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Pudney EV, Puhl RM, Schwartz MB, Halgunseth LC. The Effect of Parent-Targeted Obesity Messaging on Parental Weight Talk Intention: A Randomized Controlled Experiment. HEALTH COMMUNICATION 2024:1-12. [PMID: 39169856 DOI: 10.1080/10410236.2024.2386212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
It is unknown if parent-targeted health messages about childhood obesity affect parental weight communication with children (e.g., encouraging a child to diet). This randomized, controlled, online experiment assessed the effects of exposure to different message frames on parental intentions to 1) engage in weight communication with their child and, 2) follow the health advice in the message. A diverse sample of U.S. parents (N = 452) were randomly assigned to one of three conditions: 1) a mock news article emphasizing childhood obesity (weight-framed message) with health behavior advice for parents; 2) an article with identical health behavior advice for parents, but framed within the context of improving children's school performance (school-framed message); and 3) a no-treatment control group. Following message exposure, parents completed online surveys assessing their intention to engage in weight communication and the recommended health behaviors. Hierarchical linear regression was used to assess the relationship between experimental condition and the outcome variables. Parents in the weight-frame condition were significantly more likely to report intention to engage in weight communication with their child than parents in the control group, while there was no difference between the school-frame condition and the control group. Parents in both message conditions were equally likely to report intention to adopt the health advice, but parental weight-based self-stigma moderated the relationships. Parent-targeted health advice that features childhood obesity may encourage parents to engage in weight communication with their children. Our findings can inform the development of health messages targeting parents about children's weight-related health.
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Affiliation(s)
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, University of Connecticut
- Rudd Center for Food Policy & Health, University of Connecticut
| | - Marlene B Schwartz
- Department of Human Development & Family Sciences, University of Connecticut
- Rudd Center for Food Policy & Health, University of Connecticut
| | - Linda C Halgunseth
- Department of Human Development & Family Studies, Michigan State University
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Chung ST, Lok EYC, Chan QKN, Cheng KM, Lam SM, Lui SSY. Psychometric Properties of the Caregiver Strain Questionnaire in a Chinese Sample of Caregivers of Children with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:3059-3068. [PMID: 37344730 DOI: 10.1007/s10803-023-06028-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 06/23/2023]
Abstract
The Caregiver Strain Questionnaire assesses the three dimensions of caregiver strain, namely the objective, subjective externalized and subjective internalized strain. It was validated among caregivers of children with Autism Spectrum Disorder (ASD) in the United States and Mainland China with promising psychometric properties.This study aimed to develop and validate the Chinese (traditional script) version of the Caregiver Strain Questionnaire (C-CGSQ) among 198 caregivers of children with ASD in Hong Kong. The C-CGSQ showed excellent internal consistency (α = 0.958) and test-retest reliability (Spearman's r = 0.966). Concurrent, convergent, divergent validity and a three-factor structure (consistent with previous studies) were established. The C-CGSQ demonstrated promising psychometric properties in measuring caregiver strain among caregivers of Chinese ASD children in Hong Kong.
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Affiliation(s)
| | - Eugenia Y C Lok
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Quinney K N Chan
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Koi-Man Cheng
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Siu-Man Lam
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Simon S Y Lui
- Department of Psychiatry, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Gülbetekin E, Kardaş Özdemir F, Aşut G. The mediator role of parenting stress in the effect of stigmatization on burnout in parents of children with autism: A structural equality model. J Pediatr Nurs 2024:S0882-5963(24)00283-5. [PMID: 39054111 DOI: 10.1016/j.pedn.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/13/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE The purpose of this study was to report on the mediator role of parenting stress in the effect of stigmatization on burnout in parents of children with autism. DESIGN AND METHODS A descriptive and correlational research design was used in this study. The sample consisted of 146 parents who had children diagnosed with autism spectrum disorder and volunteered to participate in the study. A "Personal Information Form", the "Parents' Internalized Stigma of Mental Illness Scale", the "Parenting Stress Scale", and the "Parental Burnout Assessment" were used for data collection. RESULTS In the study, it was observed that the feeling of stigmatization increased as the education level increased and that variables such as the ages of the parent and the child and an increase in the number of children requiring care also affected the feeling of stigmatization. Parenting stress was found to have a "partial mediator" role in the effect of stigmatization on parental burnout. CONCLUSION Our findings emphasized the heterogeneous correlation between stigmatization, burnout, and stress levels of parents of children with autism. PRACTICE IMPLICATIONS This study has key implications for pediatric nursing practices. Pediatric nurses can educate the community about autism, what issues should be considered, and how to support parents. Furthermore, nurses can introduce parents who have children with autism to each other and direct them to parent-child activities that can regulate their moods.
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Affiliation(s)
- Eda Gülbetekin
- Igdır University Faculty of Health Sciences, Department of Pediatric Nursing, Igdır, Turkey.
| | - Funda Kardaş Özdemir
- Kafkas University Faculty of Health Sciences, Department of Pediatric Nursing, Kars, Turkey
| | - Gülçin Aşut
- Igdır University Health Services Vocational School, Igdır, Turkey
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Salami S, Alhalal E. Gender differences in predictors of quality of life for parents of children with Autism Spectrum disorder in Saudi Arabia. J Pediatr Nurs 2024; 77:e117-e124. [PMID: 38565480 DOI: 10.1016/j.pedn.2024.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Few researchers have examined gender differences in the quality of life (QoL) of parents of children with autism spectrum disorder (ASD) in diverse cultural contexts. The purpose of this study was to identify how ASD severity, affiliate stigma, perceived social support, family functioning, and coping strategies differentially predict the QoL of mothers and fathers of children with ASD in Saudi Arabia. DESIGN AND METHODS Based on a cross-sectional research design, data were gathered between April and July 2023 from a convenience sample of 376 parents (220 mothers and 156 fathers) of children with ASD in Saudi Arabia. Welch's t-test and regression were used to achieve the study purpose. RESULTS Mothers of children with ASD reported lower QoL, perceived social support, and family functioning than fathers. Mothers relied on emotion-focused coping strategies, whereas fathers used problem-focused coping strategies. Furthermore, affiliate stigma, perceived social support, and family functioning significantly predicted the QoL of mothers and fathers of children with ASD. However, the severity of ASD affected only the QoL of the mothers. Problem-focused coping significantly predicted fathers' QoL but not mothers' QoL. CONCLUSIONS The results highlight gender differences in the factors that predict the QoL of parents of children with ASD in Saudi Arabia. PRACTICE IMPLICATIONS Healthcare professionals should consider parents' gender when providing support and interventions to improve parental QoL.
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Affiliation(s)
- Salma Salami
- PhD student, Nursing College, King Saud University, (Community and Mental Health Nursing), Riyadh, Saudi Arabia.
| | - Eman Alhalal
- Associate Professor, Nursing College, King Saud University, (Community and Mental Health Nursing), Riyadh, Saudi Arabia.
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Lu M, Liu M, Pang F, Peng T, Liu Y, Wen J. Stumbling Block in Providing Physical Activity Support Among Parents of Children with Autism Spectrum Disorder: A Moderated Mediation Analysis. J Autism Dev Disord 2024; 54:2502-2512. [PMID: 37171768 DOI: 10.1007/s10803-023-05957-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 05/13/2023]
Abstract
Physical activity (PA) benefits children with autism spectrum disorder (ASD). Evidence suggests that some barriers impede parents from providing PA support for their children with ASD. Parental perceived stigma is one of these barriers. However, few studies have explored how parental perceived stigma influences parental PA support. This study aimed to investigate the relationship between parental perceived stigma and parental PA support, the mediating role of parental self-efficacy, and the moderating effect of having other typically developing children or not. A total of 274 participants were recruited to participate in the study. The results showed that parental self-efficacy mediated the association between parental perceived stigma and parental PA support and the moderating effect of having other typically developing children or not.
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Affiliation(s)
- Minghui Lu
- School of Education, Guangzhou University, Guangzhou, People's Republic of China
| | - Mingqing Liu
- School of Special Education, Yuzhang Normal University, Jiangxi, People's Republic of China
| | - Feifan Pang
- Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong, People's Republic of China
| | - Tianyu Peng
- Special Education Department, School of Education, Guangzhou University, Guangzhou, People's Republic of China
| | - Yong Liu
- School of Education, Guangzhou University, Guangzhou, People's Republic of China
| | - Jiajie Wen
- School of Education, Guangzhou University, Guangzhou, People's Republic of China.
- Guangzhou University, No. 230, West Waihuan Street, Higher Education Mega Center, Panyu District, Guangzhou City, Guangdong Province, People's Republic of China.
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Pickett AC, Valdez D, Sinclair KL, Kochell WJ, Fowler B, Werner NE. Social Media Discourse Related to Caregiving for Older Adults Living With Alzheimer Disease and Related Dementias: Computational and Qualitative Study. JMIR Aging 2024; 7:e59294. [PMID: 38896462 PMCID: PMC11222768 DOI: 10.2196/59294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/19/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND In the United States, caregivers of people living with Alzheimer disease and Alzheimer disease-related dementias (AD/ADRD) provide >16 billion hours of unpaid care annually. These caregivers experience high levels of stress and burden related to the challenges associated with providing care. Social media is an emerging space for individuals to seek various forms of support. OBJECTIVE We aimed to explore the primary topics of conversation on the social media site Reddit related to AD/ADRD. We then aimed to explore these topics in depth, specifically examining elements of social support and behavioral symptomology discussed by users. METHODS We first generated an unsupervised topic model from 6563 posts made to 2 dementia-specific subreddit forums (r/Alzheimers and r/dementia). Then, we conducted a manual qualitative content analysis of a random subset of these data to further explore salient themes in the corpus. RESULTS The topic model with the highest overall coherence score (0.38) included 10 topics, including caregiver burden, anxiety, support-seeking, and AD/ADRD behavioral symptomology. Qualitative analyses provided added context, wherein users sought emotional and informational support for many aspects of the care experience, including assistance in making key care-related decisions. Users expressed challenging and complex emotions on Reddit, which may be taboo to express in person. CONCLUSIONS Reddit users seek many different forms of support, including emotional and specific informational support, from others on the internet. Users expressed a variety of concerns, challenges, and behavioral symptoms to manage as part of the care experience. The unique (ie, anonymous and moderated) nature of the forum allowed for a safe space to express emotions free from documented caregiver stigma. Additional support structures are needed to assist caregivers of people living with AD/ADRD.
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Affiliation(s)
- Andrew C Pickett
- Department of Health & Wellness Design, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Danny Valdez
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Kelsey L Sinclair
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Wesley J Kochell
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Boone Fowler
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Nicole E Werner
- Department of Health & Wellness Design, School of Public Health, Indiana University, Bloomington, IN, United States
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Stracke M, Dobener LM, Christiansen H. Children of parents with a mental illness - stigma questionnaire: validation and revision. Front Psychiatry 2024; 15:1376627. [PMID: 38952634 PMCID: PMC11215172 DOI: 10.3389/fpsyt.2024.1376627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/13/2024] [Indexed: 07/03/2024] Open
Abstract
Introduction Mental disorders are often stigmatized in society. The stigma of mental illness affects people with a mental illness themselves as well as their family members-a phenomenon called stigma by association (SBA). Children of parents with a mental illness (COPMI) are a particular vulnerable group for SBA. In our systematic review, experienced SBA, anticipated SBA, affiliate SBA, and structural discrimination were identified as relevant stigma dimensions for children of parents with a mental illness. To assess SBA in adolescents who grow up with a parent with a mental illness, the COPMI-SQ was developed. Methods N = 930 adolescents completed the study. Of those, N = 380 adolescents (sample 1; 72.6% female, mean age 17.12 (SD = 2.01) years) reported growing up with at least one parent with a mental illness. Using confirmatory (CFA) and exploratory factor analyses (EFA) as well as standard item and reliability analyses, we analyzed and revised the COPMI-SQ in the first sample. To validate the factorial structure of the revised COPMI-SQ, CFA was also conducted in the independent sample of the other N = 550 adolescents (sample 2; 80.0% female, mean age 16.36 (SD = 1.98) years) who reported not growing up with a parent with a mental illness. To test four measurement invariance, a multiple-group CFA was conducted in the combined sample of adolescents who reported growing up with and without a parent with a mental illness (sample 1 and sample 2). Results CFA in sample 1 resulted in an inadequate model fit for the theoretically assumed four-factor structure (CFI = .687; RMSEA = .064 (90% CI = .062-.066); SRMR = .092; AIC = 229 155.63). Following EFA and item and reliability analyses in sample 1, the COPMI-SQ was reduced to four scales ("Experienced SBA," "Affiliate SBA," "Shame," and "Anticipated SBA") and two additional screening scales ("Healthcare" and "Social support"). To facilitate questionnaire use, only the three best items were retained in each scale, reducing the total item number to 12 plus five additional screener items. CFA in sample 2 also resulted in an inadequate model fit for the theoretically assumed four factor structure (CFI = .667; RMSEA = .065 (90% CI = .063-.066); SRMR = .101; AIC = 335 651.99). In comparison, the final version of the COPMI-SQ-r showed the best model fit (CFI = .945; RMSEA = .062 (90% CI = .052-.072); SRMR = .049; AIC = 60 008.05). In the multiple-group CFA (sample 1 and sample 2), metric invariance was established (χ2 (208) = 481.58, p < .001; CFI = .939; RMSEA = .053 (90% CI = .047-.059); SRMR = .056). In sample 2, internal consistency was found to be good for the total scale (α = .84) and almost acceptable to almost good for the subscales (α = .64 to.78). Discussion The revised version of the COPMI-SQ (COPMI-SQ-r) is a reliable and economic questionnaire to assess SBA in adolescents who grow up with a parent with a mental illness. The COPMI-SQ-r can be used to help develop and evaluate anti-stigma and general interventions for affected adolescents.
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Affiliation(s)
- Markus Stracke
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
- German Center for Mental Health, Philipps University Marburg, Marburg, Germany
| | - Lisa-Marie Dobener
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
- German Center for Mental Health, Philipps University Marburg, Marburg, Germany
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Nickbakht M, Ekberg K, Waite M, Scarinci N, Timmer B, Meyer C, Hickson L. The experience of stigma related to hearing loss and hearing aids: perspectives of adults with hearing loss, their families, and hearing care professionals. Int J Audiol 2024:1-8. [PMID: 38824458 DOI: 10.1080/14992027.2024.2353862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/16/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVES To explore when and how stigma-induced identity threat is experienced by adults with hearing loss (HL) and their family members (affiliate stigma) from the perspectives of adults with HL, their family members, and hearing care professionals. DESIGN Qualitative descriptive methodology with semi-structured interviews. STUDY SAMPLE Adults with acquired HL (n = 20), their nominated family members (n = 20), and hearing care professionals (n = 25). RESULTS All groups of participants believed that both HL and hearing aids were associated with stigma for adults with HL. Two themes were identified, specifically: (1) an association between HL and hearing aids and the stereotypes of ageing, disability, and difference; and (2) varied views on the existence and experience of stigma for adults with HL. Hearing care professionals focused on the stigma of hearing aids more than HL, whereas adult participants focused on stigma of HL. Family member data indicated that they experienced little affiliate stigma. CONCLUSIONS Stigma-induced identity threat related to HL and, to a lesser extent, hearing aids exists for adults with HL. Shared perceptions that associate HL and hearing aids with ageing stereotypes were reported to contribute to the identity threat, as were some situational cues and personal characteristics.
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Affiliation(s)
- Mansoureh Nickbakht
- Centre for Hearing Research, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
| | - Katie Ekberg
- Centre for Hearing Research, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
| | - Monique Waite
- Centre for Hearing Research, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
| | - Nerina Scarinci
- Centre for Hearing Research, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
| | - Barbra Timmer
- Centre for Hearing Research, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Sonova AG, Stäfa, Switzerland
| | - Carly Meyer
- Centre for Hearing Research, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
| | - Louise Hickson
- Centre for Hearing Research, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
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Kuchenbecker CM, Bevan JL. Let's Talk About Death: Applying the Disclosure Decision-Making Model to Death Planning Disclosure. HEALTH COMMUNICATION 2024; 39:1310-1319. [PMID: 37190671 DOI: 10.1080/10410236.2023.2212132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The disclosure decision-making model (DD-MM) explains an individual's decision-making process regarding whether they disclose personal health information to others and consists of three tenets (i.e., assessment of information, assessment of receiver, and disclosure efficacy). Whereas traditional DD-MM applications have focused on physiological disclosures (e.g., HIV diagnosis), this study investigates the non-visible, non-diagnosis context of disclosing desired death arrangement plans with others (i.e., how individuals wish their body to be memorialized following their death). Data from 467 individuals aged between 18 and 82 were collected through online surveys. Path analysis findings indicate that while perceptions of stigma, prognosis, and relevance to others (i.e., assessment of information) were significantly related to disclosure efficacy and anticipated response, only relevance to others was directly related to relational quality. Additionally, anticipated response and relational quality (i.e., assessment of receiver) as well as disclosure efficacy and anticipated response performed in accordance with the DD-MM. This study provides meaningful conclusions for agencies who aim to craft messages that will help resonate with, inform, and protect consumers from becoming susceptible to unethical practices in the death service industry. Limitations and future research avenues are discussed.
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Leng LL, Huang S, Zhou LG. Perceived discrimination among caregivers of children with disabilities in China: Unraveling the effects of social determinants. Soc Sci Med 2024; 351:116991. [PMID: 38833767 DOI: 10.1016/j.socscimed.2024.116991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/05/2024] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Although discrimination has gained increasing attention in research and practice intervention for family caregivers of children with disabilities, little is known about the social determinants that associate with the perceived discrimination among caregivers, especially in non-Western contexts. This study aims to examine the socio-familial and child-level determinants of perceived discrimination among family caregivers of children with disabilities in China. METHOD This study drew from a population-based cross-sectional survey in Shenzhen, China. Proportional quota sampling was conducted to get data from 2500 family caregivers of children with disabilities in rehabilitation service centers (response rate = 94.9%, n = 2373), accounting for 25% of the total population of children with disabilities receiving service in Shenzhen. Latent profile analysis was conducted to categorize three perceived discrimination groups among caregivers (i.e., severe perceived discrimination group, moderate perceived discrimination group, and low perceived discrimination group). The multinomial logistic regression models were conducted to test the association between these social determinants and perceived discrimination. RESULTS Most caregivers (82.9%) reported moderate or severe levels of perceived discrimination. Caregivers of children with moderate and severe impairments and children with mental and multiple disabilities were more vulnerable to perceiving severe social discrimination. Socio-familial characteristics, particularly the intersectionality between gender and employment, influence caregivers' perceived discrimination. CONCLUSION Caregivers of children with disabilities experience pervasive social discrimination in contemporary urban China. Our study demonstrates that the social construction of disablism and the affiliate discrimination against family caregivers of children with disabilities is complex and multidimensional and depends upon the children's disability and the caregivers' socio-demographic characteristics.
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Affiliation(s)
- Ling Li Leng
- The Department of Sociology, Zhejiang University, Hangzhou, China.
| | - Shixin Huang
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong.
| | - Lin Gang Zhou
- Center for Disability Studies, Shenzhen University, Shenzhen, China.
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Shi Y, Dong S, Liang Z, Xie M, Zhang H, Li S, Li J. Affiliate Stigma among family caregivers of individuals with dementia in China: a cross-sectional study. Front Public Health 2024; 12:1366143. [PMID: 38873291 PMCID: PMC11169882 DOI: 10.3389/fpubh.2024.1366143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Background Affiliate stigma experienced by family caregivers of individuals with dementia may seriously affect home care and prognosis of these patients. This study aimed to explore the levels of perceived affiliate stigma and its influencing factors among family caregivers of patients with dementia in mainland China, which remains a relatively unexplored topic. Methods In this cross-sectional study, purposive sampling was used to recruit dementia family caregivers from an online communication group between April and May 2022. A total of 727 eligible caregivers were included and asked to complete the demographic questionnaire, the affiliate stigma scale, and the caregiver burden inventory. Descriptive statistics, independent sample t-test, one-way analysis of variance, Pearson correlation analysis, and multiple linear regression were used to explore the factors that influence perceived affiliate stigma among dementia family caregivers. Results The mean score for affiliate stigma of dementia family caregivers was 48.09 ± 16.38 (range: 22-86). Whether there were regular breaks during patient care, time-dependent burden, developmental burden, physical burden, and social burden were significant factors influencing the affiliate stigma of dementia family caregivers. Conclusion Dementia family caregivers showed a moderate to high level of affiliate stigma. Those who had regular breaks during patient care, higher time-dependent burden, developmental burden, and physical burden and lower social burden exhibited higher levels of affiliate stigma.
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Affiliation(s)
- Yingying Shi
- School of Nursing, Wenzhou Medical University, Zhejiang, China
| | - Shishi Dong
- School of Nursing, Wenzhou Medical University, Zhejiang, China
| | - Zhiqi Liang
- School of Nursing, Wenzhou Medical University, Zhejiang, China
| | - Mengting Xie
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Hanyi Zhang
- School of Nursing, Wenzhou Medical University, Zhejiang, China
| | - Sixie Li
- School of Nursing, Wenzhou Medical University, Zhejiang, China
| | - Jufang Li
- School of Nursing, Wenzhou Medical University, Zhejiang, China
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Yang L, Ye J, Zhu H, Tang Y, Li X. Development and evaluation of a family-child reading picture book on reducing autism spectrum disorder caregivers' psychological stress: a mixed method study. Front Psychiatry 2024; 15:1390430. [PMID: 38863613 PMCID: PMC11165404 DOI: 10.3389/fpsyt.2024.1390430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/22/2024] [Indexed: 06/13/2024] Open
Abstract
Introduction The rapid increasing prevalence of ASD has become a significant global health issue. Caregivers of children with ASD are experiencing higher level of psychological stress and mental disorders. However, interventions to improve the psychological health of caregivers of children with ASD have largely been neglected. Methods Based on the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model, we initially did in-depth interviews with 8 caregivers, and conducted field observation in two rehabilitation centers to analyze the daily lives, the empowered components, the emotional moments of the children with autism and their caregivers. Then we designed the outline of the picture book, and developed it by a multi-disciplinary team by 4 rounds. After that, this picture book was sent out to 54 caregivers of children with ASD for family-child reading in one month. A quantitative questionnaire was administered before and after their reading to evaluate the efficacy of reducing their stress and affiliate stigma, and improving self-efficacy, resilience, empowerment capacity; and exit interviews were conducted after their initial reading to assess the acceptability, content appropriateness, perceived benefits and generalizability of this picture book. Quantitative data were analyzed by descriptive analysis and paired t-tests using IBM SPSS 26.0. Qualitative data were analyzed using template analysis. Results In total, 54 caregivers read the picture book with their child, with the total of 149 (an average of 2.76 per family) times reading in one month. Among them, 39 caregivers returned the following-up questionnaires. Although most of the outcome measures did not showed significant changes except the stress level decreased statistically significant (13.38 ± 3.864 to 11.79 ± 3.238, P=0.001), caregivers reported that the picture book echoed their daily lives and gave them a sense of warmth, inspiration, and hope, as well as some insight on family relationships and attitudes towards the disorder. They also expressed a willingness to disseminate the book to other families with children suffering ASD and the public. Conclusion This specially designed picture book has been proven to be an acceptable, content-appropriate, and effective family-centered psychological intervention, which could be easily scaled up.
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Affiliation(s)
- Lei Yang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jinlin Ye
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Hongrui Zhu
- School of International Nursing, Hainan Medical University, Haikou, Hainan, China
| | - Yao Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Zhang X, Wu M, Zeng T, Cai C. "I am not a good enough parent": The experience of self-stigma in parents of children with mental illness in China. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12466. [PMID: 38649333 DOI: 10.1111/jcap.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
PROBLEM Self-stigma in parents of children with mental illness is an area easily overlooked by mental health providers. Many studies have shown that self-stigma in parents may result in social interaction avoidance, lower self-esteem, increased psychological pressure, and so on. However, a comprehensive picture of how parents of children with mental illness in China experience self-stigma is lacking. METHODS Individual semistructured face-to-face interviews were conducted with 20 parents from China during their child's psychiatric hospitalization. We followed the consolidated criteria for reporting qualitative research (COREQ) checklist. FINDINGS Four main themes were identified that captured the experience of self-stigma in parents of children with mental illness: (1) losing face and fear, (2) internalizing affiliate stigma, (3) feeling of self-blame and self-doubt, and (4) keeping oneself away from society. CONCLUSIONS These findings explain how Chinese parents of children with mental illness experience self-stigma. To better effect the treatment and rehabilitation of children with mental illness, it is necessary to recognize this self-stigma in parents and take action to improve their mental health.
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Affiliation(s)
- Xi Zhang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meiliyang Wu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tieying Zeng
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunfeng Cai
- School of Nursing, Wuhan University, Wuhan, China
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Li Y, Qiu D, Wu Q, Ni A, Tang Z, Xiao S. Affiliate stigma and its association with family burden among family members of people living with schizophrenia in China. Schizophr Res 2024; 267:193-200. [PMID: 38569392 DOI: 10.1016/j.schres.2024.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 03/07/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Understanding affiliate stigma and its impact on family of people living with schizophrenia (PLS) in China is important for culturally informed intervention. This study aims to describe the pattern of affiliate stigma of family members of PLS in China and investigated the association between affiliate stigma and family burden. METHODS PLS and their family members dwelling in community were randomly recruited from four cities across China and completed measures of affiliate stigma and family burden. Linear regression analyses were used to determine the association between affiliate stigma and family burden. RESULTS A total of 493 dyads of family member and PLS were include in this study. The mean affiliate stigma in family members was 2.21 (SD = 0.61). The vast majority of family members reported the feeling of inferiority, helpless and sad because of their family members' schizophrenia, but few family members refusing to communicate or contact with the PLS. The mean score of overall family burden was 22.25 (SD = 14.90), with 98 % of participants reported moderate or severe burden. A higher level of affiliate stigma was associated with more family burden (b = 7.837, 95CI: 5.240 to 8.747). Affiliate stigma was significantly associated with family daily activities, entertainment activities, family relationship, physical health and mental health of family members, but not family economic burden. CONCLUSION A higher level of affiliate stigma was associated with more family burden among family with PLS. Anti-stigma intervention of mental illness should be consider not only PLS but also their family members.
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Affiliation(s)
- Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qiuyan Wu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Anyan Ni
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Zixuan Tang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China; National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
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15
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Wang X, Ye J, Tian X, Wang F, Guo X. Affiliate stigma and caregiver burden in parents of children with epilepsy. Prev Med Rep 2024; 41:102686. [PMID: 38524275 PMCID: PMC10960130 DOI: 10.1016/j.pmedr.2024.102686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/26/2024] Open
Abstract
Objective This study aimed to investigate the current status of affiliated stigma and caregiver burden among parents of children with epilepsy, analyze their correlation, and identify factors influencing affiliated stigma. Methods A cross-sectional survey was conducted among 194 parents of children with epilepsy who met the inclusion and exclusion criteria in Shenzhen City, Guangdong Province, China. Data were collected through questionnaires, including a demographic information sheet, an affiliated stigma scale, and a caregiver burden scale. Results The results revealed that parents of children with epilepsy experienced a moderate level of affiliated stigma, with an average score of 54.92 ± 10.44. Similarly, caregiver burden scores fell within the moderate range, with an average score of 44.14 ± 16.02. Factors influencing affiliated stigma scores included the frequency of epileptic seizures in children, the types of anti-epileptic medications taken by children, and the place of residence. The total caregiver burden score and scores in various dimensions (emotional, cognitive, and behavioral) of caregivers for epilepsy patients were positively correlated with the affiliated stigma score. Affiliated stigma was found to independently explain 21.3 % of the variation in caregiver burden. Conclusion In the future, healthcare professionals should develop targeted interventions for children with epilepsy and their parents to reduce affiliated stigma, decrease caregiver burden, and enhance the caregiving capabilities of parents of children with epilepsy. These measures are essential to improve the overall well-being of both parents and children affected by epilepsy.
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Affiliation(s)
- Xingyanan Wang
- Neurology Department, Shenzhen Children's Hospital, 518026 Shenzhen, Guangdong Province, China
| | - Jinghua Ye
- Neurology Department, Shenzhen Children's Hospital, 518026 Shenzhen, Guangdong Province, China
| | - Xiaoqin Tian
- Neurology Department, Shenzhen Children's Hospital, 518026 Shenzhen, Guangdong Province, China
| | - Fangping Wang
- Neurology Department, Shenzhen Children's Hospital, 518026 Shenzhen, Guangdong Province, China
| | - Xiaocui Guo
- Neurology Department, Shenzhen Children's Hospital, 518026 Shenzhen, Guangdong Province, China
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Liu TL, Hsiao RC, Chou WJ, Yen CF. Prospective and Cross-Sectional Factors Predicting Caregiver Motivation to Vaccinate Children with Attention-Deficit/Hyperactivity Disorder against COVID-19: A Follow-Up Study. Vaccines (Basel) 2024; 12:450. [PMID: 38793701 PMCID: PMC11125857 DOI: 10.3390/vaccines12050450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Adolescents with attention-deficit/hyperactivity disorder (ADHD) have higher risks of contracting COVID-19 and worse outcomes compared with adolescents without ADHD. The most effective method of preventing infection is vaccination. This follow-up study explored the prospective and cross-sectional factors influencing caregiver willingness to vaccinate children with ADHD against COVID-19. Baseline data on caregiver demographics, affiliate stigma, parenting stress, emotional difficulties, beliefs regarding the causes of ADHD, and ADHD symptoms were collected prior to the outbreak of the COVID-19 pandemic in Taiwan. At follow-up, the study assessed caregiver willingness to vaccinate children with ADHD, the challenges caregivers faced in parenting during the pandemic, and ADHD symptoms. The results revealed that caregiver age at baseline was positively associated with a willingness to vaccinate children against COVID-19 at follow-up. By contrast, the belief that ADHD resulted from failures in parental discipline at baseline was negatively associated with caregiver willingness to vaccinate. Parenting challenges were also negatively associated with caregiver willingness to vaccinate. Therefore, the age of caregivers, beliefs about the causes of ADHD, and parenting challenges during the pandemic should be considered when developing interventions to enhance caregiver willingness to vaccinate children with ADHD.
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Affiliation(s)
- Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80754, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Ray C. Hsiao
- Department of Psychiatry, Seattle Children’s, Seattle, WA 98195, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA 98105, USA
| | - Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung 83341, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80754, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- College of Professional Studies, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
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Estrada JAG. Unraveling socioeconomic determinants of health-related behavior, reception of information, and perceptions on disease disclosure at the time of the COVID-19 pandemic: did health insurance curb the disparities in the Philippines? BMC Public Health 2024; 24:767. [PMID: 38475807 DOI: 10.1186/s12889-024-18264-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The study uncovers micro and macro socioeconomic disparities in terms of health behavior, disease perception, and reception of information. Furthermore, findings shed light on the possible role of health insurance on access to information, disease perception and the adoption of preventive behaviors in the context of a public health emergency such as the COVID-19 pandemic. METHODS This study employed a cross-sectional design using the Philippine Demographic and Health Survey (DHS). With a total of 29,809 respondents, it evaluated the individual or household and systemwide socioeconomic determinants of four different outcomes: receipt of information, disease perception, uptake of free preventive services, and treatment-seeking behavior. In addition to logistic regression models with the socioeconomic variables as the independent variables, models for the evaluation of the moderating effect of insurance ownership were fitted. Predicted probabilities were reported for the analysis of moderating effects. RESULTS Findings show that individual and householdsocioeconomic determinants affected health-behavior and access to or receipt of information pertinent to the COVID-19 pandemic. Both education and wealth affected the receipt of information such that individuals in more advantaged socioeconomic positions were at least 30% more likely to have received information on COVID-19. Wealth was also associated to treatment-seeking behavior. Regional differences were seen across all dependent variables. Moreover, the study provides evidence that ownership of insurance can close education-based gaps in the uptake of free vaccination and COVID-19 testing. CONCLUSION It is imperative that targeted efforts be maximized by utilizing existing strategies and mechanisms to reach the marginalized and disadvantaged segments of the population. Health insurance may give off added benefits that increase proficiency in navigating through the healthcare system. Further research may focus on examining pathways by which health insurance or social policies may be used to leverage responses to public health or environmental emergencies.
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Li Y, Fuentes K, Hsu S, Ragunathan S, Lindsay S. Types and factors affecting and impact of ableism among Asian children and youth with disabilities and their caregivers: a systematic review of quantitative studies. Disabil Rehabil 2024:1-21. [PMID: 38339994 DOI: 10.1080/09638288.2024.2310755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/20/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE Asian children and youth with disabilities often experience multiple barriers and discrimination in education, healthcare, and social settings, which influence their well-being, especially the transition to adulthood. This review aims to explore the types, factors affecting and impact of ableism on Asian children and youth with disabilities and their caregivers. METHODS We conducted a systematic review and a narrative synthesis whereby we searched the literature from six international databases, including Healthstar, Ovid Medline, Embase, PsycInfo, Scopus, and Web of Science. RESULTS Twenty-nine studies were included in the review, and three themes were identified that related to ableism: (1) types and rates of ableism (i.e., stigma, bullying and victimization, and discrimination and inequalities); (2) factors affecting ableism (i.e. sociodemographic factors, familial factors, and societal factors); and (3) impacts of ableism (i.e. mental health, family impacts, and societal impacts). CONCLUSIONS Our review highlights that ableism has various types and can be influenced by multiple factors, influencing social and health outcomes of Asian families with children and youth with disabilities. This review also emphasizes the importance of increasing the public's awareness regarding disabilities to reduce ableism among Asian families with children with disabilities.
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Affiliation(s)
- Yiyan Li
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Canada
| | - Kristina Fuentes
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Canada
| | - Shaelynn Hsu
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Canada
- Faculty of Science, York University, Toronto, Canada
| | - Sharmigaa Ragunathan
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Canada
| | - Sally Lindsay
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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19
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Li XH, Deng SY, Zhang TM, Wang YZ, Wong IYL, Ran MS. Medication non-adherence and its influencing factors in persons with schizophrenia in rural China. J Ment Health 2024; 33:40-47. [PMID: 36322512 DOI: 10.1080/09638237.2022.2140789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Few studies have been conducted to explore medication non-adherence in persons with schizophrenia (PWS) and its influencing factors in rural China. This study aimed to investigate the medication non-adherence and its influencing factors among PWS in rural China. METHODS A total of 269 PWS and their family caregivers in Xinjin district, Chengdu, China were investigated on medication adherence and related factors. Logistic regression was employed to identify the influencing factors. RESULTS The results showed that 37.6% of PWS had medication non-adherence. PWS living with family caregivers had significantly lower rate of medication non-adherence (34.7%) than those not living with family caregivers (60.0%) (p < 0.01). Family caregivers' affiliate stigma of mental illness, knowledge of mental illness and self-esteem were significantly related to patients' medication non-adherence (p < 0.05). PWS' employment status, living with family caregiver, present mental status and social support were significantly related to medication adherence. CONCLUSION This study shows medication non-adherence is severe among PWS in rural China. Both patient- and family-related factors affect patients' medication adherence seriously. Except improving patients' treatment and mental status, development of family caregiving, social support network and intervention on reducing stigma of mental illness should be crucial for enhancing PWS' medication adherence.
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Affiliation(s)
- Xu-Hong Li
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China
| | - Shu-Yu Deng
- Department of Social Work and Social Administration, University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Tian-Ming Zhang
- Department of Social Work, Shanghai University, Shanghai, China
| | - Yi-Zhou Wang
- Department of Social Work and Social Administration, University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Irene Yin Ling Wong
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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20
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Pang RCC, Ho MSH, Wong PWC. A Review of the Literature on the Multiple Forms of Stigmatization of Caregivers of Children with Autism Among Ethnic Minority Groups. J Racial Ethn Health Disparities 2024; 11:545-559. [PMID: 36877377 DOI: 10.1007/s40615-023-01540-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/07/2023]
Abstract
Multiple forms of stigmatization are experienced by caregivers of children with autism among ethnic minority (EM) groups in various countries. Such forms of stigmatization can lead to delayed assessment and services for mental health among children and caregivers. This review identified the research literature on the types of stigmatization experienced by caregivers of children with autism with an EM background. A total of 19 studies published after 2010 (i.e., 12 from the USA, 2 from the UK, 1 from Canada, and 1 from New Zealand) of caregivers of 20 ethnicities were identified and reviewed, and their reporting qualities systematically also assessed. Four main themes: (1) self-stigma, (2) social stigma, (3) stigma towards EM parents of children on the autism spectrum, and (4) service utilization stigma, and nine sub-themes were identified. The discrimination experienced by caregivers were extracted, synthesized, and further discussed. While the reporting quality of the studies included is good, the depth of the understanding of this under-researched yet important phenomenon is very limited. The multiple forms of stigmatization experiences are complex, and it may be difficult to disentangle whether the causes of stigmatization were autism and/or EM related, and the types of stigmatization can vary enormously among different ethnic groups in different societies. More quantitative studies are needed to quantify the impacts of multiple forms of stigmatization on families of children with autism in EM groups so that more socially inclusive support for caregivers with an EM background in host countries can be developed.
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Affiliation(s)
| | - Mimi S H Ho
- Department of Special Education and Counselling, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, Hong Kong
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21
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Montiel-Nava C, Vargas I, Gonzalez-Avila Z, Montenegro MC, Ramírez AC. Pilgrimage for an autism diagnosis: A study of Venezuelan parents' experiences. Transcult Psychiatry 2024; 61:95-106. [PMID: 37964582 DOI: 10.1177/13634615231211482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
It cannot be assumed that the experience of having an autistic child is the same across countries since demographic and systemic factors are as diverse as the manifestation of ASD symptomatology. This study explores the lived experiences of 20 Venezuelan parents after receiving an autism diagnosis for their child. Applied thematic analysis was used to analyze parental attitudes, challenges in identifying their child's delay, access to diagnostic services, beliefs towards autism, professional evaluations, family support, and perceptions toward health and educational services for autistic children. Venezuelan parents reported a generalized lack of autism awareness, an unsupportive school system, and judgment from their extended family. Despite the universal health coverage in the country, Venezuelan parents commented on the scarcity of services, as well as the lengthy and costly processes to receive an ASD diagnosis. The results support previous research findings showing that socioeconomic factors influence how parents experience the process of obtaining an autism diagnosis for their children. For most Venezuelan parents, it might imply a long journey in which limited resources and knowledge about autism will determine its route and length. For parents, cultural values and spiritual and religious beliefs will serve as both coping mechanisms and barriers to accessing services.
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Affiliation(s)
- Cecilia Montiel-Nava
- Department of Psychological Sciences, Universidad de Texas Rio Grande Valley, Edinburg, TX, USA
| | - Irina Vargas
- Escuela de Psicología, Universidad Rafael Urdaneta, Maracaibo, Venezuela
| | - Zoila Gonzalez-Avila
- Department of Child and Youth Mental Health, Vancouver Coastal Health, BC, Canada
| | | | - Ana C Ramírez
- Department of Psychological Sciences, Universidad de Texas Rio Grande Valley, Edinburg, TX, USA
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Pudney EV, Puhl RM, Halgunseth LC, Schwartz MB. An Examination of Parental Weight Stigma and Weight Talk Among Socioeconomically and Racially/Ethnically Diverse Parents. FAMILY & COMMUNITY HEALTH 2024; 47:1-15. [PMID: 37656801 DOI: 10.1097/fch.0000000000000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Parental communication about body weight can influence children's emotional well-being and eating behaviors. However, little is known about the role of parental self-stigma concerning weight and social position variables (ie, race/ethnicity, income, and gender) in weight communication. This study examined how parents' self-stigmatization for their own weight (ie, weight bias internalization) and self-stigmatization for their child's weight (ie, affiliate stigma) relates to weight talk frequency with their children, and whether these associations vary across parental race/ethnicity, income, and gender. Parents (n = 408) completed a cross-sectional, online survey about their weight communication and self-stigmatization. Linear regression was used to examine the relationships among these variables, including interactions between the stigma variables and social position variables in predicting weight talk. Higher levels of weight bias internalization and affiliate stigma were strongly associated with increased parental weight talk frequency; parents who endorsed higher levels of internalized bias about their own weight expressed greater affiliate stigma for their child's weight, regardless of demographic characteristics or weight status. Associations between the stigma variables and weight talk outcomes were stronger among fathers and parents of higher income. Findings highlight the importance of considering weight stigma variables in parental weight communication research.
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Affiliation(s)
- Ellen V Pudney
- Department of Pediatrics, Division of Community Health & Research, Eastern Virginia Medical School, Norfolk (Dr Pudney); Department of Human Development & Family Sciences, University of Connecticut, Storrs, and Rudd Center for Food Policy & Health, University of Connecticut, Hartford (Drs Puhl and Schwartz); and Department of Human Development & Family Studies, Michigan State University, East Lansing (Dr Halgunseth)
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Son H, Ahn E, Kim J. Children's bullying victimization and maternal suicidal ideation among multicultural families in South Korea: Heterogeneity by family socioeconomic status. Soc Sci Med 2024; 341:116545. [PMID: 38160609 DOI: 10.1016/j.socscimed.2023.116545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/12/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
RATIONALE Children from multicultural families in Korea are vulnerable to bullying victimization. Despite growing evidence on the mental health consequences of bullying victimization for victims, little is known about the spillover effects on their immigrant mothers. OBJECTIVE This study examined the association between children's bullying victimization and their immigrant mothers' suicidal ideation. The potential moderating role of family socioeconomic status was also investigated. METHODS Using nine waves of the Multicultural Adolescents Panel Study spanning from 2011 to 2019 (N = 1466), this study estimated individual fixed effects models to control for unobserved individual-level heterogeneity. Interaction models were used to investigate potential heterogeneity by family socioeconomic status, including maternal education, household income, and maternal occupational status. RESULTS Fixed effects estimates revealed that children's bullying victimization is associated with an increased likelihood of suicidal ideation among marriage migrant mothers (b = 0.012, p < 0.05), even after controlling for unobserved time-invariant confounders as well as a set of time-varying covariates. Family socioeconomic status moderated this association. The association between children's bullying victimization and immigrant mothers' suicidal ideation was stronger for those with low levels of education and household income. No such moderating effects were observed for maternal occupation. CONCLUSIONS The findings of this study suggest that efforts to address the mental health consequences of bullying victimization among multicultural family children should extend beyond the victim to their immigrant mothers. When developing interventions to reduce suicidal ideation among immigrant mothers whose children have been victimized, policymakers may wish to consider the moderating role of family socioeconomic status.
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Affiliation(s)
- Hyewon Son
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea; Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea
| | - Eunhye Ahn
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Jinho Kim
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea; Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea; Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI, USA.
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de Jonge M, Boutjdir M, El-Korchi T, Torres H, Karpur A, Shih A, Elidrissi A. Urban and rural differences in needs, service use and satisfaction among caregivers of autistic children in Morocco. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:107-122. [PMID: 36800902 PMCID: PMC10771028 DOI: 10.1177/13623613221150086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
LAY ABSTRACT It is very important to understand the needs of caregivers to be able to empower caregivers and to develop or improve services around the world. Therefore, research in different regions is needed to understand differences in caregivers needs between countries, but also between areas within countries. This study investigated differences in needs and service use between caregivers of autistic children in Morocco, living in urban and rural areas. A total of 131 Moroccan caregivers of autistic children took part in the study and responded to an interview survey. The results showed both similarities and differences between urban and rural living caregivers' challenges and needs. Autistic children from urban communities were much more likely to receive intervention and attend school than children from rural communities, even though age and verbal skills of the two groups of children were comparable. Caregivers expressed similar needs for improved care and education, but different challenges in caring. Limited autonomy skills in children were more challenging to rural caregivers, while limited social-communicational skills were more challenging to urban caregivers. These differences may inform healthcare policy-makers and program developers. Adaptive interventions are important to respond to regional needs, resources, and practices. In addition, the results showed the importance of addressing challenges as experienced by caregivers such as costs related to care, barriers in access to information, or stigma. Addressing these issues may help reduce both global and within-country differences in autism care.
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Affiliation(s)
| | - Mohamed Boutjdir
- VA New York Harbor Healthcare System, USA
- State University of New York Downstate Health Sciences University, USA
- NYU Grossman School of Medicine, USA
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Zeng S, Sardar A, Beckstein A, Mohamed NH, Shen R, Xiu Y. Developing a new questionnaire of positive contributions to Chinese families by children with autism spectrum disorder. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2024; 9:23969415231221520. [PMID: 38187822 PMCID: PMC10768583 DOI: 10.1177/23969415231221520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background and Aims A literature review of both Eastern and Western literature regarding families of children with autism spectrum disorder (ASD) revealed limited empirical research that examines ASD in China. Furthermore, most research in this area comes from a deficit model and there is a lack of research that comes from a strengths background. No previous study in China has looked at the positive contributions of children with ASD to their families. The present study came from a strengths-based perspective and aimed to develop a new questionnaire to evaluate the positive contributions made to families by children who have ASD in China and are raised by their respective families. It considered the severity level of the children's disorder and the impact this had on the parents. Besides examining the children's impairment levels, the study also examined positive contributions and their relationship with socio-demographic elements such as family income and employment status of the parents, which also seem to be related to the positive contributions experienced by the parents. Methods First, based on the literature review, an initial qualitative interview protocol was developed and administered to 10 parents of children with ASD. Then, based on the analyses of the interviews, a quantitative questionnaire was developed to assess the positive contributions of children with ASD to their families. The questionnaire was then administered to 156 parents of children with ASD. The internal structure of the questionnaire was analyzed by factor analysis. The questionnaire's reliability and validity were also examined. The data were then analyzed with multiple correlation comparisons and an independent sample T-test. Results Six factors emerged for families of children with ASD. The results showed that the cumulative explanatory variance of the six dimensions of the questionnaire was 65.42%. The Cronbach's coefficient of each dimension was between 0.7 and 0.9, and the combined Cronbach's coefficient of the total questionnaire was 0.945. This study found that the overall average positive contribution to families by children with ASD was 3.32, which is at a medium level, and all six dimensions were at a medium-to-high level. This study also found that the family's monthly income contributed to the overall positive contribution, intimacy and happiness, and gaining more special knowledge through experience dimensions. Furthermore, it was found that moderate severity of ASD, high income, and parental employment were all associated with more positive contributions. Conclusion This new questionnaire appears to have good reliability and validity and seems suitable for assessing the positive contributions to families by children with ASD in China. Implications The present study may be helpful for the parents of children with ASD and will likely help them focus on the strengths of their children rather than their shortcomings. The study might also benefit counselors and researchers who would be able to use the new questionnaire to evaluate the positive contributions made to families by children who have ASD.
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Affiliation(s)
- Shulan Zeng
- College of Education Science, Chongqing Normal University, Chongqing, China
| | - Afsheen Sardar
- College of Education Science, Chongqing Normal University, Chongqing, China
| | - Amoneeta Beckstein
- College of Education Science, Chongqing Normal University, Chongqing, China
| | | | - Renhong Shen
- College of Education Science, Chongqing Normal University, Chongqing, China
| | - Yunhui Xiu
- College of Education Science, Chongqing Normal University, Chongqing, China
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Ekberg K, Hickson L. To tell or not to tell? Exploring the social process of stigma for adults with hearing loss and their families: introduction to the special issue. Int J Audiol 2023:1-11. [PMID: 38152856 DOI: 10.1080/14992027.2023.2293651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/06/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE Stigma has long been implicated as a reason why adults with acquired hearing loss are slow to seek help and for sub-optimal uptake of hearing devices. However, the field has not developed a comprehensive understanding of why stigma occurs, nor has it related this comprehensive knowledge to a theoretical framework. DESIGN This special issue presents results from a two-phase, multi-method study to systematically investigate how stigma is experienced by adults with hearing loss and their families, how they manage it in everyday life, and how these experiences relate to the decision to wear hearing aids. STUDY SAMPLE Phase 1 of the study involved 20 dyads of adults with hearing loss and their family members. Phase 2 involved 331 adults with hearing loss and 313 family members. RESULTS Results of the study are presented in each of the subsequent papers that are part of this special issue. Results are mapped onto the Major and O'Brien model of stigma-induced identity threat in each paper. CONCLUSIONS This paper provides an introduction to the Special Issue and describes the methods for the overall study that is the focus of the papers within the issue.
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Affiliation(s)
- Katie Ekberg
- Centre for Hearing Research, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Louise Hickson
- Centre for Hearing Research, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
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Brinkman AH, Barry TD, Lindsey RA. The Relation of Parental Expressed Emotion, Parental Affiliate Stigma, and Typically-developing Sibling Internalizing Behavior in Families with a Child with ASD. J Autism Dev Disord 2023; 53:4591-4603. [PMID: 36180666 DOI: 10.1007/s10803-022-05760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
Caregivers of children with autism spectrum disorder (ASD) experience greater stress, expressed emotion (EE), and affiliate stigma than caregivers of children without ASD. Siblings of children with ASD often experience greater negative functioning than siblings of individuals without ASD. The current study found significant interrelations among symptom severity and externalizing behavior in children with ASD; parental stress, affiliate stigma, and EE; and TD sibling internalizing behavior. In addition, certain subcomponents of affiliate stigma predicted unique variance in EE and TD sibling internalizing behavior. Findings may increase understanding of psychosocial functioning in families with children with ASD and allow clinicians to improve outcomes for all family members. Limitations of the study included self-report data, limited sample diversity, and a cross-sectional design.
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Affiliation(s)
- Aurora H Brinkman
- Department of Psychology, Washington State University, Johnson Tower 233, PO Box 644820, 99164-4820, Pullman, WA, USA
| | - Tammy D Barry
- Department of Psychology, Washington State University, Johnson Tower 233, PO Box 644820, 99164-4820, Pullman, WA, USA.
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Qiu D, Li Y, Wu Q, An Y, Tang Z, Xiao S. Patient's disability and caregiver burden among Chinese family caregivers of individual living with schizophrenia: mediation effects of potentially harmful behavior, affiliate stigma, and social support. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:83. [PMID: 38040711 PMCID: PMC10692118 DOI: 10.1038/s41537-023-00418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
Evidence on the associations between patient's disability and caregiver burden among Chinese family caregivers of individual living with schizophrenia is lacking. This study aimed at explore the underlying mechanisms between patient's disability and caregiver burden among Chinese family caregivers of individual living with schizophrenia. A cross-sectional study was carried out in four Chinese cities (Wuhan, Changsha, Guangzhou, and Shenzhen), between April, 2021 and March, 2022. A total of 493 patients and their family caregivers were invited to report related data. The Zarit burden interview, WHODAS 2.0, the Potentially harmful behavior scale, the Affiliate Stigma Scale, and the Multidimensional Scale of perceived social support were used to collect data. Linear regression analysis and bootstrapping analysis were conducted. The adjusted regression results showed that patients' disability (B = 0.616; 95% CI: 0.479-0.753), potentially harmful behavior on caregivers (B = 0.474; 95% CI: 0.232-0.716), and caregiver's low social support (B = -0.079; 95% CI: -0.158- -0.002), high level of affiliate stigma (B = 13.045; 95% CI: 10.227-15.864) were associated with higher level of caregiver burden (p < 0.05). In the mediation model, the direct path from patient's disability to caregiver burden (B = 0.428, β = 0.371, p < 0.001) was significant and positive. Patient's disability was indirectly associated with caregiver burden through patient's potentially harmful behavior, caregiver's affiliate stigma, and social support, the standardized regression coefficients ranged from 0.026-0.049 (p < 0.05). Patient's potentially harmful behavior, caregiver's affiliate stigma, and social support mediated the relationship between patients' disability and caregiver burden. Future intervention studies designed to target these three factors may be beneficial for family caregivers of persons living with schizophrenia.
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Affiliation(s)
- Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qiuyan Wu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yanni An
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Zixuan Tang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Chu SY, Rafi ABM, Lee J, Fierro V, Gan CH, Joginder Singh S, Hersh D, Lin LY. The relationship between affiliate stigma, stress, and quality of life for parents of individuals with cerebral palsy in Malaysia. Disabil Rehabil 2023; 45:4035-4047. [PMID: 36541160 DOI: 10.1080/09638288.2022.2153304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the relationship between affiliate stigma, stress, and perceived quality of life among parents of children with cerebral palsy (CP). METHOD Surveys (Study 1) and semi-structured interviews (Study 2) were used to collect data. Thirty-eight respondents completed the Affiliate Stigma Scale (ASS), Caregiver Burden Inventory (CBI), and Care-related Quality of Life (CarerQol) scales (GMFCS). Eleven respondents took part in semi-structured interviews, which were then thematically evaluated. RESULTS Parents did not feel stigmatized because they had a child with CP. However, parents needed some form of short-term relief from caregiving. After controlling for demographics, high stress respondents experienced high affiliate stigma whereas low stress respondents had better quality of life. Although the respondents with less stigma had a better quality of life, this effect was moderate. Three major themes emerged from the interviews. CONCLUSION Counseling, support groups, and helper services should be offered to parents. Also, healthcare professionals participating in CP rehabilitation, community-based rehabilitation, and health institutions should be educated on how to better help parents of children with CP.
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Affiliation(s)
- Shin Ying Chu
- Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), Speech Sciences Programme Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Adlina Binti Mohamed Rafi
- Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), Speech Sciences Programme Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership, and Counseling, Texas Tech University, Lubbock, TX, USA
| | - Veronica Fierro
- Department of Speech-Language Pathology, Delaware Valley University, Doylestown, PA, USA
| | - Chun Hong Gan
- Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Centre for Rehabilitation and Special Needs Studies (iCaRehab), Programme of Clinical Psychology and Behavioural Health, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Susheel Joginder Singh
- Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Centre for Rehabilitation and Special Needs Studies (iCaRehab), Speech Sciences Programme, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Deborah Hersh
- Speech Pathology, Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Ling-Yi Lin
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Liu TL, Hsiao RC, Chou WJ, Yen CF. Hopelessness in caregivers of children with attention-deficit/hyperactivity disorder: Associations with depression and anxiety and multidimensionally related factors. J Formos Med Assoc 2023; 122:1158-1164. [PMID: 37230914 DOI: 10.1016/j.jfma.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND/PURPOSE Hopelessness can compromise caregivers' mental health and impede their ability to take care of their child with attention-deficit/hyperactivity disorder (ADHD). The study aimed to explore the associations of hopelessness with caregiver depression and anxiety in caregivers of children with attention-deficit/hyperactivity disorder (ADHD). Additionally, the study examined the associations of child demographics, ADHD and oppositional defiance symptoms, and caregiver demographics, parenting stress, and affiliate stigma with hopelessness. METHODS The study included 213 caregivers of children with ADHD who completed various assessments. Caregiver hopelessness was assessed using the Beck Hopelessness Scale, while child ADHD and oppositional defiance symptoms were assessed using the Parent Form of the Swanson, Nolan, and Pelham Scale, Version IV. Parenting stress was measured using the Parenting Stress Index, Fourth Edition Short Form (PSI-4-SF), and affiliate stigma using the Affiliate Stigma Scale. Hierarchical regression analysis was used to investigate the multidimensional factors associated with caregiver hopelessness. RESULTS Caregiver hopelessness was significantly linked to caregiver depression and anxiety. Child inattention, caregiver parenting stress, and affiliate stigma were significantly associated with caregiver hopelessness. A higher level of affiliate stigma increased the association between child inattention and caregiver hopelessness. CONCLUSION These findings suggest that it is necessary to develop intervention programs for alleviating the sense of hopelessness among caregivers of children with ADHD. Such programs should focus on addressing child inattention, caregiver parenting stress, and affiliate stigma.
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Affiliation(s)
- Tai-Ling Liu
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan.
| | - Ray C Hsiao
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195-6560, USA; Department of Psychiatry, Seattle Children's, Seattle, WA98105, USA.
| | - Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, 83301, Taiwan; School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Cheng-Fang Yen
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan; College of Professional Studies, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan.
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Chan KKS, Fung WTW, Leung DCK. Self-compassion mitigates the cognitive, affective, and social impact of courtesy stigma on parents of autistic children. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1649-1660. [PMID: 36566467 DOI: 10.1007/s00127-022-02413-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/12/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE Due to the courtesy stigma of autism spectrum disorder, many parents of autistic children are devaluated and discriminated against by the public. Despite the high prevalence of this courtesy stigma, very few studies have examined its negative effects on parents of autistic children and explored the factors that may protect the parents from these negative effects. The present study utilized a 2-year, two-wave prospective longitudinal design to examine the associations of courtesy stigma with adverse cognitive (self-stigma), affective (depressive and anxiety symptoms), and social (parent-child and inter-parental conflicts) consequences for parents of autistic children and to test whether these associations would be moderated and mitigated by self-compassion. METHODS A total of 381 parents of autistic children completed questionnaires about courtesy stigma, self-compassion, self-stigma, depressive and anxiety symptoms, and parent-child and inter-parental conflicts at time 1 (T1) and time 2 (T2). RESULTS Courtesy stigma interacted with self-compassion at T1 in predicting self-stigma, depressive and anxiety symptoms, and parent-child and inter-parental conflicts at T2. Specifically, the associations of courtesy stigma with the adverse psychological consequences were weaker for parents with high self-compassion than for those with low self-compassion. CONCLUSION Our results demonstrate the prospective associations of courtesy stigma with adverse cognitive, affective, and social consequences for parents of autistic children, as well as the protective effects of self-compassion against such associations. These results highlight the importance of increasing parents' self-compassion to help them cope with courtesy stigma and improve their psychological well-being.
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Affiliation(s)
- Kevin Ka Shing Chan
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China.
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong, China.
| | - Winnie Tsz Wa Fung
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China
| | - Donald Chi Kin Leung
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China
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Romeo BG, Bevan JL. Using the Disclosure Decision-Making Model to Examine Patient Confusion Disclosure. HEALTH COMMUNICATION 2023:1-8. [PMID: 37798842 DOI: 10.1080/10410236.2023.2265121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
The disclosure decision-making model (DD-MM) has been heavily explored within its initially proposed scope. Fewer known studies have tested the DD-MM's boundaries by assessing the model's application beyond close personal relationships, and none have explored it in a context outside of long-term health conditions. The current study investigates the disclosure decision-making process of patients to their healthcare providers when they experience situational confusion. A primarily quantitative online survey analyzed data from 251 U.S. adults who felt confusion during a recent appointment with their healthcare provider. Findings indicate that, although stigma and perceived disclosure efficacy impacted patient confusion disclosure as anticipated, anticipated response and relational quality (i.e., receiver assessments) did not play a significant role in disclosure. Stigma, anticipated response, and perceived disclosure efficacy were all related to remaining patient confusion as expected. This study contributes to our understanding of the scope of disclosure decision-making model as well as the to-date overlooked nuances of situational patient confusion: what impacts confusion disclosure and its likelihood to remain beyond the appointment's end. Limitations, implications, and future directions are discussed.
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Duan W, Wang J, Wang Z. A Network Analysis of Brief Measure of Perceived Courtesy and Affiliate Stigma During COVID-19 in Hubei China. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2023; 20:623-636. [PMID: 37461302 DOI: 10.1080/26408066.2023.2192716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
PURPOSE The current study aims to test perceived affiliate and courtesy stigma in Hubei province China during the early periods of COVID-19 by using network analysis. METHOD In this study, 4,591 participants (3,034 female, mean age = 26.64) from the Hubei Province of China were recruited to conduct network analysis. RESULTS The network analysis found network connections between Estranged - Blamed, Shamed - No Strong Point, and Rejected - Plague were the strongest. The most important stigma features (nodes) of COVID-19 (i.e. Plague, No Strong Point, Discriminated, and Disgusting). DISCUSSION AND CONCLUSIONS This study uncovered the most central features of perceived affiliate and courtesy stigma on COVID-19, proposing these features (and associations between features) could be prioritized for anti-stigma interventions for the COVID-19 pandemic.
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Affiliation(s)
- Wenjie Duan
- School of Social and Public Administration, East China University of Science and Technology, Shanghai, P. R. China
| | - Jingying Wang
- School of Social and Public Administration, East China University of Science and Technology, Shanghai, P. R. China
| | - Zichuan Wang
- School of Social and Public Administration, East China University of Science and Technology, Shanghai, P. R. China
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Cheng AWY, Lai CYY. Parental stress in families of children with special educational needs: a systematic review. Front Psychiatry 2023; 14:1198302. [PMID: 37636816 PMCID: PMC10449392 DOI: 10.3389/fpsyt.2023.1198302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Background This systematic review aimed to identify the risk factors and protective factors for parental stress in families with children with special educational needs. Studies have indicated that the wellbeing of families is related to the physical, psychological, and social conditions of the children, as well as the family functioning, stress coping strategies, and social and professional support of their parents. The parents of children with special educational needs experience high levels of parental stress. Identifying the associated risk factors and protective factors may shed light on the provision of interventions to promote the mental wellbeing of these parents. Methods Boolean operators were used to search multiple online databases, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied in this systematic review. Data were extracted into categories of population, age, region, the child's diagnosis, the stress-measuring instrument, and the risk factors and protective factors. Results Twenty-six studies, including 5,169 parents and 3,726 children, were reviewed. The following four major risk factors and protective factors were found to be associated with parental stress: the sex of the parents, diagnosis-related coping issues, socioeconomic characteristics, and social isolation of the parents. Conclusions This systematic review identified four significant risk factors and protective factors related to social support from couples, family members, and social circles. Various agencies may provide financial and manpower assistance and professional support and services to improve the parents' knowledge and coping skills, as well as affectional support, early screening, and continuous assessment of the parents' progress. Social policies and interventions offering continuous and diagnosis-related support to the parents of children with special educational needs are highly recommended.
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Affiliation(s)
| | - Cynthia Y. Y. Lai
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Chu RST, Ng CM, Chu SC, Lui TT, Lau FC, Chan SKW, Lee EHM, Hui CLM, Chen EYH, Lui SSY, Chang WC. Rate and correlates of self-stigma in adult patients with early psychosis. Front Psychiatry 2023; 14:1200568. [PMID: 37520240 PMCID: PMC10374014 DOI: 10.3389/fpsyt.2023.1200568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Self-stigma impedes recovery process and is associated with poorer clinical and functional outcomes in people with psychotic disorders. However, there is limited research specifically examining self-stigma in the early stage of illness, and mixed findings were observed regarding factors associated with increased self-stigma. We aimed to investigate the rate and correlates of self-stigma in a cohort of adult patients with early psychosis using a comprehensive array of clinical, treatment and other illness-related variables. Methods A total of 101 Chinese adult early psychosis patients aged 26-55 years who had received three-year psychiatric treatment for first psychotic episode in Hong Kong and completed self-stigma assessment were included for the current investigation. A broad range of assessments encompassing socio-demographics, premorbid adjustment, onset and illness profiles, symptom severity, psychosocial functioning, treatment characteristics and medication side-effects were conducted. Results Twenty-eight (27.7%) patients had moderate-to-high levels of self-stigma. Univariate linear regression analyses showed that age at study entry, sex, educational level, age at psychosis onset, duration of untreated psychosis (DUP), insight level, global psychosocial functioning, and the use of second-generation antipsychotic were related to self-stigma levels. Final multivariable regression model revealed that female sex, younger age at entry, longer DUP and better insight were independently associated with higher levels of self-stigma. Conclusion More than one-fourth of early psychosis patients experienced significant self-stigma, highlighting an unmet need for early detection and intervention of self-stigma in the initial years of illness. Further investigation is warranted to clarify trajectories and predictors of self-stigma in the early illness course.
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Affiliation(s)
- Ryan Sai Ting Chu
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chung Mun Ng
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sheung Chit Chu
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tsz Ting Lui
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Fu Chun Lau
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Edwin Ho Ming Lee
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Christy Lai Ming Hui
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Eric Yu Hai Chen
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Simon Sai Yu Lui
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Johnson CL, Gross MA, Jorm AF, Hart LM. Mental Health Literacy for Supporting Children: A Systematic Review of Teacher and Parent/Carer Knowledge and Recognition of Mental Health Problems in Childhood. Clin Child Fam Psychol Rev 2023; 26:569-591. [PMID: 36763174 PMCID: PMC10123050 DOI: 10.1007/s10567-023-00426-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/11/2023]
Abstract
The level of mental health literacy (MHL) in adults who work with or care for children is likely to influence the timeliness and adequacy of support that children receive for mental health problems. The aim of this study was to systematically review the literature on mental health literacy for supporting children (MHLSC, recognition/knowledge) among parents and teachers of school aged children (5 to 12 years old). A systematic search was conducted for quantitative studies published between 2000 and June 2021 using three databases (MEDLINE, PsycINFO and ERIC) and relevant citations reviewed in Scopus. To be included, studies needed to measure at least either 'mental health knowledge' or 'recognition'. Synthesis proceeded according to study design, adult population, child MHP, then MHL outcome. Study quality was assessed using AXIS. 3322 documents were screened, 39 studies met inclusion criteria. 49% of studies examined teachers' knowledge or recognition of ADHD; only five studies reported on parent samples. Synthesis found a nascent field that was disparate in definitions, methods and measures. Little research focussed on knowledge and recognition for internalizing problems, or on parents. Methods used for measuring knowledge/recognition (vignette vs screening) were associated with different outcomes and the quality of studies was most often low to moderate. Adults appear to have good recognition of childhood ADHD but their knowledge of internalizing disorders is less clear. Further research is required to develop standard definitions and validated measures so gaps in MHLSC can be better identified across populations who have a role in supporting children with their mental health.
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Affiliation(s)
- Catherine L Johnson
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Level 5, 207 Bouverie Street, Carlton, VIC, 3010, Australia.
| | - Maxine A Gross
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Level 5, 207 Bouverie Street, Carlton, VIC, 3010, Australia
- Telethon Kids Institute, Adelaide, SA, Australia
| | - Anthony F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Level 5, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - Laura M Hart
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Level 5, 207 Bouverie Street, Carlton, VIC, 3010, Australia
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
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Wang YZ, Meng XD, Zhang TM, Weng X, Li M, Luo W, Huang Y, Thornicroft G, Ran MS. Affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia in rural China. Int J Soc Psychiatry 2023; 69:1024-1032. [PMID: 36708508 DOI: 10.1177/00207640231152206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although stigma and caregiving burden are important in relation to mental health recovery, few studies have been conducted on affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia (FCPWS) in rural China. AIMS This study aimed to examine the severity level of affiliate stigma and caregiving burden, and identify the correlates among FCPWS in rural China. METHODS A mental health survey was conducted (N = 253 FCPWS) in Xinjin county, Sichuan province, China. Affiliate Self-Stigma Scale and Zarit Burden Interview Short Form were used. The regression analysis was performed to explore the correlates of stigma and burden. RESULTS Most FCPWS reported experiencing high and severe level of affiliate stigma (78.66%) and caregiving burden (95.26%). Family caregivers who were middle aged, unemployed, with high caregiving burden and low quality of life (QoL), showed more severe affiliate stigma. Family caregivers who were female, older, with low income, high affiliate stigma and low QoL, experienced greater caregiving burden. CONCLUSIONS The large majority of FCPWS in rural China experienced severe affiliate stigma, caregiving burden and poor QoL. It is crucial to develop culture-specific anti-stigma interventions to reduce caregivers' stigma and caregiving burden, and improve QoL. Specific risk factors of family caregivers' affiliate stigma and caregiving burden should be considered for development of health policy and community-based mental health services.
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Affiliation(s)
- Yi-Zhou Wang
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong
| | - Xian-Dong Meng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tian-Ming Zhang
- Department of Social Work, Shanghai University, Shanghai, China
| | - Xue Weng
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, China
| | - Ming Li
- Chengdu Xinjin Second People's Hospital, China
| | - Wei Luo
- Chengdu Xinjin Second People's Hospital, China
| | - Yi Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, King's College London, UK
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Lo JWK, Ma JLC, Wong MMC, Yau-Ng MLT. Virtual care during the pandemic: Multi-family group sessions for Hong Kong Chinese families of adolescents with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:336-353. [PMID: 35343306 PMCID: PMC8961203 DOI: 10.1177/17446295221076693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The suspension of social services in Hong Kong during the COVID-19 pandemic increased the caregiver strain for families of adolescent children with intellectual disabilities, possibly aggravating their family relationships. This article reports on an online Multi-Family Group (MFG) conducted during the pandemic for Hong Kong Chinese families of adolescents affected by mild-to-moderate intellectual disabilities. A thematic analysis of the experiences of the participating service users revealed three positive effects of the intervention model: improved family relationships, mutual helpful influences occurring among families, and a new understanding of family members with intellectual disabilities. The therapeutic group process used to promote family development is illustrated by a group vignette. The challenges and the practical considerations for conducting an MFG online are discussed.
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Affiliation(s)
- Julia Wing Ka Lo
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce Lai Chong Ma
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - Mooly Mei Ching Wong
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
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Tari-Keresztes N, Armstrong N, Smith JA, Gupta H, Goding S, Endemann SA. "You Don't Get That from Professionals": A Consumer-Led Peer Recovery Program for Families and Friends of Individuals with Alcohol and Other Drugs Use Issues in Darwin. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085514. [PMID: 37107795 PMCID: PMC10138685 DOI: 10.3390/ijerph20085514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 05/11/2023]
Abstract
While there has been a reduction in alcohol consumption among Australians aged 18 years and above, about 25% of people still drink above the recommended limit. The use of alcohol and other drugs is a substantial issue in the Northern Territory; however, there have been significant investments in alcohol reforms over the past few years. This paper reports on a pilot study that involved co-designing, implementing, and evaluating the Circles of Support consumer-led recovery and empowerment program for families and friends of individuals with alcohol and other drugs use issues. The evaluation comprised a mixed-methods approach; however, this article only presents the qualitative component (n = 7). Interview data were thematically analysed, and four main themes were identified: (1) the value of a peer-to-peer approach; (2) facing challenges and distress; (3) adopting self-care strategies; and (4) the development of valuable skills. Participants enjoyed the program content and learning. This involved self-care and communication strategies, boundary setting, service navigation, the concept of post-traumatic growth, the circles of control, and the stages of change model for families. Our findings strongly support the scaling up of the program in Darwin and other locations across the Northern Territory and future program adaptation for different vulnerable target audiences.
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Affiliation(s)
- Noemi Tari-Keresztes
- Rural and Remote Health, College of Medicine & Public Health, Flinders University, Casuarina, NT 0815, Australia
- Correspondence:
| | - Noelene Armstrong
- Northern Territory Lived Experience Network, Darwin, NT 0820, Australia
| | - James A. Smith
- Rural and Remote Health, College of Medicine & Public Health, Flinders University, Casuarina, NT 0815, Australia
| | - Himanshu Gupta
- Rural and Remote Health, College of Medicine & Public Health, Flinders University, Casuarina, NT 0815, Australia
| | - Sam Goding
- Northern Territory Lived Experience Network, Darwin, NT 0820, Australia
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Schmitt RM, Huynh HP. Stay (Close to) Humble: Intellectual Humility Negatively Predicts Stigma Toward and Social Distance from Individuals with Posttraumatic Stress Disorder. Psychol Rep 2023:332941231157233. [PMID: 36780657 DOI: 10.1177/00332941231157233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Posttraumatic stress disorder (PTSD) remains a highly stigmatized disorder despite its prevalence. Given that the origin of stigmatization is rooted in cognitive representations that people hold, stigma may be differentially exhibited by people with varying degrees of cognitive flexibility. Intellectual humility, the recognition of one's own intellectual shortcomings or flaws, may allow for flexibility in how people navigate knowledge surrounding PTSD, which may reduce stigma and improve interpersonal interactions with individuals with PTSD. The present study investigated whether intellectual humility would negatively predict PTSD stigma and social distance, above and beyond demographic factors and personal or social experience with individuals with PTSD. Participants (N = 421, 67.2% men, mean age = 37.45, SDage = 9.99) completed a multidimensional measure for intellectual humility and the Mental Illness Stigma Scale adapted to assess PTSD stigma. Results confirmed our preregistered predictions. Bivariate correlations demonstrated that overall intellectual humility was negatively correlated with overall PTSD stigma, and overall intellectual humility was negatively correlated with overall social distance. That is, intellectually humble people reported less PTSD stigma and desired closer social distance with individuals with PTSD. Additionally, hierarchical multiple regression revealed that intellectual humility predicted unique variance in PTSD stigma and social distance above and beyond the contribution of demographic factors and personal experience or social relationships with someone with PTSD. These results may provide a useful framework for approaching and minimizing stigma toward PTSD.
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Affiliation(s)
- Randee M Schmitt
- Department of Psychology and Philosophy, 4038Sam Houston State University, Huntsville, TX, USA
| | - Ho Phi Huynh
- Department of Life Sciences, Texas A&M University-San Antonio, San Antonio, TX, USA
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Lin PY, Chou WJ, Hsiao RC, Liu TL, Yen CF. Association of Affiliate Stigma with Parenting Stress and Its Moderators among Caregivers of Children with Attention-Deficit/Hyperactivity Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3192. [PMID: 36833887 PMCID: PMC9959478 DOI: 10.3390/ijerph20043192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 05/31/2023]
Abstract
Caring for children with attention-deficit/hyperactivity disorder (CADHD) is stressful for caregivers. Identifying factors related to parenting stress in caregivers of CADHD can facilitate the development of intervention programs. This study aimed to examine the associations between affiliate stigma and various domains of parenting stress among caregivers of CADHD. This study also analyzed the moderating effects of demographic characteristics and the symptoms of childhood ADHD and oppositional defiant disorder (ODD) on the associations between affiliate stigma and parenting stress. In total, 213 caregivers of CADHD participated in this study. Parenting stress was assessed using the Parenting Stress Index, Fourth Edition Short Form (PSI-4-SF). Affiliate stigma was assessed using the Affiliate Stigma Scale. ADHD and ODD symptoms were assessed using the Parent Form of the Swanson, Nolan, and Pelham Scale, Version IV. The results indicated that higher affiliate stigma was significantly associated with greater parenting stress in all three domains of the PSI-4-SF. ODD symptoms increased the magnitude of parenting stress in two domains of parenting stress among caregivers with affiliate stigma. Intervention programs for relieving parenting stress among caregivers of CADHD should take affiliate stigma and child ODD symptoms into consideration.
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Affiliation(s)
- Pei-Yun Lin
- Department of Psychiatry, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 81267, Taiwan
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Wen-Jiun Chou
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung 83301, Taiwan
| | - Ray C. Hsiao
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98295, USA
- Department of Psychiatry, Seattle Children’s, Seattle, WA 98105, USA
| | - Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- College of Professional Studies, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
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Tabatabaee M, Yousefi Nooraie R, Mohammad Aghaei A, Rostam-Abadi Y, Ansari M, Sharifi S, Sharifi V. Loneliness in the presence of others: A mixed-method study of social networks of caregivers of patients with severe mental disorders. Int J Soc Psychiatry 2023; 69:190-199. [PMID: 35148620 DOI: 10.1177/00207640221077580] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND One in four families has at least one member with a mental disorder and families are the main caregivers in most patients in low and middle-income countries. Caregivers experience disruption in their routine lives, increased responsibilities, increased need for support, and changes in their network. The role of personal support networks in the health and burden of the caregivers is complex and depends on the context, cultural and socioeconomical variables. In this study, we aimed to investigate the personal support network of caregivers of patients with severe mental illness in Iran. METHODS By using a mixed-methods design, we focused on the structure and composition of caregiver networks, as well as self-perceived caregiver support. RESULTS We found that the support network of caregivers was mostly composed of immediate family members whom themselves were selectively chosen as a result of the multidimensional process of interaction between stigma, availability, and the perceived needs of caregivers. The participants mentioned economic and instrumental supports more frequently than emotional support, probably reflecting their unmet basic needs. Advocacy for providing formal systemic supports to caregivers, as well as interventions that expand caregivers personal support network is recommended. CONCLUSIONS Most participants of the study were relatively isolated and had a small network of support, mostly composed of immediate family members. Stigma was a serious source of family distress for caregivers and a limiting factor in social relationships.
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Affiliation(s)
- Maryam Tabatabaee
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Yousefi Nooraie
- Department of Public Health Sciences, School of Medicine & Dentistry, University of Rochester, Rochester, NY, USA
| | | | - Yasna Rostam-Abadi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Ansari
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shamim Sharifi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Vandad Sharifi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
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Chan KKS, Leung DCK, Fung WTW. Longitudinal impact of parents' discrimination experiences on children's internalizing and externalizing symptoms: A 2-year study of families of autistic children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:296-308. [PMID: 35585707 DOI: 10.1177/13623613221093110] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT Although many parents of autistic children are routinely discriminated against, the potential impact of this discrimination on their parenting processes and child-rearing outcomes has seldom been investigated. The present study addressed this gap in the literature by examining the longitudinal associations of parents' discrimination experiences with children's internalizing and externalizing symptoms among families of autistic children and testing whether these associations would be mediated by parental depression, harsh parenting, and coparenting conflict. On three occasions across 2 years (i.e. T1, T2, and T3), 441 parents of autistic children from Hong Kong, China, provided questionnaire data. Path analyses showed that parents' discrimination experiences at T1 had significant direct effects on parental depression, harsh parenting, and coparenting conflict at T2, which, in turn, had significant direct effects on children's internalizing and externalizing symptoms at T3. Bootstrap analyses further demonstrated that parents' discrimination experiences at T1 had significant indirect effects on children's internalizing and externalizing symptoms at T3 via parental depression, harsh parenting, and coparenting conflict at T2. Our findings have important theoretical contributions and significant practical implications. Theoretically, our findings elucidate how parents' discrimination experiences may longitudinally heighten children's internalizing and externalizing symptoms by adversely affecting parental well-being and parent-child and inter-parental relationships. Practically, our findings highlight the importance of designing and implementing community-based stigma reduction programs and family-based stigma coping interventions to reduce parents' discrimination experiences and associated adverse outcomes on well-being, parenting, marriage, and child development.
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Zhang Y, Huang C, Yang M. Family Resilience Progress from the Perspective of Parents of Adolescents with Depression: An Interpretative Phenomenological Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2564. [PMID: 36767927 PMCID: PMC9914939 DOI: 10.3390/ijerph20032564] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
Family resilience plays an important role in the healthy family development of adolescents with depression, but few studies have explored the specific process of family resilience. This study aims to explore the dynamic processes of family resilience from parents of adolescents with depression. Data were collected from 14 Chinese parents of adolescents with depression by interpretative phenomenological analysis method. Four themes and 12 sub-themes emerged: (1) decompensation phase: (i) misinterpretations of illness, (ii) heavy psychological burden, (iii) chaotic rhythms in family; (2) launch phase: (i) potential influences of labeling, (ii) we must cure my child anyway, (iii) begin adjusting to family roles; (3) recovery phase: (i) family reflection, (ii) subsequent reorganization of family resources, (iii) ultimately establishing a new balance; (4) normality phase: (i) adaption for medical seeking process, (ii) actively lower expectations, (iii) concerns of future needs. Mental health professionals could provide targeted suggestions to help the parents achieve family resilience by assessing its different phases.
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Affiliation(s)
- Yinying Zhang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Chongmei Huang
- Xiang Ya Nursing School, Central South University, Changsha 410017, China
| | - Min Yang
- Xiang Ya Nursing School, Central South University, Changsha 410017, China
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Deng SY, Wang YZ, Peng MM, Zhang TM, Li M, Luo W, Ran MS. Quality of life among family caregivers of people with schizophrenia in rural China. Qual Life Res 2023; 32:1759-1769. [PMID: 36715814 DOI: 10.1007/s11136-023-03349-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
PURPOSES To investigate quality of life (QoL) of family caregivers of people with schizophrenia and examine the influencing factors of the QoL in a Chinese rural area. METHODS This study included people with schizophrenia (n = 269) and their family caregivers (n = 269) from Xinjin district, Chengdu, China. Family caregivers' QoL was measured by the World Health Organization Quality of Life-Brief Form and its influencing factors was analyzed by the multivariate regression. RESULTS Family caregivers of people with schizophrenia had very poor QoL across four domains. The regression analysis showed that physical domain of QoL was significantly associated with age, psychiatric symptoms of people with schizophrenia, and caregiving burden of family caregivers (p < 0.05). Psychological domain of QoL was significantly related to family caregivers' affiliate stigma, caregiving burden, and psychiatric symptoms of people with schizophrenia (p < 0.05). Social domain of QoL was significantly associated with age and psychiatric symptoms of people with schizophrenia, and affiliate stigma of family caregivers (p < 0.05). Environmental domain of QoL was significantly related to age and psychiatric symptoms of people with schizophrenia, and family caregivers' caregiving burden (p < 0.05). CONCLUSION Family caregivers of people with schizophrenia had poor QoL in rural China. Family caregivers' QoL is significantly impacted by age and psychiatric symptoms of people with schizophrenia, caregivers' affiliate stigma and caregiving burden. Providing social support and psychosocial interventions for family caregivers of people with schizophrenia might be crucial to improve their QoL and caregiving.
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Affiliation(s)
- Shu-Yu Deng
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China
| | - Yi-Zhou Wang
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China
| | - Man-Man Peng
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, 519087, China
| | - Tian-Ming Zhang
- Department of Social Work, Shanghai University, Shanghai, China
| | - Ming Li
- Chengdu Xinjin Second People's Hospital, Chengdu, China
| | - Wei Luo
- Chengdu Xinjin Second People's Hospital, Chengdu, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China. .,Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
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Kaggwa MM, Najjuka SM, Mamun MA, Griffiths MD, Nyemara N, Ashaba S. Involvement and burden of informal caregivers of patients with mental illness: the mediating role of affiliated stigma. BMC Psychiatry 2023; 23:72. [PMID: 36703121 PMCID: PMC9881274 DOI: 10.1186/s12888-023-04553-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The fear and lack of understanding of mental illness can lead to stigma. The stigma of mental illness affects not only individuals who suffer from it, but also the caregivers. Stigma among caregivers can lead to delay in seeking care, poor adherence to treatment and a high risk of relapse. Caregivers of patients with mental illness are at an increased risk of distress due to the burden to stigma and caregiving burden. An increase in caregivers' burden can lead to a reduction in caregivers' involvement. There is a relationship between caregivers' involvement, burden, and affiliated stigma. The present study examined the mediating role of affiliated stigma in the relationship between caregivers' burden and involvement among informal caregivers of hospital-admitted patients with mental illness in Uganda. METHODS A cross-sectional study was conducted among 428 informal caregivers (mean age: 39.6 years [SD±14.6]; females = 62.1%). Information was collected regarding sociodemographic characteristics, affiliated stigma, and the involvement and burden of informal caregivers. RESULTS The findings indicate that affiliated stigma serves as a full mediator between the caregiver's roles and involvement (β=15.97, p<0.001). Being female increased the caregivers' burden of caregiving (β= -0.23, p<0.001). CONCLUSION The findings in the present study suggest that intervention to address affiliated stigma among caregivers of patients with mental illness should be incorporated into mainstream mental health care to reduce the caregiving burden.
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Affiliation(s)
- Mark Mohan Kaggwa
- grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science & Technology, Mbarara, 1410 Uganda ,African Centre for Suicide Prevention and Research, Mbarara, 379 Uganda ,grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Sarah Maria Najjuka
- grid.11194.3c0000 0004 0620 0548Makerere University, College of Health Sciences, Kampala, Uganda
| | - Mohammed A. Mamun
- CHINTA Research Bangladesh, Savar, Dhaka 1342 Bangladesh ,grid.411808.40000 0001 0664 5967Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342 Bangladesh
| | - Mark D. Griffiths
- grid.12361.370000 0001 0727 0669Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ United Kingdom
| | - Novatus Nyemara
- grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science & Technology, Mbarara, 1410 Uganda
| | - Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science & Technology, Mbarara, 1410, Uganda.
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Kuzu D, Perrin PB, Pugh M. The Affiliate Stigma Scale: Psychometric refinement and validation of a short form in Turkish spinal cord injury/disorder caregivers. NeuroRehabilitation 2023; 52:83-91. [PMID: 36617754 DOI: 10.3233/nre-210127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite the widespread international use of the Affiliate Stigma Scale in the context of disability, much research on its psychometric properties has taken dubious statistical approaches. OBJECTIVE The aim of this study was to examine the psychometric properties of the Affiliate Stigma Scale in a sample of Turkish spinal cord injury/disorder (SCI/D) caregivers. METHODS Participants completed the Affiliate Stigma Scale, Zarit Burden Interview, and Generalized Anxiety Disorder-7. This study conducted a series of confirmatory factor analyses (CFAs) of the Turkish Affiliate Stigma Scale using its originally theorized 3-factor structure and a 1-factor structure, as well as an exploratory factor analysis (EFA) to refine the scale items to create a short form, with a final CFA of the items in the short form. RESULTS The 3-factor and 1-factor CFAs of the 22 items from the Affiliate Stigma Scale suggested poor fit to the data across every fit index. An EFA yielded four factors, although the patterns of item loading onto the factors did not map in any discernible way to the original subscales theorized by the scale creators. A 1-factor CFA with the six items loading onto factor 1 of the EFA showed much better fit indices, with most achieving good or adequate fit. CONCLUSION The current study supports a 1-factor solution with a short form comprised of six items, at least in Turkish and with SCI/D caregivers.
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Affiliation(s)
- Duygu Kuzu
- University of Michigan, Ann Arbor, MI, USA
| | | | - Mickeal Pugh
- Virginia Commonwealth University, Richmond, VA, USA
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Pugh M, Perrin PB, Watson JD, Kuzu D, Tyler C, Villaseñor T, Lageman SK, Moreno OA. Psychometric investigation of the affiliate stigma scale in Mexican Parkinson's disease caregivers: Development of a short form. NeuroRehabilitation 2023; 52:71-81. [PMID: 34397425 DOI: 10.3233/nre-210105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Parkinson's disease (PD) caregivers, particularly in Latin America, may experience high levels of affiliate stigma due to their association with a person having a disability. The most common measure used of this construct in the literature, the Affiliate Stigma Scale, was validated using non-standard and questionable methods. OBJECTIVE The purpose of this study was to investigate the factor structure and psychometric properties of the Spanish version of the Affiliate Stigma Scale with PD caregivers in Mexico using more widely accepted psychometric approaches including confirmatory and exploratory factor analyses (CFAs, EFAs). METHODS A sample of 148 PD caregivers from Mexico completed this measure, as well as indices of caregiver burden and anxiety. RESULTS Initial CFAs revealed that the data did not fit either the originally proposed one-factor or three-factor structures. An EFA was then conducted which was unable to discern any factor structure. Upon instituting a stepwise removal alpha-if-item-deleted process, a 5-item Affiliate Stigma Scale Spanish Short Form was retained with an adequate Cronbach's alpha, good convergent validity, and a Short Form CFA generally indicating adequate fit. CONCLUSIONS The new Spanish Affiliate Stigma Scale Short Form holds promise for more appropriately measuring affiliate stigma likely in general but particularly in Spanish and among PD caregivers. The Short Form can assist not only in assessing levels of caregiver affiliate stigma, but in creating novel interventions to help support caregivers and decrease stigma.
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Affiliation(s)
- Mickeal Pugh
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Jack D Watson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Duygu Kuzu
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Carmen Tyler
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Teresita Villaseñor
- Hospital Civil Fray Antonio Alcalde, University of Guadalajara, Guadalajara, Mexico
| | - Sarah K Lageman
- Department of Neurology, Parkinson's and Movement Disorders Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Oswaldo A Moreno
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Chen YJ, Su JA, Chen JS, Liu CH, Griffiths MD, Tsai HC, Chang CC, Lin CY. Examining the association between neuropsychiatric symptoms among people with dementia and caregiver mental health: are caregiver burden and affiliate stigma mediators? BMC Geriatr 2023; 23:27. [PMID: 36646996 PMCID: PMC9841634 DOI: 10.1186/s12877-023-03735-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Neuropsychiatric disturbances are common manifestations of dementia disorders and are associated with caregiver burden and affiliate stigma. The present study investigated affiliate stigma and caregiver burden as mediators for the association between neuropsychiatric symptoms of people with dementia (PWD) and caregiver mental health such as depression and anxiety. METHODS A cross-sectional survey study was carried out with 261 dyads of PWD and informal caregivers from the outpatient department of a general hospital in Taiwan. The survey included the Caregiver Burden Inventory (CBI), the Affiliate Stigma Scale (ASS), the Taiwanese Depression Questionnaire (TPQ), and the Beck Anxiety Inventory (BAI). Mediation models were tested using the Hayes' PROCESS macro (Model 4 for parallel mediation model; Model 6 for sequentially mediation model). RESULTS Caregiver burden, affiliate stigma, caregiver depression, and caregiver anxiety were significantly associated with neuropsychiatric symptoms. After controlling for several potentially confounding variables, it was found that PWD's neuropsychiatric symptoms, caregiver burden and affiliate stigma significantly explained 52.34% of the variance in caregiver depression and 37.72% of the variance in caregiver anxiety. The parallel mediation model indicated a significantly indirect path from PWD's neuropsychiatric symptoms to caregiver mental health through caregiver burden and affiliate stigma, while the direct effect was not significant. Moreover, there was a directional association between caregiver burden and affiliate stigma in the sequential mediation model. CONCLUSIONS These findings show that it is imperative to improve caregivers' perception of those with dementia to reduce internalized stigma and to improve caregivers' mental health. Implementation of affiliate stigma assessment in clinical practice would allow distinctions to be made between the impact of affiliate stigma and the consequences of caregiver burden to help inform appropriate intervention.
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Affiliation(s)
- Yi-Jung Chen
- grid.64523.360000 0004 0532 3255Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jian-An Su
- grid.454212.40000 0004 1756 1410Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922School of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.418428.3Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan
| | - Jung-Sheng Chen
- grid.411447.30000 0004 0637 1806Department of Medical Research, E-Da Hospital, I-Shou University, Kaohsiung, 82445 Taiwan
| | - Chieh-hsiu Liu
- grid.416911.a0000 0004 0639 1727Department of Family Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Mark D. Griffiths
- grid.12361.370000 0001 0727 0669International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Hsin-Chi Tsai
- grid.411824.a0000 0004 0622 7222Department of Psychiatry, School of Medicine, Tzu Chi University, Hualien, Taiwan ,grid.414692.c0000 0004 0572 899XDepartment of Psychiatry, Tzu-Chi General Hospital, Hualien, Taiwan
| | - Chih-Cheng Chang
- grid.413876.f0000 0004 0572 9255Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan ,grid.411209.f0000 0004 0616 5076Department of Health Psychology, Chang Jung Christian University, Tainan, Taiwan
| | - Chung-Ying Lin
- grid.64523.360000 0004 0532 3255Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan ,grid.412040.30000 0004 0639 0054Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan ,grid.64523.360000 0004 0532 3255Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan ,grid.412040.30000 0004 0639 0054Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Sommers-Spijkerman M, Kavanaugh MS, Kruitwagen-Van Reenen E, Zwarts-Engelbert A, Visser-Meily JMA, Beelen A. Stigma experienced by ALS/PMA patients and their caregivers: a mixed-methods study. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:327-338. [PMID: 36593637 DOI: 10.1080/21678421.2022.2161911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: Previous work suggests that stigma negatively impacts quality of life in people living with amyotrophic lateral sclerosis (ALS) and progressive muscular atrophy (PMA). This study aimed to explore experiences of enacted stigma (experienced discrimination) and felt stigma (shame, fear of exclusion) among Dutch ALS/PMA patients and their caregivers. A secondary aim was to assess associated factors of enacted/felt stigma among patients. Methods: A two-phase mixed-methods study was conducted, comprising cross-sectional surveys among 193 ALS/PMA patients and 87 caregivers, and semi-structured interviews with 8 ALS/PMA patients and 11 family caregivers. Descriptive and multivariable regression analyses along with qualitative content analysis were used to analyze survey and interview data. Results: Survey findings indicate that patients and caregivers experience enacted and felt stigma. Interviews with both patients and caregivers revealed two manifestations of enacted stigma, including social exclusion (e.g. relationship distancing) and stigmatizing attitudes/behaviors displayed by others (e.g. staring), and three manifestations of felt stigma, including alienation (e.g. shame/embarrassment), perceived discrimination (e.g. feeling judged) and anticipated stigma (e.g. fear of exclusion). Patients and caregivers engaged in concealing and resisting responses to stigma. More bulbar symptoms, King's clinical stage, younger age and living without a partner were significantly associated with enacted/felt stigma among patients. Conclusions: Our findings reveal a range of perceptions and experiences underlying enacted/felt stigma among ALS/PMA patients and their caregivers that may serve as conversation topics in clinical practice. Future research may shed more light on the determinants as well as the consequences of stigmatizing experiences among patients and caregivers.
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Affiliation(s)
- Marion Sommers-Spijkerman
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands, and
| | - Melinda S Kavanaugh
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Esther Kruitwagen-Van Reenen
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands, and
| | - Aimée Zwarts-Engelbert
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands, and
| | - Anita Beelen
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands, and
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