Turning Our Attention to Stigma: An Objective Self-Awareness Analysis of Stigma and Its Consequences

Shining a Spotlight on Stigma: Exploring Its Impact on Oral Health-Seeking Behaviours Through the Lenses of Patients and Caregivers

Introduction The unique nature of a lack of good oral health, coupled with the lack of discussion and recognition surrounding the associated stigma, highlights it as a distinct issue. This stigma causes discomfort, devalues individuals, and necessitates urgent care and intervention. In Pakistan, a variety of reasons, including cultural beliefs, socioeconomic gaps, and poor access to dental care services, tend to exacerbate the stigma that is associated with dental care. This study aimed to determine the impact of stigma on oral health-seeking behaviours amongst the population of South Punjab in Pakistan. Methodology The study employed a qualitative design with a phenomenological approach, and the data collection was preceded by the administration of semi-structured interview guides and discussion guides to the patients and the consultant group, respectively. The targeted population was composed of patients who had reported stigmatization and a focus group of 10 dental consultants from various specialisations in dentistry. Data was collected until saturation from 16 patients who were recruited through the purposive convenience sampling technique. Results The study identified three themes, including perceived stigma impact on health-seeking behaviours and coping mechanisms; 10 subthemes emerged. Results showed social attitudes and unhealthy perceptions of oral conditions that lead to shame, loss of self-esteem, and lack of confidence among affected individuals. Behavioural reactions like mockery and discrimination further made it difficult for the participants who sought dental care and treatment. The study highlighted that stigma resulted in the avoidance of dental care, deterioration of oral health, and a tendency towards self-medication. People also used coping strategies such as hiding dental issues by avoiding social gatherings and seeking help from close friends to manage oral health stigma. Dental consultants had the strong opinion that care quality could be enhanced by utilising compassionate communication and patient education campaigns. Conclusions The experiences of patients and consultants related to dental stigma highlighted the complex interplay of sociocultural norms and healthcare practices. The study demonstrated that perceived stigma impacted the health-seeking behaviours of patients. Social support and education about oral health helped patients overcome this stigma. The study revealed that patients avoided dental treatments due to stigmatised behaviour from health professionals, a lack of affordability, and a feeling of shame to show and discuss the condition of their teeth, which got even worse due to self-remedy. The experiences of patients and consultants highlighted the need for increased advocacy, educational campaigns, and policies that can reduce inequalities in oral health and improve health equity. The study recommends specific intervention strategies and policy formulation to address oral health inequalities and contribute to advancing oral health equity in Pakistan.

Feeling out of (existential) place: Existential isolation and nonnormative group membership

Literature devoted to understanding the experiences of individuals who do not fit the cultural mold—those who belong to minority, stigmatized, or underrepresented groups—demonstrates that nonnormative status goes hand in hand with a range of negative outcomes. The current research considers a heretofore unstudied correlate of nonnormative status: existential isolation (the feeling of being alone in one’s subjective experience), which differs from feelings of interpersonal isolation (feeling alone with regard to the quantity or quality of one’s relationships). Normative, or mainstream, society may not acknowledge the experiences of those holding a nonnormative status, rendering such individuals at risk of developing heightened feelings of existential isolation. Across Studies 1a and 1b, we found consistently higher trait levels of existential isolation (but not interpersonal isolation) among people with a nonnormative group status than among their normative counterparts. This effect appeared whether we looked at nonnormativeness with regard to race, ethnicity, sexual orientation, citizenship, native language, body weight, religious affiliation, or socioeconomic status. Study 2 highlights one correlate of the existential isolation that accompanies nonnormativeness: decreased certainty with respect to judgments of racism. Implications and suggestions for future research are discussed, including addressing the correlational nature of this research and testing potential mechanisms to explain the link between nonnormative status and existential isolation.

The association of mindfulness and depression stigma among African American women participants in a mindfulness-based intervention: A pilot study

Depression stigma is a potential barrier to engagement in and efficacy of depression treatment. This pilot study examined the association of mindfulness with depression stigma among participants in an eight-week mindfulness-based intervention for depressive symptoms. Thirty-one African American women with depressive symptoms were recruited from an urban Federally Qualified Health Center (FQHC) to participate in a mindfulness intervention (M-Body). Mindfulness, depressive symptoms, and depression stigma were assessed at baseline, eight weeks, and 16 weeks. Focus groups were conducted to examine participants' subjective experiences with the mindfulness intervention. Mindfulness significantly increased from baseline to eight weeks. There was a non-significant decrease in depression from baseline to eight weeks and a significant decrease in depression from baseline to 16 weeks. Depression stigma significantly increased from baseline to eight weeks and significantly decreased from eight to 16 weeks; however, depression stigma did not return to the baseline. An exploratory qualitative analysis of focus group data revealed themes related to direct and indirect factors that may perpetuate and maintain depression stigma. This is one of the first studies to explicitly explore the relationship between mindfulness, depression symptoms, and depression stigma among African American women.

"Doctor, my back hurts and I cannot sleep." Depression in primary care patients: Reasons for consultation and perceived depression stigma

Background

General practitioners (GPs) play a significant role in depression care. Recognition of depression is crucial for adequate treatment but is impeded by a high portion of depressed patients only reporting physical symptoms to their GP. Among the many reasons for this phenomenon is mental health stigma. We investigated how patients with depression differed from patients without depression regarding the types and number of complaints presented to their GP, as well as their depression stigma. For the subgroup of patients with depression, potential associations between perceived depression stigma and number and types of presented complaints were investigated to see if these might reflect the patient’s intention to conceal mental health symptoms due to fear of being stigmatized by others. Further, we investigated if perceived depression stigma is related to depression treatment.

Methods

Data on depressive symptoms (assessed by the Depression Screening Questionnaire; DSQ), depression stigma (assessed by the Depressions Stigma Scale; DSS), type of complaints reported to the GP and treatment-related factors were collected from 3,563 unselected primary care patients of 253 GPs in a cross-sectional epidemiological study (“VERA study”) in six different German regions. Data of a total of 3,069 patients was used for analysis on complaints reported to the GP (subsample of the VERA study), and for 2,682 out of 3,069 patients data on a stigma questionnaire was available.

Results

Nearly half of the primary care patients with depression (42.2%) reported only physical complaints to their GP. Compared to patients without a depression diagnosis, patients with depression reported twice as many complaints to their GP with a mean of 2.02 (1.33) vs. 1.2 (0.69), including a more frequent combination of physical and mental symptoms (28.8% vs. 3.5%). Patients with depression showed higher total stigma compared to patients without depression, Mdn = 48 (IQR 40–54) vs. Mdn = 46.3 (IQR 29–53), due to higher perceived stigma, Mdn = 27 (IQR 21–32) vs. Mdn = 25.9 (IQR 20–29). Perceived stigma was associated with male gender (beta -.14, p = .005) and a lack of pharmacological treatment (beta -.14, p = .021) in patients with a depression diagnosis.

Conclusion

The number of complaints presented to the GP might function as a marker to actively explore depression in primary care patients, in particular when both physical and mental symptoms are reported. Perceived depression stigma should also be addressed especially in male patients. Further research should clarify the role of perceived stigma as a potential inhibitor of pharmacological treatment of depression in primary care.

The sociolinguistics of lisping: a review

This article presents a review of the lisping research literature with the aim of providing a framework for the consideration of the sociolinguistics of lisping. We consider, in turn, the nature of lisping, the construction of identity through speech, the nature of stigma, and, in particular, stigma associated with communication disorders and especially lisping. Further, we examine two aspects of the literature on lisping in more detail: lisping as minor bodily stigma and lisping and the internet. We conclude that experiential research on identity construction at the level of the individual, and stigma theory at a collective speech community level, support the case for viewing the sociolinguistics of lisping as a legitimate field of study and establishing a framework for acknowledgment of and further investigation into the self-identified adult who lisps.

Skin tone, life satisfaction, and psychological distress among African Americans: The mediating effect of stigma consciousness

This study examined the indirect effect of skin tone on psychological distress via (1) stigma consciousness and (2) life satisfaction among African American adults (N = 780; %Female = 57.65%; M_age = 37.68). Results show indirect effects of (1) skin tone on life satisfaction and (2) skin tone on psychological distress, each via stigma consciousness. Specifically, those with darker (vs. lighter) skin tones reported increased stigma consciousness, which then predicted (1) lower life satisfaction and (2) lower levels of psychological distress. Life satisfaction did not predict psychological distress. Implications for African American mental health are discussed.

Examining Discrimination, Ethnic-Racial Identity Status, and Youth Public Regard Among Black, Latino, and White Adolescents

How positively adolescents believe others feel about their ethnic-racial group (i.e., public regard) is an important part of their ethnic-racial identity (ERI), which is likely informed by contextual and individual factors. Using cluster analyses to generate ERI statuses among Black, Latino, and White adolescents (n = 1,378), we found that associations between peer versus adult discrimination and public regard varied across ERI status and ethnic-racial group. However, among all adolescents, an achieved ERI (i.e., having explored ethnicity-race and having a clear sense about its personal meaning) buffered the negative association between adult discrimination and public regard, but not between peer discrimination and public regard. Implications for understanding the interplay between contextual and individual factors for public regard are discussed.

Mindfulness based stress reduction adapted for depressed disadvantaged women in an urban Federally Qualified Health Center

BACKGROUND

In this study we examine the feasibility and preliminary effectiveness of mindfulness based stress reduction adapted for delivery in an urban Federally Qualified Health Center (FQHC).

METHODS

Thirty-one African- American adult women ages 18-65 with depressive symptoms enrolled to participate in an 8-week mindfulness group intervention. The primary outcome (depression) and secondary outcomes (stress, mindfulness, functioning, well-being, and depression stigma) were assessed at baseline, 8 and 16-weeks.

RESULTS

Depressive symptoms significantly decreased from baseline to 16 weeks. A significant decrease in stress and significant increase in mindfulness was found from baseline to 8 weeks and baseline to 16 weeks. Additionally, aspects of well-being-self-acceptance and growth-significantly increased from baseline to 8-weeks. Stigma significantly increased from baseline to 8 weeks and significantly decreased from 8 to 16 weeks (all p's < 0.05).

CONCLUSIONS

Mindfulness-based interventions implemented in FQHCs may increase access to effective treatments for mental health symptoms.

Patient and provider perspectives on HIV and HIV-related stigma in Dutch health care settings

Ensuring that people living with HIV (PLWH) feel accepted in health care settings is imperative. This mixed methods study explored the perspectives of PLWH and health professionals on their interactions. A total of 262 predominantly gay men of Dutch origin participated in a survey study of possible negative interactions with health professionals, and semi-structured interviews were subsequently conducted with 22 PLWH and 14 health professionals. Again, most PLWH were gay men of Dutch origin. All health professionals were Dutch. PLWH reported negative experiences with health professionals including awkward interactions, irrelevant questions, rude treatment, blame, pity, excessive or differential precautions, care refusal, unnecessary referrals, delayed treatment, poor support, and confidentiality breaches. They also reported positive experiences including equal treatment, being valued as a partner in one's health, social support provision, and confidentiality assurances. Health professionals reported having little experience with PLWH and only basic knowledge of HIV. They contended that PLWH are treated equally and that HIV is no longer stigmatized, but also reported fear of occupational infection, resulting in differential precautions. Additionally, they conveyed labeling PLWH's files to warn others, and curiosity regarding how patients acquired HIV. The findings suggest that there is a gap in perception between PLWH and health professionals regarding the extent to which negative interactions occur, and that these interactions should be improved. Implications for stigma reduction and care optimization are discussed.