The Stigma Complex

The Workplace Experiences of Transgender and Gender Diverse Employees: A Systematic Literature Review Using the Minority Stress Model

Transgender and gender diverse (TGD) employees encounter unique challenges in the workplace that are not shared with the rest of the working population. In this study, we conducted a systematic review of 58 empirical studies on the workplace experiences of TGD individuals published in peer-reviewed journals between 2000 and 2022. Using the Minority Stress Model as a theoretical framework, we classified the literature based on (a) the challenges that TGD employees face when navigating their gender identity at work, (b) the outcomes of minority stress processes, and (c) the mechanisms to ameliorate the impact of minority stressors. Findings suggest that TGD employees are exposed to various distal and proximal stress processes that negatively impact work outcomes and mental health, including discrimination or expectations of rejection. A key protective factor both at the organizational and interpersonal level is support, including inclusive policy development and coworker support. At the intrapersonal level, adaptive coping strategies and an integrated minority identity can countervail the impact of minority stressors. Future research should further examine intrapersonal variables while leveraging broader intersectional and international samples. Practitioners are advised to proactively and continuously review their nondiscrimination policies and practices to promote employee wellbeing and positive work outcomes.

Attitudes of ambulance service staff towards people with mental illness: A cross-sectional survey in the Verona province, Italy

Healthcare professionals can be sources of stigma for people with mental illness. Ambulance personnel are often the first healthcare providers that people with mental illness encounter during physical and mental health crises and their attitudes may be influenced by misconceptions and stereotyping views. This study aimed to assess the attitudes of ambulance personnel toward people with mental illness using the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) and to evaluate its psychometric properties. The study involved 510 ambulance staff members from a non-profit organization. The original factor structure of the OMS-HC, comprising three subscales was confirmed. The internal consistency for the OMS-HC total score was good (α=0.75) and acceptable for the subscales (Social Distance α=0.66; Attitudes α=0.59; Disclosure/Help-Seeking α=0.61). One-third of respondents displayed stigmatizing attitudes on half of the OMS-HC items. Higher scores were associated with being male, having lower levels of education, and working as both rescuers and ambulance drivers and with feeling uncomfortable when dealing with patients with mental illness. Overall, stigmatizing attitudes towards individuals with mental illness are prevalent among ambulance staff. The Italian version of the OMS-HC for ambulance personnel demonstrated satisfactory psychometric properties and is recommended for evaluating training programs targeting this population.

Identifying and Describing Mental Health Stigma Among Agricultural Youth Directors: Does Stigma Influence Practices?

OBJECTIVES

This exploratory study aims to: 1) evaluate mental health stigma levels among agricultural youth directors, 2) examine the influence of professional characteristics on stigma, and 3) investigate the relationship between agricultural youth directors' stigma levels and their self-efficacy.

METHODS

An online survey was administered from March to May 2022 to 642 agricultural youth directors in Illinois who work with youth aged 1-19. Directors' personal and perceived stigmas toward mental illness were measured using the Depression Stigma Scale. Directors' self-efficacy (perceived level of knowledge and confidence) across 19 mental health topics was measured using a 3-point Likert scale. Analyses were conducted by generating descriptive statistics and performing Mann-Whitney U tests on the data.

RESULTS

The median personal depression stigma score was 7.57 (SD = 8.02). Our analyses identified significantly higher personal depression stigma scores among men, FFA advisors, agricultural educators, and those lacking personal experience with mental illness. A lack of self-efficacy correlated significantly with increased personal stigma.

CONCLUSIONS

This study underscores the critical need for targeted educational interventions to reduce stigma among agricultural youth directors and enchance mental health literacy. Anti-stigma and mental health literacy initiatives are essential for fostering a supportive environment that encourages open discussions about mental health issues with youth within the agricultural community.

Mental Illness Stigma in Black, Latina/o, and Asian Americans

Mental illness stigma has significant psychiatric consequences and can impede mental health treatment seeking, especially among racial minority groups; who are understudied in stigma research and experience striking treatment disparities. Guided by a novel empirical model of racial minority stigma and treatment seeking, this study investigated stigma and its effects on treatment seeking in Black, Latina/o, and Asian American adults. Data were collected via national panel survey from 613 Black, Latina/o, and Asian American adults. Perceptions of mental illness including seriousness, treatability, causal attributions, desired social distancing, and perceived dangerousness were assessed. Data were analyzed and compared with a nationally representative sample of the U.S. public from the 2018 General Social Survey. Minority participants exhibited stronger mental illness stigma than the U.S. public, with Black, Latina/o, and Asian American participants largely perceiving mental illness as less serious, less treatable, and desiring greater social distance from individuals with major depression, who were perceived as potentially dangerous. Notably, different stigma components significantly associated with willingness to seek treatment differently across Black, Latina/o, and Asian American participants. Overall, study findings indicate that mental illness stigma is strong and associates with treatment seeking in Black, Latina/o, and Asian Americans, suggesting a need to develop culturally tailored interventions to reduce stigma and associated treatment utilization disparities in these underserved minority groups.

Right-wing authoritarianism, social dominance, system justification, and conservative political ideology as predictors of mental health stigma: The Hungarian case

BACKGROUND

Insights from mental health stigma research indicate the importance of societal and political views on mental health perceptions. Most studies originate from typical Western neo-liberal settings and focus on generic mental health issues. Our research explores these associations in Hungary, an understudied post-communist context with significant stigma levels, examining a broad range of stigmas related to both general and three specific mental illnesses: schizophrenia, depression, and alcohol use disorder (AUD).

AIMS

The study aims to connect a wide array of political dispositions to stigma associated with both general and specific mental illnesses, exploring both attitudes and behavioral intentions.

METHODS

We surveyed 492 participants (147 males, 342 females) on their political dispositions, including Right-Wing Authoritarianism (RWA), Social Dominance Orientation (SDO), general and economic system justification, and conservative political ideology, and their attitudes toward general and specific mental illnesses. Regression analyses identified key political dispositions influencing stigma.

RESULTS

RWA was significantly linked to most stigma outcomes, while conservative political ideology showed a selective impact. Other predictors had minimal influence on stigma outcomes.

CONCLUSION

Our findings suggest that perceptions of danger, threat, and unconventionality, as indicated by RWA, are crucial for mental health stigmatization in Hungary. Intervention programs should target these factors, particularly in similar contexts.

Patient perceptions of barriers to effective migraine management in Aotearoa New Zealand

Introduction Migraine is a complex neurological condition which requires evidence based treatment, tailored to the individual. International evidence shows that treatment is often sub-optimal, but the experience of people with migraine in NZ is unknown. Aim This study aimed to describe the barriers people with migraine disease face when seeking care for their condition in Aotearoa New Zealand (NZ). Methods The Migraine in Aotearoa New Zealand Survey (MiANZ) was delivered online via SurveyMonkey from 22 August 2022 to 7 October 2022. Questions included: sociodemographics, the Migraine Disability Assessment Scale (MIDAS), ability to access health care, perception of health professionals' knowledge and open-ended questions. Analysis used a mixed method approach. Results Five hundred and thirty people from NZ responded, of whom 82% (433/530) were female and 77% (409/530) NZ European/other. Eighty-eight percent (467/530) had accessed primary care for migraine, with 36% (167/467) finding GPs' knowledge of migraine to be excellent or very good. Forty-two percent (222/530) reported at least one instance where they had felt judged because of migraine by a health professional. Themes from free-text data included patient perception of health professionals' knowledge of migraine, the presence of stigma within medical practice and systemic barriers to accessing effective health care. Discussion People with migraine in NZ report significant barriers when trying to access effective management. Barriers were in both primary and secondary care and impacted the ability of people with migraine to manage their condition. More current migraine continuing medical education for GPs and other health professionals, better development and communication of care plans between primary and secondary care and patients and measures to address stigma are required to improve management of this complex disease.

The depiction of people with schizophrenia in news media: A cross-national analysis

BACKGROUND

Though people with schizophrenia have been habitually stigmatized in the media, the past two decades have seen a substantial rise in public awareness and anti-stigma intervention plans.

AIMS

In this comprehensive cross-national study, we examine the portrayal of people with schizophrenia in the news media across four countries: the U.S., the U.K., Russia, and Israel.

METHODS

We employed thematic content analysis to analyze 80 articles from four prominent middle-market and tabloid news media outlets.

RESULTS

Findings suggest people with schizophrenia were routinely depicted in the news media as violent and dangerous perpetrators who were typically young adult white males.

CONCLUSIONS

Though some differences existed between venues in different countries, this study suggests that despite the rise in public awareness and anti-stigma intervention plans, the media overall - regardless of country origin - mostly failed to deliver the desired anti-stigma results.

Analysis of Spanish-Language News Reports on Schizophrenia and Psychosis

OBJECTIVE

Stigma toward individuals with schizophrenia and psychosis has been widely studied in the general population, but research on Spanish-language news media coverage of these mental disorders in the Latinx population is limited. The authors aimed to examine how schizophrenia and psychosis are commonly presented in U.S. Spanish-language news media, focusing on stigmatizing stereotypes, recovery themes, and the use of best practices for reporting on mental health issues.

METHODS

A content analysis was conducted of reports from two leading U.S. Spanish-language news outlets, Univision and Telemundo, and from the newspaper database U.S. Hispanic Newsstream. The searches included articles published from August 1, 2012, to August 1, 2022, and included keywords related to schizophrenia and psychosis.

RESULTS

In total, 108 news articles were identified and coded. Several types of stigmatizing stereotypes were observed, including portraying a person with schizophrenia or psychosis as violent, suicidal, incompetent, or weak. Only 20 news articles included at least one recovery theme, with educational information about schizophrenia or psychosis being the most common. Most articles used person-first language when referring to people with these conditions, but few articles included information about treatment options or where and how to seek mental health care.

CONCLUSIONS

More studies should emphasize the importance of U.S. Spanish-language news outlets offering linguistically and culturally appropriate information on treatment options and where and how to access mental health care. Studies focusing on recovery and treatment for schizophrenia and psychosis are needed to combat public mental health stigma in the Latinx population.

Conceptualizing mental health stigma in organizational settings: a sociolinguistic perspective

BACKGROUND

Sociolinguistic research on workplace mental health stigma is scarce and consequently, there are a lack of relevant conceptual models. Drawing on Goffman's notion of stigma as a 'language of relationships', and Heller's concept of 'discursive space', this paper offers a conceptual model of how stigma is produced and reinforced in workplace settings. Specifically, the model maps the complex discursive processes of mental health stigmatization through workplace discursive practices.

METHODS

The model is empirically grounded and draws on 23 in-depth participant interviews with professional services employees in Hong Kong. Through a meta-discursive analysis of the employees' experience in the workplace, the paper investigates how mental health stigma is produced in the workplace.

RESULTS

Conceiving the workplace as a discursive space, the model demonstrates that mental health stigma unfolds across three discursive layers, namely immediate encounters, organizational practices, and societal ideologies. Mediated by discursive practices, such as identity management, stigma is both produced and perpetuated across the three layers.

CONCLUSIONS

The paper provides a model for analyzing the production of mental health stigma through dynamic discursive activities in the workplace. By doing so, it offers a way to systematically map how stigma, brought about through discourse in organizational settings, can regulate both interpersonal relationships and resource allocation (such as career prospects).

Testing the associations between poverty stigma and mental health: The role of received stigma and perceived structural stigma

BACKGROUND

Previous research has documented how people living on low incomes in the United Kingdom (UK) and internationally experience various forms of poverty stigma. The purpose of this study was to quantitatively examine how experiences of poverty stigma are associated with mental health outcomes.

METHODS

An online, cross-sectional survey was conducted with 1,000 adults living in predominantly low- and middle-income households in the UK. The survey included a questionnaire designed to measure participants' experiences of different forms of poverty stigma, as well as measures of anxiety, depression and mental well-being.

FINDINGS

Exploratory and confirmatory factor analyses of the poverty stigma questionnaire supported a two-factor solution. One factor reflected participants' experiences of being mistreated and judged unfairly by other people because they live on low income (received stigma) and the other factor reflected participants' perceptions of how people living in poverty are treated by media outlets, public services and politicians (perceived structural stigma). Both received and perceived structural stigma were independently associated with anxiety, depression and mental well-being and these relationships persisted after controlling for socioeconomic indicators. There was also evidence that received stigma and perceived structural stigma partially mediated the relationships between financial hardship and mental health outcomes.

DISCUSSION

Experiences of received and perceived structural poverty stigma are both associated with mental health and well-being. This suggests that addressing interpersonal and structural forms of poverty stigma may help to narrow socioeconomic inequalities in mental health.

The socioecology of sexual minority stigma: Advancing theory on stigma-based mechanisms underlying sexual orientation-based disparities in health

Research in public health and psychology has identified sexual minority stigma-related risk factors that contribute to sexual orientation-based health disparities across settings and societies worldwide. Existing scholarship, however, has predominantly focused on these factors as independent, stand-alone risk factors, neglecting their interconnected nature across different levels. This article theoretically explores how sexual minority stigma may function as a multilevel socioecological system, by building on prevailing theories and emphasizing the interplay between structural, interpersonal, and intrapersonal stigma-related factors. Drawing on the minority stress and socioecological theories, three central tenets are proposed, namely 1) chronosystem with immediate, accumulating, or lasting effects across spatiotemporal contexts, 2) nested multilevel system with cross-level effects, and 3) mechanistic pathways linking stigma exposure to health. By providing a nuanced and comprehensive understanding of how sexual minority stigma may operate as a multilevel socioecological system, this article reflects on the novel implications of this interpretation for future research and aims to guide future conceptualizations and studies, acknowledging the complexity of sexual minority stigma exposure across historical contexts, societies, and the individual life course in shaping physical and mental health of sexual minorities. Limitations of current research and recommendations for future research are being discussed.

Religious Social Integration, Psychedelics, and Psychological Distress

Psychedelic use has been increasingly accepted socially and legally. However, there is a gap in understanding how religion can influence the relationship between psychedelics and mental health. This study aims to explore this relationship by examining the impact of lifetime classic psychedelic use (LCPU), religious attendance, and religious salience on monthly psychological distress, using the K6 scale. The data for this project is sourced from the National Survey of Drug Use and Health (NSDUH) from 2008 to 2019, with a sample size of 458,372. The analysis utilizes several Ordinary Least Square regression models conducted in Stata 17. The results indicate that both religion and psychedelic use are associated with lower levels of psychological distress. While increased religious salience is linked to reduced distress, this effect is weakened by psychedelic use, as higher salience is associated with higher levels of distress among individuals who have used psychedelics. However, a three-way interaction analysis reveals that individuals with high religious salience and attendance experience the lowest levels of distress.

Empowering post-stroke older adults through wheelchair development: a conceptual synthesis for stigma reduction and well-being enhancement

Purpose: After a stroke, older adults may encounter social stigma due to their disability and age. This can cause emotions of shame, low self-esteem, and social isolation. The use of assistive devices can make the stigmatizing conditions even more difficult. This study attempts to establish a conceptual framework for designing wheelchairs that can help reduce stigma and improve the well-being of older people with lived experience of stroke.Method: The study utilized the research question construct classification to identify three primary research questions. To address these questions, a bibliographic search was performed using Scopus, Web of Science databases, and PubMed. Articles were selected based on their relevance to the development of wheelchairs and their focus on reducing stigma or enhancing well-being for post-stroke older adults.Results: Seventy articles were chosen to be meticulously reviewed and categorized into sub-themes. This categorization led to the creation of a comprehensive synthesis summary to address each question. The results are further synthesized to formulate a potential theoretical proposition for future investigation. The results suggest enhancing wheelchair design focusing on visibility, symbolism, usefulness, aesthetics, and adaptability through user empowerment and cultural interventions that can effectively reduce stigma, thereby improving the well-being, self-competence, and life quality of post-stroke older adults.Conclusion: The findings offer a design framework for wheelchair innovation specifically aimed at reducing the stigmatizing conditions to improve the well-being of post-stroke older adults through an interdisciplinary perspective. This study suggests further research to explore specific design strategies for wheelchair innovation across various contexts and cultures.

How Bereaved Parents Experience Public, Self Stigma Years After a Child's Death

This study identifies the stigma experienced by 12 bereaved parents 2 and 5 years after losing a child in the Sewol ferry disaster in South Korea. Using thematic analysis, we categorized the experience of stigma into two components based on Corrigan and Kosyluk's social cognitive model of stigma: public stigma and self-stigma, and each was analyzed into three types of stigma: stereotype, prejudice, and discrimination. We identified four additional factors related to stigma mitigation. The potential implications for characterizing the experiences of bereaved parents, particularly those facing stigma, are discussed in light of these findings in the longitudinal perspective.

Beyond the 5-year recovery mark: Perspectives of researchers with lived and living experience on public engagement and discourse

There has been growing attention toward including people with lived and living experience (PWLLE) with substance use, substance use disorders, and recovery in public-facing activities. The goals of including PWLLE in sharing their perspectives often include demonstrating that recovery is possible, destigmatizing and humanizing people who have substance use experiences, and leveraging their lived experience to illuminate a particular topic or issue. Recently, the National Council for Mental Wellbeing issued a set of guidelines entitled, "Protecting Individuals with Lived Experience in Public Disclosure," which included a "Lived Experience Safeguard Scale." We offer the present commentary to bolster some of the ideas presented by the Council and to articulate suggested changes to this guidance, with the goal of reducing unintentional gatekeeping and stigma. Specifically, we offer that there are numerous problems with the recommendation to only invite people who have "five or more years of sustained recovery" to contribute to public discourse. The idea of perceived stability after five years of abstinence is not new to us or the field. We suggest that this idea excludes people who have experienced the present rapidly changing substance use landscape, people who have briefly returned to use, some young people, and people with living experience who also can valuably contribute to public discourse. We offer alternative guidelines to the National Council for Mental Wellbeing and others seeking to promote practices that are inclusive to the diversity of PWLLE.

Association between stigma and quality of life among chronic refractory wounds patients and informal caregivers: an actor-partner interdependence model analysis

PURPOSE

The co-occurrence of health impairments in patients and their informal caregivers may be particularly common in intimate care settings in China. Patients with Chronic Refractory Wounds (CRWs) and their informal caregivers constitute a dyad and exhibit dyadic effects during the caring process. Unfortunately, no study has yet explored the dyadic effects of stigma on the QoL of patients with CRWs and their caregivers.

METHODS

We used a convenience sampling method and recruited CRWs patient-caregiver dyads (N = 207) in China between April 2022 and October 2023.

RESULTS

We found that: (i) dyadic members experience varying degrees of stigma; (ii) the actor-partner effect of CRWs patients' stigma on their own and their informal caregivers' QoL was significant (Path A1: β = - 1.27, Path A2: β = - 0.37, Path P1: β = - 0.08, Path P2: β = - 0.18); (iii) informal caregivers' stigma adversely affects both their own and their patients' psychological QoL((Path A4: β = - 0.65, Path P4: β = - 0.52)). Informal caregivers' stigma can negatively impact patients' physical QoL (Path P3: β = - 0.17), whereas it does not significantly affect their own physical QoL.

CONCLUSION

There is a notable actor-partner effect of the CRWs patients' stigma on their own and their informal caregivers' QoL. CRWs patients' stigma should become a priority for the government to improve CRWs patients' and informal caregivers' QoL. Besides, health professionals should be addressing several assessments and interventions to decrease informal caregivers' affiliate stigma symptoms and improve CRWs patients' and informal caregivers' QoL.

A Qualitative Study Into the Relative Stigmatization of Mental Illness by Mental Health Professionals

Mental health professionals stigmatize mental illness, which has significant ramifications for public health and policy. Within this domain, there is a lack of comprehensive research on relative stigma, emotions, and behaviors and an absence of literature that can guide research on these topics. The current study sought to address these limitations. Unstructured interviews were conducted with 22 mental health professionals, and data were analyzed using a grounded theory approach. The current study identified a collection of mental disorders (e.g., borderline personality disorder), stereotypes (e.g., dangerousness), emotion-related responses (e.g., fear), and behaviors (e.g., helping) as being key to the relative stigmatization of mental illness by mental health professionals. The results also suggested that professional context and familiarity with mental illness decrease the stigmatization of mental illness by mental health professionals. These variables and constructs were combined to form a grounded theory of mental health professionals stigmatizing mental illness. The current study has implications for the direction of future research on the stigmatization of mental illness by mental health professionals and interventions that strive to mitigate this type of stigmatization.

Stigma processes, psychological distress, and attitudes toward seeking treatment among pedohebephilic people

While stigma theories predict that stigma relates to negative attitudes toward seeking help, previous studies found mixed results among pedohebephilic individuals. We tested whether different stigma processes (i.e., general anticipated stigma, anticipation of negative therapist behavior upon disclosure, and internalized stigma), psychological distress, previous treatment experiences, and knowledge about psychotherapy can clarify attitudes toward seeking professional psychological help for this population. We conducted a pre-registered, online survey of English-speaking pedohebephilic individuals (N = 283, 88% male). Expected links between variables of interest and attitudes toward seeking treatment were assessed via structural equation modeling. After modification, the final model showed acceptable fit to the data, χ2 = 2170.61, df = 1462, p < .001, CFI = .905, RMSEA = .04, [.04,.05]. Internalized stigma predicted more positive attitudes toward seeking treatment. Lower anticipation of negative therapist behavior upon disclosure and higher knowledge about psychotherapy were also significant predictors of positive attitudes toward seeking treatment. General anticipated stigma did not predict attitudes toward seeking treatment. Our results suggest a complex association between different stigma processes and treatment-seeking, which differs from associations found for mental illness stigma. Specificity in our understanding of the components of stigma and how they interact with attitudes toward seeking treatment is required to tailor clinical work as well as messages around treatment services.

Are the self-stigma and perceived stigma of patients treated with methadone or buprenorphine still a problem fifty years after the marketing authorization for opioid agonist treatment? The observational STIGMA study

BACKGROUND

In the context of the opioid overdose crisis, understanding the barriers to seeking, attaining and remaining in treatment for patients with opioid use disorder (OUD) is a public health issue. To date, very few studies have assessed the "self-stigma" (i.e., the internalization of negative societal attitudes and stereotypes about oneself, leading to self-judgment) and "perceived stigma" (i.e., the belief that others hold negative attitudes towards oneself due to a particular condition) experienced by patients with OUD receiving opioid agonist treatment (OAT), and none have done so in France. Our study aimed to quantify self-stigma, explore some aspects of perceived stigma, determine the factors associated with greater self-stigma and examine whether the level of self-stigma was related to a delay in seeking care.

METHODS

The STIGMA study was a monocentric, cross-sectional study. The data were collected in a French hospital addiction medicine department. Participants were outpatients with current or past OUD who were still receiving or had received OAT. A questionnaire assessing sociodemographics; OUD characteristics; perceived stigma; and quantification of self-stigma by the Self-Stigma Scale-Short, was administered.

RESULTS

A total of 73 questionnaires were included in the analysis. Nearly two-thirds of the patients had a "moderate to high" level of self-stigma. These patients were significantly younger at OUD onset and were significantly more likely to have at least one dependent child than patients reporting a "very low to low" level of self-stigma. Nearly half of the participants experienced perceived stigma from a healthcare professional regarding their OUD or OAT, and nearly one-third of the participants were refused care from a healthcare professional because of their OUD or OAT. Moreover, a quarter of the sample reported delaying care due to fear of being stigmatized. We did not find a relationship between self-stigma levels and a delay in seeking care.

CONCLUSIONS

Our study highlights the need to detect stigma and to improve training in addiction medicine.

An insurmountable obstacle: Experiences of Chinese women undergoing in vitro fertilization

OBJECTIVE

This study aimed to explore the perceptions of women who have undergone unsuccessful in vitro fertilization (IVF) in Hangzhou, Zhejiang Province, China, and to explore how treatment failure has impacted their lives and relationships, thereby enabling the public to understand the unique experiences of these women.

DESIGN

A descriptive qualitative approach was employed, with purposive sampling used to recruit participants from the gynecological department of a traditional Chinese medicine clinic at a large tertiary hospital in Zhejiang province. Twelve women undergoing IVF treatment was involved in the study. Data were collected through face-to-face semi-structured interviews, which were transcribed verbatim. Conventional content analysis methods were used to analyze the data.

RESULTS

Following analysis, three main categories emerged: 1) The Psychological Experience of Initial Miscarriage from IVF Treatment, 2) The Psychological Experience of Repeated Treatment Failure, and 3) Interpersonal experiences and challenges. Women experiencing initial failure from IVF treatment reported emotions such as surprise, doubt, sadness, disappointment, and embarrassment. They perceived the process as harder than expected, leading to unexpected daily life challenges and difficulties in achieving success. As unsuccessful attempts persisted, they endured psychological suffering and lived in the shadow of repeated treatment failures. Doubts, perplexity, and anxiety grew, making reproduction seem like an insurmountable obstacle in their lives. In their interpersonal experience, women often felt guilt toward family, faced social isolation, and found it challenging to discuss IVF openly everywhere. They encountered a lack of understanding from others but also found mutual sympathy and support among people who shared similar experiences.

CONCLUSIONS

The study provided an insight into the suffering of Chinese women undergoing IVF treatment, highlighting the challenges of overcoming treatment failures. The findings not only inform Chinese infertile women considering IVF treatment but also contribute to the development of more effective support services by healthcare providers.

Race and Ethnicity and Clinician Linguistic Expressions of Doubt in Hospital Admission Notes

Importance

Stigmatizing language in electronic health records (EHRs) can generate or reinforce negative stereotypes about patients from minoritized groups and erode their trust and experience. However, less is known about the use of such language to cast doubt on patient clinical history in hospital settings.

Objective

To compare the prevalence of language expressing doubt about patient clinical history (eg, experiences and symptoms) in hospital admission notes by patient race and ethnicity.

Design, Setting, and Participants

In this cohort study, natural language processing tools were applied to analyze 54 936 admission notes from 1249 clinicians about patients aged 18 years or older at admission and hospitalized at an academic health system in the Northeast US between January 1, 2018, and February 28, 2023. Data were analyzed from September 1, 2022, to July 31, 2023.

Exposure

Patient race and ethnicity (non-Hispanic Black, non-Hispanic White, and racial and ethnic minoritized groups excluding non-Hispanic Black [includes multiple racial and ethnic groups, such as Hispanic and Asian]) as recorded in the EHR based on self-report or registrar determination.

Main Outcome and Measure

Binary indicator for at least 1 term casting doubt on patient clinical history was defined using epistemic stance, a linguistic construct expressing a writer's degree of certainty in information. Terms were manually validated via iterative review of notes by the study team.

Results

Among 56 325 admission notes (mean [SD] age of patients, 55.9 [19.0] years; 30 913 notes among female patients [54.9%]; 25 649 notes among non-Hispanic Black patients [45.5%], 26 442 notes among non-Hispanic White patients [46.9%], and 2985 notes among members of racial and ethnic minoritized groups excluding non-Hispanic Black patients [5.3%]), we analyzed 54 936 admission notes that had no missing data. Among all analyzed admission notes, 39 023 notes (71.0%) contained doubt language. Notes written about non-Hispanic Black patients had increased odds of containing at least 1 word or phrase of doubt (adjusted odds ratio, 1.21; 95% CI, 1.14-1.28; P < .001) compared with notes among non-Hispanic White patients. Compared with notes among non-Hispanic White patients, notes written about members of racial and ethnic minoritized groups excluding non-Hispanic Black patients had similar odds of containing at least 1 term of doubt.

Conclusion and Relevance

In this study, language casting doubt on patient clinical history was more likely to be found in notes of non-Hispanic Black patients. These results suggest that with the implementation of policies allowing patients full access to their health records, examining clinical documentation standards may be associated with improved patient experience.

"It's just getting the word out there": Self-disclosure by people with young-onset dementia

BACKGROUND

Sharing a dementia diagnosis with others is a prerequisite to accessing important support for social, cognitive, and physical activity. However, due to the stigma associated with dementia, individuals may be hesitant to disclose their diagnosis. Despite the importance of this issue, there is limited research on personal experiences with sharing one's diagnosis. This study explored how people with young-onset dementia disclose their diagnosis to other people, also known as self-disclosure, and how time affects self-disclosure.

METHODS

We conducted an exploratory qualitative study, using semi-structured interviews with nine people with young-onset dementia living in the United Kingdom (UK). A narrative approach to analysis was applied, focusing on understanding the core narratives, themes, tone, and imagery of each participant's narratives as well as providing a cross-case analysis to identify patterns across narratives.

RESULTS

Participants openly disclosed their diagnosis, accepting it as an illness that did not define their identity. Several were met with stigmatizing reactions, which affected their levels of openness, and a lack of understanding, which caused shrinking social networks for some. Peer support groups, advocacy activities, and strategic concealment were used to support self-disclosure.

CONCLUSION

This study provides a holistic understanding of people with young-onset dementia's experiences with self-disclosure and how these evolved. Policies should prioritize the creation of dementia-friendly communities, while recommendations for practice include integrating empowerment interventions and peer support into post-diagnostic support. These efforts will support individuals in their self-disclosure journey, promote social engagement and reduce stigma.

Unravelling Migraine Stigma: A Comprehensive Review of Its Impact and Strategies for Change

Migraine-related stigma is a pervasive issue impacting nearly half of chronic migraine patients, with significant consequences for their quality of life, disability and mental health. Despite its profound effects, migraine stigma remains under-recognised in both clinical practice and research. This narrative review explores the three primary types of stigmas affecting migraine patients: public, structural and internalised. Public stigma involves negative societal attitudes and stereotypes that trivialise the condition. Structural stigma is reflected in policies that restrict access to necessary care and resources. Internalised stigma occurs when patients absorb these negative views, leading to self-blame and diminished self-worth. Addressing these different types of stigmas is crucial for improving the understanding, diagnosis and treatment of migraine. Educational efforts, advocacy and policy reform are essential strategies in this context. A deep understanding of stigma is vital for developing effective interventions that enhance clinical management and patient quality of life. Ultimately, reducing stigma can lead to better health outcomes and a more comprehensive approach to migraine care.

Experienced discrimination and internalized stigma among people infected with SARS-CoV-2 and surviving COVID-19: Association with anxiety, depression, and insomnia symptoms

People surviving COVID-19 may experience social stigma related to their condition even after clinical recovery. This study aimed to: (1) investigate COVID-19-related experienced discrimination and internalized stigma, and (2) explore their association with symptoms of anxiety, depression, and insomnia. We conducted an online survey of people who survived COVID-19. Perception of stigma was assessed using the COVID-19 Experienced Discrimination Scale and the COVID-19 Internalized Stigma Scale. Depression, anxiety, and insomnia were assessed using, respectively, the Patient Health Questionnaire-9, the General Anxiety Disorder Scale-7, and the Insomnia Severity Index. Multivariable logistic regression analyses for each psychopathological domain were performed. A total of 579 participants participated in this study. Overall, 25% reported some degree of experienced discrimination, and 23% reported some degree of internalized stigma. Adjusted odds ratio showed that scoring higher on internalized stigma related significantly to higher symptoms of depression (2.14; 95% confidence interval [CI], 1.35-3.39), anxiety (2.30; 95% CI, 1.48-3.59), and insomnia (2.54; 95% CI, 1.64-3.95), whereas experienced discrimination was associated to anxiety (1.55; 95% CI, 1.06-2.28) and insomnia (1.82; 95% CI, 1.24-2.69). Experiences of social stigmatization are frequent among people surviving COVID-19 and seem to be associated with levels of psychological disturbances. Further research is required to elucidate the direction of these relationships to implement effective treatment strategies.

I Didn't Want the Psychotic Thing to Get Out to Anyone at All: Adolescents with Early Onset Psychosis Managing Stigma

The impact of stigmatisation on adults with mental illnesses has been thoroughly demonstrated. However, little is known about experiences of stigmatisation among adolescents with mental illness. Through semi-structured interviews with 34 Danish adolescents (14-19 years) diagnosed with psychosis, this study explores adolescents' experiences of psychosis stigma. On the basis of phenomenological analysis, we find that stigmatisation is widely experienced, and psychosis is generally regarded as more stigmatising than co-morbid mental illnesses. The participants engage in different strategies to manage possible stigma, especially strategies of (non-)disclosure. Disclosure is experienced as both therapeutic and normative, but also bears the risk of stigmatisation, and is therefore associated with numerous considerations. Being understood when disclosing is central to the participants, and lack of understanding from others is a continuous challenge. Nevertheless, participants experience benefits when feeling understood by people they confide in and can to a degree create the grounds for this through centralising aspects of their experiences of psychosis and mental illness. We argue that disclosure is both a stigma management strategy and a normative imperative, and that being understood or not is a challenge transcending stigma definitions.Clinical trial registration: Danish Health and Medicines Authority: 2612-4168. The Ethics Committee of Capital Region: H-3-2009-123. ClinicalTrials.gov: NCT01119014. Danish Data Protection Agency: 2009-41-3991.

Addressing mental illness stigma in German higher education: study protocol for a mixed-methods evaluation of a psychosocial setting-based intervention

INTRODUCTION

Mental illness stigma is associated with a range of negative consequences, such as reduced help-seeking for mental health problems. Since stigma affects individual, social, and structural aspects, multilevel interventions such as the Canadian programme The Working Mind have been proven to be the most effective. Given the solid evidence base for The Working Mind, it is our aim to implement and evaluate culturally adapted versions of the programme in German higher education, targeting students, employees and managers.

METHODS AND ANALYSIS

We will evaluate the programme with regard to its effect on mental illness stigma, openness to mental health problems, willingness to seek help, and positive mental health outcomes. Further, we will investigate the programme's effectiveness dependent on gender and personal values, various mechanisms of change, and factors facilitating and hindering implementation. The study uses a sequential explanatory mixed-methods evaluation design (QUAN → qual) that consists of three steps: (1) quasi-experimental online survey with programme participants, (2) focus groups with programme participants, and (3) qualitative interviews with programme stakeholders. The quantitative data collected in step 1 will be analysed using 2×3 analysis of variances and a parallel multiple mediation analysis. The results will inform the qualitative data to be collected in steps 2 and 3, which will be analysed using qualitative content analysis.

ETHICS AND DISSEMINATION

The study was approved by the local Ethics Committee (Ethics Committee of University Medicine Greifswald; BB 098/23). Participants have to provide written consent before taking part in a focus group or interview. As for the online survey, participants have to give their consent by agreeing to an online data protection form before they can start completing the survey. We will publish central results and the anonymised data in an Open Access Journal. Further, the statistical code will be included as a supplement to the paper(s) documenting the results of the study.

TRIAL REGISTRATION NUMBER

DRKS00033523.

Discrimination based on gender identity against transgender women and travestis in Brazil: a latent class analysis and associated factors

OBJECTIVE

To identify groups of transgender women and travestis (TGW) with specific patterns of gender-based discrimination (GBD) and analyze the factors associated with GBD.

METHODS

A cross-sectional study was conducted with TGW recruited through respondent-driven sampling in five Brazilian cities (2019-2021). Latent class analysis was used to characterize GBD (low, medium, and high) using 14 observable variables. Descriptive analysis was performed, and associations between predictor variables and GBD were estimated by adjusted odds ratios (aOR) using ordinal logistic regression.

RESULTS

Out of a total of 1,317 TGW, 906 (68.8%) answered questions about GBD. Most were under 34 years old, single, and had a Brown race/skin color. GBD was classified as "low," "medium," and "high," with estimates of 41.7, 44.5, and 13.8%, respectively. Variables positively associated with higher intensity of GBD included living in Manaus compared to São Paulo, being ≤34 years old compared to >34, being homeless compared to living in one's own house or rented apartment, not having legally changed one's name compared to those who had, and reporting physical or sexual violence compared to those who did not report. Variables negatively associated with higher intensity of GBD included having a Brown or Asian race/skin color compared to White and a monthly income ≥1 minimum wage compared to ³1.

CONCLUSION

A high proportion of GBD was observed in Brazilian TGW, with this outcome associated with more vulnerable sociodemographic characteristics and a history of violence.

Designing the first culturally-sensitive stigma survey tailored for adolescents: RN-CSS

AIMS

The Red Noses Culturally-Sensitive Stigma Survey (RN-CSS) contributes to the underexplored research domain of adolescents' stigmatising attitudes and behaviours towards peers with mental health difficulties and mental healthcare services. It also addresses the need for comprehensive and culturally-sensitive tools to assess stigma in this context.

METHODS

Drawing on insights from focus groups and building upon the existing Stigma in Global Context-Mental Health Study, we have successfully developed and implemented the first culturally-sensitive stigma survey tailored for school-aged adolescents of different migration/cultural backgrounds. The questionnaire includes an unlabelled case vignette depicting a peer with symptoms of depression and gathers data on various domains, including (1) sociodemographic variables; (2) education-related information; (3) COVID-19; (4) perceptions of mental health difficulties and mental healthcare services (i.e. severity assessment, causal attributions, care recommendations, personal stigma, perceived stigma, and service stigma); (5) subjective wellbeing and familiarity with mental health difficulties; (6) social support; (7) school context; (8) bullying; and (9) knowledge of anti-stigma campaigns.

RESULTS

Our final sample comprises 5075 pupils from 38 secondary schools in Flanders, Belgium.

CONCLUSIONS

In this article, we present the study's background and rationale, the development of the questionnaire, and the sampling and recruitment methods employed. Furthermore, we provide a summary of the sample characteristics and preliminary descriptive results of the RN-CSS. Subsequent empirical studies will address the research objectives outlined in this protocol paper. The research opportunities provided by the developed materials and dataset are being discussed.

It's not who you know, but who you are: Explaining income gaps of stigmatized-caste business owners in India

Scholars across disciplines and around the world have diverted research attention to rising income inequalities across groups and strategies to reduce them. The literature has broadly identified human capital and social capital as two potential tools to facilitate economic mobility and to reduce inequalities. However, it is not known whether these tools work equally well for stigmatized groups, particularly in societies with systemic inequalities. Analyzing data from a pan-India survey, we show that business owners from stigmatized groups (i.e., Dalits in India, who are stigmatized as untouchables) experience a business income gap of around 16% compared to others, including those business owners who are from communities that are disadvantaged but are not similarly stigmatized. We find that, instead of being reduced, this gap in fact increases at higher levels of social capital, especially bridging social capital, illustrating the social processes of stigmatization that limit the benefits that Dalits can reap from social capital. By contrast, Dalits can reap similar income benefits as others from human capital. Our results show that human capital helps stigmatized groups mitigate the implications of stigma, but social capital does not.

Stigma in functional neurological disorder (FND) - A systematic review

OBJECTIVE

The purpose of this systematic review was to evaluate stigma and Functional Neurological Disorder (FND) regarding: 1) prevalence and associated factors, 2) the nature and context of stigma in FND, and 3) stigma-reduction interventions.

METHODS

We searched four relevant databases from inception to December 2023, using search terms relevant to FND and stigma themes. We employed the method of synthesis by "aggregation and configuration" to synthesise and analyse the data into emergent themes.

RESULTS

We found 127 studies, spanning 148 countries, involving 18,886 participants. Of these, 4889 were patients, 13,123 were healthcare professionals, and 526 were caregivers. Quantitatively, stigma has been mainly studied in patients with functional seizures, and was higher than patients with epilepsy in three studies. Stigma experienced by patients is associated with poorer quality of life and caregiver burden. We found 10 themes and 29 subthemes revealing stigma as a systemic process, with intrapersonal, interpersonal and structural aspects. Few studies examined the perspective of caregivers, the public or online community. We identified six anti-stigma interventions.

CONCLUSION

Stigma in FND is a layered process, and affects patient quality of life and provision of care. Stigma needs to be addressed from the top structures, at governmental level, so that appropriate care pathways can be created, giving patients with FND parity of esteem with other medical conditions.

Social Stigma and COVID-19 Vaccine Refusal in France

CONTEXT

In 2021, French health authorities strongly promoted vaccination against COVID-19. The authors assumed that refusing this vaccine became a stigma, and they investigated potential public stigma toward unvaccinated people among the French population.

METHODS

A representative sample of the French adult population (N = 2,015) completed an online questionnaire in September 2021. The authors focused on participants who were already vaccinated against COVID-19 or intended to get vaccinated (N = 1,742). A cluster analysis was used to obtain contrasted attitudinal profiles, and the authors investigated associated factors with logistic regressions.

FINDINGS

Regarding attitudes toward unvaccinated people, a majority of respondents supported several pejorative statements, and a significant minority also endorsed social rejection attitudes. The authors found four contrasting attitudinal profiles: moral condemnation only (32% of respondents), full stigma (26%), no stigma (26%), and stigma rejection (16%). Early vaccination, civic motives for it, faith in science, rejection of political extremes, and being aged 65 or older were the main factors associated with stigmatizing attitudes toward unvaccinated people.

CONCLUSIONS

The authors found some evidence of stigmatization toward unvaccinated people, but further research is needed, especially to investigate perceived stigmatization among them. The authors discuss their results with reference to the concept of "folk devils" and from a public health perspective.

Stigma experienced as worse than symptoms of schizophrenia: A qualitative study about The OpusPanel

AIM

Former patients and relatives of people who have received treatment in OPUS, a Danish specialized early intervention for first episode psychosis, have since 2009 worked to reduce stigma and increase hope related to schizophrenia and psychosis. They established The OpusPanel to share their own stories of living with an invisible disorder with new patients, health care professionals, politicians, and members of the public. The impact of The OpusPanel on stigma has not previously been explored or evaluated. The article aims to evaluate and gain an in-depth understanding of The OpusPanel's anti-stigma impact.

METHODS

In a qualitative design, 27 people with different affiliations to The OpusPanel were interviewed using semi-structured interview guides to capture their individual experiences of listening to, interacting with, or being part of The OpusPanel. Interview guides were constructed following a focus group interview with members of The OpusPanel. Analysis of the multi-perspectival dataset was facilitated through an interpretative phenomenological approach with investigator triangulation. Preliminary results were returned to the focus group members to ensure relevance and accuracy.

RESULTS

The study found that almost all interviewees described a sense of hopefulness and decreased stigma after having experienced a member from The OpusPanel present their story or participating as panel members themselves.

CONCLUSION

The findings suggest that attending presentations or participating in The OpusPanel reduces stigmatizing views about others or oneself. The study may inform The OpusPanel and similar initiatives for challenging stigma related to schizophrenia or psychosis.

Understanding the public stigma of mental illness: a mixed-methods, multi-level, exploratory triangulation study

BACKGROUND

This study examines the role of themata in understanding mental health-related stigma. It is motivated by the need for alternative theoretical-methodological approaches beyond the dominant frameworks in education and contact-based anti-stigma public health efforts, which have shown mixed effects. Specifically, it addresses the need for a more nuanced framework in stigma research, one that is sensitive to the dialogues through which people relate themselves to mental health and stigma in context.

METHODS

The research employs an exploratory mixed-methods approach, including the analysis of 529 news reports, 20 focus group discussions, and 19 one-to-one interviews, all concerning representations of shared living arrangements with someone perceived to have experiences of mental illness. Thematic analysis and natural language processing are used within a convergent triangulation design to analyze the data.

RESULTS

We found that mental health and illness were communicated through an overarching Self/Other thema and five subordinate themata: normal/abnormal, harm/non-harm, bounded/non-bounded, and moral/immoral. Despite familiarity with psychological distress and 'modern' explanations of mental illness, concerns about social identity motivated representations of mental illness as a predominantly permanent, negative form of personhood marked by abnormality, harm, distance, and immorality. Additionally, concerns about personal vulnerability, including historically rooted fears of contagion, motivated distancing representations of mental illness, rather than neutral portrayals.

CONCLUSIONS

Themata have under-developed theoretical and methodological potential for addressing mental health-related stigma, particularly in their ability to describe the dynamic ways in which culture motivates people to both resist and reproduce stigma, partly through ambivalences, absences, tensions, and ambiguities in representation. A critical discussion is provided on how themata may support ecological strategies in mental health campaigns over generic models, emphasizing the need to understand group knowledge and contact dynamics to mitigate adverse effects. Themata Public Health Unintended Consequences Mixed Methods Behaviour Change Natural Language Processing.

Mental Health Stigma in the Workplace and its Association with Possible Actions of Managers to Prevent Sickness Absence of Employees with Mental Health Problems in the Swedish Private Sector: a Video Vignette Study

PURPOSE

Mental health problems (MHPs) are subjected to workplace stigma and can deteriorate into common mental disorders (CMDs) and sickness absence (SA). Research has shown that personal stigmatizing attitudes limit managers' efforts towards employees with MHPs, but knowledge is lacking regarding stigma in social contexts (contextual stigma) and different types of possible preventive actions. This study investigates personal stigmatizing attitudes and three contextual stigma layers (employee, collegial, organizational) and different types of possible actions to prevent SA of employees with MHPs.

METHOD

Survey data of 2769 Swedish managers working in the private sector were analysed. Personal stigmatizing attitudes were measured with the managerial stigma towards employee depression scale and supplemented with four additional items capturing contextual stigma. Managers watched video vignettes and assessed which preventive actions (n  = 20) were possible to use in their organization. A sum score was calculated reflecting the 'number of actions'. Principal component analysis revealed three action types: adapt tasks and setting, involve experts, and social support. A score reflecting the 'possibilities to implement actions' was calculated for each type. Multiple linear regression analyses were conducted with the four stigma layers as independent variables for each of the three action variables.

RESULTS

Personal stigmatizing attitudes and contextual stigma were significantly associated with both 'number of actions' and 'possibilities for implementing actions' relating to all action types. Patterns of associations with contextual stigma were significant but varied between the different action types.

CONCLUSION

This study substantiated the role of personal stigmatizing attitudes and contextual stigma in relation to possible actions of managers to prevent SA of employees with MHPs. The results emphasize the role of contextual stigma. Implications for practice and research are discussed.

The Effects of Stigma: Older Persons and Medicinal Cannabis

Cannabis has long been stigmatized as an illicit drug. Since legalization in Canada for both medical and recreational purposes, older adults' cannabis consumption has increased more than any other age group. Yet, it is unclear how the normalization of cannabis has impacted perceptions of stigma for older adults consuming cannabis medicinally. Qualitative description was used to elucidate the experiences of older Canadians aged 60+ related to stigma and their consumption of cannabis for medicinal purposes. Data collection involved semi-structured interviews. Data analysis examined how participants managed stigma related to cannabis use. Perceived stigma was evident in many participants' descriptions of their perceptions of cannabis in the past and present, and influenced how they accessed and consumed cannabis and their comfort in discussing its use with their healthcare providers. Participants employed several distinct strategies for managing stigma-concealing, re-framing, re-focusing, and proselytizing. Findings suggest that while medical cannabis consumption is becoming increasingly normalized among older adults, stigma related to cannabis persists and continues to shape older adults' experiences. A culture shift needs to occur among healthcare providers so that they are educated about cannabis and willing to discuss the possibilities of medicinal cannabis consumption with older adults. Otherwise, older adults may seek advice from recreational or other non-medical sources. Healthcare providers require education about the use of medical cannabis, so they can better advise older adults regarding its consumption for medicinal purposes.

Public stigma against fentanyl overdose decedents in the United States: A conjoint vignette experiment

The United States is facing a drug overdose crisis, and stigma against people who use drugs is a major roadblock to implementing solutions. Despite the public health importance of understanding and mitigating substance use stigma, prior research has focused mainly on perceptions of individuals with substance use disorders and a limited set of demographic traits. This leaves critical gaps in our understanding of stigma against fentanyl overdose decedents, who represent a much broader group, including people who use substances recreationally. This study develops a more robust understanding of these attitudes through an experimental vignette survey fielded to a national sample of American adults (n = 1432). Respondents were shown two fictional fentanyl overdose obituaries where a complex suite of decedent characteristics-including demographic traits and contexts of substance use-were randomly varied in a conjoint design. Respondents then endorsed one of the two decedents for each of several attitudinal outcomes, including blameworthiness and support for various interventions, and justified their choices in an open-ended format. Results indicate that the public assesses victims of fentanyl overdose meritocratically, making judgments based on personal history and life experience rather than traditional race, class, and gender status beliefs. While certainly a signal of progress on some fronts, this meritocratic lens conflicts with the public health model of addressing the overdose crisis and exposes the alarming persistence of explicit stigma against people who use drugs.

Measuring persistent somatic symptom related stigmatisation: Development of the Persistent Somatic Symptom Stigma scale for Healthcare Professionals (PSSS-HCP)

OBJECTIVE

Persistent somatic symptoms (PSS) describe recurrent or continuously occurring symptoms such as fatigue, dizziness, or pain that have persisted for at least several months. These include single symptoms such as chronic pain, combinations of symptoms, or functional disorders such as fibromyalgia or irritable bowel syndrome. While stigmatisation by healthcare professionals is regularly reported, there are limited measurement instruments demonstrating content validity. This study develops a new instrument to measure stigmatisation by healthcare professionals, the Persistent Somatic Symptom Stigma scale for Healthcare Professionals (PSSS-HCP).

METHODS

Development was an iterative process consisting of research team review, item generation and cognitive interviewing. We generated a longlist of 60 items from previous reviews and qualitative research. We conducted 18 cognitive interviews with healthcare professionals in the United Kingdom (UK). We analysed the relevance, comprehensibility and comprehensiveness of items, including the potential for social desirability bias.

RESULTS

After research team consensus and initial feedback, we retained 40 items for cognitive interviewing. After our first round of interviews (n = 11), we removed 20 items, added three items and amended five items. After our second round of interviews (n = 7), we removed four items and amended three items. No major problems with relevance, comprehensibility, comprehensiveness or social desirability were found in remaining items.

CONCLUSIONS

The provisional version of the PSSS-HCP contains 19 items across three domains (stereotypes, prejudice, discrimination), demonstrating sufficient content validity. Our next step will be to perform a validation study to finalise item selection and explore the structure of the PSSS-HCP.

Study on the Profiles of Sleep Disorders, Associated Factors, and Pathways Among Gynecological Cancer Patients - A Latent Profile Analysis

Background

Gynecological cancer generally refers to malignant tumors in gynecology, commonly including cervical cancer, endometrial cancer, and ovarian cancer. Patients with gynecological cancer often suffer from sleep disorders after clinical treatment. Except for serious sleep disorders, female characteristics, family roles, and feudal beliefs make their self-stigma at a medium to high level, leading to huge pressure. This study aims to identify potential categories of sleep disorders, and analyze the relationship between self-stigma, perceived stress, and sleep disorders.

Methods

A cross-sectional study was conducted in 2021-2022. Two hundred and two patients' data were collected from ShengJing Hospital Affiliated to China Medical University in Liaoning, Shenyang by using paper questionnaires for face-to-face surveys. The survey tools included the Pittsburgh Sleep Quality Index (PSQI), the Perceived Stress Scale (PSS), and the Social Impact Scale (SIS). Potential profile analysis (LPA), multiple logistic regression analysis, and structural equation modeling (SEM) were performed by Mplus 8.3, SPSS 26.0, and Amos 24.0 statistical tools, respectively.

Results

Three latent patterns of sleep disorders were found: "Good Sleep group (42.5%)", "Sleep Deficiency group (32.4%)", and "Sleep Disturbance group (25.1%)". Patients with high perceived stress were more likely to report a moderate (OR=1.142, 95% CI: 1.061-1.230) or high (OR=1.455, 95% CI: 1.291-1.640) level of sleep disorders. Self-stigma did not have a direct effect on sleep disorders (0.055, P>0.05), but it could have indirect effect on sleep disorders through perceived stress (0.172, P<0.01).

Conclusion

The perceptions of sleep disorders among gynecological cancer patients varies and exhibits individual differences. Gynecological cancer patients who feels alienated or discriminated may cause high pressure. This internal pressure can exacerbate sleep disorders.

A combined intervention strategy to increase linkage to and retention in substance use treatment for individuals accessing hospital-based services: study protocol

Background

In 2020, New Mexico had the highest alcohol related death and the 11th highest drug overdose rate in the U.S. Towards the long-term goal of addressing this public health problem, we are implementing and evaluating an multi-level intervention designed to identify adults at risk of substance use disorder (SUD) and encourage linkage to and retention in treatment. The first level includes equipping the ED and medical inpatient units of a safety-net hospital with a method to screen individuals at risk of a SUD. The second level includes Seeking Safety (SS), a trauma-specific treatment for PTSD and SUD; and pharmacotherapy for SUD. Motivational Interviewing (MI) is used throughout both levels. Using the SPIRIT guidelines and checklist, this study protocol describes the multi-level intervention and the methodology we are using to assess feasibility and effectiveness.

Methods

We are using a Type 1 hybrid implementation design with a non-randomized approach (ISRCTN registration # ISRCTN33100750). We aim to enroll 110 adults ( ≧ 18 ) who screen positive for unhealthy use of alcohol, prescription medications (used nonmedically) and/or illicit drugs. Peer support workers are responsible for screening, using MI to increase engagement in screening and treatment and delivery of SS. Pharmacotherapy is provided by addiction clinical specialists. Treatment is provided post hospital discharge via telehealth to increase access to care. Participants are identified through (1) review of electronic health records for individuals with a chief or secondary complaint or mental health condition relating to alcohol and/or other drug use, (2) referrals from clinical staff and (3) screening in the ED and medical inpatient units. Feasibility is being measured through process data. Effectiveness will be determined by changes in two primary outcomes: (i) PTSD symptom severity; and (ii) substance use.

Discussion

Our study will expand on research related to the implementation of treatment strategies for patients presenting at EDs and admitted to medical inpatients units wherein there is a significant window of opportunity to link patients with follow-up behavioral and clinical services for alcohol and/or drug misuse. The challenges associated with implementation and strategies that have been helpful to address these challenges will further inform the field.

Mechanisms upholding the persistence of stigma across 100 years of historical text

Today, many social groups face negative stereotypes. Is such negativity a stable feature of society and, if so, what mechanisms maintain stability both within and across group targets? Answering these theoretically and practically important questions requires data on dozens of group stereotypes examined simultaneously over historical and societal scales, which is only possible through recent advances in Natural Language Processing. Across two studies, we use word embeddings from millions of English-language books over 100 years (1900-2000) and extract stereotypes for 58 stigmatized groups. Study 1 examines aggregate, societal-level trends in stereotype negativity by averaging across these groups. Results reveal striking persistence in aggregate negativity (no meaningful slope), suggesting that society maintains a stable level of negative stereotypes. Study 2 introduces and tests a new framework identifying potential mechanisms upholding stereotype negativity over time. We find evidence of two key sources of this aggregate persistence: within-group "reproducibility" (e.g., stereotype negativity can be maintained by using different traits with the same underlying meaning) and across-group "replacement" (e.g., negativity from one group is transferred to other related groups). These findings provide novel historical evidence of mechanisms upholding stigmatization in society and raise new questions regarding the possibility of future stigma change.

Exploring the Relationship Between Anticipated Stigma and Community Shared Concerns about HIV on Defaulting from HIV Care in Rural South Africa

Although stigma has been associated with people living with HIV defaulting from care, there is a gap in understanding the specific impact of individual stigma and community-level concern about HIV on defaulting.

Methods

This is a secondary analysis of a unique dataset that links health facility-based medical records to a population-representative community survey conducted in 2018 in rural Mpumalanga province, South Africa. We used the parametric g-formula to estimate associations among individual anticipated stigma, low perceived community and local leader concern about HIV, and defaulting from care in the prior year. In addition, we estimated the population-level effects of intervening to reduce stigma and increase concern on defaulting.

Results

Among 319 participants on treatment, 42 (13.2%) defaulted from care during the prior year. Anticipated stigma (risk ratio [RR] 1.22, 95% confidence interval [CI]: 0.72, 2.74), low perceived concern about HIV/AIDS from community leadership (RR 1.12, 95% CI 0.76, 3.38), and low shared concerns about HIV/AIDS in the community (RR 1.37; 95% CI 0.79, 3.07) were not significantly associated with default. Hypothetical population intervention effects to remove individual anticipated stigma and low community concerns yielded small reductions in default (~1% reduction).

Conclusions

In this sample, we found limited impact of reducing anticipated stigma and increasing shared concern about HIV on retention in care. Future studies should consider the limitations of this study by examining the influence of other sources of stigma in more detail and assessing how perceptions of stigma and concern impact the full HIV testing and care cascade.

Prevalence and burden of migraine in the United States: A systematic review

BACKGROUND

This study reviewed migraine prevalence and disability gathered through epidemiologic survey studies in the United States conducted over the past three decades. We summarized these studies and evaluated changing patterns of disease prevalence and disability.

METHODS

We conducted a systematic review of US studies addressing the prevalence, disability, and/or burden of migraine, including both episodic migraine (EM) and chronic migraine (CM). A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was used in conjunction with the PubMed search engine. Eligible studies were published before February 2022, were conducted in the United States, included representative samples, and used a case definition of migraine based on the International Classification of Headache Disorders (ICHD). The primary measure of disease burden was the Migraine Disability Assessment Scale (MIDAS). The MIDAS measures days lost due to migraine over 3 months in three domains and defines groups with moderate (Grade III) or severe disability (Grade IV) using cut-scores.

RESULTS

Of the 1609 identified records, 26 publications from 11 US population-based studies met eligibility criteria. The prevalence of migraine in the population has remained relatively consistent for the past 30 years: ranging from 11.7% to 14.7% overall, 17.1% to 19.2% in women, and 5.6% to 7.2% in men in the studies reviewed. CM prevalence is 0.91% (1.3% among women and 0.5% of men) in adults and 0.8% in adolescents. The proportion of people with migraine and moderate-to-severe MIDAS disability (Grades III-IV), has trended upward across studies from 22.0% in 2005 to 39.0% in 2012, to 43.2% in 2016, and 42.4% in 2018. A consistently higher proportion of women were assigned MIDAS Grades III/IV relative to men.

CONCLUSION

The prevalence of migraine in the United States has remained stable over the past three decades while migraine-related disability has increased. The disability trend could reflect changes in reporting, study methodology, social and societal changes, or changes in exacerbating or remediating factors that make migraine more disabling, among other hypotheses. These issues merit further investigation.

Understanding mental health stigma and discrimination in Ethiopia: A qualitative study

Background

Stigma is significantly impacted by cultural and contextual value systems. People with mental health conditions frequently have to deal with the condition itself and the associated stigma and discrimination. Contextual understanding is essential to design measures and interventions.

Objective

This study aimed to explore the experiences and perceptions of people with mental health conditions, their families and key stakeholders.

Method

A qualitative method used to understand mental health-related stigma and its local contexts. Sixteen participants, including service users, caregivers, service providers and health service administrators, were interviewed.

Result

People with mental health conditions and their caregivers experienced various forms of stigmatization which is linked to attributions about the causality of the illness, overt manifestations of mental health condition leading to easy identification and functional impairments that adversely affect participation. Social contact, lived experiences sharing and training of service providers are relevant intervention strategy to address stigma.

Implication

Stigma and exclusion are prominent in the experiences of people with mental health conditions and their caregivers in this rural Ethiopian setting. Measurement of stigma and the development of interventions should consider how stigma is socially constructed. Anti-stigma interventions need to be implemented alongside expanded local access to mental healthcare.

The relationship between felt stigma and non-fatal overdose among rural people who use drugs

BACKGROUND

Drug overdose deaths in the United States exceeded 100,000 in 2021 and 2022. Substance use stigma is a major barrier to treatment and harm reduction utilization and is a priority target in ending the overdose epidemic. However, little is known about the relationship between stigma and overdose, especially in rural areas. We aimed to characterize the association between felt stigma and non-fatal overdose in a multi-state sample of rural-dwelling people who use drugs.

METHODS

Between January 2018 and March 2020, 2,608 people reporting past 30-day opioid use were recruited via modified chain-referral sampling in rural areas across 10 states. Participants completed a computer-assisted survey of substance use and substance-related attitudes, behaviors, and experiences. We used multivariable logistic regression with generalized estimating equations to test the association between felt stigma and recent non-fatal overdose.

RESULTS

6.6% of participants (n = 173) reported an overdose in the past 30 days. Recent non-fatal overdose was significantly associated with felt stigma after adjusting for demographic and substance use-related covariates (aOR: 1.47, 95% CI: 1.20-1.81). The association remained significant in sensitivity analyses on component fear of enacted stigma items (aOR: 1.48, 95% CI: 1.20-1.83) and an internalized stigma item (aOR: 1.51, 95% CI: 1.07-2.14).

CONCLUSIONS

Felt stigma related to substance use is associated with higher risk of non-fatal overdose in rural-dwelling people who use drugs. Stigma reduction interventions and tailored services for those experiencing high stigma are underutilized approaches that may mitigate overdose risk.

Perceived Ageism is Associated With Recurrent Falling Among Older Colombian Adults

Literature on the association between ageism and falling among older adults is limited. Using data from the nationwide cross-sectional SABE (Salud, Bienestar y Envejecimiento) Colombia Survey in 2015 with 18,875 participants aged ≥60 years living in the communities, the study aims to evaluate the association between perceived ageism within the family, neighborhood, health services, and public services, and recurrent falling. Participants had a mean age of 69.2 ± 7.1; 56.1% were female. Recurrent falling prevalence was 15%, and experiencing any ageism was 10%. Multivariable logistic regression analyses showed higher odds of recurrent falling for any ageism (OR = 1.81, 95% CI 1.61-2.02, p < .0001). High depressive symptoms mediated 10.1% of the association between any ageism and recurrent falling, followed by low instrumental activities of daily living (9.7%) and multimorbidity (9.3%). Current findings open new areas of gerontological research by expanding the risk factors for falling among older adults to include ageism perceptions.

Why Culture and Context Matters: Examining Differences in Mental Health Stigma and Social Distance Between Latino Individuals in the United States and Mexico

This study examines the influence of cultural context on social distance and perceptions of stigma towards mental health conditions among Latino populations in Houston, TX, USA and Mexico City, Mexico. We employed a community-based experimental vignette survey to assess perceptions towards individuals experiencing symptoms of alcohol misuse, depression, and psychosis. Participants (n = 513) from Houston and Mexico City were asked about their willingness to accept community members experiencing mental health symptoms in various social roles, their perceptions of stigma related to these symptoms, anticipated danger, possible positive outcomes, and the community member's ability to change. Findings demonstrate significant differences in stigma perceptions between Latino respondents in the US and in Mexico. Houston participants reported lower public stigma and perceived dangerousness of someone with mental health concerns compared to respondents in Mexico City. Furthermore, the cultural context may influence the association between various dimensions of stigma, with some inverse relationships occurring based on location of data collection. Findings illuminate the complex interplay between cultural context, mental health symptoms, and stigma, and underscores the need for culturally nuanced interventions to reduce mental health stigma and promote service utilization in Latino communities.

Stigma power in practice: Exploring the contribution of Bourdieu's theory to stigma, discrimination and health research

Stigma and discrimination are increasingly understood as shaping health, and in turn conceptualised as social processes shaped by power and structural inequities. A challenge to analysis and implementing interventions is developing theory that can integrate analysis of structure, agency and power. One theoretical framework already promoted by prominent scholars as supporting this need is Bourdieu's social practice theory. This paper explores the application to date of Bourdieu's theory on stigma, discrimination and health. The paper describes how existing health literature has used concepts of symbolic violence, fields, capitals and habitus to develop insight into stigma power. The discussion explores how this theoretical framework is though underutilised and there has been little consideration of new programmatic approaches based on this theory. Directions for future research include the need for integrated approaches to analysis, especially using habitus to explore stigma power, and addressing processes of change. Directions for conceptualising interventions address how a mismatch of field and habitus could foster change and then the role for prophets in fostering symbolic revolutions. All these potential directions must in turn be integrated within the vast scholarship on stigma. In conclusion, further application and development of Bourdieu's social practice theory could help address the theoretical challenges facing the field of stigma, discrimination and health research.

Exploring perspectives of stigma and discrimination among people with lived experience of mental health conditions: a co-produced qualitative study

Background

Efforts to understand the mechanisms and consequences of mental health-related stigma and discrimination need to center the perspectives of people affected by these negative impacts, through research efforts that are led or co-led by people with lived experience (PWLE) of mental health conditions.

Methods

This study used co-production principles to explore global perspectives of stigma and discrimination among people meeting the inclusion criteria of identifying as PWLEs and being willing to share their experiences of stigma and discrimination resulting from a diagnosis of a mental health condition, and who had also participated in anti-stigma activities. Participants were recruited online via a self-selecting snowball sampling method. Qualitative data were collected from respondents via an anonymous global online survey conducted between 12/01/2021 and 02/28/2022. The main outcomes assessed were open-ended, qualitative responses to questions exploring experiences of stigma and discrimination, experiences regarding diagnoses, language/terminology related to mental health, impact of stigma and discrimination, and involvement with anti-stigma interventions. Data were synthesised through digital text network analysis and thematic content analysis.

Findings

A total of 198 respondents from over 30 countries across Europe, the Americas, Africa, Asia, and Australia/Oceania were included in the study. The results reflected five themes: 1) the role of language and words; 2) the role of media in perpetuating and reducing stigma; 3) societal reactions to mental health conditions and strategies to cope with these; 4) knowledge about activities to reduce stigma and discrimination and their impact; and 5) personal involvement in activities to reduce stigma and discrimination.

Interpretation

The findings highlight that people with mental health conditions are aware of and experience stigma and discrimination across core domains of daily life. The importance of recognising the key role PWLEs can play in efforts to reduce stigma and discrimination was highlighted, and how they can be appropriately supported to contribute and have their experiential expertise recognised. Meaningful and authentic collaborations between PWLEs and other stakeholders can enhance the quality and relevance of strategies to reduce stigma and discrimination. This is, to our knowledge, the first study of its kind to use a co-production approach to explore experiences and reflections of stigma and discrimination related to mental health from a global perspective. However, the results are not broadly representative of the general PWLE population or suggestive of globally uniform experiences of stigma and discrimination.

Funding

None.

"Early in the morning, there's tolerance and later in the day it disappears" - The intersection of resource scarcity, stress and stigma in mental health and substance use care in South Africa

Stress is a challenge among non-specialist health workers worldwide, particularly in low-resource settings. Understanding and targeting stress is critical for supporting non-specialists and their patients, as stress negatively affects patient care. Further, stigma toward mental health and substance use conditions also impacts patient care. However, there is little information on the intersection of these factors. This sub-analysis aims to explore how substance use and mental health stigma intersect with provider stress and resource constraints to influence the care of people with HIV/TB. We conducted semi-structured interviews (N=30) with patients (n=15) and providers (n=15, non-specialist health workers) within a low-resource community in Cape Town, South Africa. Data were analyzed using thematic analysis. Three key themes were identified: (1) resource constraints negatively affect patient care and contribute to non-specialist stress; (2) in the context of stress, non-specialists are hesitant to work with patients with mental health or substance use concerns, who they view as more demanding and (3) stress contributes to provider stigma, which negatively impacts patient care. Findings highlight the need for multilevel interventions targeting both provider stress and stigma toward people with mental health and substance use concerns, especially within the context of non-specialist-delivered mental health services in low-resource settings.

A Systematic Review of Public Stigmatization Toward Women Victims of Intimate Partner Violence in Low- and Middle-Income Countries

Public stigmatization of women victims of intimate partner violence (IPV) has begun to be studied because of its negative impact on recovery from violence. This systematic review aimed to analyze such stigmatization in low- and middle-income countries (LAMIC) by identifying social norms and perceptions linked to public stigmatizing responses, such responses, negative consequences of those responses on victims, and other factors associated with public stigma. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, five databases were searched using "stigma" and multiple synonyms of IPV as keywords. Selected articles were empirical, written in English, published in peer-reviewed journals, and reported findings on public stigma toward women victims of IPV that had occurred in LAMIC. Nineteen articles met the inclusion criteria. Patriarchal gender roles, normalization of IPV and the consideration of violence as a private matter were the most prevalent social norms among the studies. These led to blaming, isolating, and discriminating against the victim, making her feel ashamed, considering her less valuable than before suffering IPV, and dismissing or denying the abuse. Many negative consequences were identified. Anticipated public stigma, associated with not disclosing the abuse and not seeking help, was the most popular. Public stigmatization was stronger when other public stigmas intersected and in the case of disadvantaged social circumstances. Consequences were diminished by protective factors such as informal support and gender-based violence support services. This review provides a global vision for future research in each specific sociocultural context and is a first step in the design of anti-stigma programs in LAMIC.