Stigma and intellectual disability: a review of related measures and future directions

Affiliate Stigma among family caregivers of individuals with dementia in China: a cross-sectional study

Background

Affiliate stigma experienced by family caregivers of individuals with dementia may seriously affect home care and prognosis of these patients. This study aimed to explore the levels of perceived affiliate stigma and its influencing factors among family caregivers of patients with dementia in mainland China, which remains a relatively unexplored topic.

Methods

In this cross-sectional study, purposive sampling was used to recruit dementia family caregivers from an online communication group between April and May 2022. A total of 727 eligible caregivers were included and asked to complete the demographic questionnaire, the affiliate stigma scale, and the caregiver burden inventory. Descriptive statistics, independent sample t-test, one-way analysis of variance, Pearson correlation analysis, and multiple linear regression were used to explore the factors that influence perceived affiliate stigma among dementia family caregivers.

Results

The mean score for affiliate stigma of dementia family caregivers was 48.09 ± 16.38 (range: 22-86). Whether there were regular breaks during patient care, time-dependent burden, developmental burden, physical burden, and social burden were significant factors influencing the affiliate stigma of dementia family caregivers.

Conclusion

Dementia family caregivers showed a moderate to high level of affiliate stigma. Those who had regular breaks during patient care, higher time-dependent burden, developmental burden, and physical burden and lower social burden exhibited higher levels of affiliate stigma.

A new measure of physicians' erroneous assumptions towards adults with intellectual disability: A first study

BACKGROUND

Incomplete knowledge and unfamiliarity with intellectual disability (ID) contribute to erroneous assumptions of physicians towards ID, which negatively impact the health equity of people with ID. This study aimed to identify the erroneous assumptions that, based on the ID stakeholders' perceptions, were the most prevalent in physicians and damaging for the healthcare of adults with ID, verify their unidimensionality and that no personal characteristics of ID stakeholders were associated with their ratings of erroneous assumptions' prevalence and damage.

METHODS

Seventy-four possible physician erroneous assumptions were developed concerning health, daily living skills and quality of life of individuals with ID. ID stakeholders rated each one for perceived prevalence in physicians and damage for the healthcare of adults with ID. Frequency analysis, exploratory factor analysis and correlations were run separately for participants' prevalence and damage ratings.

RESULTS

Twenty-seven erroneous assumptions were identified as those perceived most prevalent and damaging. Their unidimensionality was ascertained and participants' characteristics were not associated with their prevalence and damage ratings.

CONCLUSIONS

The identified assumptions are appropriate to represent the items of a new instrument that can be used in medical education to guide the development of curricula to change erroneous assumptions.

Developmental disabilities in Africa: A scientometric review

BACKGROUND

Developmental disabilities are disproportionately more investigated in higher-income countries. However, global prevalence of developmental disabilities indicate that a large proportion of individuals with disabilities reside in low- and middle-income nations.

AIMS

The present work therefore aims to conduct a scientometric review to survey available literature on developmental disabilities in low- and middle-income countries belonging to the continent of Africa.

METHODS AND PROCEDURES

A literature search was conducted on Scopus, where a total of 1720 relevant publications (and an accompanying 66 thousand references) were found, representing research conducted between 1950 to 2022. Then, document co-citation analysis was performed to chart significant co-citation relationships between relevant articles and their cited references.

OUTCOMES AND RESULTS

The generated network based on document co-citation analysis revealed a total of 14 distinct thematic research clusters and 12 significant documents that have been frequently cited in the literature on developmental disabilities in Africa.

CONCLUSIONS AND IMPLICATIONS

The scientometric review revealed a trend of broadening research towards systems of care, away from a medical model of disease. It is projected that future research will continue to capitalise on inter-disciplinary strengths to arrive at a more nuanced understanding of developmental disability from all levels - individuals, families, to communities.

Affiliate stigma and related factors among parents of autism spectrum condition: A pilot study from mainland China

BACKGROUND

Autistic individuals show differences in social and behavioral performances. Autism-related stigma affects autistic children as well as their caregivers (e.g., parents). Research has shown that stigmatizing reactions from others toward caregivers of autistic children are common and that these caregivers suffer from affiliate stigma.

AIMS

To examine the level of affiliate stigma among parents of autistic children and its predictive factors in mainland China.

METHODS

This was a cross-sectional study involving parents of autistic children from mainland China. The sample consisted of 183 parents (mean age  =  36.5 years). The measures assessed included demographic characteristics, and parents completed two questionnaires. The Social Responsiveness Scale (SRS) was used to evaluate the characteristics of children by their parent's subjective assessments, and the Affiliate Stigma Scale (ASS) was used to investigate the affiliate stigma level of parents.

RESULTS

The affiliate stigma levels of parents of autistic children were high, and the mean score of the affect subscale was higher than those of the other subscales. The mean ASS score differed significantly between employed and unemployed parents, those aged under 40 and over 40, and high- and low-income parents. The hierarchical regression analysis showed that parents' age, monthly household income, and mean SRS score were significant predictors of the mean ASS score. The results indicated that parents of autistic children and their children need more social support and inclusion in mainland China.

CONCLUSION

The present study confirms the importance of studying primary caregivers (i.e., parents) in the context of traditional mainland Chinese culture. Although preliminarily, findings showed that the affiliate stigma levels of parents are high in mainland China, probably due to the influence of traditional cultural values. Moreover, considering the importance of autistic child characteristics, our results suggest that we should increase public knowledge of autism, enrich the general understanding of autism, and reduce the autism-related stigma of parents in mainland Chinese societies.

Rates and Correlates of Stigmatization Expressed by Parents of Young Children with Developmental Difficulties in a Middle-Income Country

OBJECTIVE

Information on stigmatization of young children with developmental difficulties (DDs) in low- and middle-income countries (LMICs), where most children reside, is crucial to combat stigma globally. We aimed to identify rates and correlates of stigmatization of young children with DDs in a middle-income country, Turkey.

METHOD

In this cross-sectional study, parents of children aged 0 to 42 months attending Ankara University School of Medicine, Department of Pediatrics, Developmental-Behavioral Pediatrics Division for their first visit were recruited consecutively. Parents responded to the written open-ended stigma questions of the Expanded Guide for Monitoring Child Development. Stepwise logistic regression analysis was used to determine factors associated with stigmatization.

RESULTS

The sample comprised 306 children (60.8% boys) with DDs (72.9% with chronic illness/disability and 27.1% with isolated language delay). Most of the mothers (61.1%) and fathers (60.7%) had less than high school education. Stigmatization was reported by 102 (33.3%) families. Child's sex, age, and health condition were not, but 5 of 9 environmental/contextual factors examined were statistically significantly associated with stigmatization. In the logistic regression model, not receiving support from relatives/friends (odds ratio [OR] = 4.97, 95% confidence interval [CI] = 2.16-11.48) and feelings of depression in the mother were independent factors associated with stigmatization (OR = 2.16, 95% CI = 1.04-4.50).

CONCLUSION

In a referred sample from Turkey and likely other LMICs, a large proportion of parents of young children with DDs report having experienced stigmatization at their first developmental assessment. Interventions that aim to address stigmatization in this early period must focus on support from family/friends and maternal mental health, which are independent strong correlates of stigma.

Impact of the intellectual disability severity in the Spanish Personal Outcomes Scale

BACKGROUND

The interest in measuring quality of life (QoL) in persons with intellectual disability (ID) has brought about a number of QoL measurements for this population. These measurements need to address two issues that have contributed to enhancing the current instruments. First, the necessity to develop measures with adequate psychometric properties, which has been discussed in recent studies, and second, the agreement between experts in analysing objective and subjective perspectives, as well as the use of self-report to include the participation of the person with ID. The question that we set out to investigate in this paper is whether the measurements function properly for the person with ID, independent of their level of severity. We used the Spanish version of the Personal Outcomes Scale, as it is a psychometrically sound instrument and includes three sources of information (the person with ID, a professional and a family member).

METHOD

The sample was composed of 529 persons with ID (296 men, representing 55.95% of the total sample, and 233 women, with M_age  = 35.03, SD = 10.82) from several regions of Spain, along with their professional of reference and a family member. The severity variable was estimated for each item based on estimations of differential item functioning.

RESULTS

The results showed that several items were undervalued by the assessments if the severity of the ID was greater. Mainly, this difference was observed in the assessments by professionals and in the dimensions of rights, personal development and self-determination.

CONCLUSIONS

This paper focuses on the uses and interpretations of the results of the QoL measurements in the Personal Outcomes Scale. The results indicate that, in our sample, when people with high levels of ID are assessed, the functioning of some items are affected by the severity of this disability. For correct use, these items must be interpreted on the basis of the results obtained. Additionally, it is necessary to thoroughly review the QoL indicators for persons with severe or profound ID.

Public stigmatisation of people with intellectual disabilities: a mixed-method population survey into stereotypes and their relationship with familiarity and discrimination

PURPOSE

Stigmatisation can negatively affect opportunities for people with intellectual disabilities to participate in society. Stereotyping, a first step in the process of stigmatisation, has been insufficiently explored for people with intellectual disabilities. This study examined the general public's set of stereotypes that is saliently attributed to people with intellectual disabilities as well as the relationship of these stereotypes with discriminatory intentions and familiarity.

MATERIALS AND METHODS

A mixed-method cross-sectional survey within a representative sample of the Dutch population (n = 892) was used. Stereotypes were analysed with factor analysis of a trait-rating scale, and qualitative analysis of an open-ended question. The relationship between stereotypes and discrimination as well as familiarity with people with intellectual disabilities was explored through multivariate analyses.

RESULTS AND CONCLUSIONS

Four stereotype-factors appeared: "friendly", "in need of help", "unintelligent", and "nuisance". Stereotypes in the "nuisance" factor seemed unimportant due to their infrequent report in the open-ended question. "Friendly", "in need of help", "unintelligent" were found to be salient stereotypes of people with intellectual disabilities due to their frequent report. The stereotypes did not relate to high levels of explicit discrimination. Yet due to the both positive and negative valence of the stereotypes, subtle forms of discrimination may be expected such as limited opportunities for choice and self-determination. This may affect opportunities for rehabilitation and might be challenged by protest-components within anti-stigma efforts.IMPLICATIONS FOR REHABILITATIONThere is currently sparse input for anti-stigma campaigns regarding people with intellectual disabilities.Anti-stigma interventions may benefit from adopting protest elements: education of the general public about inequalities that are experienced by people with intellectual disabilities.Especially support staff should be informed about the experienced and/or anticipated stigma of people with intellectual disabilities.As a way of opposing stigma, support staff should empower people for example by conducting strategies to disclose their (intellectual) disabilities.People with intellectual disabilities can challenge stigma by learning to tell a positive narrative on the lives they lead, using their strengths and coping with their limitations.

Dehumanization, prejudice, and social policy beliefs concerning people with developmental disabilities

We investigated the nature of prejudice toward people with developmental disabilities, its potential roots in dehumanization, its implications for social policy beliefs affecting this target group, and strategies for reducing prejudice toward people with developmental disabilities. Studies 1 ( N = 196, MTurk) and 2 ( N = 296, undergraduates) tested whether prejudice took a hostile or ambivalent (both hostile and benevolent components) form. Consistent support for a hostile prejudice model was found. This model was comprised of beliefs that people with developmental disabilities may harm others, should be kept separate from others, and are dependent on others. Also, greater dehumanization was associated with greater prejudice, and prejudice mediated the effect of dehumanization on participants’ social policy beliefs. Study 3 ( N = 151, MTurk) provided construct validity for the newly developed multidimensional measure of prejudice. Study 4 ( N = 156, undergraduates) showed that presenting a person with developmental disabilities in either humanizing or individuating ways reduced dehumanization and prejudice and, in turn, increased the favorability of social policy beliefs.

The role of integrated behavioral health in caring for patients with metabolic disorders

This review of integrated behavioral health (IBH) provides a background on IBH models, and the benefits of IBH in pediatric practice with an emphasis on how IBH specialists can collaborate with families and clinicians. An overview of intellectual disability (ID) and psychiatric disorders focused on disorders of inborn errors of metabolism (IEM) highlights issues in assessment and monitoring of these patients with implications for clinical practice and the role of IBH in caring for patients with IEM disorders.

Persons with disabilities as experts-by experience: using personal narratives to affect community attitudes in Kilifi, Kenya

BACKGROUND

The last decade has seen improved public awareness of disability in sub-Saharan Africa. However, negative and stereotypical views of disability still persist in many communities. We conducted a study to promote awareness of disability in rural Kenya, using a process of reflection and education. This paper reports on the second aspect - education. The research question was: How can personal narratives of living with disability affect community attitudes and responses to disability?

METHODS

A qualitative phenomenological approach was adopted. Twenty community-based groups involving 249 participants took part. Each group participated in one focus group discussion at baseline, to explore the members' personal experiences and views of disability. The intervention involved three adults with disabilities sharing their personal narratives with each group. After the intervention, repeat focus group discussions were conducted with each group. Thematic analysis was carried out according to the framework method.

RESULTS

The emergent framework consisted of four main themes, organised as opposing constructs: 'burden' and 'agency', 'sub-human' and 'human'. 'Burden' focused on the perceived hopelessness of the situation. Post-intervention revealed greater support for the 'agency' of persons with disabilities, evidenced by what the person could do, rather than their inability, and the relevance of support. The 'sub-human' to 'human' construct captured dehumanising and discriminating practice towards persons with disabilities on one side, and recognition of the person and inclusion in the community on the other. Whilst support and empathy were evident at the pre-intervention stage, post-intervention revealed greater recognition of people with disabilities as fellow human beings.

CONCLUSION

This study provides a proof of concept regarding the deployment of persons with disabilities as agents for change. Exposure to experts-by-experience provided community groups with opportunities to reflect on, examine and adjust their views on disability in this rural part of Kenya. The sharing of personal narratives appeared to resonate with group members, to encourage recognition of the person and not just the disability, and to move their resolve toward ideas for collective action. Further research is needed to assess the effects of such interventions.

Explicit and implicit attitudes towards people with intellectual disabilities: The role of contact and participant demographics

BACKGROUND

Intellectual disability research has concentrated on self-reported explicit attitudes with little focus on implicit attitudes. Such attitudes are evaluations which occur with or without conscious awareness, respectively. This investigation examined participants' (N = 234) attitudes towards individuals with intellectual disabilities with reference to participants' gender, age, level of education, frequency of contact and closeness.

METHOD

UK adults completed explicit (ATTID) and implicit attitude (ST-IAT) measures, and provided demographics via an online survey.

RESULTS

Participant demographics predicted explicit attitudes-with differing cognitive, affective and behavioural associations. Contact frequency was most significant. Implicit attitudes were not predicted, evidencing implicit-explicit attitude differences.

CONCLUSIONS

The results encourage more implicit-explicit attitude relationship research regarding disability. The associations between demographics, contact and implicit attitudes should be explored further. Research should question whether implicit attitudes reflect participants' true beliefs-denoting less importance to demographics-or whether they reflect wider societal values rather than individuals' attitudes.

Increasing positive attitudes toward individuals with disabilities through community service learning

Providing equal-status contact between those with and without disabilities can improve attitudes and reduce discrimination toward individuals with disabilities. This study investigated community service learning as a means by which to provide college students with equal-status contact with individuals with disabilities and increase their positive attitudes toward those with disabilities. A total of 166 college students in one university in the United States enrolled in an Introduction to Disability course received content on disability in society and participated in community service involving 20h of direct contact with individuals with disabilities. Findings indicated that college students who had prior contact with individuals with disabilities had more positive attitudes toward individuals with disabilities than college students who did not have prior contact at the start of the course. For the college students who did not have any prior contact, their attitudes toward individuals with disabilities became significantly more positive at the end of the community service learning course. Implications and suggestions for future research are discussed.

The influence of stigma on the quality of life for prostate cancer survivors

The purpose of the present study was to investigate the influence of stigma on prostate cancer (PCa) survivors' quality of life. Stigma for lung cancer survivors has been the focus of considerable research (Else-Quest & Jackson, 2014); however, gaps remain in understanding the experience of PCa stigma. A cross-sectional correlational study was designed to assess the incidence of PCa stigma and its influence on the quality of life of survivors. Eighty-five PCa survivors were administered survey packets consisting of a stigma measure, a PCa-specific quality of life measure, and a demographic survey during treatment of their disease. A linear regression analysis was conducted with the data received from PCa survivors. Results indicated that PCa stigma has a significant, negative influence on the quality of life for survivors (R² = 0.33, F(4, 80) = 11.53, p < 0.001). There were no statistically significant differences in PCa stigma based on demographic variables (e.g., race and age). Implications for physical and mental health practitioners and researchers are discussed.

Social workers' attributions towards individuals with dual diagnosis of intellectual disability and mental illness

BACKGROUND

The present study aimed to explore the applicability of the attribution model to social workers' attributions towards clients with dual diagnosis of intellectual disability and psychiatric illness. Specifically, the study examined the relations between social workers' attribution of responsibility, causality, stereotypes of dangerousness, their emotional reactions and behavioural reactions towards clients with dual diagnosis.

METHOD

Social workers (N = 279) completed questionnaires measuring attributions of responsibility, causation and dangerousness, and reported on their emotional and behavioural reactions to clients diagnosed with DD.

RESULTS

Most social workers reported high levels of helping behaviours. The strongest predictor of discriminatory behaviours was the stereotype of dangerousness. Social workers who reported feeling less anger and more pity towards clients with DD tended to report higher levels of helping behaviour. But contrary to attribution theory, fear and anger did not predict discriminatory behaviours.

CONCLUSION

The results are discussed in relation to the core values of social work and to professional identity.

Measuring public discomfort at meeting people with disabilities

The discomfort reported by the general public at the prospect of personal contact with marginalised groups is an expression of the stigma they experience. This has been widely studied in relation to ethnic minorities and immigrants but less so for persons with disabilities. A national survey with a representative sample of over 1100 Irish adults provided an opportunity to examine reported discomfort with persons who had different impairments, including mental health conditions, with four other minority groups. Moreover, the personal and situational variables associated with expressions of discomfort were identified. Respondents were most comfortable having persons with physical and sensorial disabilities living in their neighbourhood or in their workplace but less so for persons with intellectual disabilities and even less for people with mental health conditions. They were much less comfortable with the four other social groups: gay, lesbian or bisexual people; Eastern European migrant workers; black and ethnic minority groups and least of all, travellers. Moreover, a factor analysis confirmed that the scores given to the impaired groups were significantly correlated with each other but less so with the other four social groupings, although these were significantly inter-correlated among themselves. Respondents who were more comfortable with both sets of minority groups tended to have more social connections in their personal lives and to reside in towns or villages rather than cities. They also expressed more positive attitudes to the inclusion of persons with disabilities in Irish society. The gradient in levels of public discomfort across minority groups may provide a sensitive indicator of the differential stigma experienced by persons with impairments within societies but there remains the possibility that an alliance with other minority groups would also help to promote more positive attitudes and reduce their wider social exclusion.

Public stigma in intellectual disability: do direct versus indirect questions make a difference?

BACKGROUND

Stigma may negatively impact individuals with intellectual disabilities (ID). However, most studies in the field have been based on the use of direct measurement methods for assessing stigma. This study examined public stigma towards individuals with ID within a representative sample of the Israeli public by comparing direct versus indirect questioning.

METHODS

Vignette methodology was utilised with two questionnaire versions. In the direct questionnaire (n = 306), the participants were asked how they would think, feel and behave if a man with ID asked them a question in a public place. In the indirect questionnaire (n = 301), the participants were asked to report how a hypothetical 'other man' would think, feel and behave in the same situation.

RESULTS

Higher levels of stigma were reported among participants that answered the indirect questionnaire version. Furthermore, among those participants that answered the indirect questionnaire version, subjective knowledge of ID was a less important correlate of stigma than for those participants that answered the direct questionnaire.

CONCLUSION

Several explanations are suggested for the finding that indirect questioning elicits more negative stigmatic attitudes. Among others, indirect questioning may be a more appropriate methodology for eliciting immediate beliefs. Furthermore, the results call for implementing a comprehensive, multi-level programme to change stigma.

The role of personality variables in predicting attitudes toward people with intellectual disability: An Australian perspective

BACKGROUND

Personality dimensions such as openness and agreeableness have been found to be associated with prejudice levels towards several minority groups. Yet these variables have been mostly ignored by existing research into attitudes towards people with intellectual disability (PWID), which has primarily focused on contact and demographic variables. The current study investigated the relationship between personality dimensions and attitudes toward PWID.

METHODS

An online survey was completed by 466 adult participants recruited through a variety of sources. The survey consisted of a well-validated attitude survey, the Big Five inventory, contact related and demographic questions.

RESULTS

The hypothesis that higher levels of the personality dimensions openness and agreeableness would be significantly associated with positive attitudes towards PWID was supported. However the effect was relatively weak and the strongest predicting factor of positive attitudes was increased quality of contact with PWID. More positive attitudes were also associated with females, more highly educated and younger participants.

CONCLUSIONS

Results provide support for an integrated (including person and situational factors) theoretical approach to attitudes research in this field. Practically, results support programmes that stimulate and promote quality interactions between PWID and the wider community.

Does type of disability make a difference in affiliate stigma among family caregivers of individuals with autism, intellectual disability or physical disability?

BACKGROUND

Studies have shown that beyond public and self stigma, stigma can also impact family members. Only scant research has examined the internalised aspects of stigma, known as affiliate stigma, among family caregivers of individuals with disabilities. This study examined affiliate stigma among family caregivers of individuals with developmental disabilities via a comparison between caregivers of individuals with intellectual disabilities (ID), autism spectrum disorders (ASD) and physical disabilities (PD) in Israel.

METHODS

Family caregivers (n = 171) of individuals with developmental disabilities, mainly ID (22.4%), ASD (32.9%) and PD (27.1%), completed a self-report structured questionnaire including the Affiliate Stigma Scale and background variables.

RESULTS

Results supported a one-factor structure for the Affiliate Stigma Scale. Overall, affiliate stigma was relatively low in this sample, but was found to be higher among caregivers of individuals with ASD when compared with caregivers of individuals with ID or PD.

CONCLUSION

Findings from this study point to the importance of supporting caregivers of individuals with ASD to decrease their feelings of stigma. It is also important to further develop scales measuring affiliate stigma in order to capture the multi-dimensional nature of the concept.

Interventions aimed at increasing knowledge and improving attitudes towards people with intellectual disabilities among lay people

Despite policies aimed at ensuring equal rights and maximising respect and social inclusion for people with intellectual disabilities, in their daily lives many continue to face negative attitudes and discrimination within society. Misconceptions about what it means to have an intellectual disability and about the capabilities of people with intellectual disabilities appear widespread, and may contribute to prejudice and discrimination. This review provides a summary and evaluation of empirical interventions aimed at increasing knowledge and targeting negative attitudes towards this population among lay people of working age. An electronic search using PsycINFO, Web of Science and PubMed identified 22 English language studies published between 1990 and early 2014 that reported a specific intervention with a lay population sample. The majority of studies reported promising outcomes, particularly those aimed at increasing knowledge of intellectual disability through education. Support for the positive influence of contact with people with intellectual disabilities was demonstrated across several interventions. Interventions delivered at least partly by individuals with intellectual disabilities, and educational interventions appear to hold the most promise. The evidence is limited though by the weaknesses of measurement tools employed.

Stigma: Barriers to Culture and Identity for People With Intellectual Disability

This exploratory article examines disability culture and identity for people with intellectual disability. In doing so, we argue that the stigma around intellectual disability severely affects people with intellectual disability's sense of culture and identity. This stigma causes internalized ableism and leads to people with intellectual disability disassociating from other people with intellectual disability in an attempt to cope with this stigma. True community inclusion for people with intellectual disability can only occur when this stigma is removed. Fortunately, as we argue, the self-advocacy movement is making great strides in doing so. The self-advocacy movement must be supported to achieve true inclusion and a sense of culture and identity for people with intellectual disability.

Medical students' attitudes towards people with intellectual disabilities: a literature review

The present paper provides a review of research on medical students' attitudes to people with intellectual disabilities. The attitudes of medical students warrant empirical attention because their future work may determine people with intellectual disabilities' access to healthcare and exposure to health inequalities. An electronic search of Embase, Ovid MEDLINE(R), PsycINFO, Scopus, and Web of Science was completed to identify papers published up to August 2013. Twenty-four studies were identified, most of which evaluated the effects of pedagogical interventions on students' attitudes. Results suggested that medical students' attitudes to people with intellectual disabilities were responsive to interventions. However, the evidence is restricted due to research limitations, including poor measurement, self-selection bias, and the absence of control groups when evaluating interventions. Thus, there is a dearth of high-quality research on this topic, and past findings should be interpreted with caution. Future research directions are provided.

Stigma, public awareness about intellectual disability and attitudes to inclusion among different ethnic groups

BACKGROUND

Attitudes to the inclusion of people with intellectual disabilities (IDs) have been studied extensively, yet evidence on public awareness about ID and stigma is limited. The relationship between attitudes, knowledge and stigma associated with ID is poorly understood. The present study examined these factors and the relationships between them in the context of a multicultural society.

METHOD

UK residents of working age (n = 1002) were presented with a diagnostically unlabelled vignette of someone with a mild ID. They were asked to label the difficulties presented and to complete measures of social distance and attitudes to the inclusion of people with IDs.

RESULTS

While attitudes to the inclusion of people with IDs were relatively positive overall, social contact was viewed with ambivalence. Inclusion attitudes and social distance were only moderately correlated. Across the whole sample 28% recognised typical symptoms of mild ID. Recognition of ID was associated with lower stigma and more positive attitudes than attribution of the difficulties presented to other causes. White Westerners showed increased knowledge, lower stigma and favoured inclusion more than participants from ethnic minorities. Among the latter group, Asians showed lower stigma and attitudes more in line with inclusion policies than participants of Black African/Caribbean backgrounds. Once a host of contextual factors were considered jointly, only contact was consistently associated with the variables measured.

CONCLUSIONS

Stigma associated with ID is of concern across all ethnic groups, although it appears to be increased among the public from ethnic minorities. Given that contact and awareness are associated with reduced stigma, they should be considered as prime foci for efforts to tackle ID stigma. The current findings serve as baseline for attempts to increase public awareness and tackle stigma.

Awareness of schizophrenia and intellectual disability and stigma across ethnic groups in the UK

Research has examined the public's understanding of mental illness and stigma, but there is scant evidence on intellectual disabilities. This study investigated whether the public from different ethnic groups can recognise symptoms of schizophrenia and intellectual disability depicted in a vignette, and what factors predict recognition and social distance. A survey of lay people of working age was completed in the UK (N=1002). The sample was ethnically mixed, with the largest groups consisting of white UK residents, and people from Asian and black African/Caribbean backgrounds. Regression analyses were performed to identify predictors of recognition and social distance. Across the whole sample, 25.7% recognised schizophrenia and 28.0% intellectual disability. Ethnicity, gender, education and prior contact predicted recognition of both vignettes. Social distance was higher for schizophrenia than intellectual disability, but overall participants were ambivalent to mildly negative about social contact with individuals with either symptomatology. Familiarity was associated with lower social distance for both conditions. Symptom recognition predicted reduced social distance for intellectual disability, but not for schizophrenia. The low levels of awareness of symptoms and high levels of stigma among some ethnic groups indicate a need for targeted public education efforts and further research.

Tackling stigma associated with intellectual disability among the general public: a study of two indirect contact interventions

Although evidence abounds that people with intellectual disabilities are exposed to stigma and discrimination, few interventions have attempted to tackle stigma among the general public. This study set out to assess the impact of two brief indirect contact interventions on lay people's inclusion attitudes, social distance and positive behavioral intentions, and to explore emotional reactions towards the two interventions. 925 participants completed the first online survey. Participants were randomized to watch either a 10 min film based on intergroup contact theory, or a film based on a protest message. In total, 403 participants completed the follow-up survey at one month. Both interventions were effective at changing inclusion attitudes and social distance in the short term and these effects were partially maintained at one month. The protest based intervention had a greater effect compared to the contact one on aspects of inclusion attitudes and evoked stronger emotional reactions. Despite small effect sizes, brief indirect contact interventions may have a potential role in tackling public stigma associated with intellectual disability but their effects on behavioral intentions are questionable.

Attitudes towards people with intellectual disabilities: a comparison of young people from British South Asian and White British backgrounds

Research with South Asian families of individuals with intellectual disabilities (ID) suggests an increased fear of stigma and isolation from the community. Evidence on attitudes towards ID among the wider community is very limited and was the focus of the present study. Responses were collected from 737 college students aged 16-19 using the Community Living Attitudes Scale-ID version. Results indicated that British South Asians (n=355) were less in favour of the social inclusion of people with ID than White British young people (n=382). British South Asian adolescents were more likely to hold the view that people with ID should be sheltered and not empowered. It is proposed that future inclusion policies integrate ethnic minority views whose religious and cultural values do not always conform to the core values of social inclusion policies. It is also proposed that culturally specific school based interventions could be introduced with the aims of decreasing stigma and fostering attitudes in line with the aims of normalisation.

Self stigma in people with intellectual disabilities and courtesy stigma in family carers: a systematic review

People with intellectual disability are one of the most stigmatised groups in society. Despite this, research in this area has been limited. This paper provides a review of studies examining self stigma in people with intellectual disability, and courtesy and affiliate stigma in family carers. An electronic search of studies published between 1990 and February 2012, using four databases and hand searching of journals was conducted. Thirty-seven papers were included in the review: 17 studies examined self stigma and 20 studies examined courtesy or affiliate stigma. The findings indicate that both individuals and family carers experience stigma and that it may have a negative impact on psychological wellbeing. Awareness of stigma in people with intellectual disability appears to be related to the extent to which individuals accept and internalise the label of intellectual disability. Most of the studies were qualitative studies or small descriptive studies. There is a lack of large prevalence studies and longitudinal studies examining the impact of stigma, in both individuals with intellectual disability and their carers.

Youth leadership program for changing self-image and attitude toward people with disabilities

Society has a negative attitude toward people with intellectual disabilities or psychiatric disabilities. It is well documented that they are subjected to prejudice, stigma, and negative attitudes (Di Giulio, 2003; Finger, 1994). Professional literature indicates that information about disabilities and encounters with persons with disabilities can change negative attitudes (Carter, Hughes, Copeland, & Breen, 2001; Krajewski & Flaherty, 2000). This study accompanied 164 9th-grade students from various junior high schools throughout Israel. Half of the students participated in an integration program for changing attitudes toward persons with disabilities, and the other half served as the control group. The research examined the existence and the degree of relationship between participation in the program, changes in attitudes toward people with disabilities, and self-image. The research findings pointed to a positive change in attitudes of the participants of the program in comparison with the control group, resulting mainly from personal contact with people with disabilities. No relationship was found between levels of self-image of the research group and attitudes toward people with disabilities.