The Self-Stigma Process in Criminal Offenders

Development and Initial Validation of Measures of Proximal Stigmas and Experiences of Discrimination for Minor Attracted People

Stigma-related stressors are central to understanding psychopathology, distress, and coping in stigmatized groups; individuals who experience attractions to children are a highly stigmatized group. Currently, few validated self-report measures exist to assess stigma-related stressors in minor attracted people (MAPs) and the current research describes the development and initial validation of two measures of internalized stigma and experiences of discrimination. A sample of MAPs (n = 289; mean age = 31.8 years, SD = 12.2) was recruited online and completed a set of self-report measures assessing stigma-related stress, negative mental health outcomes, substance use, and coping. Exploratory factor analyses of the two newly developed stigma-related stress measures were conducted and convergent associations with other constructs were examined for validity evidence. Exploratory factor analyses indicated a two-factor solution to both the measure of internalized stigma and experiences of discrimination. The total scale scores and factors scores generally demonstrated the anticipated patterns of correlations with mental health concerns, distress, coping, and substance use. Clinical intervention with MAPs may benefit from an exploration of stigma-related stressors in clients' lives to improve mental health outcomes. The relatively large sample that was recruited from multiple online forums is a strength of the current study. The use of a self-report measurement modality for all measures used in the study weakens that strength of the validation evidence presented here. These results provide initial validity evidence for the measures of stigma-related stress in MAPs and the promise of stigma processes in understanding negative outcomes in this population.

Self-stigma of incarceration and its impact on health and community integration

BACKGROUND

Individuals returning to the wider community from incarceration face many re-entry barriers, including stigmatising beliefs regarding past criminal record, that have impact on health and re-entry. Understanding the development and impact of self-stigma on health can inform re-entry and rehabilitation services.

AIMS

The two aims of this study were first, to evaluate a previously established model of self-stigma applied to individuals who have experienced incarceration and, secondly, to study the impact of self-stigma on physical and mental health as well as community integration on re-entry.

METHODS

This is a cross-sectional study of 129 formerly incarcerated adults recruited using an online platform and asked to complete online rating scales about self-stigmatisation, health and sense of community integration. Repeated-measures analysis of variance, correlation analysis, and path analyses were used to evaluate the model.

RESULTS

There was support for the four distinct stages of self-stigmatisation apparent in mental health research. There was a relationship between self-stigma harm and sense of community integration, mediated by mental but not physical health status scores.

CONCLUSION

Our findings add to work on self-stigmatisation in the field of mental health by showing that the concept appears relevant and appears in similar staging among formerly incarcerated individuals and that self-stigmatisation is likely to be important for their community reintegration. Our sample was not typical of the wider prison population for race and gender distribution, in particular having fewer than expected those minority groups likely to be especially vulnerable to stigmatisation by others. Our findings nevertheless suggest that further, preferably, longitudinal research on self-stigma to enable better understanding of pathways could substantially help treatment and rehabilitation of individuals after release from a correctional facility.

Perceived stigma in burn survivors: Associations with resourcefulness and alexithymia

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Peer Mentors as Prison Volunteers: Building Bridges Between Institutions and Communities

One creative way that Departments of Corrections offset costs is by relying on volunteers. Prison volunteers are a heterogeneous group, who provide various programs to incarcerated populations. One unique subset of prison volunteers are peer mentors, who are individuals who have experienced criminal justice interventions and have desisted from criminal activities. These mentors provide unique guidance to individuals who are currently incarcerated or are preparing for release. The current study analyzed responses from peer mentors (N = 51) and explored their motivations and experiences. Thematic analysis was utilized to assess self-reported motivations and thoughts. Participants described internal, relational, and religious/community-based motivations for facing the barriers and challenges inherent in returning to prisons, in order to provide volunteer services. There is little known about prison volunteers and less about peer mentors. We encourage future research and policy to capitalize on the unique benefits peer mentors may provide incarcerated individuals.

The role of substance use treatment in reducing stigma after release from incarceration: A qualitative analysis

BACKGROUND

People with substance use disorders (SUD) who have been involved in the legal system often experience stigma upon reentry into the community after incarceration. Although substance use treatment can sometimes be a source of stigma, it may also reduce stigma by facilitating connections with providers, reducing distress, or helping people feel more integrated in their community. However, research has rarely examined the potential for treatment to reduce stigma.

METHODS

This study examined stigma experiences and the degree to which substance use treatment reduced stigma among 24 people with SUDs who were receiving care in an outpatient treatment facility after release from incarceration. Qualitative interviews were conducted and analyzed using a content analysis approach.

RESULTS

Participants reported negative self-judgements as well as perceiving negative judgments from the community upon reentry. With regard to stigma reduction, themes emerged around substance use treatment repairing strained family relationships and reducing participants' self-stigma. Aspects of treatment that reportedly reduced stigma included the treatment facility having a nonjudgmental atmosphere, patients trusting the staff, and working with peer navigators who had lived experience of SUD and incarceration.

CONCLUSIONS

Results from this study suggest that substance use treatment has the potential to decrease the negative impacts of stigma upon release from incarceration, which continues to be a major barrier. Though more research on stigma reduction is needed, we suggest some preliminary considerations for treatment programs and providers.

Support, don't punish: Drug decriminalization is harm reduction

Despite large investments in and policy support for harm reduction including naloxone, syringes, and medications for opioid use disorder, people who use drugs continue to experience unprecedented rates of mortality from overdose and morbidity from infectious diseases. The criminalization of drug use has disproportionately exacerbated these drug-related harms and imposed short- and long-term burdens on already marginalized and vulnerable populations. Pharmacy professionals and students are not immune to the effects of drug criminalization, where one conviction can lead to the loss of their license, employment, or educational progress. Communities become less healthy and stagnate in punitive criminalization systems, further reducing opportunities for growth. Decriminalization of drug use and possession is an urgently needed and effective approach to drug use that shifts resources from punishment to public health, thereby reducing the negative impacts of drug use and keeping communities safe and healthy. Pharmacists play essential roles in the prevention and management of drug misuse and use disorders. As policy makers consider and implement drug decriminalization, pharmacists must actively advocate for these policies and educate community and organizational partners on the individual, professional, and community benefits of this harm reduction strategy.

Discrimination, social support, and health-related quality of life among individuals with criminal records

Several studies have found an association between social identity-based discrimination and reduced physical health. Research also indicates that social support may sometimes protectively moderate this relationship. This study addresses the lack of sufficient research regarding these connections among individuals facing criminal record discrimination. The authors analyzed the responses of 168 people with felony records who completed a nationwide, online survey. While controlling for several other potentially impactful variables, the authors used regression analyses to explore the relationship between criminal record discrimination and reported healthy days per month and whether social support protectively moderated this relationship. There was a significant negative association between criminal record discrimination and healthy days among those with notably low social support. Meanwhile, moderate levels of social support appeared to protectively extinguish this relationship. This study suggests that social support may influence whether criminal record discrimination negatively impacts health.

Burn self-stigma: A hybrid concept analysis

AIM

As burn self-stigma has not been addressed fully, the purpose of current study is to analyze dimensions of the concept using literature and lived experiences in burn survivors.

METHODS

Using hybrid concept analysis method, we investigated self-stigma in three phases (i.e. theoretical, fieldwork, and final analytical phase). In the first phase we reviewed the literature using PubMed, SCOPUS, Web of Science, Cochrane Library, OVID, SID and Google Scholar. Thirteen semi-structured interviews with burn survivors were conducted during the fieldwork phase. Two extra interviews with health care providers were undertaken for the aim of data triangulation. Textual content analysis and inductive content analysis were used to analyze the data of the first and second phases of this study, respectively. The findings of both phases were combined in the final analytical phase and a comprehensive definition was emerged.

RESULTS

We assigned all our findings into three content areas (i.e. antecedents, properties and consequences), which are dimensions of self-stigma. In final analytical phase antecedent, properties and consequences of the concept were formed in one (society's misconception about burns), three (negative definition of self, emotional responses, and behavioral responses), and three (negative individual effects, negative social effects, and negative familial effects) categories, respectively. Based on these categories and their corresponding subcategories, a comprehensive definition of the concept was presented.

CONCLUSION

Burn self-stigma is a state in which burn survivors experience unfavorable thoughts and feelings about themselves as a result of society's misconceptions about them. They give emotional and behavioral responses that define them in a negative way. In the end, the burn survivor's individual, familial, and social dimensions are significantly impacted.

Characterisation of social support following incarceration among black sexual minority men and transgender women in the HPTN 061 cohort study

OBJECTIVE

To examine longitudinal associations between recent incarceration and subsequent social support among black sexual minority men and transgender women, and whether associations differed between those who did and did not have support prior to incarceration.

DESIGN

A secondary analysis in 2020 of data from the HIV Prevention Trials Network 061, a cohort study of black sexual minority men and transgender women recruited in 2009-2010 and followed for 12 months.

SETTING

Six US cities (Atlanta, Boston, Los Angeles, New York City, San Francisco and Washington DC).

PARTICIPANTS

Individuals ≥18 years of age who identified as black, reported being male or assigned male at birth, reported ≥1 unprotected anal intercourse event with a male partner in the past 6 months, and reported on incarceration at the 6-month follow-up visit.

EXPOSURE

Having spent ≥1 night in jail/prison in the past 6 months reported at the 6-month follow-up visit.

OUTCOME

Social support measured using a six-item scale assessing frequency of emotional/informational, affectionate and tangible support (range 6-30); and dichotomous indicators of low support for each item (ie, receiving that form of support none/little of the time).

RESULTS

Among participants who returned for the 6-month visit (N=1169), 14% had experienced incarceration in the past 6 months. Mean support score was 20.9; 18.9 among those with recent incarceration versus 21.2 among those without. Recent incarceration predicted lower support (adjusted β -2.40, 95% CI -3.94 to -0.85). Those recently incarcerated had increased risk of lacking emotional/informational (eg, no one to talk to adjusted risk ratio (aRR) 1.55, 95% CI 1.13 to 2.13) and affectionate (aRR 1.51, 95% CI 1.11 to 2.04) but not tangible support. Effects appeared somewhat stronger among those who had support at baseline.

CONCLUSIONS

Incarceration may reduce support on re-entry among black sexual minority men and transgender women, populations unequally targeted for incarceration and at risk for low support.

Mental and Physical Health Problems as Conditions of Ex-Prisoner Re-Entry

The article focuses on a less-discussed issue of social marginalization of people leaving penitentiaries, which is the prevalence of multifaceted health problems experienced by people in this category. It includes poor health status, resulting from, among others, poor housing conditions, harmful or risky lifestyle, and lack of access to medical services. Data from the District Inspectorate of the Prison Service in Lodz, Poland on the health conditions of inmates was accessed. These data were supplemented by qualitative research conducted in 21 juvenile detention centers and 8 prisons across the country, conducting direct observations and In-Depth Interviews (IDI). A total of 198 IDIs were conducted with incarcerated (72) and released (30) juvenile offenders, and incarcerated (68) and released (28) adult offenders. These were complemented by IDIs with experts (50) and Focus Group Interviews (FGIs; 8) with male and female inmates in 4 Polish prisons. The study revealed that mental and physical health is a serious obstacle to social reintegration of ex-prisoners. It is rarely addressed by state institutions. There are strong associations between neglect of health issues in the prison population and increasing social exclusion after leaving prison. As Poland has a restrictive penal policy, former prisoners remain a group with social stigma and little support.

Protective and Compensatory Effects of Group Identification on the Mental Health of People Living with HIV

Despite persistent stigmatization of people living with HIV (PLHIV) across the globe, group identification among these individuals may serve to counteract the detrimental effect of prejudice and discrimination associated with the stigmatized identity. Drawing on resilience theory and social identity theory, this study examined how multiple dimensions of group identification (i.e., in-group ties, in-group affect, and centrality) function to buffer and neutralize the negative impact of HIV stigma. A total of 281 PLHIV were recruited from the only community-based public HIV clinic in Hong Kong to participate in this study. The results revealed a protective effect of in-group affect, which moderated the relationship between HIV stigma and mental health, such that HIV stigma was not associated with mental health among people with higher positive in-group affect. In addition, a positive compensatory effect of in-group ties was found in people with higher HIV identity centrality. Given the protective effect of in-group affect, it is important to re-story the lives among PLHIV by challenging their maladaptive beliefs about being PLHIV and building a positive sense of identity in their personal narratives. Community-based interventions should be provided to individuals with higher HIV identity centrality by offering peer support groups and engaging them in community work.

The Impact of Criminal Record Stigma on Quality of Life: A Test of Theoretical Pathways

Across multiple stigmatized groups, research suggests that stigma may negatively impact individual wellbeing. This impact often occurs through a sequential pathway that includes perceiving societal stigma, a diminished and stereotyped self-concept (i.e., internalized stigma), experiences of discrimination and rejection, and attempts to cope with stigma (e.g., secrecy or withdrawal). While prior research supports individual links within this pathway, no study has evaluated a model representing the relationships between all of these factors in relation to criminal record stigma. This study utilized cross-sectional data from an online survey of 198 adults to test the pathways through which criminal record-related stigma impacts individual quality of life. The results indicated that perceived stigma was a significant predictor of discrimination and rejection experiences, secrecy coping strategies, and decreased quality of life. There was also a significant indirect association between perceived stigma and quality of life through secrecy coping. Consistent with recent criminal record stigma research, internalized stigma was low among respondents. These findings point to the importance of reducing criminal record stigma and discrimination, so that individuals with criminal records have more opportunities to enhance their quality of life without having to withdraw from society or keep their record a secret.

Who internalizes courtesy stigma and how? A study among Israeli Arab family caregivers of persons with dementia

Objectives: The expected rise in the number of persons with dementia is accompanied by an increasing interest in understanding and reducing the stigmatic beliefs experienced by family caregivers of persons with the disease. While researchers have recently distinguished between family caregivers' perceptions of public stereotypes (i.e., courtesy stigma) and the internalization of these perceptions (i.e., affiliate stigma), no study has yet assessed the characteristics of dementia caregivers who internalize courtesy stigma and how they do so. The aim of this study was to examine the characteristics of family caregivers of persons with dementia who internalize courtesy stigma, and to investigate this internalization process.Method: Structured face-to-face interviews were conducted with 175 Israeli Arab family caregivers (87.4% female; 71.4% adult children; mean age = 54.28) for persons with Alzheimer's disease.Results: Overall, half of the participants reported experiencing affiliate stigma as a result of taking care of a relative with dementia. Regression analyses showed that lower educational level, increased courtesy stigma and lower levels of social support were the main predictors of affiliate stigma. Social support partially mediated the association between courtesy and affiliate stigma.Conclusion: Our findings provide important insights for the conceptual understanding and the development of interventions to reduce stigma among family caregivers of persons with dementia.

Reentry interventions that address substance use: A systematic review

Justice-involved individuals with substance use problems have heightened risk of relapse and recidivism after release from incarceration, making reentry a critical time to provide evidence-based treatments (EBTs) for substance use; however, the extent to which reentry interventions incorporate EBTs for substance use is unclear. This systematic review identified studies of reentry interventions in the past 10 years that address substance use, assessed whether EBTs were used, and explored which interventions were effective in reducing substance use and recidivism postrelease. Eligible studies included interventions that began during incarceration and continued postrelease or began within 3 months of release and addressed substance use in some capacity. One hundred twelve full text articles were reviewed and 38 met inclusion criteria, representing 34 unique interventions. Of the 34 interventions, 21 provided substance use treatment whereas 13 facilitated connections to treatment. Of the 21 interventions providing treatment, the primary modalities were cognitive-behavioral therapy (n = 6), motivational interviewing (n = 2), medication assisted treatment (n = 2), therapeutic community (n = 2), psychoeducation or 12-step (n = 5), and four did not specify the modality. Of the 31 studies that assessed recidivism outcomes, 18 found reduced recidivism for the treatment group on at least one indicator (e.g., rearrest, reincarceration). Of the 13 studies that assessed substance use outcomes, 7 found reduced substance use for the treatment group on at least one indicator. Results were not consistent for any particular treatment approach or modality and highlight the need for consistent integration of EBTs for substance use into reentry interventions. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A conceptual model for understanding post-release opioid-related overdose risk

Post-release opioid-related overdose mortality is the leading cause of death among people released from jails or prisons (PRJP). Informed by the proximate determinants framework, this paper presents the Post-Release Opioid-Related Overdose Risk Model. It explores the underlying, intermediate, proximate and biological determinants which contribute to risk of post-release opioid-related overdose mortality. PRJP share the underlying exposure of incarceration and the increased prevalence of several moderators (chronic pain, HIV infection, trauma, race, and suicidality) of the risk of opioid-related overdose. Intermediate determinants following release from the criminal justice system include disruption of social networks, interruptions in medical care, poverty, and stigma which exacerbate underlying, and highly prevalent, substance use and mental health disorders. Subsequent proximate determinants include interruptions in substance use treatment, including access to medications for opioid use disorder, polypharmacy, polydrug use, insufficient naloxone access, and a return to solitary opioid use. This leads to the final biological determinant of reduced respiratory tolerance and finally opioid-related overdose mortality. Mitigating the risk of opioid-related overdose mortality among PRJP will require improved coordination across criminal justice, health, and community organizations to reduce barriers to social services, ensure access to health insurance, and reduce interruptions in care continuity and reduce stigma. Healthcare services and harm reduction strategies, such as safe injection sites, should be tailored to the needs of PRJP. Expanding access to opioid agonist therapy and naloxone around the post-release period could reduce overdose deaths. Programs are also needed to divert individuals with substance use disorder away from the criminal justice system and into treatment and social services, preventing incarceration exposure.

Buffering Internalization of HIV Stigma: Implications for Treatment Adherence and Depression

BACKGROUND

One mechanism through which social stigma of HIV affects health outcomes for people living with HIV (PLWH) is through internalization of stigma. However, this transformation of social stigma in the community into internalized stigma may not be of the same magnitude for all PLWH. We examined the moderating effects of 3 personality traits-fear of negative social evaluation, attachment-related anxiety, and dispositional resilience-in transforming perceived stigma in the community into internalized stigma. Furthermore, we investigated downstream effects of these moderated associations on depressive symptoms and antiretroviral treatment (ART) adherence.

SETTING/METHODS

In study 1, data from 203 PLWH in the Southeast United States were analyzed controlling for age, sex, education, race, and time on ART. In study 2, data from 453 women in a multisite study were analyzed controlling for age, education, race, time on ART, and substance use.

RESULTS

In both studies, fear of negative evaluation and attachment-related anxiety moderated the effect of perceived HIV stigma in the community on internalized HIV stigma: People higher on those moderating variables had stronger associations between perceived stigma in the community and internalized stigma. In study 2, resilience was assessed and also moderated the effect of perceived HIV stigma in the community on internalized stigma. In moderated mediation models, fear of negative evaluation, attachment-related anxiety, and resilience moderated the indirect effect of perceived HIV stigma in the community on ART adherence and depression through internalized stigma.

CONCLUSIONS

Interventions to assuage internalization of HIV stigma should focus on bolstering attachment-related security, social competence, and resilience.

Self-stigma among Criminal Offenders: Risk and Protective Factors

Those involved in the criminal justice system are swiftly identified as "criminals." Receipt of this label may promote self-stigma, a process wherein criminal stereotypes are internalized and produce negative psychological and behavioral consequences. Research has yet to identify which types of offenders are at risk for, or in contrast, protected from, experiencing self-stigma. The current study examines whether risk and protective factors predict multiple components of the self-stigma process (i.e., perceived stigma, stereotype agreement, internalized stigma, anticipated stigma) in a sample of male jail inmates (N = 111). Results showed that mental health symptoms were a consistent risk factor across three of four self-stigma components, whereas antisocial characteristics were a risk factor for stereotype agreement and internalized stigma. Self-esteem was a protective factor for internalized and anticipated stigma. Implications for preventing self-stigma among offenders are discussed.

Mental Health Providers' Attitudes About Criminal Justice-Involved Clients With Serious Mental Illness

OBJECTIVE

Community mental health providers' attitudes toward criminal justice-involved clients with serious mental illness were examined.

METHODS

A total of 627 Maryland psychiatric rehabilitation program providers responded to a survey (83% response rate). Measures assessed providers' experience with, positive regard for, and perceptions of similarity, with their clients with serious mental illness. Chi-square tests were used to compare providers' attitudes toward clients with and without criminal justice involvement.

RESULTS

Providers reported lower regard for criminal justice-involved clients than for clients without such involvement. Providers were less likely to report having a great deal of respect for clients with (79%) versus without (95%) criminal justice involvement. On all items that measured providers' perceived similarity with their clients, less than 50% of providers rated themselves as similar, regardless of clients' criminal justice status.

CONCLUSIONS

Future research should explore how providers' attitudes toward criminal justice-involved clients influence service delivery for this group.