prejudice positively predicting this difference (Experiment 2). These findings extend the literature on racial prototypicality and categorization by showing that relative prejudice tempers the extent of category competition and response conflict engaged when initially perceiving faces.

Structural Vulnerability: Operationalizing the Concept to Address Health Disparities in Clinical Care

The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of "structural vulnerability." A structural vulnerability assessment tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients' health problems is presented to help clinicians identify patients likely to benefit from additional multidisciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizing structural vulnerability in clinical practice and introducing it in medical education can help health care practitioners think more clearly, critically, and practically about the ways social structures make people sick. Use of the assessment tool could promote "structural competency," a potential new medical education priority, to improve understanding of how social conditions and practical logistics undermine the capacities of patients to access health care, adhere to treatment, and modify lifestyles successfully. Adoption of a structural vulnerability framework in health care could also justify the mobilization of resources inside and outside clinical settings to improve a patient's immediate access to care and long-term health outcomes. Ultimately, the concept may orient health care providers toward policy leadership to reduce health disparities and foster health equity.

Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults

BACKGROUND

Discrimination promotes multisystem physiological dysregulation termed allostatic load, which predicts morbidity and mortality. It remains unclear whether weight-related discrimination influences allostatic load.

PURPOSE

The aim of this study was to prospectively examine 10-year associations between weight discrimination, allostatic load, and its components among adults 25-75 years in the Midlife Development in the US Biomarker Substudy.

METHODS

Participants with information on weight discrimination were analyzed (n=986). At both timepoints, participants self-reported the frequency of perceived weight discrimination across nine scenarios as "never/rarely" (scored as 0), "sometimes" (1), or "often" (2). The two scores were averaged and then dichotomized as "experienced" versus "not experienced" discrimination. High allostatic load was defined as having ≥3 out of 7 dysregulated systems (cardiovascular, sympathetic/parasympathetic nervous systems, hypothalamic pituitary axis, inflammatory, lipid/metabolic, and glucose metabolism), which collectively included 24 biomarkers. Relative risks (RR) were estimated from multivariate models adjusted for sociodemographic and health characteristics, other forms of discrimination, and BMI.

RESULTS

Over 41% of the sample had obesity, and 6% reported weight discrimination at follow-up. In multivariable-adjusted analyses, individuals who experienced (versus did not experience) weight discrimination had twice the risk of high allostatic load (RR, 2.07; 95 % CI, 1.21; 3.55 for baseline discrimination; 2.16, 95 % CI, 1.39; 3.36 for long-term discrimination). Weight discrimination was associated with lipid/metabolic dysregulation (1.56; 95 % CI 1.02, 2.40), glucose metabolism (1.99; 95 % CI 1.34, 2.95), and inflammation (1.76; 95 % CI 1.22, 2.54), but no other systems.

CONCLUSIONS

Perceived weight discrimination doubles the 10-year risk of high allostatic load. Eliminating weight stigma may reduce physiological dysregulation, improving obesity-related morbidity and mortality.

Perceived weight discrimination mediates the prospective relation between obesity and depressive symptoms in U.S. and U.K. adults

OBJECTIVE

Obesity has been shown to increase risk of depression. Persons with obesity experience discrimination because of their body weight. Across 3 studies, we tested for the first time whether experiencing (perceived) weight-based discrimination explains why obesity is prospectively associated with increases in depressive symptoms.

METHOD

Data from 3 studies, including the English Longitudinal Study of Ageing (2008/2009-2012/2013), the Health and Retirement Study (2006/2008-2010/2012), and Midlife in the United States (1995/1996-2004/2005), were used to examine associations between obesity, perceived weight discrimination, and depressive symptoms among 20,286 U.S. and U.K. adults.

RESULTS

Across all 3 studies, Class II and III obesity were reliably associated with increases in depressive symptoms from baseline to follow-up. Perceived weight-based discrimination predicted increases in depressive symptoms over time and mediated the prospective association between obesity and depressive symptoms in all 3 studies. Persons with Class II and III obesity were more likely to report experiencing weight-based discrimination, and this explained approximately 31% of the obesity-related increase in depressive symptoms on average across the 3 studies.

CONCLUSION

In U.S. and U.K. samples, the prospective association between obesity (defined using body mass index) and increases in depressive symptoms in adulthood may in part be explained by perceived weight discrimination. (PsycINFO Database Record

Stigma toward psychosis and its formulation process: prejudice and discrimination against early stages of schizophrenia

BACKGROUND

Stigma toward psychosis can prevent social attendance and help-seeking behavior. Early detection and intervention has been shown to improve patient outcome in schizophrenia. The aim of this study was to reveal the characteristics and formulation process of stigma toward each clinical stage of schizophrenia, taking people's backgrounds into consideration.

METHODS

The participants consisted of three groups: general public, patients with mental illness, and psychiatric professionals. We performed a survey examining stigmas toward people with psychotic-like-experiences (PLE), at-risk mental state for psychosis (ARMS), schizophrenia, or depression. Prejudice was measured using a 21-item questionnaire, and discrimination was measured using the Social Distance Scale.

RESULTS

The participants consisted of 149 people from the general public, 97 patients, and 119 psychiatric professionals. Generally, a similar pattern was observed among the groups in which prejudice and discrimination against PLE was mildest, followed by that against ARMS and depression, and finally schizophrenia. When the stigma of the general public was compared with that of psychiatric professionals, the prejudice and discrimination against PLE of the general public were both lower than those of the psychiatric professionals. However, the prejudice of the general public was stronger than that of the professionals for ARMS. Furthermore, the discrimination of the general public was stronger than that of the professionals for schizophrenia.

CONCLUSIONS

The stigmas of mental illness differed according to the clinical stage, although the pattern of severity was similar among the three groups. A formulation process is suggested in which stigma toward schizophrenia develops from an attitudinal property (prejudice) against ARMS and a behavioral property (discrimination) against schizophrenia.

Perceptions of mistreatment among trainees vary at different stages of clinical training

BACKGROUND

Mistreatment of trainees remains a frequently reported phenomenon in medical education. One barrier to creating an educational culture of respect and professionalism may be a lack of alignment in the perceptions of mistreatment among different learners. Through the use of clinical vignettes, our aim was to assess the perceptions of trainees toward themes of potential mistreatment at different stages of training.

METHODS

Based on observations from external experts embedded in the clinical learning environment, six thematic areas of potential mistreatment were identified: verbal abuse, specialty-choice discrimination, non-educational tasks, withholding/denying learning opportunities, neglect and gender/racial insensitivity. Corresponding clinical vignettes were created and distributed to 1) medical students, 2) incoming interns, 3) residents/fellows. Perceptions of the appropriateness of the interactions depicted in the vignettes were measured on a 5-point Likert scale. Scores were categorized into neutral or appropriate (≤3) or inappropriate (i.e. mistreatment) (>3) and compared using chi-squared tests.

RESULTS

Four hundred twenty seven trainees participated (182 students, 120 interns, 125 residents/fellows). Proportions of students perceiving mistreatment differed significantly from those of interns and residents/fellows in domains of verbal abuse, specialty discrimination and gender/racial insensitivity (p < 0.05). In scenarios comparing interns to residents/fellows, no significant differences were noted in perceptions of mistreatment in the domains of non-educational tasks, withholding learning and neglect.

CONCLUSIONS

Perceptions of mistreatment differ at different developmental stages of medical training. After exposure to the clinical learning environment, perceptions of incoming interns did not differ from those of residents/fellows, implicating clinical rotations as a key period in indoctrinating students into the prevailing culture. More longitudinal studies are needed to confirm or better examine this phenomenon.

[Violence and discrimination in the workplace. The effects on health and setting-related approaches to prevention and rehabilitation]

Violence in the workplace is a widespread problem that manifests itself in very different forms. The consequences for victims and companies are equally diverse. Sexual harassment is a special form of violence at the workplace. Violence may come from external perpetrators (attacks on cashiers) or from persons inside a company or establishment (colleagues, patients, people in care). Statutory accident insurance institutions in Germany (UV, "Unfallversicherungsträger") receive approximately 16,000 occupational injury reports per year that resulted from violence and led to extended incapacity to work. The numbers are increasing steadily. Particularly affected by violence are people working in healthcare and social welfare. Both psychological and physical violence can lead to severe disorders such as post-traumatic stress disorder (PTSD). To avoid violence, technical, organisational, and personal protective measures are needed. The training of de-escalation officers in the areas affected can be helpful. For victims of psychological and physical violence in the workplace, the UV offers special psychotherapeutic support and recommends the training of first-aiders.