701
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Chan KKS, Mak WWS. Attentional Bias Associated with Habitual Self-Stigma in People with Mental Illness. PLoS One 2015; 10:e0125545. [PMID: 26177536 PMCID: PMC4503620 DOI: 10.1371/journal.pone.0125545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 03/25/2015] [Indexed: 11/19/2022] Open
Abstract
As habitual self-stigma can have a tremendous negative impact on people with mental illness, it is of paramount importance to identify its risk factors. The present study aims to examine the potential contributory role of attentional bias in habitual self-stigma. People with mental illness having strong (n = 47) and weak (n = 47) habitual self-stigma completed a computerized emotional Stroop task which included stigma-related, positive, and non-affective words as stimuli. The strong habit group was found to exhibit faster color-naming of stigma-related words (compared to non-affective words), whereas the weak habit group showed no difference in the speed of response to different stimuli. These findings suggest that people with stronger habitual self-stigma may be more able to ignore the semantic meaning of stigma-related words and focus on the color-naming task. Moreover, people with stronger habitual self-stigma may have greater attentional avoidance of stigma-related material. The present study is the first to demonstrate a specific relationship between habitual self-stigma and biased processing of stigma-related information. In order to further determine the role and the nature of attentional bias in habitual self-stigma, future research should employ a broader range of experimental paradigms and measurement techniques to examine stigma-related attentional bias in people with mental illness.
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Affiliation(s)
- Kevin K. S. Chan
- Department of Psychological Studies, The Hong Kong Institute of Education, Tai Po, Hong Kong
- Centre for Psychosocial Health, The Hong Kong Institute of Education, Tai Po, Hong Kong
| | - Winnie W. S. Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
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702
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Oliveira SEH, Esteves FG, Pereira EG, Carvalho M, Boyd JE. The Internalized Stigma of Mental Illness: Cross-Cultural Adaptation and Psychometric Properties of the Portuguese Version of the ISMI Scale. Community Ment Health J 2015; 51:606-12. [PMID: 25612794 DOI: 10.1007/s10597-015-9828-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/13/2015] [Indexed: 11/26/2022]
Abstract
This study examined the psychometric properties of the Portuguese version of the ISMI scale in a sample of 253 adult psychiatric outpatients. The exploratory factor analysis replicated the five factor structure of the scale. The results revealed good internal consistency. Criterion-related validity supported the variability in response to stigma across clinical diagnoses. Thus, the Portuguese version of the ISMI scale can be considered appropriate to measure and differentiate between stigmatization experiences. Also, in order to design more focused approaches aimed to reduce the negative effects of internalized stigma, its use in institutional and in community-based mental health services is recommended.
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Affiliation(s)
- Sandra E H Oliveira
- CIS-IUL, Instituto Universitário de Lisboa (ISCTE-IUL), Av. das Forças Armadas, 1649-026, Lisboa, Portugal,
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703
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Joseph AJ, Tandon N, Yang LH, Duckworth K, Torous J, Seidman LJ, Keshavan MS. #Schizophrenia: Use and misuse on Twitter. Schizophr Res 2015; 165:111-5. [PMID: 25937459 DOI: 10.1016/j.schres.2015.04.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/01/2015] [Accepted: 04/09/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The role and prevention of stigma in mental illness is an area of evolving research. AIMS The present study is the first to examine the use and misuse of the word 'schizophrenia' on Twitter.com in comparison with another illness (diabetes) by analyzing Tweets that use the adjective and noun forms of schizophrenia and diabetes. METHOD Tweets containing one of four search terms (#schizophrenia, #schizophrenic, #diabetes, #diabetic) were collected over a forty-day time period. After establishing inter-rater reliability, Tweets were rated along three dimensions: medical appropriateness, negativity, and sarcasm. Chi square tests were conducted to examine differences in the distributions of each parameter across illnesses and across each word form (noun versus adjective). RESULTS Significant differences were seen between the two illnesses (i.e., among "schizophrenia", "schizophrenic", "diabetes", and "diabetic") along each parameter. Tweets about schizophrenia were more likely to be negative, medically inappropriate, sarcastic, and used non-medically. The adjective ("schizophrenic") was more often negative, medically inappropriate, sarcastic, and used non-medically than the noun "schizophrenia." Schizophrenia tweets were more likely to be negative and sarcastic when used non-medically and in a medically inappropriate manner. CONCLUSIONS Our findings confirm the presence of a great deal of misuse of the term schizophrenia on Twitter, and that this misuse is considerably more pronounced by the adjectival use of the illness. These findings have considerable implications for efforts to combat stigma, particularly for youth anti-stigma efforts.
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Affiliation(s)
- Adam J Joseph
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Neeraj Tandon
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Lawrence H Yang
- Department of Epidemiology, Columbia University, New York, NY, United States
| | - Ken Duckworth
- National Alliance on Mental Illness, Arlington, VA, United States
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Larry J Seidman
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Matcheri S Keshavan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
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704
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Farrelly S, Jeffery D, Rüsch N, Williams P, Thornicroft G, Clement S. The link between mental health-related discrimination and suicidality: service user perspectives. Psychol Med 2015; 45:2013-2022. [PMID: 25678059 DOI: 10.1017/s0033291714003158] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Suicide is a major global public health issue. Mental illness is a risk factor for suicide, but as many individuals with a diagnosed mental health problem do not experience suicidal ideation or attempt suicide, other individual and societal factors must be considered. Mental illness-related discrimination is one potential risk factor. METHOD Using mixed methods, the influence of discrimination on suicidality amongst 194 individuals diagnosed with depression, bipolar or schizophrenia spectrum disorders was investigated. Qualitative interviews with a sub-sample of 58 individuals who reported a link between experience of discrimination and suicidality were analysed using framework analysis. Quantitative methods were used to examine the model derived from qualitative analyses. RESULTS Results indicate that the experience of discrimination led 38% of the overall sample of 194 participants, to suicidal feelings and 20% reported that it contributed to making a suicide attempt. The qualitative model derived from interviews with a sub-sample of 58 participants suggested that the experience of discrimination is experienced as a stressor that exceeds coping resources, leading to a negative self-image and a perception of decreased supportive networks/social structure. The anticipation of further negative events and treatment, and the perception of a lack of supportive networks led individuals in this study to feelings of hopelessness and suicidality. Quantitative analyses provided support for the model. CONCLUSIONS These data suggest that both psychological therapies aimed at improving coping skills and population-level anti-stigma interventions that reduce the occurrence of discrimination may provide some protection against suicide amongst individuals with mental health problems.
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Affiliation(s)
- S Farrelly
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
| | - D Jeffery
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
| | - N Rüsch
- Department of Psychiatry II,University of Ulm and BKH Günzburg,Germany
| | - P Williams
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
| | - G Thornicroft
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
| | - S Clement
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
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705
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Rimkeviciene J, Hawgood J, O'Gorman J, De Leo D. Personal Stigma in Suicide Attempters. DEATH STUDIES 2015; 39:592-599. [PMID: 26086667 DOI: 10.1080/07481187.2015.1037972] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this study was to explore suicide attempters' experiences of personal stigma. This qualitative study included a focus group of 7 experienced clinicians and semi-structured interviews with 8 suicide attempters. Thematic analysis of the data yielded four main themes: seriousness, care, "badness," and avoidance. Experiences of stigma pervaded all contexts, but were most emotionally upsetting to the participants in interpersonal relationships. The findings show the importance of evaluating stigma for suicide attempters during suicide risk assessment and the need for specifically tailored interventions to combat suicide stigma at the individual level.
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Affiliation(s)
- Jurgita Rimkeviciene
- a Australian Institute for Suicide Research and Prevention , Griffith University , Queensland , Australia
| | - Jacinta Hawgood
- a Australian Institute for Suicide Research and Prevention , Griffith University , Queensland , Australia
| | - John O'Gorman
- a Australian Institute for Suicide Research and Prevention , Griffith University , Queensland , Australia
| | - Diego De Leo
- a Australian Institute for Suicide Research and Prevention , Griffith University , Queensland , Australia
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706
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Aakre JM, Klingaman EA, Docherty NM. The relationship between stigma sentiments and self-identity of individuals with schizophrenia. Psychiatr Rehabil J 2015; 38:125-131. [PMID: 25799298 PMCID: PMC4469555 DOI: 10.1037/prj0000119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Stigma sentiments are the attitudes held toward a culturally devalued label or group. The present study measures schizophrenia stigma sentiments and self-identity to assess self-stigma experienced by people with schizophrenia. METHOD Ninety individuals with schizophrenia and 23 controls with no history of psychosis rated the evaluation, potency, and activity of "A person with schizophrenia or schizoaffective disorder," (stigma sentiments) and of "Myself as I really am" (self-identity). t tests, correlations, and regression analysis were used to (a) test relationships among stigma sentiments and self-identity in the groups separately; (b) test a model for predicting self-identity in the schizophrenia group, using stigma sentiments, current symptoms, and current functioning; and (c) compare the participant groups' stigma sentiments and self-identities. RESULTS The evaluation category of self-identity and of stigma sentiment were correlated in the schizophrenia group, r(88) = .44, p < .001, but not in the control group. Current symptoms and the evaluation category of stigma sentiments were significant predictors of the evaluation category of self-identity in the schizophrenia group. The evaluation and potency stigma sentiments reported by the 2 groups did not differ; the control group rated itself more favorably on evaluation and potency than did the schizophrenia group. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Self-evaluation of individuals with schizophrenia was less favorable than self-evaluation of individuals with no psychosis history, and evaluation attitudes held by individuals with schizophrenia regarding the schizophrenia label were associated with their self-identity. Results suggest preliminary utility of this simple measure in identifying self-stigma experienced by individuals with schizophrenia.
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Affiliation(s)
- Jennifer M Aakre
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC)
| | - Elizabeth A Klingaman
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC)
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707
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Lien YJ, Kao YC, Liu YP, Chang HA, Tzeng NS, Lu CW, Loh CH. Internalized stigma and stigma resistance among patients with mental illness in Han Chinese population. Psychiatr Q 2015; 86:181-97. [PMID: 25150055 DOI: 10.1007/s11126-014-9315-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Research suggests that accurate measurement is essential in evaluating internalized stigma and abilities to combat with stigma for treatment compliances and outcomes in individuals with mental illness. The purpose of this study was to assess the reliability and validity of the Chinese version of the Internalized Stigma of Mental Illness Scale (ISMIS-C), which is one of the few tools available to measure internalized stigma and stigma resistance (SR) simultaneously. A total of 160 outpatients with (n = 103) and without (n = 57) psychotic disorders were administrated with the ISMIS-C, and measures of self-esteem, self-efficacy, depression, and hopelessness. Overall, the 29-item ISMIS-C was presented to be internal reliable (Cronbach's alpha = 0.90), and reliable over time (intraclass correlation coefficients = 0.36-0.73). The construct validity of the ISMIS-C derived from the factor analysis was nearly identical to the original version. ISMIS-C dimension scores were well correlated with each other and measures of self-esteem, self-efficacy, depression, and hopelessness. Our data also demonstrated that psychotic patients experienced higher internalized stigma scores than those without psychotic diagnoses, but endorsed indifferently on SR scores. This scale can be used as an informative device when investigating "internalized stigma" and "SR" among individuals with or without psychotic disorders.
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Affiliation(s)
- Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
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708
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Ryan J, Virani A, Austin JC. Ethical issues associated with genetic counseling in the context of adolescent psychiatry. Appl Transl Genom 2015; 5:23-9. [PMID: 26937355 PMCID: PMC4745399 DOI: 10.1016/j.atg.2015.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/04/2015] [Accepted: 06/05/2015] [Indexed: 01/19/2023]
Abstract
Genetic counseling is a well-established healthcare discipline that provides individuals and families with health information about disorders that have a genetic component in a supportive counseling encounter. It has recently been applied in the context of psychiatric disorders (like schizophrenia, bipolar disorder, schizoaffective disorder, obsessive compulsive disorder, depression and anxiety) that typically appear sometime during later childhood through to early adulthood. Psychiatric genetic counseling is emerging as an important service that fills a growing need to reframe understandings of the causes of mental health disorders. In this review, we will define psychiatric genetic counseling, and address important ethical concerns (we will particularly give attention to the principles of autonomy, beneficence, non-maleficence and justice) that must be considered in the context of its application in adolescent psychiatry, whilst integrating evidence regarding patient outcomes from the literature. We discuss the developing capacity and autonomy of adolescents as an essential and dynamic component of genetic counseling provision in this population and discuss how traditional viewpoints regarding beneficence and non-maleficence should be considered in the unique situation of adolescents with, or at risk for, psychiatric conditions. We argue that thoughtful and tailored counseling in this setting can be done in a manner that addresses the important health needs of this population while respecting the core principles of biomedical ethics, including the ethic of care.
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Affiliation(s)
- Jane Ryan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Alice Virani
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
- Centre for Applied Ethics, University of British Columbia, Vancouver, Canada
| | - Jehannine C. Austin
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
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709
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Soares RG, Silveira PS, Noto AR, Boyd JE, Ronzani TM. Validação da Versão Brasileira da Escala ISMI Adaptada para Dependentes de Substâncias. PSICOLOGIA: TEORIA E PESQUISA 2015. [DOI: 10.1590/0102-37722015021093229238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Esse estudo teve como objetivo validar a escala Internalized Stigma of Mental Illness – ISMI adaptada para dependentes de substâncias psicoativas, no Brasil. A pesquisa foi conduzida com uma amostra de 299 dependentes de substâncias. O valor do alfa de Cronbach do escore total foi de 0,83 e o Coeficiente Spearman-Brown de 0,76. A validade de constructo, estimada pela Análise Fatorial Exploratória de Máxima Verossimilhança, demonstrou correlação estatisticamente significativa (p<0,01) entre a ISMI e as escalas CES-D (r=0,47), Escala de Esperança de Herth (r=-0,19) e Escala de Autoestima de Rosenberg (r=-0,48). A versão brasileira da ISMI demonstrou propriedades psicométricas satisfatórias e promete ser um instrumento útil para mensurar estigma internalizado entre dependentes de substâncias.
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710
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Link BG, Wells J, Phelan JC, Yang L. Understanding the Importance of “Symbolic Interaction Stigma:” How Expectations about the Reactions of Others Adds to the Burden of Mental illness Stigma. Psychiatr Rehabil J 2015; 38:117-24. [PMID: 26075528 PMCID: PMC5328656 DOI: 10.1037/prj0000142] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Important components of stigma include imagining what others might think of a stigmatized status, anticipating what might transpire in an interaction with others, and rehearsing what one might do if something untoward occurs. These imagined relations are here called symbolic interaction stigma and can have an impact even if the internalization of negative stereotypes fails to occur. Concepts and measures that capture symbolic interaction stigma are introduced, and a preliminary assessment of their impact is provided. METHOD Four self-report measures of symbolic interaction stigma (perceived devaluation discrimination, anticipation of rejection, stigma consciousness, and concern with staying in) were developed or adapted and administered to a sample of individuals who have experienced mental illness (N = 65). Regression analyses examined whether forms of symbolic interaction stigma were associated with withdrawal, self-esteem, and isolation from relatives independent of measures of internalization of stigma and rejection experiences. RESULTS As evidenced by scores on 4 distinct measures, symbolic interaction stigma was relatively common in the sample, somewhat more common than the internalization of stigma. In addition, measures of symbolic interaction stigma were significantly associated with withdrawal, self-esteem, and isolation from relatives even when a measure of the internalization of stigma was statistically controlled. CONCLUSION The study suggests the potential importance of considering symbolic interaction forms of stigma in understanding and addressing stigma and its consequences. Being aware of symbolic interaction stigma could be useful in enhancing rehabilitation goals if an approach to counteracting the negative effects of these aspects of stigma can be developed.
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Affiliation(s)
- Bruce G Link
- Mailman School of Public Health, Columbia University
| | | | - Jo C Phelan
- Mailman School of Public Health, Columbia University
| | - Lawrence Yang
- Mailman School of Public Health, Columbia University
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711
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Sælør KT, Ness O, Semb R. Taking the plunge: Service users’ experiences of hope within the mental health and substance use services. ACTA ACUST UNITED AC 2015. [DOI: 10.15714/scandpsychol.2.e9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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712
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Brown-Johnson CG, Cataldo JK, Orozco N, Lisha NE, Hickman NJ, Prochaska JJ. Validity and reliability of the Internalized Stigma of Smoking Inventory: An exploration of shame, isolation, and discrimination in smokers with mental health diagnoses. Am J Addict 2015; 24:410-8. [PMID: 25930661 DOI: 10.1111/ajad.12215] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/16/2015] [Accepted: 03/14/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES De-normalization of smoking as a public health strategy may create shame and isolation in vulnerable groups unable to quit. To examine the nature and impact of smoking stigma, we developed the Internalized Stigma of Smoking Inventory (ISSI), tested its validity and reliability, and explored factors that may contribute to smoking stigma. METHODS We evaluated the ISSI in a sample of smokers with mental health diagnoses (N = 956), using exploratory and confirmatory factor analysis, and assessed construct validity. RESULTS Results reduced the ISSI to eight items with three subscales: smoking self-stigma related to shame, felt stigma related to social isolation, and discrimination experiences. Discrimination was the most commonly endorsed of the three subscales. A multivariate generalized linear model predicted 21-30% of the variance in the smoking stigma subscales. Self-stigma was greatest among those intending to quit; felt stigma was highest among those experiencing stigma in other domains, namely ethnicity and mental illness-based; and smoking-related discrimination was highest among women, Caucasians, and those with more education. DISCUSSION AND CONCLUSION Smoking stigma may compound stigma experiences in other areas. Aspects of smoking stigma in the domains of shame, isolation, and discrimination were related to modeled stigma responses, particularly readiness to quit and cigarette addiction, and were found to be more salient for groups where tobacco use is least prevalent. SCIENTIFIC SIGNIFICANCE The ISSI measure is useful for quantifying smoking-related stigma in multiple domains.
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Affiliation(s)
- Cati G Brown-Johnson
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Janine K Cataldo
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Nicholas Orozco
- Joint Medical Program, University of California Berkeley, School of Public Health, Berkeley, California.,University of California San Francisco, School of Medicine, San Francisco, California
| | - Nadra E Lisha
- Center for Tobacco Control Research and Education, University of California, San Francisco, California
| | - Norval J Hickman
- California Tobacco-Related Disease Research Program, University of California, Office of the President, Oakland, California
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, California
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713
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Sarkin A, Lale R, Sklar M, Center KC, Gilmer T, Fowler C, Heller R, Ojeda VD. Stigma experienced by people using mental health services in San Diego County. Soc Psychiatry Psychiatr Epidemiol 2015; 50:747-56. [PMID: 25406401 DOI: 10.1007/s00127-014-0979-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 11/10/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This paper describes how individuals struggling with severe mental illness experience stigma along multiple dimensions including their experiences of discrimination by others, their unwillingness to disclose information about their mental health, and their internalization or rejection of the negative and positive aspects of having mental health problems. METHODS This cross-sectional study employs descriptive analyses and linear regression to assess the relationship between demographics, mental health diagnoses and self-reported stigma among people receiving mental health services in a large and ethnically diverse county public mental health system (n = 1,237) in 2009. We used the King Stigma Scale to measure three factors related to stigma: discrimination, disclosure, and positive aspects of mental illness. RESULTS Most people (89.7 %) reported experiencing some discrimination from having mental health problems. Regression analyses revealed that younger people in treatment experienced more stigma related to mental health problems. Women reported experiencing more stigma than men, but men were less likely to endorse the potentially positive aspects of facing mental health challenges than women. Although people with mood disorders reported more discomfort with disclosing mental illness than people with schizophrenia, they did not report experiencing more discrimination than people with schizophrenia. CONCLUSIONS Study findings suggest that the multidimensional experiences of stigma differ as a function of age, gender, and diagnosis. Importantly, these findings should inform anti-stigma efforts by describing different potential treatment barriers due to experiences of stigma among people using mental health services, especially among younger people and women who may be more susceptible to stigma.
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Affiliation(s)
- Andrew Sarkin
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, 92093, USA,
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714
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Chambers SK, Baade P, Youl P, Aitken J, Occhipinti S, Vinod S, Valery PC, Garvey G, Fong KM, Ball D, Zorbas H, Dunn J, O'Connell DL. Psychological distress and quality of life in lung cancer: the role of health-related stigma, illness appraisals and social constraints. Psychooncology 2015; 24:1569-77. [PMID: 25920906 PMCID: PMC5029590 DOI: 10.1002/pon.3829] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 01/19/2023]
Abstract
Objective Health‐related stigma is associated with negative psychological and quality of life outcomes in lung cancer patients. This study describes the impact of stigma on lung cancer patients' psychological distress and quality of life and explores the role of social constraints and illness appraisal as mediators of effect. Methods A self‐administered cross‐sectional survey examined psychological distress and quality of life in 151 people (59% response rate) diagnosed with lung cancer from Queensland and New South Wales. Health‐related stigma, social constraints and illness appraisals were assessed as predictors of adjustment outcomes. Results Forty‐nine percent of patients reported elevated anxiety; 41% were depressed; and 51% had high global distress. Health‐related stigma was significantly related to global psychological distress and quality of life with greater stigma and shame related to poorer outcomes. These effects were mediated by illness appraisals and social constraints. Conclusions Health‐related stigma appears to contribute to poorer adjustment by constraining interpersonal discussions about cancer and heightening feelings of threat. There is a need for the development and evaluation of interventions to ameliorate the negative effects of health‐related stigma among lung cancer patients. © 2015 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Suzanne K Chambers
- Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,Health and Wellness Institute, Edith Cowan University, Perth, Australia.,Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Peter Baade
- Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Philippa Youl
- Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | | | - Stefano Occhipinti
- Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia
| | - Shalini Vinod
- Liverpool Cancer Therapy Centre, Sydney, Australia.,Macarthur Cancer Therapy Centre, Sydney, Australia.,University of NSW, Sydney, Australia.,University of Western Sydney, Sydney, Australia
| | - Patricia C Valery
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Kwun M Fong
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia.,Thoracic Research Centre, University of Queensland, Brisbane, Australia
| | - David Ball
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | | | - Jeff Dunn
- Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,School of Social Science, University of Queensland, Brisbane, Australia
| | - Dianne L O'Connell
- Cancer Council New South Wales, Sydney, Australia.,School of Population Health and Community Medicine, University of NSW, Sydney, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.,Sydney Medical School - Public Health, University of Sydney, Sydney, Australia
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715
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Threader J, McCormack L. Cancer-related trauma, stigma and growth: the 'lived' experience of head and neck cancer. Eur J Cancer Care (Engl) 2015; 25:157-69. [PMID: 25899673 DOI: 10.1111/ecc.12320] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 11/29/2022]
Abstract
Head and neck cancer is associated with multiple layers of distress including stigma. Stigma attraction or devalued social identity is twofold: (1) it is a cancer associated with lifestyle risk factors and (2) treatment often results in confronting facial disfigurement. Subjective interpretations from nine head and neck cancer patients were analysed using Interpretative Phenomenological Analysis. An overarching superordinate theme--Distress, Stigma and Psychological Growth--encompassed four subordinate themes. Two themes captured the expressed trauma and terror as a result of diagnosis and treatment, and two the redefining of self despite stigma through meaning making. Distress was interpreted as a catalyst for awakening new life interpretations and combined with social support to facilitate two distinct pathways of growth: (1) psychological growth without support; (2) psychological and relational growth with support. Previously unfelt empathetic understanding and altruism for others with cancer emerged from the impact of stigma on 'self'. Acceptance allowed a new sense of identity that recognised cancer-related traumatic distress as integral to growth for these participants. The present study offers a unique insight into cancer-related trauma and stigma and the potential to redefine a more accepting, empathic and altruistic 'self' for psychological growth. Implications are discussed.
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Affiliation(s)
- J Threader
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
| | - L McCormack
- Faculty of Science and IT, School of Psychology, University of Newcastle, Callaghan, NSW, Australia
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716
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Dealing with stigma: experiences of persons affected by disabilities and leprosy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:261329. [PMID: 25961008 PMCID: PMC4413953 DOI: 10.1155/2015/261329] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 01/19/2023]
Abstract
Persons affected by leprosy or by disabilities face forms of stigma that have an impact on their lives. This study seeks to establish whether their experiences of stigma are similar, with a view to enabling the two groups of people to learn from each other. Accounts of experiences of the impact of stigma were obtained using in-depth interviews and focus group discussion with people affected by leprosy and by disabilities not related to leprosy. The analysis shows that there are a lot of similarities in impact of stigma in terms of emotions, thoughts, behaviour, and relationships between the two groups. The main difference is that those affected by leprosy tended to frame their situation in medical terms, while those living with disabilities described their situation from a more social perspective. In conclusion, the similarities offer opportunities for interventions and the positive attitudes and behaviours can be modelled in the sense that both groups can learn and benefit. Research that tackles different aspects of stigmatization faced by both groups could lead to inclusive initiatives that help individuals to come to terms with the stigma and to advocate against exclusion and discrimination.
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717
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Takada S, Weiser SD, Kumbakumba E, Muzoora C, Martin JN, Hunt PW, Haberer JE, Kawuma A, Bangsberg DR, Tsai AC. The dynamic relationship between social support and HIV-related stigma in rural Uganda. Ann Behav Med 2015; 48:26-37. [PMID: 24500077 DOI: 10.1007/s12160-013-9576-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cross-sectional studies show that human immunodeficiency virus (HIV) stigma is negatively correlated with social support. PURPOSE The purpose of this study is to examine the bidirectional relationship between social support and HIV stigma. METHODS We collected quarterly data from a cohort of 422 people living with HIV in Uganda, followed for a median of 2.1 years. We used multilevel regression to model the contemporaneous and 3-month-lagged associations between social support and both enacted and internalized stigma. RESULTS Lagged enacted stigma was negatively correlated with emotional and instrumental social support, and lagged instrumental social support was negatively correlated with enacted stigma. Internalized stigma and emotional social support had reciprocal lagged associations. CONCLUSIONS Interventions to reduce enacted stigma may strengthen social support for people living with HIV. Improved social support may in turn have a protective influence against future enacted and internalized stigma.
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Affiliation(s)
- Sae Takada
- Harvard Medical School, Boston, MA, USA,
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718
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Inglis A, Koehn D, McGillivray B, Stewart SE, Austin J. Evaluating a unique, specialist psychiatric genetic counseling clinic: uptake and impact. Clin Genet 2015; 87:218-24. [PMID: 24773225 PMCID: PMC4318688 DOI: 10.1111/cge.12415] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/24/2014] [Accepted: 04/25/2014] [Indexed: 01/20/2023]
Abstract
People with psychiatric disorders and their family members have expressed interest in receiving genetic counseling (GC). In February 2012, we opened the first (to our knowledge) specialist psychiatric GC clinic of its kind, for individuals with non-syndromic psychiatric disorders and their families. Prior to GC and at a standard 1-month follow-up session, clinical assessment tools are completed, specifically, the GC outcomes scale (GCOS, which measures empowerment, completed by all clients) and the Illness Management Self Efficacy scale (IMSES, completed by those with mental illness). Consecutive English-speaking clients attending the clinic between 1 February 2012 and 31 January 2013 who were capable of consenting were asked for permission to use their de-identified clinical data for research purposes. Descriptive analyses were conducted to ascertain demographic details of attendees, and paired sample t-tests were conducted to assess changes in GCOS and IMSES scores from pre- to post-GC. Of 143 clients, seven were unable to consent, and 75/136 (55.1%) consented. Most were female (85.3%), self-referred (76%), and had personal experience of mental illness (65.3%). Mean GCOS and IMSES scores increased significantly after GC (p < 0.0001 and p = 0.011, respectively). In a naturalistic setting, GC increases empowerment and self-efficacy in this population.
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Affiliation(s)
- Angela Inglis
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - David Koehn
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Barbara McGillivray
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - S. Evelyn Stewart
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Jehannine Austin
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
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719
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Benoit C, McCarthy B, Jansson M. Stigma, sex work, and substance use: a comparative analysis. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:437-451. [PMID: 25688450 DOI: 10.1111/1467-9566.12201] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Stigma is a widely used concept in social science research and an extensive literature claims that stigmatisation contributes to numerous negative health outcomes. However, few studies compare groups that vary in the extent to which they are stigmatised and even fewer studies examine stigma's independent and mediating effects. This article addresses these gaps in a comparative study of perceived stigma and drug use among three low-income feminised service occupations: sex work, food and alcoholic beverage serving, and barbering and hairstyling. An analysis of longitudinal data shows positive associations between sex work, perceived stigma, and socially less acceptable drug use (for example, heroin and cocaine), and that stigma mediates part of the link between sex work and the use of these drugs. Our overall findings suggest that perceived stigma is pronounced among those who work in the sex industry and negatively affects health independently of sex work involvement.
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Affiliation(s)
- Cecilia Benoit
- Centre for Addictions Research of BC, Department of Sociology, University of Victoria, BC, Canada
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720
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Boyle MP. Identifying correlates of self-stigma in adults who stutter: Further establishing the construct validity of the Self-Stigma of Stuttering Scale (4S). JOURNAL OF FLUENCY DISORDERS 2015; 43:17-27. [PMID: 25614323 DOI: 10.1016/j.jfludis.2014.12.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 12/03/2014] [Accepted: 12/17/2014] [Indexed: 05/14/2023]
Abstract
PURPOSE This study was set up to further establish the construct validity of the Self-Stigma of Stuttering Scale (4S) by demonstrating its associations with other established scales and replicating its original factor structure and reliability estimates. METHOD Web surveys were completed by 354 adults who stutter recruited from Board Certified Specialists in Fluency Disorders, and adult chapters of the National Stuttering Association. Participants completed a series of psychometrically validated scales measuring self-stigma, hope, empowerment, quality of life, social support, anxiety, depression, and self-rated speech disruption. RESULTS Higher subscale and total stigma scores on the 4S were associated with significantly lower levels of hope, empowerment, quality of life, and social support, and significantly higher levels of anxiety, depression, and self-rated speech disruption. The original factor structure of the 4S was replicated, and reliability estimates of the subscales ranged from adequate to excellent. CONCLUSIONS The findings of this study support the construct validity of the 4S and its use by clinicians and researchers intending to measure the construct of self-stigma in adults who stutter. EDUCATIONAL OBJECTIVES Readers should be able to: (a) distinguish between the various components of self-stigma; (b) describe how the various components of the self-stigma model relate to hope, empowerment, quality of life, and social support, self-rated speech disruption, anxiety, and depression; (c) summarize the psychometric properties of the Self-Stigma of Stuttering Scale (4S) in terms of reliability, factor structure, and construct validity; (d) discuss how the 4S could be used in research and clinical practice.
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Affiliation(s)
- Michael P Boyle
- Department of Communication Sciences and Disorders, Oklahoma State University, United States.
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721
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Kim WJ, Song YJ, Ryu HS, Ryu V, Kim JM, Ha RY, Lee SJ, Namkoong K, Ha K, Cho HS. Internalized stigma and its psychosocial correlates in Korean patients with serious mental illness. Psychiatry Res 2015; 225:433-9. [PMID: 25554354 DOI: 10.1016/j.psychres.2014.11.071] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 11/25/2014] [Accepted: 11/28/2014] [Indexed: 11/29/2022]
Abstract
We aimed to examine internalized stigma of patients with mental illness in Korea and identify the contributing factors to internalized stigma among socio-demographic, clinical, and psychosocial variables using a cross-sectional study design. A total of 160 patients were recruited from a university mental hospital. We collected socio-demographic data, clinical variables and administered self-report scales to measure internalized stigma and levels of self-esteem, hopelessness, social support, and social conflict. Internalized stigma was identified in 8.1% of patients in our sample. High internalized stigma was independently predicted by low self-esteem, high hopelessness, and high social conflict among the psychosocial variables. Our finding suggests that simple psychoeducation only for insight gaining cannot improve internalized stigma. To manage internalized stigma in mentally ill patients, it is needed to promote hope and self-esteem. We also suggest that a relevant psychosocial intervention, such as developing coping skills for social conflict with family, can help patients overcome their internalized stigma.
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Affiliation(s)
- Woo Jung Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Youn Joo Song
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Sook Ryu
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Vin Ryu
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Jae Min Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ra Yeon Ha
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kee Namkoong
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Hyun-Sang Cho
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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722
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Wu TH, Chang CC, Chen CY, Wang JD, Lin CY. Further psychometric evaluation of the self-stigma scale-short: measurement invariance across mental illness and gender. PLoS One 2015; 10:e0117592. [PMID: 25659115 PMCID: PMC4320062 DOI: 10.1371/journal.pone.0117592] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 12/28/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study cross-validated the factor structure of the Self-Stigma Scale-Short (SSS-S) in a cohort of patients with mental illness in southern Taiwan. The measurement invariance of the SSS-S factor structure across mental illness and gender was also examined. METHODS The sample consisted of 161 patients with schizophrenia (51.6% males; mean age ± SD = 40.53 ± 10.38 years) and 189 patients with other mental illnesses (34.9% males; mean age = 46.52 ± 11.29 years). RESULTS The internal reliability (total score: α = 0.948) and concurrent validity (r = 0.335 to 0.457 with Depression and Somatic Symptoms Scale; r = -0.447 to -0.556 with WHOQOL-BREF) of the SSS-S were both satisfactory, and the results verified that the factor structure in our Taiwan sample (RMSEA = 0.0796, CFA = 0.992) was the same as that of the Hong Kong population. In addition, the results supported the measurement invariance of the SSS-S across mental illness (ΔRMSEAs = -0.0082 to -0.0037, ΔCFAs = 0.000) and gender (ΔRMSEAs = -0.0054 to -0.0008, ΔCFAs = -0.001 to 0.000). CONCLUSION Future studies can use the SSS-S to compare self-stigma between genders and between patients with different kinds of mental illnesses.
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Affiliation(s)
- Tsung-Hsien Wu
- Department of Psychiatry, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
- Health Service and Population Research Department, Institute of Psychiatry, King’s College London, London, United Kingdom
- Department of Senior Citizen Service Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chih-Yin Chen
- Department of Senior Citizen Service Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Department of Nursing, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Internal Medicine and Occupational Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chung-Ying Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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723
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Stigma resistance in eating disorders. Soc Psychiatry Psychiatr Epidemiol 2015; 50:279-87. [PMID: 24974079 DOI: 10.1007/s00127-014-0923-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/22/2014] [Indexed: 01/19/2023]
Abstract
PURPOSE Stigma resistance, described as the capacity to counteract or remain unaffected by the stigma of mental illness, may play a crucial role in the fight against stigma. Little is known, however, about stigma resistance and its correlates in people with eating disorders. This study investigated stigma resistance in people currently diagnosed (n = 325) and recovered (n = 127) from anorexia nervosa, bulimia nervosa, and EDNOS. METHODS Participants completed an Internet survey that included the Stigma Resistance subscale of the Internalized Stigma of Mental Illness Scale together with a battery of psychosocial and psychiatric measures. RESULTS A minimal-to-low level of stigma resistance was exhibited by 26.5% of currently diagnosed participants compared to just 5.5% of recovered participants. Stigma resistance was significantly higher among the recovered than the currently diagnosed (Cohen's d = 0.25) after controlling for differences in eating disorder and depression symptoms, attitudes about seeking psychological help, self-esteem, years between symptom onset and diagnosis, and years since diagnosis. Greater stigma resistance among the currently diagnosed was associated with less marked eating disorder and depression symptoms, higher self-esteem, more positive attitudes about seeking psychological treatment, and lower internalized stigma. CONCLUSIONS Stigma resistance is a promising concept that warrants further study. Researchers should consider designing interventions that specifically cultivate stigma resistance in people with eating disorders as a complement to current interventions that target public perceptions of eating disorders. Clinicians may consider incorporating the concept into their practice to help patients rebuff the adverse effects of mental illness stigmatization.
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724
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Gras LM, Swart M, Slooff CJ, van Weeghel J, Knegtering H, Castelein S. Differential stigmatizing attitudes of healthcare professionals towards psychiatry and patients with mental health problems: something to worry about? A pilot study. Soc Psychiatry Psychiatr Epidemiol 2015; 50:299-306. [PMID: 25123701 DOI: 10.1007/s00127-014-0931-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE This study compares stigmatizing attitudes of different healthcare professionals towards psychiatry and patients with mental health problems. METHODS The Mental Illness Clinicians Attitude (MICA) questionnaire is used to assess stigmatizing attitudes in three groups: general practitioners (GPs, n = 55), mental healthcare professionals (MHCs, n = 67) and forensic psychiatric professionals (FPs, n = 53). RESULTS A modest positive attitude towards psychiatry was found in the three groups (n = 176). Significant differences were found on the total MICA-score (p < 0.001). GPs scored significantly higher than the FPs and the latter scored significantly higher than the MHCs on all factors of the MICA. Most stigmatizing attitudes were found on professionals' views of health/social care field and mental illness and disclosure. Personal and work experience did not influence stigmatizing attitudes. CONCLUSIONS Although all three groups have a relatively positive attitude using the MICA, there is room for improvement. Bias toward socially acceptable answers cannot be ruled out. Patients' view on stigmatizing attitudes of professionals may be a next step in stigma research in professionals.
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Affiliation(s)
- Laura M Gras
- Lentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG, Groningen, The Netherlands
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725
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Boyle MP. Relationships between psychosocial factors and quality of life for adults who stutter. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 24:1-12. [PMID: 25410098 DOI: 10.1044/2014_ajslp-14-0089] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/22/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE In this study, the author examined the relationship of social support, empowerment, self-help support group participation, and group identification to quality of life in adults who stutter. METHOD Two-hundred forty-nine adults who stutter completed a web-based survey, including measures of social support, empowerment, self-help support group participation, group identification, and quality of life. RESULTS After controlling for demographic and stuttering parameters, both empowerment in the self-esteem/self-efficacy domain and social support from family significantly predicted quality of life in adults in the sample. CONCLUSIONS Increased self-esteem/self-efficacy and social support from family relates to improved quality of life in adults who stutter, independent of stuttering severity. Treatments that increase feelings of self-esteem/self-efficacy and strengthen social support from the family should be considered for individuals who struggle to cope with stuttering in order to enhance their quality of life.
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726
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Abstract
BACKGROUND The characterization of auditory verbal hallucinations (AVH) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), diverges from recent research literature, which demonstrates the occurrence of AVH in individuals who are psychologically healthy. This discrepancy raises the question of how the public perceives AVH. Public perceptions are important because they could potentially affect how individuals with AVH interpret these experiences and how people view voice hearers. AIMS Because media portrayals can provide a window into how phenomena are viewed by the public, an archival study of newspaper articles was carried out to examine depictions of AVH. METHODS A sample of 181 newspaper articles originating in the United States was analyzed using a content analysis approach. RESULTS The majority of articles examined contained no suggestion that AVH are possible in psychologically healthy individuals. Most articles suggested that AVH were a symptom of mental illness, and many suggested that AVH were associated with criminal behavior, violence and suicidality. CONCLUSION The news media examined tended to present a misleading and largely pathologizing view of AVH. More research is needed to shed light on how, and to what extent, public perceptions may influence those who experience AVH.
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727
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Hersh M. Overcoming Barriers and Increasing Independence – Service Robots for Elderly and Disabled People. INT J ADV ROBOT SYST 2015. [DOI: 10.5772/59230] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The paper discusses the potential of assistive service robots to support disabled and elderly people. It shows that they have considerable untapped potential in this area, but also that inappropriate implementations could increase isolation, reduce independence and lead to users feeling as though they are under surveillance. The main body of the paper presents an overview of existing applications and discusses their benefits and potential problems. This is organized by an extension of the common classification into socially and physically assistive robots by the two categories of sensory assistive and mixed assistance robots. Another more detailed classification is also presented. This discussion is introduced by an overview of many of the technological components of smart mobile robots. It is followed by a discussion of user acceptance. The problems of existing models based on either solely positive or solely negative factors are noted and a model containing both types of factors is proposed. The need for continuing research is noted and various proposals are made.
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728
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Ho AHY, Potash JS, Fong TCT, Ho VFL, Chen EYH, Lau RHW, Au Yeung FSW, Ho RTH. Psychometric properties of a Chinese version of the Stigma Scale: examining the complex experience of stigma and its relationship with self-esteem and depression among people living with mental illness in Hong Kong. Compr Psychiatry 2015; 56:198-205. [PMID: 25284279 DOI: 10.1016/j.comppsych.2014.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/10/2014] [Accepted: 09/16/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Stigma of mental illness is a global public health concern, but there lacks a standardized and cross-culturally validated instrument for assessing the complex experience of stigma among people living with mental illness (PLMI) in the Chinese context. AIM This study examines the psychometric properties of a Chinese version of the Stigma Scale (CSS), and explores the relationships between stigma, self-esteem and depression. METHODS A cross-sectional survey was conducted with a community sample of 114 Chinese PLMI in Hong Kong. Participants completed the CSS, the Chinese Self-Stigma of Mental Illness Scale, the Chinese Rosenberg Self-Esteem Scale, and the Chinese Patient Health Questionnaire-9. An exploratory factor analysis was conducted to identify the underlying factors of the CSS; concurrent validity assessment was performed via correlation analysis. RESULTS The original 28-item three-factor structure of the Stigma Scale was found to be a poor fit to the data, whereas a revised 14-item three-factor model provided a good fit with all 14 items loaded significantly onto the original factors: discrimination, disclosure and positive aspects of mental illness. The revised model also displayed moderate to good internal consistency and good construct validity. Further findings revealed that the total stigma scale score and all three of its subscale scores correlated negatively with self-esteem; but only total stigma, discrimination and disclosure correlated positively with depression. CONCLUSION The CSS is a short and user-friendly self-administrated questionnaire that proves valuable for understanding the multifaceted stigma experiences among PLMI as well as their impact on psychiatric recovery and community integration in Chinese communities.
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Affiliation(s)
- Andy H Y Ho
- Division of Psychology, School of Humanities and Social Sciences, Nanyang Technological University, Singapore; Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
| | - Jordan S Potash
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China; Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Art Therapy Program, The George WA University, Washington, DC, USA
| | - Ted C T Fong
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China
| | - Vania F L Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Robert H W Lau
- Lok Hong Intergrated Community Centre for Mental Wellness, Tung Wah Group of Hospital, Hong Kong, China
| | - Friendly S W Au Yeung
- The Providence Garden for Rehab, Hong Kong Sheng Kung Hui Welfare Council, Hong Kong, China
| | - Rainbow T H Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China; Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China.
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729
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Anxiety, bulimia, drug and alcohol addiction, depression, and schizophrenia: what do you think about their aetiology, dangerousness, social distance, and treatment? A latent class analysis approach. Soc Psychiatry Psychiatr Epidemiol 2015; 50:27-37. [PMID: 24972643 DOI: 10.1007/s00127-014-0925-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/22/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Mental illness stigma is a serious societal problem and a critical impediment to treatment seeking for mentally ill people. To improve the understanding of mental illness stigma, this study focuses on the simultaneous analysis of people's aetiological beliefs, attitudes (i.e. perceived dangerousness and social distance), and recommended treatments related to several mental disorders by devising an over-arching latent structure that could explain the relations among these variables. METHODS Three hundred and sixty university students randomly received an unlabelled vignette depicting one of six mental disorders to be evaluated on the four variables on a Likert-type scale. A one-factor Latent Class Analysis (LCA) model was hypothesized, which comprised the four manifest variables as indicators and the mental disorder as external variable. RESULTS The main findings were the following: (a) a one-factor LCA model was retrieved; (b) alcohol and drug addictions are the most strongly stigmatized; (c) a realistic opinion about the causes and treatment of schizophrenia, anxiety, bulimia, and depression was associated to lower prejudicial attitudes and social rejection. CONCLUSION Beyond the general appraisal of mental illness an individual might have, the results generally point to the acknowledgement of the specific features of different diagnostic categories. The implications of the present results are discussed in the framework of a better understanding of mental illness stigma.
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730
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Świtaj P, Grygiel P, Anczewska M, Wciórka J. Loneliness mediates the relationship between internalised stigma and depression among patients with psychotic disorders. Int J Soc Psychiatry 2014; 60:733-40. [PMID: 24346002 DOI: 10.1177/0020764013513442] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Stigmatisation is a source of chronic stress and a major barrier to recovery for people with mental illnesses. The internalisation of stigma can have a negative impact on an individual's social relations and lead to feelings of loneliness and depression. AIM This research is aimed at testing the hypothesis that the internalised stigma of mental illness contributes to the intensification of depressive symptoms indirectly, through its impact on feelings of loneliness. METHODS A total of 110 individuals with diagnoses of psychotic disorders (International Classification of Diseases-10th Revision (ICD-10): F20-F29) were assessed with measures of internalised stigma, loneliness, depression, positive and negative symptoms and global functioning. The ordinary least squares regression was used for data analysis. RESULTS After adding loneliness to the regression model, the initially significant impact of internalised stigma on depressive symptoms disappeared. As expected, loneliness proved to be a full mediator in the relationship between stigma and depression. CONCLUSION The study findings provide useful insights into the mechanisms of the harmful effects of stigma on people with mental illness. Internalised stigma and loneliness should be considered important targets for interventions aiming to promote recovery.
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Affiliation(s)
- Piotr Świtaj
- I Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Marta Anczewska
- I Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Jacek Wciórka
- I Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
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731
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Matheson SL, Shepherd AM, Carr VJ. How much do we know about schizophrenia and how well do we know it? Evidence from the Schizophrenia Library. Psychol Med 2014; 44:3387-3405. [PMID: 25065407 DOI: 10.1017/s0033291714000166] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND True findings about schizophrenia remain elusive; many findings are not replicated and conflicting results are common. Well-conducted systematic reviews have the ability to make robust, generalizable conclusions, with good meta-analyses potentially providing the closest estimate of the true effect size. In this paper, we undertake a systematic approach to synthesising the available evidence from well-conducted systematic reviews on schizophrenia. METHOD Reviews were identified by searching Medline, EMBASE, CINAHL, Current Contents and PsycINFO. The decision to include or exclude reviews, data extraction and quality assessments were conducted in duplicate. Evidence was graded as high quality if reviews contained large samples and robust results; and as moderate quality if reviews contained imprecision, inconsistency, smaller samples or study designs that may be prone to bias. RESULTS High- and moderate-quality evidence shows that numerous psychosocial and biomedical treatments are effective. Patients have relatively poor cognitive functioning, and subtle, but diverse, structural brain alterations, altered electrophysiological functioning and sleep patterns, minor physical anomalies, neurological soft signs, and sensory alterations. There are markers of infection, inflammation or altered immunological parameters; and there is increased mortality from a range of causes. Risk for schizophrenia is increased with cannabis use, pregnancy and birth complications, prenatal exposure to Toxoplasma gondii, childhood central nervous system viral infections, childhood adversities, urbanicity and immigration (first and second generation), particularly in certain ethnic groups. Developmental motor delays and lower intelligence quotient in childhood and adolescence are apparent. CONCLUSIONS We conclude that while our knowledge of schizophrenia is very substantial, our understanding of it remains limited.
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Affiliation(s)
- S L Matheson
- Schizophrenia Research Institute, Darlinghurst, Sydney, NSW,Australia
| | - A M Shepherd
- Schizophrenia Research Institute, Darlinghurst, Sydney, NSW,Australia
| | - V J Carr
- Schizophrenia Research Institute, Darlinghurst, Sydney, NSW,Australia
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732
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Successful coping in urban, community-dwelling older adults with HIV. J Assoc Nurses AIDS Care 2014; 26:151-63. [PMID: 25665886 DOI: 10.1016/j.jana.2014.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/19/2014] [Indexed: 01/24/2023]
Abstract
By 2015, 50% of HIV-infected individuals in the United States will be 50 years of age and older. Examining successful coping in older adults with HIV could expand existing coping toolkits, enhance disease management, and improve overall outcomes. We explored how urban, community-dwelling older adults (N = 40) coped with HIV infection, comorbidities, and related stressors. Participants completed an individual or focus group interview session using open-ended questions formulated from extended participant observation. Data were analyzed for theme development using interpretive hermeneutics and qualitative content analysis. Stressors included HIV, comorbidities, fear, anger, stigma, and finances. Three themes for successful coping were identified: accessing support, helping selves and helping others, and tapping into spirituality. Participants engaged in active, meaning-based strategies to successfully cope with HIV and related stressors. These strategies can be adapted for other older adults with HIV, leading to holistic care and improved outcomes.
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733
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Peters RMH, Dadun, Van Brakel WH, Zweekhorst MBM, Damayanti R, Bunders JFG, Irwanto. The cultural validation of two scales to assess social stigma in leprosy. PLoS Negl Trop Dis 2014; 8:e3274. [PMID: 25376007 PMCID: PMC4222778 DOI: 10.1371/journal.pntd.0003274] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 09/16/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Stigma plays in an important role in the lives of persons affected by neglected tropical diseases, and assessment of stigma is important to document this. The aim of this study is to test the cross-cultural validity of the Community Stigma Scale (EMIC-CSS) and the Social Distance Scale (SDS) in the field of leprosy in Cirebon District, Indonesia. METHODOLOGY/PRINCIPLE FINDINGS Cultural equivalence was tested by assessing the conceptual, item, semantic, operational and measurement equivalence of these instruments. A qualitative exploratory study was conducted to increase our understanding of the concept of stigma in Cirebon District. A process of translation, discussions, trainings and a pilot study followed. A sample of 259 community members was selected through convenience sampling and 67 repeated measures were obtained to assess the psychometric measurement properties. The aspects and items in the SDS and EMIC-CSS seem equally relevant and important in the target culture. The response scales were adapted to ensure that meaning is transferred accurately and no changes to the scale format (e.g. lay out, statements or questions) of both scales were made. A positive correlation was found between the EMIC-CSS and the SDS total scores (r=0.41). Cronbach's alphas of 0.83 and 0.87 were found for the EMIC-CSS and SDS. The exploratory factor analysis indicated for both scales an adequate fit as unidimensional scale. A standard error of measurement of 2.38 was found in the EMIC-CSS and of 1.78 in the SDS. The test-retest reliability coefficient was respectively, 0.84 and 0.75. No floor or ceiling effects were found. CONCLUSIONS/SIGNIFICANCE According to current international standards, our findings indicate that the EMIC-CSS and the SDS have adequate cultural validity to assess social stigma in leprosy in the Bahasa Indonesia-speaking population of Cirebon District. We believe the scales can be further improved, for instance, by adding, changing and rephrasing certain items. Finally, we provide suggestions for use with other neglected tropical diseases.
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Affiliation(s)
- Ruth M. H. Peters
- Athena Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Dadun
- Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | | | | | - Rita Damayanti
- Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Joske F. G. Bunders
- Athena Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Irwanto
- Centre for Disability Studies, Faculty of Social and Political Sciences, Universitas Indonesia, Depok, Indonesia
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734
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Affiliation(s)
- Joseph Hayes
- Division of Psychiatry, University College London, Charles Bell House, London, W1W 7EJ.
| | - Vaughan Bell
- Division of Psychiatry, University College London, Charles Bell House, London, W1W 7EJ
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735
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Koschorke M, Padmavati R, Kumar S, Cohen A, Weiss HA, Chatterjee S, Pereira J, Naik S, John S, Dabholkar H, Balaji M, Chavan A, Varghese M, Thara R, Thornicroft G, Patel V. Experiences of stigma and discrimination of people with schizophrenia in India. Soc Sci Med 2014; 123:149-59. [PMID: 25462616 PMCID: PMC4259492 DOI: 10.1016/j.socscimed.2014.10.035] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 10/14/2014] [Accepted: 10/17/2014] [Indexed: 01/19/2023]
Abstract
Stigma contributes greatly to the burden of schizophrenia and is a major obstacle to recovery, yet, little is known about the subjective experiences of those directly affected in low and middle income countries. This paper aims to describe the experiences of stigma and discrimination of people living with schizophrenia (PLS) in three sites in India and to identify factors influencing negative discrimination. The study used mixed methods and was nested in a randomised controlled trial of community care for schizophrenia. Between November 2009 and October 2010, data on four aspects of stigma experienced by PLS and several clinical variables were collected from 282 PLS and 282 caregivers and analysed using multivariate regression. In addition, in-depth-interviews with PLS and caregivers (36 each) were carried out and analysed using thematic analysis. Quantitative findings indicate that experiences of negative discrimination were reported less commonly (42%) than more internalised forms of stigma experience such as a sense of alienation (79%) and significantly less often than in studies carried out elsewhere. Experiences of negative discrimination were independently predicted by higher levels of positive symptoms of schizophrenia, lower levels of negative symptoms of schizophrenia, higher caregiver knowledge about symptomatology, lower PLS age and not having a source of drinking water in the home. Qualitative findings illustrate the major impact of stigma on ‘what matters most’ in the lives of PLS and highlight three key domains influencing the themes of 'negative reactions' and ‘negative views and feelings about the self’, i.e., ‘others finding out’, ‘behaviours and manifestations of the illness’ and ‘reduced ability to meet role expectations’. Findings have implications for conceptualising and measuring stigma and add to the rationale for enhancing psycho-social interventions to support those facing discrimination. Findings also highlight the importance of addressing public stigma and achieving higher level social and political structural change. Internalised experiences of stigma were reported more commonly than discrimination. A range of negative reactions beyond ‘discrimination’ led to feelings of devaluation. Negative discrimination was predicted by illness features, e.g., positive symptoms. Negative reactions were also linked to reduced ability to meet role expectations. What mattered most to PLS was to achieve role expectations in marriage and work.
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Affiliation(s)
- Mirja Koschorke
- Centre for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.
| | - R Padmavati
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | | | - Alex Cohen
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Sujit John
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | | | | | | | | | - R Thara
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Vikram Patel
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK; Sangath, Goa, India
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736
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Galderisi S, Rossi A, Rocca P, Bertolino A, Mucci A, Bucci P, Rucci P, Gibertoni D, Aguglia E, Amore M, Bellomo A, Biondi M, Brugnoli R, Dell'Osso L, De Ronchi D, Di Emidio G, Di Giannantonio M, Fagiolini A, Marchesi C, Monteleone P, Oldani L, Pinna F, Roncone R, Sacchetti E, Santonastaso P, Siracusano A, Vita A, Zeppegno P, Maj M. The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. WORLD PSYCHIATRY : OFFICIAL JOURNAL OF THE WORLD PSYCHIATRIC ASSOCIATION (WPA) 2014. [PMID: 25273301 DOI: 10.1002/wps.20167.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In people suffering from schizophrenia, major areas of everyday life are impaired, including independent living, productive activities and social relationships. Enhanced understanding of factors that hinder real-life functioning is vital for treatments to translate into more positive outcomes. The goal of the present study was to identify predictors of real-life functioning in people with schizophrenia, and to assess their relative contribution. Based on previous literature and clinical experience, several factors were selected and grouped into three categories: illness-related variables, personal resources and context-related factors. Some of these variables were never investigated before in relationship with real-life functioning. In 921 patients with schizophrenia living in the community, we found that variables relevant to the disease, personal resources and social context explain 53.8% of real-life functioning variance in a structural equation model. Neurocognition exhibited the strongest, though indirect, association with real-life functioning. Positive symptoms and disorganization, as well as avolition, proved to have significant direct and indirect effects, while depression had no significant association and poor emotional expression was only indirectly and weakly related to real-life functioning. Availability of a disability pension and access to social and family incentives also showed a significant direct association with functioning. Social cognition, functional capacity, resilience, internalized stigma and engagement with mental health services served as mediators. The observed complex associations among investigated predictors, mediators and real-life functioning strongly suggest that integrated and personalized programs should be provided as standard treatment to people with schizophrenia.
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Affiliation(s)
- Silvana Galderisi
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138, Naples, Italy
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737
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Campo-Arias A, Herazo E. Estigma y salud mental en personas víctimas del conflicto armado interno colombiano en situación de desplazamiento forzado. ACTA ACUST UNITED AC 2014; 43:212-7. [DOI: 10.1016/j.rcp.2014.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 09/13/2014] [Indexed: 11/25/2022]
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738
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Galderisi S, Rossi A, Rocca P, Bertolino A, Mucci A, Bucci P, Rucci P, Gibertoni D, Aguglia E, Amore M, Bellomo A, Biondi M, Brugnoli R, Dell'Osso L, De Ronchi D, Di Emidio G, Di Giannantonio M, Fagiolini A, Marchesi C, Monteleone P, Oldani L, Pinna F, Roncone R, Sacchetti E, Santonastaso P, Siracusano A, Vita A, Zeppegno P, Maj M. The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry 2014; 13:275-87. [PMID: 25273301 PMCID: PMC4219069 DOI: 10.1002/wps.20167] [Citation(s) in RCA: 318] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
In people suffering from schizophrenia, major areas of everyday life are impaired, including independent living, productive activities and social relationships. Enhanced understanding of factors that hinder real-life functioning is vital for treatments to translate into more positive outcomes. The goal of the present study was to identify predictors of real-life functioning in people with schizophrenia, and to assess their relative contribution. Based on previous literature and clinical experience, several factors were selected and grouped into three categories: illness-related variables, personal resources and context-related factors. Some of these variables were never investigated before in relationship with real-life functioning. In 921 patients with schizophrenia living in the community, we found that variables relevant to the disease, personal resources and social context explain 53.8% of real-life functioning variance in a structural equation model. Neurocognition exhibited the strongest, though indirect, association with real-life functioning. Positive symptoms and disorganization, as well as avolition, proved to have significant direct and indirect effects, while depression had no significant association and poor emotional expression was only indirectly and weakly related to real-life functioning. Availability of a disability pension and access to social and family incentives also showed a significant direct association with functioning. Social cognition, functional capacity, resilience, internalized stigma and engagement with mental health services served as mediators. The observed complex associations among investigated predictors, mediators and real-life functioning strongly suggest that integrated and personalized programs should be provided as standard treatment to people with schizophrenia.
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Affiliation(s)
- Silvana Galderisi
- Department of Psychiatry, University of Naples SUNLargo Madonna delle Grazie, 80138, Naples, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'AquilaL'Aquila, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of TurinTurin, Italy
| | - Alessandro Bertolino
- Department of Neurological and Psychiatric Sciences, University of BariBari, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Naples SUNLargo Madonna delle Grazie, 80138, Naples, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Naples SUNLargo Madonna delle Grazie, 80138, Naples, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of BolognaBologna, Italy
| | - Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, University of BolognaBologna, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of CataniaCatania, Italy
| | - Mario Amore
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of GenoaGenoa, Italy
| | - Antonello Bellomo
- Department of Medical Sciences, Psychiatry Unit, University of FoggiaFoggia, Italy
| | - Massimo Biondi
- Department of Neurology and Psychiatry, Sapienza University of RomeRome, Italy
| | - Roberto Brugnoli
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of RomeRome, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of PisaPisa, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, Section of Psychiatry, University of BolognaBologna, Italy
| | - Gabriella Di Emidio
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'AquilaL'Aquila, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience and Imaging, Chair of Psychiatry, G. d'Annunzio UniversityChieti, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine and Clinical Department of Mental Health, University of SienaSiena, Italy
| | - Carlo Marchesi
- Department of Neuroscience, Psychiatry Unit, University of ParmaParma, Italy
| | - Palmiero Monteleone
- Department of Medicine and Surgery, Chair of Psychiatry, University of SalernoSalerno, Italy
| | - Lucio Oldani
- Department of Psychiatry, University of MilanMilan, Italy
| | - Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine, Section of Psychiatry, University of CagliariCagliari, Italy
| | - Rita Roncone
- Department of Life, Health and Environmental Sciences, Unit of Psychiatry, University of L'AquilaL'Aquila, Italy
| | - Emilio Sacchetti
- Psychiatric Unit, School of Medicine, University of Brescia, and Department of Mental HealthSpedali Civili Hospital, Brescia, Italy
| | - Paolo Santonastaso
- Psychiatric Clinic, Department of Neurosciences, University of PaduaPadua, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, Chair of Psychiatry, Tor Vergata University of RomeRome, Italy
| | - Antonio Vita
- Psychiatric Unit, School of Medicine, University of Brescia, and Department of Mental HealthSpedali Civili Hospital, Brescia, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Psychiatric Unit, University of Eastern PiedmontNovara, Italy
| | - Mario Maj
- Department of Psychiatry, University of Naples SUNLargo Madonna delle Grazie, 80138, Naples, Italy
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739
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Karidi MV, Vasilopoulou D, Savvidou E, Vitoratou S, Rabavilas AD, Stefanis CN. Aspects of perceived stigma: the Stigma Inventory for Mental Illness, its development, latent structure and psychometric properties. Compr Psychiatry 2014; 55:1620-5. [PMID: 24957956 DOI: 10.1016/j.comppsych.2014.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 04/07/2014] [Accepted: 04/07/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to develop a new brief and easy to administer self-stigma scale for mental illness as well as to assess the correlations between self-stigma and psychopathology of chronic schizophrenic patients. METHODS The Stigma Inventory for Mental Illness (SIMI) was administered to 100 outpatients diagnosed with schizophrenia. Psychopathology and overall functioning were assessed with the Positive and Negative Symptom Scale (PANSS) and Global Assessment Scale (GAS), respectively. RESULTS The final scale consists of 12 items. Factor analysis concluded to two dimensions: perceptions of social stigma and self-efficacy. Both factors were found to be reliable (high internal consistency and stability coefficients). Significant correlations were present with psychopathology, functioning and selected items from the Community Attitudes toward the Mentally Ill (CAMI) inventory. CONCLUSION The SIMI scale is a reliable and valid psychometric tool that can be used to assess patient's self-stigma and self-efficacy. The findings suggest also that psychopathology has an immediate effect on endorsing self-stigmatizing attitudes.
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Affiliation(s)
- Maria Veroniki Karidi
- Psychosocial Vocational Rehabilitation Unit (PVRU). University Mental Health Research Institute (UMHRI), Athens, Greece.
| | - Despoina Vasilopoulou
- Psychosocial Vocational Rehabilitation Unit (PVRU). University Mental Health Research Institute (UMHRI), Athens, Greece
| | - Eugenia Savvidou
- Psychosocial Vocational Rehabilitation Unit (PVRU). University Mental Health Research Institute (UMHRI), Athens, Greece
| | - Silia Vitoratou
- Biostatistics Department, Institute of Psychiatry, King's College London, UK
| | - Andreas D Rabavilas
- Psychosocial Vocational Rehabilitation Unit (PVRU). University Mental Health Research Institute (UMHRI), Athens, Greece
| | - Constantinos N Stefanis
- Psychosocial Vocational Rehabilitation Unit (PVRU). University Mental Health Research Institute (UMHRI), Athens, Greece
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740
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Aukst-Margetić B, Jakšić N, Boričević Maršanić V, Jakovljević M. Harm avoidance moderates the relationship between internalized stigma and depressive symptoms in patients with schizophrenia. Psychiatry Res 2014; 219:92-4. [PMID: 24857565 DOI: 10.1016/j.psychres.2014.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 04/28/2014] [Accepted: 05/05/2014] [Indexed: 11/30/2022]
Abstract
This study investigated the associations between internalized stigma, depressive symptoms, and temperament dimension Harm avoidance. One hundred and seventeen stable outpatients with schizophrenia completed a battery of self-report instruments. Internalized stigma was significantly positively related to depressive symptoms, while Harm avoidance moderated the internalized stigma-depressive symptoms relationship.
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Affiliation(s)
- Branka Aukst-Margetić
- Department of Psychiatry, University Hospital Center Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia.
| | - Nenad Jakšić
- Department of Psychiatry, University Hospital Center Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia
| | | | - Miro Jakovljević
- Department of Psychiatry, University Hospital Center Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia
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741
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Yin Y, Zhang W, Hu Z, Jia F, Li Y, Xu H, Zhao S, Guo J, Tian D, Qu Z. Experiences of stigma and discrimination among caregivers of persons with schizophrenia in China: a field survey. PLoS One 2014; 9:e108527. [PMID: 25259732 PMCID: PMC4178170 DOI: 10.1371/journal.pone.0108527] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/22/2014] [Indexed: 01/19/2023] Open
Abstract
In China, caregivers for family members with schizophrenia play an important role in treatment and recovery but may experience stigma and discrimination simply because of their family relationship. The object of this study was to measure the degrees and correlates of stigma and discrimination experiences among this group. Four hundred twenty-seven caregivers participated in this hospital-based and cross-sectional study in Ningbo and Guangzhou, China. Data were collected by trained interviewers using fixed questionnaires. Stigma and discrimination experiences were measured by the Modified Consumer Experiences of Stigma Questionnaire (MCESQ). Caregivers’ social support was measured by the Social Support Rating Scale. Parametric analysis, nonparametric analysis and multivariate linear regression were used. The mean (SD) score of MCESQ was 2.44(0.45), 2.91(0.71) for stigma experiences and 1.97(0.37) for discrimination experiences on a five-point score (“1 = never” and “5 = very often”). Approximately 65% of caregivers reported that they tried to conceal their family members’ illness, and 71% lacked the support of friends. The experience of stigma was significantly negatively associated with the perceived social support of caregivers (standard β = −0.2,p<0.001). Caregivers who were children of the patients experienced fewer stigmas than other (standard β = −0.18, p<0.001). Urban residence (standard β = −0.12, p<0.01) and patients did not complete primary school education (standard β = −0.13, p<0.01) were negatively related with stigmas. In addition, stigma and discrimination was more experienced in Zhejiang than in Guangdong (p<0.05). In conclusion, this study performed that caregivers of people with schizophrenia in China experienced general stigmas and rare discrimination and found the relations with social support, kinship, patient’s educational level and regional differences. More interventions and supports should been given to caregivers who are lack of social support, who live in rural area and who are the patients’ parents, spouses or siblings.
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Affiliation(s)
- Yi Yin
- School of Social Development and Public Policy, Beijing Normal University, Beijing, P. R. China
| | - Weijun Zhang
- School of Social Development and Public Policy, Beijing Normal University, Beijing, P. R. China
| | - Zhenyu Hu
- Office of Director, Ningbo Kangning Hospital, Ningbo, Zhejiang, P. R. China
| | - Fujun Jia
- Guangdong Mental Health Center, Guangdong General Hospital, Guangzhou, Guangdong, P. R. China
| | - Yafang Li
- Department of Medical Affairs, Peking Union Medical College Hospital, Beijing, P. R. China
| | - Huiwen Xu
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, New York, United States of America
| | - Shuliang Zhao
- School of Public Management, Yunnan University of Finance and Economics, Kunming, Yunnan, P. R. China
| | - Jing Guo
- Department of Sociology, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Donghua Tian
- School of Social Development and Public Policy, Beijing Normal University, Beijing, P. R. China
| | - Zhiyong Qu
- School of Social Development and Public Policy, Beijing Normal University, Beijing, P. R. China
- * E-mail:
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742
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Bifftu BB, Dachew BA, Tiruneh BT. Stigma resistance among people with schizophrenia at Amanuel Mental Specialized Hospital Addis Ababa, Ethiopia: a cross-sectional institution based study. BMC Psychiatry 2014; 14:259. [PMID: 25212121 PMCID: PMC4174330 DOI: 10.1186/s12888-014-0259-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 09/04/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Schizophrenia is one of the most disabling and severely stigmatized mental disorders. Together with social stigma, internalized stigma and perceived stigma can trigger a vicious cycle and diminishes the stigma resistance abilities of individual. Helping patients to cope up with perceived and internalized stigma play crucial role in fighting stigma. This study aimed to assess the prevalence and associated factors of stigma resistance among people with schizophrenia attending the outpatient department of Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. METHODS Institution based cross-sectional study design was employed. Single population proportion formula was used to calculate sample size. Subjects were selected by systematic sampling techniques. Bivariate and multivariate logistic regressions were performed to identify the presence and strength of association. Odds ratios with 95% confidence interval were computed to determine the level of significance. RESULTS A total of 411 subjects participated in the study giving a response rate of 97.4%. The prevalence of low stigma resistance was found to be 51.6%. Rural residence (AOR = 0.29 (95% CI: 0.142, 0.594), difficulties of adherence to antipsychotic medication (AOR = AOR = 0.3, 95% CI: 0.155, 0.542), internalized stigma (AOR = 0.24, 95% CI: (0.111, 0.530), alienation (AOR = 0.5, 95% CI: (0.270, 0.927), stereotype endorsement (AOR = 0.37(95% CI: 0.312, 0.463) and social withdrawal (AOR = 0.27, 95% CI: (0.156, 0.468) were factors statistically associated with low stigma resistance. CONCLUSION In this study, overall more than half of the study participants had low stigma resistance. Rural residence, difficulties of adherence to antipsychotic medication, high internalized stigma, alienation and social withdrawal were factors statistically associated with low stigma resistance. Encouraging participations in different social relationships such as befriending programs, family and peer support groups are recommended.
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Affiliation(s)
- Berhanu Boru Bifftu
- College of Medicine and Health Sciences Department of
Nursing, Gondar University, P.O. Box: 196, Gondar, Ethiopia
| | - Berihun Assefa Dachew
- Institution of Public Health, Department of Epidemiology and
Biostatistics, Gondar University, College of Medicine and Health Sciences, P.O. Box: 196, Gondar, Ethiopia
| | - Bewket Tadesse Tiruneh
- College of Medicine and Health Sciences Department of
Nursing, Gondar University, P.O. Box: 196, Gondar, Ethiopia
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743
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James TT, Kutty VR. Assessment of Internalized Stigma Among Patients With Mental Disorders in Thiruvananthapuram District, Kerala, India. Asia Pac J Public Health 2014; 27:439-49. [DOI: 10.1177/1010539514545645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to compare the prevalence of high internalized stigma of mental illness among patients attending community-based and psychiatric hospital–based care in Thiruvananthapuram district, Kerala, India and to examine the factors associated with high internalized stigma. A cross-sectional survey was conducted among 290 patients, mean age 45 years, 38.2% and 61.8% female. A Malayalam version of the Internalized Stigma of Mental Illness inventory was used for assessing internalized stigma. A multistage random sampling method was adopted. The prevalence of high internalized stigma was higher among patients from community-based care (44.7%) as compared with those from psychiatric hospital–based care (34.1%). Apart from treatment in community-based care, age ≤45 years, unemployment, absence of long-term friendships, no hope of cure with medication, presence of other illnesses, and substance use were significantly associated with high internalized stigma. More than one third of the subjects had high internalized stigma.
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Affiliation(s)
- Tintu T. James
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - V. Raman Kutty
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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744
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[Stigma: Barrier to Access to Mental Health Services]. ACTA ACUST UNITED AC 2014; 43:162-7. [PMID: 26575130 DOI: 10.1016/j.rcp.2014.07.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 07/01/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND The perceived stigma represents a sociocultural barrier to access mental health services and prevents individuals who meet criteria for a mental disorder the possibility of receiving comprehensive and integred care. OBJECTIVE To update institutional mechanisms by which stigma related to mental disorders, perceived and perpetrated, acts as a barrier to mental health access. RESULTS Stigma as a barrier to access to mental health services is due to a reduction in service requests, the allocation of limited resources to mental health, the systematic process of impoverishment of the people who suffer a mental disorder, increased risk of crime, and implications in contact with the legal system, and the invisibility of the vulnerability of these people. CONCLUSIONS Structured awareness and education programs are needed to promote awareness about mental disorders, promote community-based psychosocial rehabilitation, and reintegration into productive life process. In Colombia, the frequency and variables associated with the stigma of mental disorders needs to be studied. This knowledge will enable the implementation of measures to promote the social and labor inclusion of people who meet the criteria for mental disorders.
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745
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Pinto MD, Hickman RL, Thomas TL. Stigma Scale for Receiving Psychological Help (SSRPH): An Examination Among Adolescent Girls. West J Nurs Res 2014; 37:1644-61. [PMID: 25100566 DOI: 10.1177/0193945914543954] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Stigma is one of the greatest obstacles to care and impedes recovery. The Stigma Scale for Receiving Professional Psychological Help (SSRPH), a measure of public stigma, has been used in young adults and has limited psychometric data in adolescents. This article reports the reliability and validity of the SSRPH in adolescent girls (N = 156, age = 13-17). Discriminant validity was supported, but concurrent validity was not. The confirmatory factor analysis revealed excellent model fit and serves as beginning evidence for construct validity. Cronbach's alpha for the SSRPH was .65. The SSRPH was stable over 8 weeks. Findings suggest that the SSRPH can serve as a foundation for further instrument development. Future studies may explore enhancing the reliability and validity of the SSRPH and use advanced analytic techniques to examine the overall global construct of stigma, the latent constructs of public and private stigma, and associations of individual items to these constructs.
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746
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Effectiveness of group cognitive-behavioral therapy in reducing self-stigma in Japanese psychiatric patients. Asian J Psychiatr 2014; 10:39-44. [PMID: 25042950 DOI: 10.1016/j.ajp.2014.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/18/2014] [Accepted: 02/22/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE There is evidence that the stigma surrounding mental illness may be greater in Japan than elsewhere. However, few Japanese studies have focused on self-stigma (the internalization of social stigma), and few interventions to reduce self-stigma exist. To remedy this deficiency, we evaluated the efficacy of group cognitive-behavioral therapy (CBT) in reducing self-stigma and examined the relationship between cognitive restructuring and self-stigma. METHODS We administered a 10-session group CBT program to 46 Japanese outpatients with anxiety and depressive symptoms (36 men, 10 women; mean age=38.57 years, SD=8.33; 20 diagnosed with mood disorders; 24 with neurotic, stress-related, or somatoform disorders; and 2 with other disorders). A pretest-posttest design was used to examine the relationship between cognitive restructuring and self-stigma. Outcomes were measured using the Japanese versions of the Devaluation-Discrimination Scale, Dysfunctional Attitude Scale, Beck Depression Inventory-II, State-Trait Anxiety Inventory State-Form, and Rosenberg's Self Esteem Scale. RESULTS Participants exhibited significant improvements in depression, anxiety, and maladjusted cognitive bias and reductions in self-stigma. Cognitive bias was significantly correlated with self-stigma. CONCLUSIONS Group CBT is effective in improving both emotional symptoms and self-stigma in outpatients with anxiety and depressive symptoms. Reduction in self-stigma plays a mediating role in alleviating emotional symptoms and improving cognition.
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747
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Wood L, Burke E, Byrne R, Pyle M, Chapman N, Morrison A. Stigma in psychosis: A thematic synthesis of current qualitative evidence. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2014. [DOI: 10.1080/17522439.2014.926561] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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748
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Affiliation(s)
- Timothy R Campellone
- Department of Psychology, University of California, 3210 Tolman Hall, Berkeley, CA 94720-1690, USA.
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749
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Taft TH, Riehl ME, Dowjotas KL, Keefer L. Moving beyond perceptions: internalized stigma in the irritable bowel syndrome. Neurogastroenterol Motil 2014; 26:1026-35. [PMID: 24832499 PMCID: PMC8569739 DOI: 10.1111/nmo.12357] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 04/07/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Internalized stigma (IS) is an important construct in the chronic illness literature with implications for several patient reported outcomes. To date, no study exists evaluating IS in patients with the irritable bowel syndrome (IBS). METHODS Two hundred and forty three online and clinical participants completed the following questionnaires: the IS scale for mental illness (ISMI; modified for IBS), perceived stigma scale for IBS, NIH-PROMIS Anxiety and Depression Scales, IBS quality of life scale, and the Perceived Health Competence Scale. Demographical and clinical data were also collected. KEY RESULTS The modified ISMI was reliable and valid in this population. Participants reported both perceived and IS. Alienation was most reported, followed by social withdrawal and discrimination experiences. IS predicted 25-40% of the variance in psychological functioning, quality of life, healthcare utilization, and health competence when controlling for stigma perception and disease variables. IBS patients perceived more stigma from personal relations than healthcare providers. Hispanic participants reported more perceived stigma, indicating there may be cultural differences in IBS-related stigma experience. Symptom severity, disruptiveness, and treatment choices are also implicated in stigma perception and internalization. CONCLUSIONS & INFERENCES Patients with IBS report both perceived and IS with alienation most reported. However, IS significantly predicts several patient outcomes when controlling for PS. Cultural and illness traits may influence how stigma is perceived and internalized. Future research is warranted.
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Affiliation(s)
- T. H. Taft
- Center for Psychosocial Research in GI; Feinberg School of Medicine Division of Gastroenterology & Hepatology; Northwestern University; Chicago IL USA
| | - M. E. Riehl
- Center for Psychosocial Research in GI; Feinberg School of Medicine Division of Gastroenterology & Hepatology; Northwestern University; Chicago IL USA
| | - K. L. Dowjotas
- Center for Psychosocial Research in GI; Feinberg School of Medicine Division of Gastroenterology & Hepatology; Northwestern University; Chicago IL USA
| | - L. Keefer
- Center for Psychosocial Research in GI; Feinberg School of Medicine Division of Gastroenterology & Hepatology; Northwestern University; Chicago IL USA
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750
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Abstract
Anecdotal reports of increased stigma toward mental illness among Orthodox Jews seems to conflict with an existing literature describing less stigmatization toward depression among Jewish individuals. This online survey study investigated stigma toward depression and treatment preference among Orthodox and non-Orthodox Jews (N = 391). All participants were presented with a depression vignette to assess for stigma and then randomized to a vignette depicting a treatment modality (behaviorally oriented or insight oriented) to assess for treatment preference across several delivery options (individual, group, or Internet). Results indicated elevated depression stigma among Orthodox Jews as expressed by elevated levels of secrecy, treatment-seeking stigma, family/marriage stigma, and stigmatizing experiences, but not attitudinal social distancing. No group differences were found with respect to overall treatment preference, treatment modality, or manner of delivery. Overall, participants preferred individual therapy more than group and Internet therapy and preferred group therapy more than Internet therapy. Clinical and research implications are discussed.
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