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Sanguinetti RD, Soriano JE, Squair JW, Cragg JJ, Larkin-Kaiser KA, McGirr A, Phillips AA. National survey of mental health and suicidal thoughts in people with spinal cord injury. Spinal Cord 2022; 60:444-450. [PMID: 35347266 DOI: 10.1038/s41393-022-00783-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cross-sectional epidemiological study. OBJECTIVES Previous studies have quantified longitudinal psychological morbidity in individuals with spinal cord injury (SCI) relative to uninjured individuals. However, there is limited information regarding how lifestyle and socioeconomic factors are associated with mental health conditions in individuals with SCI. This study aims to quantify and compare mental health and suicidal thoughts in people with and without SCI, and examine the associations between mental health, suicidal thoughts, sex, age, lifestyle, and socioeconomic factors. SETTING Canada. METHODS The 2010 Canadian Community Health Survey (n > 40,000) was used, which includes several measures assessing mental health and suicidal thoughts. Bivariate and multivariate logistic regressions were performed and odds ratios with corresponding 95% confidence intervals were estimated. Sensitivity analyses were performed to evaluate the effect of covariates on reported effect sizes. RESULTS People with SCI had higher odds of having mood (3.6) and anxiety disorders (2.5), suicidal thoughts (2.3), self-perceived stress (1.9), and depression (4.4); in addition to lower odds of having good self-perceived mental health (0.24) and satisfaction with life (0.25). These differences persisted after adjusting for age, sex, lifestyle, and socioeconomic factors. Lower household income, fruit and vegetable consumption, and physical activity levels, and increased smoking use were associated with poorer mental health in individuals with SCI. CONCLUSIONS Mental health is poorer in those with SCI when compared with the general population. Those with SCI exhibit a unique profile of lifestyle and socioeconomic factors that are associated with poorer mental health and increased suicidal thoughts.
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Affiliation(s)
| | - Jan Elaine Soriano
- Departments of Physiology and Pharmacology Cardiac Sciences & Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jordan W Squair
- Departments of Physiology and Pharmacology Cardiac Sciences & Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,MD/PhD Training Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jacquelyn J Cragg
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Kelly A Larkin-Kaiser
- Departments of Physiology and Pharmacology Cardiac Sciences & Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Alexander McGirr
- Department of Psychiatry, Hotchkiss Brain Institute, Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
| | - Aaron A Phillips
- Departments of Physiology and Pharmacology Cardiac Sciences & Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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2
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Abdul-Chani MM, Moreno CP, Reeder JA, Zuckerman KE, Lindly OJ. Perceived community disability stigma in multicultural, low-income populations: Measure development and validation. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 115:103997. [PMID: 34062480 PMCID: PMC8260446 DOI: 10.1016/j.ridd.2021.103997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/24/2021] [Accepted: 05/18/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Stigma and knowledge about disabilities differ across groups, impacting care. No validated measures of perceived community disability stigma exist for families in multicultural communities, at risk for disparities. AIMS Develop and validate a brief bilingual (i.e., English/Spanish) perceived disability stigma measure, compare perceived disability and autism stigma, and examine perceived disability stigma by parent sociodemographic characteristics and disability familiarity. METHODS AND PROCEDURES Secondary data from 522 parents with children ages 2-5 years were recruited from Oregon WIC Special Supplemental Nutrition Program agencies for a child development and disability survey in 2015. The study sample included items regarding disability familiarity and stigma, among the survey population, which was 50 % Latino. Internal consistency, reliability and structural validity were examined. Secondary data on perceived disability and similar autism stigma items were compared. Nested multivariable linear regression assessed associations of perceived disability stigma with sociodemographic characteristics and disability familiarity. OUTCOMES AND RESULTS Five perceived disability stigma items had reasonable internal consistency and performed well in the confirmatory factor analysis. Perceived autism stigma was greater than perceived disability stigma. Latino parents reported less perceived disability stigma than white parents. Parents who knew 1+ individual(s) with a disability reported greater perceived disability stigma. CONCLUSIONS AND IMPLICATIONS The perceived disability stigma scale demonstrated sound psychometric properties. Results suggest differences in how stigma is perceived across sociodemographic characteristics and disability familiarity.
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Affiliation(s)
- Monica M Abdul-Chani
- The University of Alabama at Birmingham, Department of Psychology, United States.
| | | | - Julie A Reeder
- Oregon WIC Program, Oregon Health Authority, United States.
| | | | - Olivia J Lindly
- Northern Arizona University, Department of Health Sciences, United States.
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3
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Ochoa-Morales A, Fresan-Orellana A, Hernández-Mojica T, Jara-Prado A, Corona-Vázquez T, Flores-Rivera JJ, Rito-García CY, Rivas-Alonso V, Guerrero-Camacho JL, Dávila-Ortiz de Montellano DJ. Perceived discrimination in patients with multiple sclerosis and depressive symptomatology. Mult Scler Relat Disord 2020; 48:102705. [PMID: 33383366 DOI: 10.1016/j.msard.2020.102705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/08/2020] [Accepted: 12/18/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiple Sclerosis is the central nervous system's most common demyelinating disease and the second leading cause of neurological disability in young adults. Its natural development involves physical and cognitive impairment. Patients commonly perceive discrimination against them, regardless of its occurrence, accepting it as an inherent part of the disease. OBJECTIVE This study aimed to determine the association between perceived discrimination and the depressive symptoms and physical disability present in patients diagnosed with multiple sclerosis, treated at the Demyelinating Diseases Clinic of the National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez. METHODS A cross-sectional study was conducted in 98 patients diagnosed with multiple sclerosis. Demographic and clinical variables were obtained through clinical interviews. The severity of the disease was determined using the Extended Disability Status Scale (EDSS), depressive symptoms were assessed with the Beck Depression Inventory (BDI), and perceived discrimination was rated using the King Internalized Stigma Scale. RESULTS The studied sample's mean age was 36.3 years, schooling 13.6 years, symptoms onset was at 26.2 years (with a delay in diagnosis of 3.2 years), and a disease evolution of 10.9 years. 71.4% were single; 52% had an unpaid work activity and 57.1% were women. The EDSS average was 3.5 points; 24.5% presented moderate to severe depressive symptoms and 53.1% referred perceived discrimination. CONCLUSIONS Perceived discrimination in patients with multiple sclerosis was associated with earlier disease onset, depressive symptoms, and the lack of caregivers. Medical care and life quality improvement for this vulnerable group require greater education regarding the disease and the establishment of patient support programs.
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Affiliation(s)
- A Ochoa-Morales
- Genetics Department. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - A Fresan-Orellana
- Clinical Epidemiology Laboratory. Clinical Research Directorate. National Institute of Psychiatry "Ramón de la Fuente Muñiz," Mexico City, Mexico
| | - T Hernández-Mojica
- Genetics Department. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - A Jara-Prado
- Genetics Department. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - T Corona-Vázquez
- Clinical Laboratory of Neurodegenerative Diseases. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - J J Flores-Rivera
- Clinical Laboratory of Neurodegenerative Diseases. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico.; ABC Neurological Center, Mexico City, Mexico
| | - C Y Rito-García
- Clinical Laboratory of Neurodegenerative Diseases. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - V Rivas-Alonso
- Clinical Laboratory of Neurodegenerative Diseases. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - J L Guerrero-Camacho
- Genetics Department. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
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4
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Holingue C, Kalb LG, Klein A, Beasley JB. Experiences With the Mental Health Service System of Family Caregivers of Individuals With an Intellectual/Developmental Disability Referred to START. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 58:379-392. [PMID: 33032318 DOI: 10.1352/1934-9556-58.5.379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/29/2019] [Indexed: 06/11/2023]
Abstract
People with intellectual and developmental disabilities (IDD) frequently have behavioral or mental health needs, but experience obstacles to treatment. Family caregivers are often responsible for coordinating the care of individuals with IDD. This study examined family caregiver experiences using intake data from a national tertiary crisis intervention model designed for people with IDD and mental health needs. Caregivers (n = 488) completed the Family Experiences Interview Schedule. Less than half of families reported satisfaction with the mental health services received. Notable gaps were in crisis, night and weekend services, choice of services and providers, communication and coordination between providers, and specialized training. Experiences were worse for caregiving fathers and individuals with IDD with co-occurring chronic medical conditions.
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Affiliation(s)
| | - Luther G Kalb
- Luther G. Kalb, Johns Hopkins Bloomberg School of Public Health and Kennedy Krieger Institute
| | - Ann Klein
- Ann Klein and Joan B. Beasley, University of New Hampshire Institute on Disability UCED
| | - Joan B Beasley
- Ann Klein and Joan B. Beasley, University of New Hampshire Institute on Disability UCED
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5
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Sung-Man B. The long-term effects of perceived community disorder and social stigma on depressive symptoms among adolescent school dropouts using multivariate latent growth modeling. SCHOOL PSYCHOLOGY INTERNATIONAL 2020. [DOI: 10.1177/0143034320951232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to examine the long-term effects of perceived community disorder and social stigma on depressive symptoms among adolescent school dropouts. This study used 2–4 wave data of a Longitudinal Survey and Support Plan for Dropouts. Multivariate latent growth modeling indicated that social stigma was associated with greater number of depressive symptoms and had an indirect influence on depressive symptoms through self-esteem. In addition, perceived community disorder was related to greater number of depressive symptoms. Finally, self-esteem was negatively related to depressive symptoms and female adolescents reported more depressive symptoms than male adolescents. This study suggests that policy and social efforts are needed to reduce perceived community disorder and social stigma to prevent the depression in adolescent school dropouts.
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Affiliation(s)
- Bae Sung-Man
- Department of Psychology and Psychotherapy, Dankook University, Cheonan, Republic of Korea
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6
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Solomons L. ‘Too often missing’ report findings: let's start with what our patients are telling us. PRACTICAL DIABETES 2019. [DOI: 10.1002/pdi.2226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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7
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Rwatschew FL, Langan K, Dent H. Embarking on Recovery: When Does Stigma End? Investigating the Experiences of Discrimination and How These Affect Aspirations in Recovery From Substance Misuse. JOURNAL OF HUMANISTIC PSYCHOLOGY 2019. [DOI: 10.1177/0022167819853896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Helen Dent
- Staffordshire University, Staffordshire, UK
- Nottingham University, Nottingham, UK
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8
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Mukaetova-Ladinska EB, Cosker G, Chan M, Coppock M, Scully A, Kim SY, Kim SW, McNally RJQ, Teodorczuk A. Delirium Stigma Among Healthcare Staff. Geriatrics (Basel) 2018; 4:E6. [PMID: 31023974 PMCID: PMC6473673 DOI: 10.3390/geriatrics4010006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/20/2018] [Accepted: 12/23/2018] [Indexed: 11/16/2022] Open
Abstract
Older people with delirium occupy more than one third of acute medical beds and require increased medical attention, as care at present is suboptimal. In addition, since delirium is undetected, it should form a target for teaching in wards. Moreover, as people with delirium are largely dependent on daily interactions and care by inpatients professional staff, it is important to address stigmatisation of these vulnerable patients. This is especially important as previous studies have shown that negative staff attitudes towards these patients undermine good care. This single center cross-sectional study was designed to determine the extent of institutional stigma among health professionals involved in the care of people with delirium. For this, professional staff working on medical wards and in communities were approached to fill in a questionnaire containing the adapted Delirium Stigma Scale and the EuroQol five dimensions (EQ-5D-5L) questionnaire. Additional demographic information concerning their education and professional and personal experience with delirium was also collected. The characteristics associated with stigma were determined from the sample. The findings of our study provide an insight into the high level of stigmatisation of delirium patients among professionals (mean 11.66/18 points). This was not related to professionals' own experiences of delirium, their educational and professional backgrounds, or them having received formal delirium education. However, working closely with people with delirium seems to have a positive impact on the de-stigmatisation of this population among health professionals. Our findings that attitudes are not influenced by formal delirium teaching need to be incorporated into the design of interprofessional educational interventions. Accordingly, we advocate more direct patient-oriented and care delivered teaching interventions.
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Affiliation(s)
- Elizabeta B Mukaetova-Ladinska
- Institute of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7RH, UK.
- The Evington Centre, Leicestershire Partnership NHS Trust, Leicester General Hospital, Gwendolen Rd, Leicester LE5 4QG, UK.
| | - Glynis Cosker
- Northumberland, Tyne and Wear NHS Foundation Trust, Richardson Unit, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4PL, UK.
| | - Mahathir Chan
- Northumberland, Tyne and Wear NHS Foundation Trust, Richardson Unit, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4PL, UK.
| | - Michael Coppock
- Northumberland, Tyne and Wear NHS Foundation Trust, Richardson Unit, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4PL, UK.
| | - Ann Scully
- Northumberland, Tyne and Wear NHS Foundation Trust, Richardson Unit, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4PL, UK.
| | - Seon-Young Kim
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju 61469, Korea.
| | - Sung-Wan Kim
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju 61469, Korea.
| | - Richard J Q McNally
- Institute of Health & Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.
| | - Andrew Teodorczuk
- School of Medicine and Health Institute for the Development of Education and Scholarship (Health IDEAS), Griffith University, Queensland 4122, Australia.
- The Prince Charles Hospital, Metro North, Brisbane, Queensland 4032, Australia.
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9
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Frank C, Zamorski MA, Colman I. Stigma doesn't discriminate: physical and mental health and stigma in Canadian military personnel and Canadian civilians. BMC Psychol 2018; 6:61. [PMID: 30567607 PMCID: PMC6300033 DOI: 10.1186/s40359-018-0273-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background Illness-related stigma has been identified as an important public health concern. Past research suggests there is a disproportionate risk of mental-health stigma in the military, but this same finding has not yet been established for physical-health stigma. The current study aimed to assess the independent contribution of mental and physical health on both enacted stigma (discriminatory behaviour) and felt stigma (feelings of embarrassment) and to determine whether these associations were stronger for military personnel than civilians. Methods Data were obtained from the 2002 Canadian Community Health Survey - Mental Health and Well-being and its corresponding Canadian Forces Supplement. Logistic regressions were used to examine a potential interaction between population (military [N = 1900] versus civilian [N = 2960]), mental health, and physical health in predicting both enacted and felt stigma, with adjustments made for socio-demographic information, mental health characteristics, and disability. Results Mental health did not predict enacted or felt stigma as a main effect nor in an interaction. There was a strong link between physical health and enacted and felt stigma, where worse physical health was associated with an increased likelihood of experiencing both facets of stigma. The link between physical health and enacted stigma was significantly stronger for military personnel than for civilians. Conclusions Physical health stigma appears to be present for both civilians and military personnel, but more so for military personnel. Elements of military culture (e.g., the way care is sought, culture of toughness, strict fitness requirements) as well as the physical demands of the job could be potential predictors of group differences.
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Affiliation(s)
- Christine Frank
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada. .,Department of National Defence, Ottawa, ON, Canada.
| | - Mark A Zamorski
- Canadian Forces Health Services Group, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ian Colman
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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10
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Boyle MP, Fearon AN. Self-stigma and its associations with stress, physical health, and health care satisfaction in adults who stutter. JOURNAL OF FLUENCY DISORDERS 2018; 56:112-121. [PMID: 29111141 DOI: 10.1016/j.jfludis.2017.10.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/07/2017] [Accepted: 10/19/2017] [Indexed: 05/14/2023]
Abstract
PURPOSE The aim of this study was to identify potential relationships between self-stigma (stigma awareness and stigma application) and stress, physical health, and health care satisfaction among a large sample of adults who stutter. It was hypothesized that both stigma awareness and stigma application would be inversely related to measures of physical health and health care satisfaction, and positively related to stress. Furthermore, it was anticipated that stress mediated the relationship between self-stigma and physical health. METHOD A sample of adults who stutter in the United States (n=397) completed a web survey that assessed levels of stigma awareness and stigma application, stress, physical health, and health care satisfaction. Correlational analyses were conducted to determine the relationships between these variables. RESULTS Higher levels of stigma awareness and stigma application were associated with increased stress, decreased overall physical health, and decreased health care satisfaction (i.e., discomfort obtaining health care due to stuttering, and adverse health care outcomes due to stuttering), and these relationships were statistically significant. Stress was identified as a mediator between stigma application and physical health. CONCLUSION Because adults who stutter with higher levels of self-stigma are at risk for decreased physical health through increased stress, and lower satisfaction with their health care experiences as a result of stuttering, it is important for professionals to assess and manage self-stigma in clients who stutter. Self-stigma has implications for not only psychological well-being, but stress, physical health, and health care satisfaction as well.
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Affiliation(s)
- Michael P Boyle
- Department of Communication Sciences and Disorders, Montclair State University, United States.
| | - Alison N Fearon
- Department of Communication Sciences and Disorders, Montclair State University, United States
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Ehrlich C, Chester P, Kisely S, Crompton D, Kendall E. Making sense of self-care practices at the intersection of severe mental illness and physical health-An Australian study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e47-e55. [PMID: 28685496 DOI: 10.1111/hsc.12473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2017] [Indexed: 06/07/2023]
Abstract
The poor physical health of people who experience severe mental illness (SMI) is an important public health issue that has been acknowledged, yet not properly addressed. People who live with SMI perform a myriad of complex tasks in order to take care of their physical health, while receiving unpredictable levels of support and assistance from health professionals. In this qualitative study, we aimed to uncover the kinds of work people with SMI do in order to look after their physical health. In a metropolitan area in Queensland, Australia, 32 people with lived experience of SMI participated in semi-structured, face-to-face interviews. Data were digitally recorded, transcribed verbatim and open coded. They were then themed using a constant comparative process. We found that people with SMI were engaged in a "rhythm of life with illness" that consisted of relatively short, acute and chaotic cycles of mental and physical illness, accompanied by much longer mental and physical illness recovery cycles. Participants engaged in three specific types of health-related work to manage these cycles: discovery work (and the associated role of the health professional); sense-making work to meaningfully interpret health and illness; and embedding work to become engaged self-managers of illness and producers of health. We discuss how varying levels of support from health professionals impact consumers' self-management of their physical and mental health; how health professionals influence consumers' experience of treatment burden; and implications for practice.
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Affiliation(s)
- Carolyn Ehrlich
- School of Human Services and Social Work, Griffith University, Meadowbrook, Queensland, Australia
- Hopkins Centre, Menzies Health Institute, Griffith University, Meadowbrook, Queensland, Australia
| | - Polly Chester
- School of Human Services and Social Work, Griffith University, Meadowbrook, Queensland, Australia
- Hopkins Centre, Menzies Health Institute, Griffith University, Meadowbrook, Queensland, Australia
| | - Steve Kisely
- School of Medicine, The University of Queensland, Woolloongabba, Queensland, Australia
| | - David Crompton
- School of Human Services and Social Work, Griffith University, Meadowbrook, Queensland, Australia
- Hopkins Centre, Menzies Health Institute, Griffith University, Meadowbrook, Queensland, Australia
- Metro South Addiction and Mental Health Services, Upper Mount Gravatt, Queensland, Australia
| | - Elizabeth Kendall
- School of Human Services and Social Work, Griffith University, Meadowbrook, Queensland, Australia
- Hopkins Centre, Menzies Health Institute, Griffith University, Meadowbrook, Queensland, Australia
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Sickel AE, Seacat JD, Nabors NA. Mental health stigma: Impact on mental health treatment attitudes and physical health. J Health Psychol 2016; 24:586-599. [PMID: 27909162 DOI: 10.1177/1359105316681430] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to test two models of the impact of mental health stigma on both attitudes toward seeking psychological help and physical health. General self-efficacy, self-esteem, and anxiety were tested as potential mediators of these two relationships. A sample of adults ( N = 423) aged 18-72 years was surveyed using the participant pool of a large, distance learning university. Structural equation modeling results indicated that mental health stigma directly and indirectly influenced treatment attitudes and physical health. Internal self-variables mediated the relationship between mental health stigma and both study outcomes.
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13
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van Boekel LC, Brouwers EPM, van Weeghel J, Garretsen HFL. Experienced and anticipated discrimination reported by individuals in treatment for substance use disorders within the Netherlands. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:e23-e33. [PMID: 26417904 DOI: 10.1111/hsc.12279] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 06/05/2023]
Abstract
Experiences and expectations of discrimination (anticipated discrimination) may delay treatment seeking among people with substance use disorders. In addition, experienced and anticipated discrimination can be a barrier to successful recovery and rehabilitation. The aim of this study was to study the level of experienced and anticipated (the expectation to be rejected) discrimination among individuals in treatment for substance use disorders as well as the association between both concepts of discrimination. In addition, the association of experienced and anticipated discrimination with clinical and social characteristics was investigated. A cross-sectional survey among individuals in treatment for substance use disorders in the Netherlands was carried out in 2012. Individuals in treatment (N = 186) completed a self-reported questionnaire about experienced and anticipated discrimination. Descriptive statistics and chi-squared analyses were performed to investigate the level of experienced and anticipated discrimination and the association between both concepts. Linear regression analyses were used to investigate the association with clinical and social characteristics, such as occupational status and type of treatment. Individuals in treatment for substance use disorders reported high levels of experienced and anticipated discrimination. Respondents experienced most discrimination in family ties, intimate relationships and friendships. Experienced and anticipated discrimination were both positively correlated. Having complex substance use problems and a longer history of substance use problems was related to higher levels of experienced discrimination. In conclusion, experienced and anticipated discrimination were highly prevalent among individuals in treatment for substance use disorders. Attention in addiction treatment for adequate coping with discrimination may be needed in order to achieve successful social participation and rehabilitation of these individuals.
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Affiliation(s)
- Leonieke C van Boekel
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Evelien P M Brouwers
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Jaap van Weeghel
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
- Phrenos Centre of Expertise, Utrecht, the Netherlands
- Parnassia Group, Dijk en Duin Mental Health Center, Castricum, the Netherlands
| | - Henk F L Garretsen
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
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14
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Ali A, King M, Strydom A, Hassiotis A. Self-reported stigma and its association with socio-demographic factors and physical disability in people with intellectual disabilities: results from a cross-sectional study in England. Soc Psychiatry Psychiatr Epidemiol 2016; 51:465-74. [PMID: 26498927 DOI: 10.1007/s00127-015-1133-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to investigate whether socio-demographic variables and physical disability (e.g. sensory impairment and mobility problems) were associated with self-reported stigma in people with intellectual disabilities (ID), and to examine whether age, sex and ethnicity modified the relationship between severity of intellectual disability and self-reported stigma. METHODS 229 participants with mild or moderate intellectual disabilities were recruited from 12 centres/sites in England from community intellectual disability services, day centres, supported housing schemes, voluntary organisations and invitation letters. Information on physical disability and socio-demographic variables were obtained using a structured data collection form. Self-reported stigma was measured using a validated questionnaire. RESULTS Age was associated with self-reported stigma, with older adults reporting more stigmatising experiences. Participants with moderate intellectual disabilities were more likely to report being treated differently such as being made fun of and being treated like children. Physical disability such as sensory, mobility and speech problems were not associated with self-reported stigma. Gender modified the relationship between severity of ID and self-reported stigma as participants who were male and had moderate ID were more likely to report stigma compared to females with moderate ID. Categorical age also modified the relationship between severity of ID and self-reported stigma as older participants who had moderate ID were more likely to report stigma compared to younger people with moderate ID. CONCLUSIONS Older adults and those with moderate ID are potentially at higher risk of being targets of public stigma or are more likely to report stigma. Interventions to help individuals cope with stigma could be targeted to this group.
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Affiliation(s)
- Afia Ali
- The Division of Psychiatry, University College London, 2nd Floor Charles Bell House, 67-73 Riding House Street, London, W1W 7EY, UK.
| | - Michael King
- The Division of Psychiatry, University College London, 2nd Floor Charles Bell House, 67-73 Riding House Street, London, W1W 7EY, UK
| | - Andre Strydom
- The Division of Psychiatry, University College London, 2nd Floor Charles Bell House, 67-73 Riding House Street, London, W1W 7EY, UK
| | - Angela Hassiotis
- The Division of Psychiatry, University College London, 2nd Floor Charles Bell House, 67-73 Riding House Street, London, W1W 7EY, UK
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Zerger S, Bacon S, Corneau S, Skosireva A, McKenzie K, Gapka S, O’Campo P, Sarang A, Stergiopoulos V. Differential experiences of discrimination among ethnoracially diverse persons experiencing mental illness and homelessness. BMC Psychiatry 2014; 14:353. [PMID: 25496296 PMCID: PMC4275956 DOI: 10.1186/s12888-014-0353-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 12/05/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This mixed methods study explored the characteristics of and experiences with perceived discrimination in an ethnically diverse urban sample of adults experiencing homelessness and mental illness. METHODS Data were collected in Toronto, Ontario, as part of a 4-year national randomized field trial of the Housing First treatment model. Rates of perceived discrimination were captured from survey questions regarding perceived discrimination among 231 ethnoracially diverse participants with moderate mental health needs. The qualitative component included thirty six in-depth interviews which explored how individuals who bear these multiple identities of oppression navigate stigma and discrimination, and what affects their capacity to do so. RESULTS Quantitative analysis revealed very high rates of perceived discrimination related to: homelessness/poverty (61.5%), race/ethnicity/skin colour (50.6%) and mental illness/substance use (43.7%). Immigrants and those who had been homeless three or more years reported higher perceived discrimination on all three domains. Analysis of qualitative interviews revealed three common themes related to navigating these experiences of discrimination among participants: 1) social distancing; 2) old and new labels/identities; and, 3) 'homeland' cultures. CONCLUSIONS These study findings underscore poverty and homelessness as major sources of perceived discrimination, and expose underlying complexities in the navigation of multiple identities in responding to stigma and discrimination. TRIAL REGISTRATION Current Controlled Trials ISRCTN42520374 . Registered 18 August 2009.
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Affiliation(s)
- Suzanne Zerger
- Centre for Research on Inner City Health, Li KaShing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5C 1N8, Canada.
| | - Sarah Bacon
- Centre for Research on Inner City Health, Li KaShing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5C 1N8, Canada.
| | - Simon Corneau
- Université du Québec à Montréal, 405 Rue Sainte-Catherine Est, Montréal, Québec, H2L 2C4, Canada.
| | - Anna Skosireva
- Centre for Research on Inner City Health, Li KaShing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5C 1N8, Canada.
| | - Kwame McKenzie
- Health Services and Health Equity Research, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada.
| | - Susan Gapka
- Centre for Research on Inner City Health, Li KaShing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5C 1N8, Canada.
| | - Patricia O’Campo
- Centre for Research on Inner City Health, Li KaShing Knowledge Institute of St. Michael’s Hospital, 209 Victoria Street, Toronto, Ontario M5C 1N8 Canada ,Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON M5T 3M7 Canada
| | - Aseefa Sarang
- Across Boundaries: An Ethno-racial Mental Health Centre, 51 Clarkson Ave, Toronto (Ontario), M6E 2T5, Canada.
| | - Vicky Stergiopoulos
- Centre for Research on Inner City Health, Li KaShing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5C 1N8, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.
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Nakhaie R, Wijesingha R. Discrimination and Health of Male and Female Canadian Immigrant. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2014. [DOI: 10.1007/s12134-014-0392-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hatfield JP, Hirsch JK, Lyness JM. Functional impairment, illness burden, and depressive symptoms in older adults: does type of social relationship matter? Int J Geriatr Psychiatry 2013; 28:190-8. [PMID: 22495689 PMCID: PMC3417080 DOI: 10.1002/gps.3808] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 03/09/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The nature of interpersonal relationships, whether supportive or critical, may affect the association between health status and mental health outcomes. We examined the potential moderating effects of social support, as a buffer, and family criticism, as an exacerbating factor, on the association between illness burden, functional impairment and depressive symptoms. METHODS Our sample of 735 older adults, 65 years and older, was recruited from internal and family medicine primary care offices. Trained interviewers administered the Hamilton Rating Scale for Depression, Duke Social Support Inventory, and Family Emotional Involvement and Criticism Scale. Physician-rated assessments of health, including the Karnofsky Performance Status Scale and Cumulative Illness Rating Scale, were also completed. RESULTS Linear multivariable hierarchical regression results indicate that social interaction was a significant buffer, weakening the association between illness burden and depressive symptoms, whereas perceived social support buffered the relationship between functional impairment and depressive symptoms. Family criticism and instrumental social support were not significant moderators. CONCLUSIONS Type of medical dysfunction, whether illness or impairment, may require different therapeutic and supportive approaches. Enhancement of perceived social support, for those who are impaired, and encouragement of social interactions, for those who are ill, may be important intervention targets for treatment of depressive symptoms in older adult primary care patients.
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Corneau S, Stergiopoulos V. More than being against it: anti-racism and anti-oppression in mental health services. Transcult Psychiatry 2012; 49:261-82. [PMID: 22508637 DOI: 10.1177/1363461512441594] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anti-racism and anti-oppression frameworks of practice are being increasingly advocated for in efforts to address racism and oppression embedded in mental health and social services, and to help reduce their impact on mental health and clinical outcomes. This literature review summarizes how these two philosophies of practice are conceptualized and the strategies used within these frameworks as they are applied to service provision toward racialized groups. The strategies identified can be grouped in seven main categories: empowerment, education, alliance building, language, alternative healing strategies, advocacy, social justice/activism, and fostering reflexivity. Although anti-racism and anti-oppression frameworks have limitations, they may offer useful approaches to service delivery and would benefit from further study.
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The influence of disability on suicidal behaviour. ALTER-EUROPEAN JOURNAL OF DISABILITY RESEARCH 2012. [DOI: 10.1016/j.alter.2011.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Brondolo E, Hausmann LRM, Jhalani J, Pencille M, Atencio-Bacayon J, Kumar A, Kwok J, Ullah J, Roth A, Chen D, Crupi R, Schwartz J. Dimensions of perceived racism and self-reported health: examination of racial/ethnic differences and potential mediators. Ann Behav Med 2011; 42:14-28. [PMID: 21374099 DOI: 10.1007/s12160-011-9265-1] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Many details of the negative relationship between perceived racial/ethnic discrimination and health are poorly understood. PURPOSE The purpose of this study was to examine racial/ethnic differences in the relationship between perceived discrimination and self-reported health, identify dimensions of discrimination that drive this relationship, and explore psychological mediators. METHODS Asian, Black, and Latino(a) adults (N=734) completed measures of perceived racial/ethnic discrimination, self-reported health, depression, anxiety, and cynical hostility. RESULTS The association between perceived discrimination and poor self-reported health was significant and did not differ across racial/ethnic subgroups. Race-related social exclusion and threat/harassment uniquely contributed to poor health for all groups. Depression, anxiety, and cynical hostility fully mediated the effect of social exclusion on health, but did not fully explain the effect of threat. CONCLUSIONS Our results suggest that noxious effects of race-related exclusion and threat transcend between-group differences in discriminatory experiences. The effects of race-related exclusion and threat on health, however, may operate through different mechanisms.
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Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med 2010; 71:2150-61. [PMID: 21051128 DOI: 10.1016/j.socscimed.2010.09.030] [Citation(s) in RCA: 838] [Impact Index Per Article: 59.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 07/12/2010] [Accepted: 09/21/2010] [Indexed: 12/13/2022]
Abstract
An expansive body of research has investigated the experiences and adverse consequences of internalized stigma for people with mental illness. This article provides a systematic review and meta-analysis of the extant research regarding the empirical relationship between internalized stigma and a range of sociodemographic, psychosocial, and psychiatric variables for people who live with mental illness. An exhaustive review of the research literature was performed on all articles published in English that assessed a statistical relationship between internalized stigma and at least one other variable for adults who live with mental illness. In total, 127 articles met the inclusion criteria for systematic review, of which, data from 45 articles were extracted for meta-analyses. None of the sociodemographic variables that were included in the study were consistently or strongly correlated with levels of internalized stigma. The review uncovered a striking and robust negative relationship between internalized stigma and a range of psychosocial variables (e.g., hope, self-esteem, and empowerment). Regarding psychiatric variables, internalized stigma was positively associated with psychiatric symptom severity and negatively associated with treatment adherence. The review draws attention to the lack of longitudinal research in this area of study which has inhibited the clinical relevance of findings related to internalized stigma. The study also highlights the need for greater attention on disentangling the true nature of the relationship between internalized stigma and other psychosocial variables.
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Affiliation(s)
- James D Livingston
- Forensic Psychiatric Services Commission, BC Mental Health & Addiction Services, British Columbia, Canada.
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