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Holland A, Freeman TP, Nicholls J, Burke C, Howkins J, Harris M, Hickman M, Attwood A, Carlisle V, Krykant P, Maynard OM. Making sense of drug use and dependence-A scoping review of mass media interventions intended to reduce stigma towards people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 132:104543. [PMID: 39226769 DOI: 10.1016/j.drugpo.2024.104543] [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: 04/26/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND People who use drugs face entrenched stigma, which fosters shame, restricts service access, and exacerbates inequalities. The use of mass media in anti-stigma interventions offers an opportunity to challenge stigmatising attitudes at scale. There are, however, inconsistencies in messaging approaches used in mass media anti-stigma interventions, and how authors conceptualise and measure 'stigma'. METHODS This scoping review maps literature on the development and/or evaluation of mass media interventions intended to reduce stigma towards people who use drugs. We systematically searched seven databases for reports about: (i) people who use drugs, (ii) stigma, (iii) mass media. We charted data about intervention (i) subjects and recipients, (ii) format, (iii) authors, (iv) content; and (v) conceptualisation and measurement of stigma. We narratively synthesised findings with qualitative content analyses. RESULTS From 14,256 records, we included 49 reports about 35 interventions. 25/35 were from the last five years and 19/35 were from the United States. Intended recipients included the public and/or specified sub-populations, often including healthcare workers. Most interventions were intended to reduce stigma towards people with patterns of drug use perceived to be problematic, as opposed to people who use drugs in general. Interventions ranged from single pieces of media to complex multi-format campaigns. People who use(d) drugs contributed to 22/35 interventions. Professionals working in medical disciplines co-authored 29/35 interventions. Intervention content often had a medical focus, describing dependence as a 'disease' or medical issue, and emphasised the benefits of recovery. Other interventions, however, criticised medical framings. In some interventions drug use and people who use drugs were described in markedly negative terms. 'Stigma' was often under-theorised, and measurement approaches were inconsistent, with 42 instruments used to measure phenomena associated with stigma across 19 quantitative evaluations. CONCLUSION We found inconsistencies in approaches to reduce and measure stigma, potentially reflecting different motivations for intervention development. The primary motivation of many interventions was seemingly to promote drug service engagement and recovery.
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Affiliation(s)
- Adam Holland
- School of Psychological Science, University of Bristol, 12a Priory Road, Clifton, Bristol, UK; Bristol Medical School, University of Bristol, Canynge Hall, Clifton, Bristol, UK; London School of Hygiene and Tropical Medicine, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, UK.
| | - Tom P Freeman
- University of Bath, Department of Psychology, Addiction and Mental Health Group, Bath, UK
| | | | - Chloe Burke
- School of Psychological Science, University of Bristol, 12a Priory Road, Clifton, Bristol, UK; University of Bath, Department of Psychology, Addiction and Mental Health Group, Bath, UK
| | - Joshua Howkins
- Bristol Medical School, University of Bristol, Canynge Hall, Clifton, Bristol, UK
| | - Magdalena Harris
- London School of Hygiene and Tropical Medicine, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, UK
| | - Matthew Hickman
- Bristol Medical School, University of Bristol, Canynge Hall, Clifton, Bristol, UK
| | - Angela Attwood
- School of Psychological Science, University of Bristol, 12a Priory Road, Clifton, Bristol, UK
| | - Vicky Carlisle
- Bristol Medical School, University of Bristol, Canynge Hall, Clifton, Bristol, UK
| | - Peter Krykant
- Cranstoun, Thames Mews, Portsmouth Road, Esher, Surrey, UK
| | - Olivia M Maynard
- School of Psychological Science, University of Bristol, 12a Priory Road, Clifton, Bristol, UK
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Maher L, Leece B, Sheaves F, Wilson A, Brown J, O'Connell L, Carnegie-Brown M, Stanbury L, Turalic U, Mooney D, Hoyling L, Cama E, Treloar C. Moving from 'stigma reduction' to 'inclusion': development of the inclusion collaborative at Nepean Blue Mountains Local Health District, New South Wales. Harm Reduct J 2024; 21:158. [PMID: 39192243 DOI: 10.1186/s12954-024-01080-0] [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: 02/11/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024] Open
Abstract
This commentary outlines the development of an Inclusion Collaborative in a large health district in Sydney, New South Wales Australia. The Collaborative grew out of ongoing efforts to reduce stigma associated with blood borne viruses while recognising that there are many health conditions and situations where people feel judged when attending services for health care. The formation of the Collaborative drew in health workers in other sectors to create a critical mass of voices calling for stigma reduction, move beyond siloed responses to stigma and to reframe conversations about stigma to a more positive description of "inclusion". The involvement of consumer representatives (paid for their time) was a key principle of the Collaborative. The members of the Collaborative identified the common experience of their clients being 'othered' by the mainstream services and that services can be unwelcoming or not supportive of difference, and therefore create a significant barrier to accessing healthcare. The group considered ways to highlight these issues among colleagues from mainstream services and community members who were not 'othered'. The Collaborative designed and carried out a range of activities including a Festival of Inclusion, a series of seeding grants for staff and consumer-focused initiatives, promotion of diversity days and an audit of compliance with strategic priorities. The Inclusion Collaborative is an example of a structured approach for efforts to reducing stigma that draws on the ambitions of many parts of a large, complex public health service to deliver better outcomes for its staff and consumers.
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Affiliation(s)
- Louise Maher
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - Bronwyn Leece
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | | | - Andrew Wilson
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - James Brown
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | | | | | - Linda Stanbury
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - Una Turalic
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - Deanna Mooney
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - Larissa Hoyling
- Nepean Blue Mountains Local Health District, Sydney, Australia
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Heley K, Vanderpool RC, Vedham V. Global cancer stigma research: a U.S. National Cancer Institute workshop report. J Natl Cancer Inst Monogr 2024; 2024:4-10. [PMID: 38836530 DOI: 10.1093/jncimonographs/lgad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/06/2023] [Accepted: 12/22/2023] [Indexed: 06/06/2024] Open
Abstract
Stigma is a social process characterized by negative beliefs, attitudes, and stereotypes associated with a specific attribute or characteristic that leads to discrimination and social exclusion. Stigma manifests across the cancer control continuum and remains a key challenge for cancer prevention and control worldwide. In this commentary, we provide an overview of the U.S. National Cancer Institute's (NCI) Global Cancer Stigma Research Workshop, a multi-disciplinary international conference held virtually in September 2022, which focused on the intersection of cancer and stigma. The meeting was unique in its convening of researchers, advocates, clinicians, and non-governmental and governmental organizations, who-as a collective-provided overarching topics, cross-cutting considerations, and future directions for the cancer stigma research community to consider, which we describe herein. In summary, studying cancer stigma comprehensively requires a holistic, adaptive, and multifaceted approach-and should consider interrelated factors and their intersection within diverse cultural and social contexts worldwide. Collectively, there was a call for: an inclusive approach, encouraging researchers and practitioners to identify and measure cancer stigma as a driver for cancer health inequities globally; an expansion of existing research methodology to include diversity of experiences, contexts, and perspectives; and collaborations among diverse stakeholders to develop more effective strategies for reducing stigma and improving cancer outcomes. Such efforts are essential to cultivating effective and equitable approaches to preventing and treating cancer worldwide.
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Affiliation(s)
- Kathryn Heley
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Robin C Vanderpool
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Vidya Vedham
- Center for Global Health, Office of the Director, National Cancer Institute, Rockville, MD, USA
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4
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Gu C, Bu H, Lv Z, He A. Sexual Self-Identification Offsets and Self-Stigma Moderates: Expanding the Rejection-Identification Model to Examine Stigma's Effects on Well-Being Among Gay and Bisexual Men. JOURNAL OF HOMOSEXUALITY 2024:1-20. [PMID: 38833645 DOI: 10.1080/00918369.2024.2360608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Gender and sexual minorities still face stigma-related stress from all areas of society. The rejection-identification model (RIM) proposes that some stigmatized individuals may respond to the negative effects of stigma on well-being by enhancing their self-identification. However, this does not apply to all gender and sexual minorities. Grounded in minority stress theory and the RIM, this study examined how stigma-related stressors (i.e. perceived stigma and self-stigma) and their associated mechanisms impact sexual self-identification and subjective well-being. A total of 366 Chinese gay and bisexual men were included in the study. The results showed that sexual self-identification, as a protective factor, mediated the association between perceived stigma and subjective well-being. Furthermore, the indirect effect of the mediation model was moderated by self-stigma, such that the indirect effect of perceived stigma on subjective well-being through sexual self-identification was the highest among Chinese gay and bisexual men with low self-stigma. Given that research into the mental health and well-being of Chinese gay and bisexual men is still in its infancy, our findings are important and may help in developing and improving socially and psychologically sensitive counseling services or intervention strategies for these populations.
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Affiliation(s)
- Chudan Gu
- Humanities School, Donghua University, Shanghai, China
| | - He Bu
- School of Social and Public Administration, East China University of Science and Technology, Shanghai, China
| | - Zijian Lv
- School of Journalism and Communication, Jinan University, Guangzhou, China
| | - Along He
- School of Journalism & Communication, Nanjing University, Nanjing, China
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5
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He J, Cui S, Cui T, Barnhart WR, Han J, Xu Y, Nagata JM. Exploring the associations between muscularity teasing and eating and body image disturbances in Chinese men and women. Body Image 2024; 49:101697. [PMID: 38460293 DOI: 10.1016/j.bodyim.2024.101697] [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: 10/02/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
This study described muscularity teasing in both men and women and explored its associations with eating and body image disturbances in adults from China. A total of 900 Chinese adults (50% women) were recruited online. Correlation and regression analyses were conducted to examine the relationships between muscularity teasing and a battery of measures on eating and body image disturbances. Gender differences in the associations were examined. Men reported more muscularity teasing than women (31.6% men vs. 15.6% women; χ2(1,N = 900) = 31.99, p < .001). Muscularity teasing was significantly and positively correlated with all measures in both men and women. Muscularity teasing explained significant, unique variance in all measures for men and women, except for body fat dissatisfaction in women, beyond covariates (i.e., age, body mass index, and weight teasing). The relationships between muscularity teasing and eating and body image disturbances were generally stronger in men than women. Findings further suggest that muscularity teasing is an important factor related to eating and body image disturbances in men and women, but muscularity teasing might be more detrimental to men's eating behaviors and body image. Future research is needed to further explore the directionality and mechanisms of the links between muscularity teasing and eating and body image disturbances.
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Affiliation(s)
- Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China.
| | - Shuqi Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Tianxiang Cui
- Department of Psychology, University of Macau, Taipa, Macau, China
| | - Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Jiayi Han
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Yinuo Xu
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Jason M Nagata
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA
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6
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McGhie-Fraser B, McLoughlin C, Lucassen P, Ballering A, van Dulmen S, Brouwers E, Stone J, Olde Hartman T. Measuring persistent somatic symptom related stigmatisation: Development of the Persistent Somatic Symptom Stigma scale for Healthcare Professionals (PSSS-HCP). J Psychosom Res 2024; 181:111689. [PMID: 38704347 DOI: 10.1016/j.jpsychores.2024.111689] [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: 02/12/2024] [Revised: 04/19/2024] [Accepted: 04/28/2024] [Indexed: 05/06/2024]
Abstract
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.
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Affiliation(s)
- Brodie McGhie-Fraser
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Caoimhe McLoughlin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
| | - Peter Lucassen
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Aranka Ballering
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Sandra van Dulmen
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands; Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | - Evelien Brouwers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands.
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
| | - Tim Olde Hartman
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands.
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Broady TR, Valerio H, Alavi M, Wheeler A, Silk D, Martinello M, Conway A, Milat A, Dunlop A, Murray C, Henderson C, Amin J, Read P, Marks P, Degenhardt L, Stevens A, Prain B, Hayllar J, Reid D, Montebello M, Wade A, Christmass M, Cock V, Dore GJ, Treloar C, Grebely J. Factors associated with experiencing stigma, discrimination, and negative health care treatment among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104468. [PMID: 38795465 DOI: 10.1016/j.drugpo.2024.104468] [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: 02/20/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Stigma has negative consequences for the health of people who inject drugs and people living with hepatitis C virus (HCV). This study evaluated factors associated with stigma related to injecting drug use (IDU) or HCV and those associated with being treated negatively by health workers. METHODS ETHOS Engage is an observational cohort study of people who inject drugs attending drug treatment clinics and needle and syringe programs in Australia. Participants completed a questionnaire including IDU- and HCV-related stigma, and negative treatment by health workers. Logistic regression was used to identify factors associated with experiencing stigma and negative treatment in a cross-sectional sample. RESULTS Of 1,211 participants, 31% were women, 64% had injected drugs in the previous month, and 65% had been diagnosed with HCV. IDU-related stigma was reported by 57% of participants and was associated with being a woman, higher than Year 10 education, homelessness, opioid agonist treatment, recent injecting, overdose history, hospitalisation for drug use, and unknown HCV status. HCV-related stigma was reported by 34% of participants diagnosed with HCV and was associated with being a woman, homelessness, receptive needle/syringe sharing, arrest for drug use/possession, and recent HCV testing. Negative treatment from health workers was reported by 45% of participants and was associated with being a woman, receptive needle/syringe sharing, hospitalisation for drug use, and arrest for drug use/possession. DISCUSSION AND CONCLUSIONS Results highlight important intersections and disparities in stigmatising experiences among people who inject drugs. Considering these intersections can assist health services provide more inclusive care.
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Affiliation(s)
- Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.
| | - Heather Valerio
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Alice Wheeler
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - David Silk
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Anna Conway
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia; The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Faculty of Medicine and Health, Camperdown, Australia
| | - Adrian Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia; Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Carolyn Murray
- Population Health Strategy & Performance, NSW Health, New South Wales, Australia
| | | | - Janaki Amin
- Department of Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia
| | - Phillip Read
- Kirketon Road Centre, Sydney, New South Wales, Australia
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Annabelle Stevens
- Centre for Population Health, NSW Health, New South Wales, Australia
| | - Bianca Prain
- Centre for Population Health, NSW Health, New South Wales, Australia
| | - Jeremy Hayllar
- Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - David Reid
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Mark Montebello
- North Sydney Local Health District, Sydney, New South Wales, Australia
| | - Alexandra Wade
- Mid North Coast Local Health District, New South Wales, Australia
| | - Michael Christmass
- Next Step Drug and Alcohol Service, Perth, Western Australia, Australia; National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Victoria Cock
- Drug and Alcohol Services South Australia, Adelaide, South Australia, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Jauch M, Occhipinti S, O'Donovan A, Clough B. A Qualitative Study Into the Relative Stigmatization of Mental Illness by Mental Health Professionals. QUALITATIVE HEALTH RESEARCH 2024:10497323241238618. [PMID: 38768408 DOI: 10.1177/10497323241238618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
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.
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Affiliation(s)
| | - Stefano Occhipinti
- Griffith University, Brisbane, QLD, Australia
- International Research Centre for the Advancement of Health Communication, Department of English and Communication, Hong Kong Polytechnic University, Hong Kong, China
| | | | - Bonnie Clough
- Griffith University, Brisbane, QLD, Australia
- Griffith Centre for Mental Health, Brisbane, QLD, Australia
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Charlesworth TES, Hatzenbuehler ML. Mechanisms upholding the persistence of stigma across 100 years of historical text. Sci Rep 2024; 14:11069. [PMID: 38744930 PMCID: PMC11094178 DOI: 10.1038/s41598-024-61044-z] [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: 10/03/2023] [Accepted: 04/30/2024] [Indexed: 05/16/2024] Open
Abstract
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.
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Affiliation(s)
- Tessa E S Charlesworth
- Kellogg School of Management, Northwestern University, 2211 Campus Dr, Evanston, IL, 60208, USA.
| | - Mark L Hatzenbuehler
- Department of Psychology, Harvard University, 33 Kirkland St, Cambridge, MA, 02138, USA
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10
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Pachankis JE, Hatzenbuehler ML, Klein DN, Bränström R. The Role of Shame in the Sexual-Orientation Disparity in Mental Health: A Prospective Population-Based Study of Multimodal Emotional Reactions to Stigma. Clin Psychol Sci 2024; 12:486-504. [PMID: 38938414 PMCID: PMC11210704 DOI: 10.1177/21677026231177714] [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] [Indexed: 06/29/2024]
Abstract
Despite the prominence of shame in stigma theories, its role in explaining population-level mental health disparities between the stigmatized and non-stigmatized has not been investigated. We assessed shame explicitly (via self-report) and implicitly (via a behavioral task) in a prospective, representative cohort of sexual minority and heterosexual young adults in Sweden (baseline n=2,222). Compared to heterosexuals, sexual minorities evidenced higher explicit and implicit shame, which explained sexual orientation disparities in depression, social anxiety, and suicidal thoughts. Among sexual minorities, there was an indirect effect of shame in the association between interpersonal stigma (i.e., past-year family rejection and childhood bullying) and later experiences of adverse mental health; an indirect effect did not exist for the related construct, internalized stigma. Results suggest extending existing stigma theories to consider emotions like shame as characteristic reactions to stigma and guide the search for treatment targets focused on reducing the mental health sequelae of stigma.
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Affiliation(s)
- John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health
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11
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Zamorano S, Santos-Olmo AB, Sánchez-Iglesias I, Muñoz-Lara I, Muñoz M. The stigma of intellectual disability in Spain: a nationally representative survey. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:477-490. [PMID: 38263598 DOI: 10.1111/jir.13122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Stigma towards people with intellectual disability affects various aspects of their lives, including access to employment, housing, health and social care services. Furthermore, this stigma reduces their social opportunities and is even reflected in laws that diminish their autonomy. Due to the practical significance of this issue, the aim of this research is to explore for the first time the social stigma associated with intellectual disability in a representative sample of the Spanish population. METHOD A cross-sectional quantitative descriptive study was conducted, involving a representative sample of the population (N = 2746). The study includes descriptive analyses and hierarchical regressions to examine various dimensions of stigma, such as attitudes, attributions, and intentions of social distance. RESULTS Medium levels of stigma are found regarding attitudes and attributions towards people with intellectual disability, while levels are medium-low concerning the intention of social distance. The most reliable indicators of stigma across its various dimensions encompass attitudes, attributions, and the intention of social distance. Factors that contribute to lower stigma include knowing someone with an intellectual disability, being willing to discuss intellectual disability with an acquaintance who has it and having a progressive political ideology. People with intellectual disability show more negative attributions towards themselves. Living with a person with an intellectual disability is another predictor of more stigmatising attitudes, but less intention of social distance. Results are mixed regarding age, gender, and educational level. CONCLUSION Combating the stigmatisation of people with intellectual disabilities must include comprehensive actions to address attitudes, attributions and behavioural intentions. Public policies, such as national campaigns and programmes, should include contact with and open conversations about intellectual disability, and sensitivity to sociodemographic variables.
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Affiliation(s)
- S Zamorano
- Department of Personality, Assessment and Clinical Psychology, School of Psychology, Complutense University of Madrid, Madrid, Spain
- Chair Against Stigma Grupo 5-Complutense University of Madrid, Madrid, Spain
| | - A B Santos-Olmo
- Department of Personality, Assessment and Clinical Psychology, School of Psychology, Complutense University of Madrid, Madrid, Spain
- Chair Against Stigma Grupo 5-Complutense University of Madrid, Madrid, Spain
| | - I Sánchez-Iglesias
- Department of Psychobiology and Behavioral Sciences Methods, School of Psychology, Complutense University of Madrid, Madrid, Spain
- Chair Against Stigma Grupo 5-Complutense University of Madrid, Madrid, Spain
| | - I Muñoz-Lara
- Chair Against Stigma Grupo 5-Complutense University of Madrid, Madrid, Spain
| | - M Muñoz
- Department of Psychobiology and Behavioral Sciences Methods, School of Psychology, Complutense University of Madrid, Madrid, Spain
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12
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Timmons S, McGinnity F, Carroll E. Ableism differs by disability, gender and social context: Evidence from vignette experiments. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2024; 63:637-657. [PMID: 37971159 DOI: 10.1111/bjso.12696] [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: 07/04/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
Existing research on prejudice and discrimination towards disabled people (i.e. 'ableism') has conceptualized it as a general attitude, obscuring the role of social context in its manifestation. We aimed to investigate whether and how ableism manifests differently depending on the nature of the disability, the disabled person's gender and the social context of the interaction. A nationally representative sample of 2000 adults read a series of vignettes about issues faced by disabled people (e.g. employment, relationships). Vignettes varied by presence and type of disability and the disabled person's gender. Judgements about how a disabled person was treated showed clear evidence of ableism towards some conditions (e.g. autism) but not others (e.g. a spine disorder). Judgements about the actions of a disabled person were more nuanced. A disability-gender intersectionality effect was observed for judgements about romantic relationships, with physically disabled women penalized compared to men but no gender difference was observed for intellectual disability. No intersectionality or ableism was observed on a vignette about refusing poorly paid work. We find clear evidence that ableism manifests differently depending on the nature of the individual's disability, their gender and the social context, questioning previous conceptualizations of ableism as a general attitude.
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Affiliation(s)
- Shane Timmons
- Economic and Social Research Institute, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Frances McGinnity
- Economic and Social Research Institute, Dublin, Ireland
- Department of Sociology, Trinity College Dublin, Dublin, Ireland
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13
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Henderson K, Lewis, Sloan CE, Bessesen DH, Arterburn D. Effectiveness and safety of drugs for obesity. BMJ 2024; 384:e072686. [PMID: 38527759 DOI: 10.1136/bmj-2022-072686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Recent publicity around the use of new antiobesity medications (AOMs) has focused the attention of patients and healthcare providers on the role of pharmacotherapy in the treatment of obesity. Newer drug treatments have shown greater efficacy and safety compared with older drug treatments, yet access to these drug treatments is limited by providers' discomfort in prescribing, bias, and stigma around obesity, as well as by the lack of insurance coverage. Now more than ever, healthcare providers must be able to discuss the risks and benefits of the full range of antiobesity medications available to patients, and to incorporate both guideline based advice and emerging real world clinical evidence into daily clinical practice. The tremendous variability in response to antiobesity medications means that clinicians need to use a flexible approach that takes advantage of specific features of the antiobesity medication selected to provide the best option for individual patients. Future research is needed on how best to use available drug treatments in real world practice settings, the potential role of combination therapies, and the cost effectiveness of antiobesity medications. Several new drug treatments are being evaluated in ongoing clinical trials, suggesting that the future for pharmacotherapy of obesity is bright.
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Affiliation(s)
| | - Lewis
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Caroline E Sloan
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Daniel H Bessesen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
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14
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Stringer KL, Norcini Pala A, Cook RL, Kempf MC, Konkle-Parker D, Wilson TE, Tien PC, Wingood G, Neilands TB, Johnson MO, Logie CH, Weiser SD, Turan JM, Turan B. Intersectional Stigma, Fear of Negative Evaluation, Depression, and ART Adherence Among Women Living with HIV Who Engage in Substance Use: A Latent Class Serial Mediation Analysis. AIDS Behav 2024:10.1007/s10461-024-04282-6. [PMID: 38489140 DOI: 10.1007/s10461-024-04282-6] [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] [Accepted: 01/25/2024] [Indexed: 03/17/2024]
Abstract
Women Living with HIV (WLHIV) who use substances face stigma related to HIV and substance use (SU). The relationship between the intersection of these stigmas and adherence to antiretroviral therapy (ART), as well as the underlying mechanisms, remains poorly understood. This study aimed to examine the association between intersectional HIV and SU stigma and ART adherence, while also exploring the potential role of depression and fear of negative evaluation (FNE) by other people in explaining this association. We analyzed data from 409 WLHIV collected between April 2016 and April 2017, Using Multidimensional Latent Class Item Response Theory analysis. We identified five subgroups (i.e., latent classes [C]) of WLHIV with different combinations of experienced SU and HIV stigma levels: (C1) low HIV and SU stigma; (C2) moderate SU stigma; (C3) higher HIV and lower SU stigma; (C4) moderate HIV and high SU stigma; and (C5) high HIV and moderate SU stigma. Medication adherence differed significantly among these classes. Women in the class with moderate HIV and high SU stigma had lower adherence than other classes. A serial mediation analysis suggested that FNE and depression symptoms are mechanisms that contribute to explaining the differences in ART adherence among WLHIV who experience different combinations of intersectional HIV and SU stigma. We suggest that FNE is a key intervention target to attenuate the effect of intersectional stigma on depression symptoms and ART adherence, and ultimately improve health outcomes among WLHIV.
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Affiliation(s)
- Kristi Lynn Stringer
- Department of Health and Human Performance, Community and Public Health, Middle Tennessee State University, Murfreesboro, TN, 37132, USA.
| | | | - Robert L Cook
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health, and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine and Population Health, University of Mississippi Medical Center, Oxford, MS, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Phyllis C Tien
- Department of Medicine, Department of Veteran Affairs Medical Center, University of California, San Francisco and Medical Service, San Francisco, CA, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York City, NY, USA
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mallory O Johnson
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, USA
- Women's College Research Institute, Women's College Hospital, Toronto, ON, USA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Public Health, School of Medicine, Koc University, Istanbul, Turkey
| | - Bulent Turan
- College of Social Sciences and Humanities, Psychology, Koc University, Istanbul, Turkey
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Charlesworth TES, Ghate K, Caliskan A, Banaji MR. Extracting intersectional stereotypes from embeddings: Developing and validating the Flexible Intersectional Stereotype Extraction procedure. PNAS NEXUS 2024; 3:pgae089. [PMID: 38505691 PMCID: PMC10949907 DOI: 10.1093/pnasnexus/pgae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/13/2024] [Indexed: 03/21/2024]
Abstract
Social group-based identities intersect. The meaning of "woman" is modulated by adding social class as in "rich woman" or "poor woman." How does such intersectionality operate at-scale in everyday language? Which intersections dominate (are most frequent)? What qualities (positivity, competence, warmth) are ascribed to each intersection? In this study, we make it possible to address such questions by developing a stepwise procedure, Flexible Intersectional Stereotype Extraction (FISE), applied to word embeddings (GloVe; BERT) trained on billions of words of English Internet text, revealing insights into intersectional stereotypes. First, applying FISE to occupation stereotypes across intersections of gender, race, and class showed alignment with ground-truth data on occupation demographics, providing initial validation. Second, applying FISE to trait adjectives showed strong androcentrism (Men) and ethnocentrism (White) in dominating everyday English language (e.g. White + Men are associated with 59% of traits; Black + Women with 5%). Associated traits also revealed intersectional differences: advantaged intersectional groups, especially intersections involving Rich, had more common, positive, warm, competent, and dominant trait associates. Together, the empirical insights from FISE illustrate its utility for transparently and efficiently quantifying intersectional stereotypes in existing large text corpora, with potential to expand intersectionality research across unprecedented time and place. This project further sets up the infrastructure necessary to pursue new research on the emergent properties of intersectional identities.
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Affiliation(s)
| | - Kshitish Ghate
- Language Technologies Institute, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Aylin Caliskan
- Information School, University of Washington, Seattle, WA 98105, USA
| | - Mahzarin R Banaji
- Department of Psychology, Harvard University, Cambridge, MA 02138, USA
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16
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Merrell WN, Choi S, Ackerman JM. When and Why People Conceal Infectious Disease. Psychol Sci 2024; 35:215-225. [PMID: 38265420 DOI: 10.1177/09567976231221990] [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] [Indexed: 01/25/2024] Open
Abstract
People sick with infectious illnesses face negative social outcomes, like exclusion, and may take steps to conceal their illnesses from others. In 10 studies of past, current, and projected illness, we examined the prevalence and predictors of infection concealment in adult samples of U.S. university students, health-care employees, and online crowdsourced workers (total N = 4,110). About 75% reported concealing illness in interpersonal interactions, possibly placing others in harm's way. Concealment motives were largely social (e.g., wanting to attend events like parties) and achievement oriented (e.g., completing work objectives). Disease characteristics, including potential harm and illness immediacy, also influenced concealment decisions. People imagining harmful (vs. mild) infections concealed illness less frequently, whereas participants who were actually sick concealed frequently regardless of illness harm, suggesting state-specific biases underlying concealment decisions. Disease concealment appears to be a widely prevalent behavior by which concealers trade off risks to others in favor of their own goals, creating potentially important public-health consequences.
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Affiliation(s)
| | - Soyeon Choi
- Department of Psychology, University of Michigan
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17
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Shapiro RE, Nicholson RA, Seng EK, Buse DC, Reed ML, Zagar AJ, Ashina S, Muenzel EJ, Hutchinson S, Pearlman EM, Lipton RB. Migraine-Related Stigma and Its Relationship to Disability, Interictal Burden, and Quality of Life: Results of the OVERCOME (US) Study. Neurology 2024; 102:e208074. [PMID: 38232340 PMCID: PMC11097761 DOI: 10.1212/wnl.0000000000208074] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES This population-based analysis characterizes the relative frequency of migraine-related stigma and its cross-sectional relationship to migraine outcomes. We hypothesized that migraine-related stigma would be inversely associated with favorable migraine outcomes across headache day categories. METHODS OVERCOME (US) is a web-based observational study that annually recruited a demographically representative US sample and then identified people with active migraine using a validated migraine diagnostic questionnaire. It also assessed how frequently respondents experienced migraine-related stigma using a novel 12-item questionnaire (Migraine-Related Stigma, MiRS) that contained 2 factors; feeling that others viewed migraine as being used for Secondary Gain (8 items, α = 0.92) and feeling that others were Minimizing disease Burden (4 items, α = 0.86). We defined 5 groups: (1) MiRS-Both (Secondary Gain and Minimizing Burden often/very often; (2) MiRS-SG (Secondary Gain often/very often); (3) MiRS-MB (Minimizing Burden often/very often); (4) MiRS-Rarely/Sometimes; (5) MiRS-Never. Using MiRS group as the independent variable, we modeled its cross-sectional relationship to disability (Migraine Disability Assessment, MIDAS), interictal burden (Migraine Interictal Burden Scale-4), and migraine-specific quality of life (Migraine Specific Quality of Life v2.1 Role Function-Restrictive) while controlling for sociodemographics, clinical features, and monthly headache day categories. RESULTS Among this population-based sample with active migraine (n = 59,001), mean age was 41.3 years and respondents predominantly identified as female (74.9%) and as White (70.1%). Among respondents, 41.1% reported experiencing, on average, ≥4 monthly headache days and 31.7% experienced migraine-related stigma often/very often; the proportion experiencing migraine-related stigma often/very often increased from 25.5% among those with <4 monthly headache days to 47.5% among those with ≥15 monthly headache days. The risk for increased disability (MIDAS score) was significant for each MiRS group compared with the MiRS-Never group; the risk more than doubled for the MiRS-Both group (rate ratio 2.68, 95% CI 2.56-2.80). For disability, interictal burden, and migraine-specific quality of life, increased migraine-related stigma was associated with increased disease burden across all monthly headache day categories. DISCUSSION OVERCOME (US) found that 31.7% of people with migraine experienced migraine-related stigma often/very often and was associated with more disability, greater interictal burden, and reduced quality of life.
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Affiliation(s)
- Robert E Shapiro
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Robert A Nicholson
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Elizabeth K Seng
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Dawn C Buse
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Michael L Reed
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Anthony J Zagar
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Sait Ashina
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - E Jolanda Muenzel
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Susan Hutchinson
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Eric M Pearlman
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Richard B Lipton
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
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18
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Ghajarzadeh M, Fitzgerald KC, Mowry EM, Nourbakhsh B. Association between demographics, socioeconomics, and disease-related factors and the perception of stigma in people with MS. Mult Scler 2024; 30:238-246. [PMID: 38179970 DOI: 10.1177/13524585231223057] [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] [Indexed: 01/06/2024]
Abstract
BACKGROUND Stigma is prevalent among individuals with chronic diseases, such as multiple sclerosis (MS) and those with comorbid mental health disorders, but its associated factors are poorly understood. OBJECTIVE To investigate the prevalence and correlates of stigma in people living with MS. METHODS We analyzed data from the MS Partners Advancing Technology and Health Solutions (MS PATHS) network, which collected patient information and outcomes during routine clinic visits. We used a multinomial logistic regression model to examine the cross-sectional association between stigma and demographic, socioeconomics, and MS-related factors. RESULTS We included 11,634 participants. The mean Neuro-QoL stigma T-score was 47.2 ± 8.6, and 17.7% of participants were classified as having moderate to severe stigma using established cutoffs. Multinomial logistic regression models suggest that higher disability levels, progressive form of the disease, shorter duration of the disease, and unemployment were associated with higher stigma while being male, married, undergoing treatment with high-efficacy disease-modifying therapies (DMTs), and being from European MS centers were associated with lower stigma perception. Disability levels, measured by Patient-Determined Disease Steps (PDDS), had the strongest independent association with stigma. CONCLUSION Stigma remains a relevant issue for people living with MS. Factors, such as physical and cognitive disability, DMT, and employment status may influence the severity of perceived stigma.
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Affiliation(s)
- Mahsa Ghajarzadeh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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19
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Pu Y, Xu W. Parenting Desire Among Sexual Minority Women in China: From the Stigma Perspective. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:293-306. [PMID: 37620669 DOI: 10.1007/s10508-023-02682-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023]
Abstract
In China, women who are childless or have children outside of heterosexual marriage are generally stigmatized. Consequently, Chinese sexual minority women are challenged for their willingness to have children. This study explored how multiple (structural-interpersonal-individual) levels of sexual minority stigma are related to parenting desire among Chinese sexual minority women. Furthermore, it examined the mediation mechanism of individual stigma and the moderation effect of outness to one's family in the link between structural/interpersonal stigma and parenting desire. Participants (265 lesbian and 193 bisexual women) completed online measures of structural stigma (adherence to Confucianism), interpersonal stigma (discrimination events), individual stigma (internalized homophobia and rejection sensitivity), outness to one's family, and parenting desire. Lesbian women reported lower structural and individual stigma and parenting desire levels than bisexual women. Sexual minority women's high adherence to Confucianism, internalized homophobia, and rejection sensitivity were positively associated with their increased parenting desires. Notably, adherence to Confucianism and discrimination events were associated with parenting desire through internalized homophobia, but not rejection sensitivity; moreover, outness to one's family buffered the direct link between adherence to Confucianism and parenting desire and strengthened the direct link between discrimination events and internalized homophobia and the indirect link between discrimination events and parenting desire. This study contributes to a robust understanding of how sexual minority stigma is connected to parenting desire among sexual minority women in Chinese sociocultural contexts, providing cultural-specific evidence to support theories of stigma and minority stress.
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Affiliation(s)
- Yaxin Pu
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, 610065, China
- Institute of Psychology, Sichuan University, Chengdu, China
| | - Wenjian Xu
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, 610065, China.
- Institute of Psychology, Sichuan University, Chengdu, China.
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20
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Tuck CZ, Cooper R, Aryeetey R, Gray LA, Akparibo R. A critical review and analysis of the context, current burden, and application of policy to improve cancer equity in Ghana. Int J Equity Health 2023; 22:254. [PMID: 38066530 PMCID: PMC10709985 DOI: 10.1186/s12939-023-02067-2] [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: 06/20/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Cancer causes a major disease burden worldwide. This is increasingly being realised in low and middle-income countries, which account disproportionately for preventable cancer deaths. Despite the World Health Organization calling for governments to develop policies to address this and alleviate cancer inequality, numerous challenges in executing effective cancer policies remain, which require consideration of the country-specific context. As this has not yet been considered in Ghana, the aim of this review was to bring together and critique the social-environmental, health policy and system factors to identifying opportunities for future health policies to reduce cancer burden in the Ghanian context. A critical policy-focused review was conducted to bring together and critique the current health systems context relating to cancer in Ghana, considering the unmet policy need, health system and social factors contributing to the burden and policy advances related to cancer. CONCLUSION The findings highlight the changing burden of cancer in Ghana and the contextual factors within the socio-ecosystem that contribute to this. Policies around expanding access to and coverage of services, as well as the harmonization with medical pluralism have potential to improve outcomes and increase equity but their implementation and robust data to monitor their impact pose significant barriers.
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Affiliation(s)
- Chloe Zabrina Tuck
- School of Medicine and Population Health, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
- School of Public Health, University of Ghana, Accra, Ghana.
| | - Richard Cooper
- School of Medicine and Population Health, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | | | - Laura A Gray
- School of Medicine and Population Health, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Robert Akparibo
- School of Medicine and Population Health, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
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21
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Warren A. The relationship between perceived stigma and perceived stress in cognitive decline: a survey of persons with mild cognitive impairment and their caregivers. Front Psychol 2023; 14:1293284. [PMID: 38144994 PMCID: PMC10740212 DOI: 10.3389/fpsyg.2023.1293284] [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: 09/12/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction While Alzheimer's disease and other causes of dementia have rapidly become a global health crisis with growing incidence that is unabated, the incidence of Mild Cognitive Impairment (MCI) far exceeds that of Alzheimer's disease. Persons with MCI demonstrate some level of cognitive impairment, but daily functions remain intact and there is no certainty that they will develop dementia. Yet, the possibility conjures a considerable amount of fear and anxiety, further fueled by a vast array of misconceptions and stigma. The pervasive nature of this stigma permeates society and culture at many levels. Persons with MCI who are at higher risk for development of dementia may be especially vulnerable to fear and stigma associated with the diagnosis. Based on this premise, the primary aim of this study was to examine the relationship between perceived stigma and perceived stress in persons with MCI and their care partners, including the relationship between income and the study variables. The secondary aim was to examine the effect of a combined cognitive rehabilitation and wellness program on these perceptions. Methods Thirty participants were recruited from Mayo Clinic's Health Action to Benefit Independence and Thinking (HABIT) program. MCI (n = 15) and care partner (n = 15) participants completed the Stigma Impact Scale (SIS) and the Perceived Stress Scale (PSS) before and after the HABIT program. Results Average SIS and PSS scores decreased in the MCI, care partner, and combined groups, both pre- and post-HABIT. Linear regression was used to assess the relationship between perceived stigma and stress, controlling for income. A significant relationship was found between perceived stigma and perceived stress both pre and post-HABIT. Discussion The results suggest a relationship exists between perceived stigma and perceived stress in persons with MCI and their care partners, and an educational program such as HABIT may strengthen this relationship by informing participants of potential challenges that occur in cognitive decline. Understanding these relationships may provide an opportunity to provide tools for this vulnerable population.
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Affiliation(s)
- Alison Warren
- The Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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Funer F. Admitting the heterogeneity of social inequalities: intersectionality as a (self-)critical framework and tool within mental health care. Philos Ethics Humanit Med 2023; 18:21. [PMID: 38001488 PMCID: PMC10668443 DOI: 10.1186/s13010-023-00144-6] [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: 04/04/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Inequities shape the everyday experiences and life chances of individuals at the margins of societies and are often associated with lower health and particular challenges in accessing quality treatment and support. This fact is even more dramatic for those individuals who live at the nexus of different marginalized groups and thus may face multiple discrimination, stigma, and oppression. To address these multiple social and structural disadvantages, intersectional approaches have recently gained a foothold, especially in the public health field. This study makes an empirically informed argument for the merits of increasing the use of intersectional frameworks in the mental health field. In the mental health field, the potential for greater attention to multiple unjustified disadvantages appears to be of particular importance, as many mental health service users already face stigma and discrimination because of their mental health issues and thus may benefit particularly frequently and far-reachingly from effective problem awareness about multiple disadvantages. Intersectional approaches may help address the complexity, interdependence, and mutual constitution of social inequalities better than previous approaches that examined only one category of sociostructural stratification. By helping to identify the needs of those at the greatest risk of poor health, intersectional frameworks and tools can contribute not only to better address the needs of multiple disadvantaged individuals with mental health issues but also to the promotion of equity in the field of mental health, contributing to the reduction of health disparities.
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Affiliation(s)
- Florian Funer
- Institute of Ethics and History of Medicine, Eberhard Karls University Tübingen, Tübingen, Germany.
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Warren A. BPSD reconsidered: diagnostic considerations to preserve personhood in persons with dementia. FRONTIERS IN DEMENTIA 2023; 2:1272400. [PMID: 39081991 PMCID: PMC11285549 DOI: 10.3389/frdem.2023.1272400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/31/2023] [Indexed: 08/02/2024]
Abstract
BPSD is relatively common but profoundly disturbing to persons with dementia, their family, and caregivers. Growing recognition of the impact of BPSD on quality of life has improved recently, but assessment and management approaches are still lacking. Considerable controversy surrounding the label of BPSD has garnered a great deal of attention, with implications of its contribution to the already pervasive dementia-related stigma experienced by persons with dementia and their caregivers. This brief review aims to summarize salient viewpoints, controversies, and considerations of the assessment, management, and perception of BPSD, in an effort to offer potential recharacterizations of BPSD to promote and prioritize personhood in persons with dementia.
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Affiliation(s)
- Alison Warren
- The Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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da Silva JC, de Araujo CM, Lüders D, Santos RS, Moreira de Lacerda AB, José MR, Guarinello AC. The Self-Stigma of Hearing Loss in Adults and Older Adults: A Systematic Review. Ear Hear 2023; 44:1301-1310. [PMID: 37381145 DOI: 10.1097/aud.0000000000001398] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVES Previous studies have demonstrated that individuals with hearing loss can internalize social stigmas, resulting in several self-perceived negative connotations, such as incompetence, cognitive impairment, and social disability. This systematic review aimed to investigate the impact of the social stigma associated with hearing loss on the self-stigma experienced by adults and older adults. DESIGN Combinations of words and appropriate truncations were selected and adjusted specifically for each electronic database. The Population, Exposure, Comparator, Outcomes, and Study Characteristics strategy was used to delimit the scope of the review, bearing in mind the importance of a well-formulated research question. RESULTS A total of 953 articles were retrieved from the final search of each database. Thirty-four studies were selected for full-text reading. Thirteen were excluded, and 21 studies were ultimately included in this review. The results of this review were divided into three themes: (1) impact of social stigmas on self-stigma, (2) effect of emotions on self-stigma, and (3) other factors that impact self-stigma. The themes were related to the relationship between the individual and social perceptions reported by the participants with respect to their hearing experiences. CONCLUSIONS Our results suggest that the impact of social stigma associated with hearing loss on the self-stigma of adults and older adults is strongly associated with the effects of aging and hearing loss, which may lead to withdrawal, social segregation, and negative self-perception.
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Affiliation(s)
- Jamile Cabral da Silva
- Master and Doctoral Program of Communication Disorders, University Tuiuti of Paraná, Curitiba, Paraná, Brazil
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Krendl AC, Perry BL. Stigma Toward Substance Dependence: Causes, Consequences, and Potential Interventions. Psychol Sci Public Interest 2023; 24:90-126. [PMID: 37883667 DOI: 10.1177/15291006231198193] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Substance dependence is a prevalent and urgent public health problem. In 2021, 60 million Americans reported abusing alcohol within the month prior to being surveyed, and nearly 20 million Americans reported using illegal drugs (e.g., heroin) or prescription drugs (e.g., opioids) for nonmedical reasons in the year before. Drug-involved overdose rates have been steadily increasing over the past 20 years. This increase has been primarily driven by opioid and stimulant use. Despite its prevalence, drug dependence is one of the most stigmatized health conditions. Stigma has myriad negative consequences for its targets, including limiting their access to employment and housing, disrupting interpersonal relationships, harming physical and mental health, and reducing help-seeking. However, because research on stigma toward people with substance use disorders (SUDs) is relatively sparse compared with research on stigma toward other mental illnesses, the field lacks a comprehensive understanding of the causes and consequences of SUD stigma. Moreover, it remains unclear how, if at all, these factors differ from other types of mental illness stigma. The goal of this review is to take stock of the literature on SUD stigma, providing a clear set of foundational principles and a blueprint for future research and translational activity.
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Affiliation(s)
- Anne C Krendl
- Department of Psychological and Brain Sciences, Indiana University Bloomington
| | - Brea L Perry
- Department of Sociology, Indiana University Bloomington
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Vizin G, Szekeres T, Juhász A, Márton L, Dank M, Perczel-Forintos D, Urbán R. The role of stigma and depression in the reduced adherence among young breast cancer patients in Hungary. BMC Psychol 2023; 11:319. [PMID: 37814282 PMCID: PMC10561463 DOI: 10.1186/s40359-023-01355-4] [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: 04/16/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The main aim of our study was to investigate the role of depression, stigmatization, body shame and self-compassion in the adherence of young Hungarian breast cancer patients aged between 18 and 45 years. METHODS In a cross-sectional online survey, data were collected from 99 young breast cancer patients (BC). Participants completed self-report questionnaires on socio-demographic and cancer-specific parameters as well as psychological factors (adherence: 12-item Medication Adherence Scale; depression: Hospital Anxiety and Depression Scale; stigmatization: Stigma Scale for Chronic Illnesses; body shame: Experience of Shame Scale; self-compassion: Self-Compassion Scale). We tested the predictors and mediators of adherence using hierarchical regression, mediation and moderation analysis among BC patients. RESULTS We found that adherence was significantly associated with body shame and stigmatization in our BC sample. In addition, stigmatization alone was a significant predictor of lower adherence. Finally, in mediation models, where body shame was a mediator, we found a significant direct effect between stigma and adherence, in other words body shame had a significant mediating effect between these variables. According to our moderation analysis, self-compassion as a significant moderator acts as a protective factor in the linear relationship between stigma and lower adherence. CONCLUSIONS Our results highlight the importance of stigma and body shame in the development of adherence in oncological care among young Hungarian BC patients aged between 18 and 45 years. Assessment of stigma, body shame, self-compassion, and the improvement of the availability of evidence-based psychological interventions may increase the adherence of young Hungarian BC patients, leading to more favourable rates of survival.
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Affiliation(s)
- Gabriella Vizin
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, 1064, Hungary.
| | - Tamás Szekeres
- Faculty of General Medicine, Department of Clinical Psychology, Semmelweis University, Üllői út 25, Budapest, 1095, Hungary
| | - Anita Juhász
- Faculty of General Medicine, Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Üllői út 78, Budapest, 1082, Hungary
| | - Lilla Márton
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, 1064, Hungary
| | - Magdolna Dank
- Faculty of General Medicine, Department of Internal Medicine and Oncology, Oncology Profile, Semmelweis University, Tömő u. 25-29, Budapest, 1st, 1083, Hungary
| | - Dóra Perczel-Forintos
- Faculty of General Medicine, Department of Clinical Psychology, Semmelweis University, Üllői út 25, Budapest, 1095, Hungary
| | - Róbert Urbán
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, 1064, Hungary
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Sugisawa H, Shimizu Y, Kumagai T, Shishido K, Koda Y, Shinoda T. Influence of dialysis-related stigma on health-related indicators in Japanese patients undergoing hemodialysis. Ther Apher Dial 2023; 27:855-865. [PMID: 37052040 DOI: 10.1111/1744-9987.13992] [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: 02/01/2023] [Revised: 03/06/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Focusing on impacts to health-related indicators in older Japanese patients, this study analyzed both the direct influence of dialysis-related stigma and influences of its intersectionality with other stigmatized characteristics. METHODS Data were collected through a cross-sectional survey of 7461 outpatients in dialysis facilities. Other stigmatized characteristics include lower income, lower education, disabled activities of daily living, and diabetic end-stage renal disease (ESRD) as a cause for starting dialysis treatment. RESULTS The average rate of an "agree" response on dialysis-related stigma items was 18.2%. Dialysis-related stigma significantly influenced all three health-related indicators, including suspected depression, informal networks, and compliance with dietary therapy. In addition, each interaction between dialysis-related stigma and educational attainment, gender, and diabetic ESRD significantly influence one health-related indicator. CONCLUSION These results suggest that dialysis-related stigma has both a significant direct and synergic influence with other stigmatized characteristics on health-related indicators.
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Affiliation(s)
- Hidehiro Sugisawa
- Gerontology Program, J. F. Oberlin University Graduate School of International Studies, Tokyo, Japan
| | | | - Tamaki Kumagai
- School of Health Sciences, International University of Health and Welfare, Odawara, Kanagawa, Japan
| | | | - Yutaka Koda
- Koda Medical and Dialysis Clinic, Niigata, Japan
| | - Toshio Shinoda
- Advanced Course for Clinical Engineering, Teikyo University Junior College, Tokyo, Japan
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Alley J, Brener SA, Diamond LM. Associations Between Childhood Victimization, Adult Victimization, and Physical Health Among Sexually Diverse Adults at Different Stages of Life. LGBT Health 2023; 10:505-513. [PMID: 37115554 PMCID: PMC10623468 DOI: 10.1089/lgbt.2022.0240] [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] [Indexed: 04/29/2023] Open
Abstract
Purpose: Research examining health disparities in sexually diverse populations is quite variable. The purpose of the present article was to shed light on the conflicting findings pertaining to minority stress and health by examining the potential impact of age, childhood victimization, and different measurements of health. Methods: The present research used data from the Generations Study, a questionnaire study of sexually diverse adults (ages 18-60) surveyed between 2016 and 2019. We modeled direct and indirect links among (1) childhood exposure to physical or sexual abuse, (2) adult exposure to victimization or harassment, and (3) adult physical health status, assessed both subjectively and objectively. Participants were 1398 sexually diverse adults (e.g., lesbian, gay, bisexual); the present work only utilizes wave one of the data collected in 2016. Results: We found that both childhood abuse and adult harassment/victimization predicted sexually diverse adults' health status, but these associations only manifested as diagnosable disease outcomes among adults over 50. Associations between childhood abuse and adult health were partly attributable to the fact that abuse-exposed children were disproportionately exposed to harassment and victimization as adults. Conclusion: Our research makes a novel contribution to our understanding of the health effects of stigma by pinpointing the multiple, cascading pathways through which adversity relates to health.
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Affiliation(s)
- Jenna Alley
- Department of Psychology, The University of Utah, Salt Lake City, Utah, USA
| | - Susan A. Brener
- Department of Psychology, The University of Utah, Salt Lake City, Utah, USA
| | - Lisa M. Diamond
- Department of Psychology, The University of Utah, Salt Lake City, Utah, USA
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Mellen EJ, Hatzenbuehler ML. Sexual Violence-Related Stigma, Mental Health, and Treatment-Seeking: A Multimodal Assessment in a Population-Based Study of Young Adults. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:11243-11271. [PMID: 37491905 DOI: 10.1177/08862605231179715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Sexual violence (SV) is a stigmatized form of trauma, yet the stigma experiences of those reporting SV are often assumed rather than explicitly measured. We adapted a measure that quantified three key features of SV stigma across three levels: negative self-image (individual), disclosure concerns (interpersonal), and concerns about public attitudes (structural). We administered this measure to a population-based sample of Swedish young adults (N = 453) who reported a history of either sexual assault (SA) or intimate partner sexual violence (IPSV). Among both groups, 89% endorsed at least one item on the stigma scale. Experiences of SV-related stigma were associated with significantly higher symptoms of generalized anxiety, depression, and posttraumatic stress disorder, with greater perceived need for mental health treatment, and with more shame (measured implicitly via a reaction-time task). Experiences of stigma were negatively associated with symptoms of alcohol misuse. Results suggest that exposure to SV stigma may be a critical, but often overlooked, correlate of post-assault recovery.
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Le Forestier JM, Page-Gould E, Chasteen AL. Which Identities Are Concealable? Individual Differences in Concealability. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2023:1461672231198162. [PMID: 37714825 DOI: 10.1177/01461672231198162] [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: 09/17/2023]
Abstract
Concealment is a common and consequential identity management strategy. But which identities are concealable? In three studies (n = 468; obs = 4,068), we find substantial individual differences in which identities people experience as concealable. These individual differences in concealability manifest as Person × Identity interactions, such that people experience varying levels of concealability for each of their individual identities. In two additional studies (n = 465; obs = 3,784), we find that these individual differences predict the frequency and efficacy of concealment. We conclude that it is inaccurate to label entire categories of identities as either concealable or conspicuous and urge intergroup researchers to consider people's unique experiences of concealability. Pre-registrations for Studies 1 to 4 and open materials, code, and data for all studies are available on the Open Science Framework: https://osf.io/m95qu/.
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Cecil V, Pendry LF, Ashbullby K, Salvatore J. Masquerading their way to authenticity: Does age stigma concealment benefit older women? J Women Aging 2023; 35:428-445. [PMID: 36174986 DOI: 10.1080/08952841.2022.2128245] [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: 06/01/2022] [Revised: 07/27/2022] [Accepted: 09/17/2022] [Indexed: 10/14/2022]
Abstract
As women age they can be subject to both sexism and ageism, and consequently be stereotyped as low in competence and irrelevant despite having a relatively young subjective age. Drawing on theories of stigma, we conducted a survey study of older women (N = 184) with a strong interest in fashion and their visual image. We used template thematic analysis to understand their experiences in relation to their age-changed appearance. Two major themes were identified: unfavourable experiences of ageism and efforts to evade these experiences through attention to appearance. Our participants employed masquerade to conceal or reduce the visible evidence of their age-both to avoid ageism and to align their outward appearance more closely with their inner, felt, authentic selves. We interrogate the benefits and penalties of concealment for a group whose stigmatised condition is dynamic, changing as their appearance grows increasingly dissimilar to societally favoured youthfulness. Masquerade may for this group of women produce more positive than negative outcomes, via effects on felt authenticity.
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Affiliation(s)
- Vanessa Cecil
- Department of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Louise F Pendry
- Department of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Katherine Ashbullby
- Department of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Jessica Salvatore
- Department of Psychology, James Madison University, Harrisonburg, VA, USA
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Akyirem S, Ekpor E, Namumbejja Abwoye D, Batten J, Nelson LE. Type 2 diabetes stigma and its association with clinical, psychological, and behavioral outcomes: a systematic review and meta-analysis. Diabetes Res Clin Pract 2023:110774. [PMID: 37307898 DOI: 10.1016/j.diabres.2023.110774] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/25/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023]
Abstract
AIM To synthesize quantitative research evidence on the association between type 2 diabetes (T2D) stigma and psychological, behavioral, and clinical outcomes. METHODS We searched APA PyschInfo, Cochrane Central, Scopus, Web of Science, Medline, CINAHL and EMBASE through November 2022. Peer-reviewed observational studies examining the association between T2D stigma and psychological, behavioral, and/or clinical outcomes were eligible for inclusion. Risk of bias was assessed with the JBI critical appraisal checklist. Correlation coefficients were pooled in random effect meta-analyses. RESULTS Our search produced 9642 citations, 29 met the inclusion criteria. Included articles were published between 2014 and 2022. We found a weak positive correlation between T2D stigma and HbA1C (r=0.16, 95% CI:0.08 to 025, I2=70%, N=7 studies), a moderate positive correlation between T2D stigma and depressive symptoms (r=0.49, 95% CI: 0.44 to 0.54, I2=26.9%, n=5 studies) and diabetes distress (r=0.54, 95% CI: 0.35 to 0.72, I2=96.9%, n=7studies). Persons with T2D stigma who experienced stigma tended to have less engagement in diabetes self-management, though this association was weak (r=-0.17, 95% CI: -0.25 to -0.08, I2=79.8%, n=7studies). CONCLUSIONS T2D stigma was associated with negative health outcomes. Further studies are required to disentangle the underlying causal mechanisms to inform the development of appropriate stigma-reduction interventions.
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Affiliation(s)
| | | | | | - Janene Batten
- Harvey Cushing/John Hay Whitney Medical Library, Yale University
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Broady TR, Brener L, Horwitz R, Cama E, Treloar C. Reducing stigma towards people living with HIV and people who inject drugs using social norms theory: An online study with Australian health care workers. Drug Alcohol Depend 2023; 249:109953. [PMID: 37302358 DOI: 10.1016/j.drugalcdep.2023.109953] [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: 10/10/2022] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite extensive evidence regarding the negative effects of stigma experienced by people living with HIV (PLHIV) and people who inject drugs within health care settings, comparatively little evidence exists regarding the effectiveness of initiatives to reduce this stigma. METHOD This study developed and assessed brief online interventions based on social norms theory with a sample of Australian health care workers (n=653). Participants were randomly allocated to either 1) HIV intervention group, or 2) injecting drug use intervention group. They completed baseline measures of their attitudes towards either PLHIV or people who inject drugs, matching measures of their perceptions of their colleagues' attitudes, plus a series of items reflecting behavioural intentions and agreement with stigmatising behaviour towards PLHIV or people who inject drugs. Participants were presented with a social norms video before completing the measures again. RESULTS At baseline, participants' agreement with stigmatising behaviour was correlated with their perceptions of how many of their colleagues would agree. After watching the video, participants reported more positive perceptions of their colleagues' attitudes towards PLHIV and people who inject drugs, as well as more positive personal attitudes towards people who inject drugs. Changes in perceptions of colleagues' support for stigmatising behaviour independently predicted changes in participants' personal agreement with that behaviour. CONCLUSION Findings suggest that interventions based on social norms theory that address health care workers' perceptions of their colleagues' attitudes can play an important role in contributing to broader initiatives to reduce stigma in health care settings.
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Affiliation(s)
| | - Loren Brener
- Centre for Social Research in Health, UNSW, Australia
| | - Robyn Horwitz
- Centre for Social Research in Health, UNSW, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW, Australia
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Hamill MM, Hu F, Adebajo S, Kokogho A, Tiamiyu AB, Parker ZF, Charurat ME, Ake JA, Baral SD, Nowak RG, Crowell TA. Food and Water Insecurity in Sexual and Gender Minority Groups Living With HIV in Lagos, Nigeria. J Acquir Immune Defic Syndr 2023; 93:171-180. [PMID: 36881816 PMCID: PMC10293107 DOI: 10.1097/qai.0000000000003183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Food and water insecurity are associated with poor health outcomes that may be exacerbated by social marginalization and barriers to health care experienced by sexual and gender minorities (SGM) in resource-limited settings. We explored factors associated with food and water insecurity in SGM with HIV. SETTING A longitudinal study of 357 men who have sex with men, transgender women, and other gender-identifying people in Lagos, Nigeria. METHODS Laboratory testing, interviews, food and water assessments, and anthropometry were performed quarterly. Robust Poisson regression with generalized estimating equations was used to evaluate factors potentially associated with food and water insecurity. RESULTS From 2014 to 2018, 357 SGM with HIV completed either the food or water assessments. At baseline, participants identified as cisgender men who have sex with men 265 (74.2%), transgender women 63 (17.7%), or as nonbinary/other gender 29 (8.1%). Food insecurity and water insecurity were reported by 63/344(18.3%) and 113/357(31.7%), respectively, at any visit. Food and water insecurity each decreased with ongoing study participation. Food insecurity was associated with nonpartnered relationship status, CD4 count <500 cells/mm 3 , and lack of access to piped water. Water insecurity was associated with age 25 years or older, living with a man, transactional sex, and food insecurity. CONCLUSIONS Food and water insecurity were common among SGM in Nigeria and decreased with continued study participation, suggesting amenability to intervention when SGM are successfully engaged in care. Targeted interventions to support food and water security may improve HIV-related outcomes, such as CD4 count.
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Affiliation(s)
- Matthew M. Hamill
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, USA
| | - Fengming Hu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
| | - Sylvia Adebajo
- Maryland Global Initiatives Corporation, University of Maryland Baltimore, Baltimore, USA
| | - Afoke Kokogho
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
| | - Abdulwasiu B. Tiamiyu
- HJF Medical Research International, Abuja, Nigeria
- US Army Medical Research Directorate-Africa/Nigeria, Abuja, Nigeria
| | - Zahra F. Parker
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
- US Army Medical Research Directorate-Africa/Nigeria, Abuja, Nigeria
| | - Manhattan E. Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
| | - Stefan D. Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, USA
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Trevor A. Crowell
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
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Scheer JR, Helminen EC, Cascalheira CJ, Jaipuriyar V, Shaw TJ, Zabelski S, Behari K, Pirog S, Batchelder AW, Possemato K, Hughes TL, Sullivan TP. Probable PTSD, PTSD symptom severity, and comorbid PTSD and hazardous drinking among sexual minority women compared to heterosexual women: A meta-analysis. Clin Psychol Rev 2023; 102:102283. [PMID: 37150043 PMCID: PMC10205673 DOI: 10.1016/j.cpr.2023.102283] [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] [Received: 10/08/2022] [Revised: 01/24/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) is more prevalent among sexual minority women (SMW) than among heterosexual women. PTSD risk varies among SMW, but no meta-analysis has clarified sexual identity-related disparities in probable PTSD among women or SMW's heterogeneity in PTSD risk. SMW are also at pronounced risk of comorbid PTSD and hazardous drinking (HD). However, the difference in comorbid PTSD/HD between SMW and heterosexual women is understudied. This meta-analysis aimed to provide a comprehensive understanding of differences between SMW and heterosexual women and among SMW across demographic characteristics. Peer-reviewed publications that were written in English and reported quantitative data on PTSD specific to SMW were included. Eligible publications (n = 45) were identified through a systematic search of 11 electronic databases, supplemented by a search of reference lists of relevant papers. We found that probable PTSD, PTSD symptom severity, and probable comorbid PTSD/HD are highly prevalent among SMW, with SMW of color, transgender and gender diverse people, and bi+ women (e.g., bisexual, pansexual, queer) being at greatest risk. These results emphasize the need to improve accurate assessment of trauma-related sequelae among SMW and to develop, disseminate, and implement culturally sensitive treatments to reduce PTSD and comorbid PTSD/HD among at-risk SMW.
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Affiliation(s)
- Jillian R Scheer
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA.
| | - Emily C Helminen
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA; College of Health Science and Technology, Rochester Institute of Technology, USA
| | - Cory J Cascalheira
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA; Department of Counseling & Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Virinca Jaipuriyar
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Thomas J Shaw
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Sasha Zabelski
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Kriti Behari
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Sophia Pirog
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Abigail W Batchelder
- Harvard Medical School, Harvard University, Boston, MA, USA; Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY, USA
| | - Tonda L Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York, NY, USA; Columbia University School of Nursing Center for Sexual and Gender Minority Research, New York, NY, USA
| | - Tami P Sullivan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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36
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Lanthier S, Mason R, Logie CH, Myers T, Du Mont J. "Coming out of the closet about sexual assault": Intersectional sexual assault stigma and (non) disclosure to formal support providers among survivors using Reddit. Soc Sci Med 2023; 328:115978. [PMID: 37276773 DOI: 10.1016/j.socscimed.2023.115978] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 05/12/2023] [Accepted: 05/19/2023] [Indexed: 06/07/2023]
Abstract
Sexual assault is a pervasive, violent and often gendered crime that can result in significant negative consequences. Many sexual assault survivors consider disclosing to health and social care providers, therapists, and others who collectively fall under the banner of formal support, in order to access information, referrals, treatment and/or emotional support, however barriers to disclosure remain. This qualitative study is unique in its application of an intersectional sexual assault stigmatization framework to understand (non)disclosure to formal support providers among diverse sexual assault survivors. Through anonymous online narratives posted to the platform Reddit, survivors documented experiences of intersectional sexual assault stigma (perceived, internalized, anticipated, experienced) showing that they were not only stigmatized through negative gender stereotyping, but they were also marginalized through other structural inequities. The experience of multiple marginalization that arose from intersectional sexual assault stigma often impeded survivors in accessing and/or utilizing the formal support they wished for. The findings suggest that formal support providers could benefit from stigma reduction training related specifically to sexual assault survivors and that current models of stigma and discrimination training need to be expanded to include intersectional stigma. Further, the findings suggest that beyond training at an organizational level, a broader intervention aimed at reducing structural stigma and discrimination toward sexual assault survivors at a societal level appears warranted. Implications for future research related to the unique disclosure, health, and social care needs of diverse sexual assault survivors and support-seeking online alongside or in lieu of formal support are discussed.
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Affiliation(s)
- Stephanie Lanthier
- Women's College Research Institute, Women's College Hospital, Canada; Dalla Lana School of Public Health, University of Toronto, Canada.
| | - Robin Mason
- Women's College Research Institute, Women's College Hospital, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Carmen H Logie
- Women's College Research Institute, Women's College Hospital, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, Canada; Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Ted Myers
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
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van der Voorn B, Camfferman R, Seidell JC, Puhl RM, Halberstadt J. Weight-biased attitudes about pediatric patients with obesity in Dutch healthcare professionals from seven different professions. J Child Health Care 2023:13674935221133953. [PMID: 36861392 DOI: 10.1177/13674935221133953] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Little is known about the prevalence of negative weight-biased attitudes among Dutch healthcare professionals (HCPs) when treating children and adolescents with obesity and whether interdisciplinary differences are present. Accordingly, we asked Dutch HCPs that treat pediatric patients with obesity to complete a validated 22-item self-report questionnaire about their weight-biased attitudes. In total, 555 HCPs participated from seven different disciplines: 41 general practitioners (GPs), 40 pediatricians, 132 youth healthcare physicians, 223 youth healthcare nurses, 40 physiotherapists, 40 dieticians, and 39 mental health professionals. HCPs from all disciplines reported to experience negative weight-biased attitudes among themselves. Pediatricians and GPs scored highest on negative weight-biased attitudes, including frustrations in treating children with obesity, and feeling less confident and prepared to treat children with obesity. Dieticians scored the least negative weight-biased attitudes. Participants from all groups perceived weight bias expressed by their colleagues, toward children with obesity. These findings are comparable to results reported by adult HCPs from other countries. Interdisciplinary differences were found and underscore the need for more research on contributing factors that impact explicit weight bias among pediatric HCPs.
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Affiliation(s)
- Bibian van der Voorn
- Department of Health Science, 1190Vrije Universiteit, Amsterdam, The Netherlands
| | - Roxanna Camfferman
- Department of Health Science, 1190Vrije Universiteit, Amsterdam, The Netherlands
| | - Jacob C Seidell
- Department of Health Science, 1190Vrije Universiteit, Amsterdam, The Netherlands
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Health, Department of Human Development & Family Sciences, University of Connecticut, Hartfort, CT, USA
| | - Jutka Halberstadt
- Department of Health Science, 1190Vrije Universiteit, Amsterdam, The Netherlands
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Klusaritz H, Bilger A, Paterson E, Summers C, Barg FK, Cronholm PF, Saine ME, Sochalski J, Doubeni CA. Impact of Stigma on Clinician Training for Opioid Use Disorder Care: A Qualitative Study in a Primary Care Learning Collaborative. Ann Fam Med 2023; 21:S31-S38. [PMID: 36849482 PMCID: PMC9970664 DOI: 10.1370/afm.2920] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 03/01/2023] Open
Abstract
PURPOSE We undertook a study to examine how stigma influences the uptake of training on medication for opioid use disorder (MOUD) in primary care academic programs. METHODS We conducted a qualitative study of 23 key stakeholders responsible for implementing MOUD training in their academic primary care training programs that were participants in a learning collaborative in 2018. We assessed barriers to and facilitators of successful program implementation and used an integrated approach to develop a codebook and analyze the data. RESULTS Participants represented the family medicine, internal medicine, and physician assistant fields, and they included trainees. Most participants described clinician and institutional attitudes, misperceptions, and biases that enabled or hindered MOUD training. Perceptions included concerns that patients with OUD are "manipulative" or "drug seeking." Elements of stigma in the origin domain (ie, beliefs by primary care clinicians or the community that OUD is a choice and not a disease), the enacted domain (eg, hospital bylaws banning MOUD and clinicians declining to obtain an X-Waiver to prescribe MOUD), and the intersectional domain (eg, inadequate attention to patient needs) were perceived as major barriers to MOUD training by most respondents. Participants described strategies that improved the uptake of training, including giving attention to clinician concerns, clarifying the biology of OUD, and ameliorating clinician fears of being ill equipped to provide care for patients. CONCLUSIONS OUD-related stigma was commonly reported in training programs and impeded the uptake of MOUD training. Potential strategies to address stigma in the training context, beyond providing content on effective evidence-based treatments, include addressing the concerns of primary care clinicians and incorporating the chronic care framework into OUD treatment.
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Affiliation(s)
- Heather Klusaritz
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea Bilger
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Paterson
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Courtney Summers
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Frances K Barg
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Elle Saine
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julie Sochalski
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chyke A Doubeni
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania .,Department of Family and Community Medicine, The Ohio State University, Columbus, Ohio
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Herrera SN, Larsen EM, Deluca JS, Crump FM, Grivel M, Blasco D, Bryant C, Shapiro DI, Downing D, Girgis RR, Brucato G, Huang D, Kufert Y, Verdi M, West ML, Seidman LJ, Link BG, McFarlane WR, Woodberry KA, Yang LH, Corcoran CM. The association between mental health stigma and face emotion recognition in individuals at risk for psychosis. STIGMA AND HEALTH 2023; 8:31-39. [PMID: 36968262 PMCID: PMC10038192 DOI: 10.1037/sah0000379] [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] [Indexed: 11/08/2022]
Abstract
Self-stigma has been associated with reduced accuracy of face emotion recognition in individuals at clinical high risk for psychosis (CHR). Stigma may also relate to slowing of performance during cognitive tasks for which a negative stereotype is relevant. This study aimed to investigate the association of mental illness stigma with face emotion recognition among CHR individuals. Participants were 143 CHR individuals identified using the Structured Interview for Psychosis-Risk Syndromes (SIPS). Face emotion recognition was assessed using the Penn Emotion Recognition Task (ER-40). Stigma was assessed using discrimination, stereotype awareness, and stereotype agreement subscales of the Mental Health Attitudes Interview for CHR. We tested associations of ER-40 accuracy and response times with these stigma variables, including the role of clinical and demographic factors. Racial/ethnic minoritized participants had higher attenuated positive symptoms than non-minoritized participants. Longer ER-40 response times were correlated with greater stereotype agreement (r=.17, p=.045) and discrimination (r=.22, p=.012). A regression model predicting ER-40 response times revealed an interaction of stereotype agreement with minoritized status (p=.008), with slower response times for minoritized participants as stereotype agreement increased. Greater disorganized symptoms and male gender also predicted longer response times. ER-40 accuracy was not associated with stigma. Overall, minoritized CHR individuals with greater internalized stigma took longer to identify face emotions. Future research is needed to assess whether slower response times are specific to social cues, and if internalized stigma interferes with performance in real-world social situations. Reducing stigma may be an important target for interventions that aim to improve social skills.
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Affiliation(s)
- Shaynna N. Herrera
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Emmett M. Larsen
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Joseph S. Deluca
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | | | - Margaux Grivel
- School of Global Public Health, New York University, New York NY, USA
| | - Drew Blasco
- School of Global Public Health, New York University, New York NY, USA
| | - Caitlin Bryant
- Department of Psychology, University of Massachusetts Boston, Boston MA, USA
- Commonwealth Research Center, Beth Israel Deaconess Medical Center, Boston MA, USA
| | - Daniel I. Shapiro
- Commonwealth Research Center, Beth Israel Deaconess Medical Center, Boston MA, USA
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis CA, USA
| | - Donna Downing
- Maine Medical Center Research Institute, Portland ME, USA
| | - Ragy R. Girgis
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York NY, USA
| | - Gary Brucato
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York NY, USA
| | - Debbie Huang
- Mailman School of Public Health, Columbia University, New York NY, USA
| | - Yael Kufert
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Mary Verdi
- Maine Medical Center Research Institute, Portland ME, USA
| | - Michelle L. West
- Commonwealth Research Center, Beth Israel Deaconess Medical Center, Boston MA, USA
- Maine Medical Center Research Institute, Portland ME, USA
- Anschutz Medical Campus, Department of Psychiatry, University of Colorado, Aurora CO, USA
| | - Larry J. Seidman
- Commonwealth Research Center, Beth Israel Deaconess Medical Center, Boston MA, USA
- Department of Psychiatry, Harvard Medical School, Boston MA, USA
| | - Bruce G. Link
- Department of Sociology, University of California, Riverside, Riverside CA, USA
| | - William R. McFarlane
- Maine Medical Center Research Institute, Portland ME, USA
- Department of Psychiatry, Tufts University, Boston MA, USA
| | - Kristen A. Woodberry
- Commonwealth Research Center, Beth Israel Deaconess Medical Center, Boston MA, USA
- Maine Medical Center Research Institute, Portland ME, USA
- Department of Psychiatry, Harvard Medical School, Boston MA, USA
- Department of Psychiatry, Tufts University, Boston MA, USA
| | - Lawrence H. Yang
- School of Global Public Health, New York University, New York NY, USA
- Mailman School of Public Health, Columbia University, New York NY, USA
| | - Cheryl M. Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York NY, USA
- Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peter Veterans Affairs Medical Center, Bronx, NY, USA
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40
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Saalim K, Amu-Adu P, Amoh-Otu RP, Akrong R, Abu-Ba’are GR, Stockton MA, Vormawor R, Torpey K, Nyblade L, Nelson LE. Multi-level manifestations of sexual stigma among men with same-gender sexual experience in Ghana. BMC Public Health 2023; 23:166. [PMID: 36694150 PMCID: PMC9872747 DOI: 10.1186/s12889-023-15087-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
Sexual stigma and discrimination toward men who have same-gender sexual experiences are present across the globe. In Ghana, same-gender sexual desires and relationships are stigmatized, and the stigma is sanctioned through both social and legal processes. Such stigma negatively influences health and other material and social aspects of daily life for men who have sex with men (MSM). However, there is evidence that stigma at the interpersonal level can intersect with stigma that may be operating simultaneously at other levels. Few studies provide a comprehensive qualitative assessment of the multi-level sexual stigma derived from the direct narratives of men with same-gender sexual experience. To help fill this gap on sexual stigma, we qualitatively investigated [1] what was the range of sexual stigma manifestations, and [2] how sexual stigma manifestations were distributed across socioecological levels in a sample of Ghanaian MSM. From March to September 2020, we conducted eight focus group discussions (FGDs) with MSM about their experiences with stigma from Accra and Kumasi, Ghana. Data from the FGDs were subjected to qualitative content analysis. We identified a range of eight manifestations of sexual stigma: (1) gossiping and outing; (2) verbal abuse and intrusive questioning; (3) non-verbal judgmental gestures; (4) societal, cultural, and religious blaming and shaming; (5) physical abuse; (6) poor-quality services; (7) living in constant fear and stigma avoidance; and (8) internal ambivalence and guilt about sexual behavior. Sexual stigma manifestations were unevenly distributed across socioecological levels. Our findings are consistent with those of existing literature documenting that, across Africa, and particularly in Ghana, national laws and religious institutions continue to drive stigma against MSM. Fundamental anti-homosexual sentiments along with beliefs associating homosexuality with foreign cultures and immorality drive the stigmatization of MSM. Stigma experienced at all socioecological levels has been shown to impact both the mental and sexual health of MSM. Deeper analysis is needed to understand more of the lived stigma experiences of MSM to develop appropriate stigma-reduction interventions. Additionally, more community-level stigma research and interventions are needed that focus on the role of family and peers in stigma toward MSM in Ghana.
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Affiliation(s)
| | | | | | | | | | - Melissa A. Stockton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY USA
- New York State Psychiatric Institute, New York, NY USA
| | | | | | | | - LaRon E. Nelson
- Yale School of Nursing, New Haven, CT USA
- Yale Institute for Global Health, New Haven, CT USA
- Yale Center for Interdisciplinary Research on AIDS, New Haven, CT USA
- Yale School of Public Health, New Haven, CT USA
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41
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Dopelt K, Davidovitch N, Davidov N, Plot I, Boas H, Barach P. "As if we are branded with the mark of Cain": stigma, guilt, and shame experienced by COVID-19 survivors in Israel - a qualitative study. CURRENT PSYCHOLOGY 2023:1-14. [PMID: 36684454 PMCID: PMC9838295 DOI: 10.1007/s12144-023-04241-9] [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] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
Stigma is associated with harmful health outcomes, and it fuels social and health inequalities. It can undermine social cohesion and encourage social exclusion of groups, which may contribute to secrecy about disease symptoms, avoidance of disease testing and vaccination, and further spread of a contagious illness. Stigmatization is a social process set to exclude those who are perceived to be a potential source of disease and may pose a threat to effective interpersonal and social relationships. In this qualitative study, we delved into the stigmatization experiences of twenty COVID-19 recovered patients during the COVID-19 first wave, using in-depth semi-structured interviews conducted during November 2020. Using thematic analysis, we found that the process of stigmatization was all-encompassing, from the stage of diagnosis throughout the duration of the disease and the recovery phases. On the basis of the data, we hypothesized that stigma is a significant public health concern, and effective and comprehensive interventions are needed to counteract the damaging and insidious effects during infectious disease pandemics such as COVID-19, and reduce infectious disease-related stigma. Interventions should address provision of emotional support frameworks for the victims of stigmatization and discrimination that accompany the COVID-19 pandemic and future pandemics. This study was conducted in the early days of the COVID-19 pandemic, when uncertainty about the disease was high and fear of contamination fueled high levels of stigmatization against those who became ill with Covid-19.
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Affiliation(s)
- Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Nadav Davidovitch
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Nikol Davidov
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Ira Plot
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Hagai Boas
- Department of Politics and Governance, Ben Gurion University of the Negev, Beer Sheva, Israel
- The Van Leer Jerusalem Institute, Jerusalem, Israel
| | - Paul Barach
- Thomas Jefferson University, Philadelphia, PA USA
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42
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Jankowski SE, Yanos P, Dixon LB, Amsalem D. Reducing Public Stigma Towards Psychosis: A Conceptual Framework for Understanding the Effects of Social Contact Based Brief Video Interventions. Schizophr Bull 2023; 49:99-107. [PMID: 36190348 PMCID: PMC9810007 DOI: 10.1093/schbul/sbac143] [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] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND HYPOTHESIS Public stigma reduces treatment-seeking and increases the duration of untreated psychosis among young people with psychosis. Social contact-based video interventions have been shown to be effective at reducing stigma; however, more research is needed regarding very brief interventions less than 2 minutes long, which are suitable for social media platforms and particularly relevant for young adults. We recently conducted three randomized control trials and demonstrated the efficacy of such videos to reduce stigma toward individuals with psychosis among young adults of the general public. However, it is unclear what elements contributed to the effectiveness of these very brief interventions. STUDY DESIGN The present article proposes a conceptual framework to discern what elements contributed to the efficacy of these interventions. We first review the existing literature describing social contact-based interventions and how they impact the cognitions, emotions, and behaviors of participants. STUDY RESULTS Then, using this lens, we suggest an alternate observation of the data from our studies by examining changes in stigmatizing views across time, rather than utilizing mean scores and conceptualizing how key characteristics of our interventions helped reduce stigma. We also highlight future research directions, including the need to look at mediators and moderators of change and the need to examine behavioral outcomes. STUDY CONCLUSIONS By hypothesizing how these interventions are proposed to work, this framework is intended to provide a roadmap for further development of brief video-based interventions to reduce stigma.
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Affiliation(s)
- Samantha E Jankowski
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Philip Yanos
- Department of Psychology, John Jay College Of Criminal Justice, City University of New York, New York, NY, USA
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
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43
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Predicting different dimensions of schizophrenia-related stigma in Israel: Exploring the applicability of the common sense model of illness. Arch Psychiatr Nurs 2023; 43:9-14. [PMID: 37032022 DOI: 10.1016/j.apnu.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 12/08/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
The common sense model of illness is a promising conceptual framework that can promote our understanding of the predictors of schizophrenia-related public stigma. Because stigma is a multidimensional phenomenon, studies on schizophrenia-related stigma need to account for the origins of the various aspects of this phenomenon. This study explored which common sense model of illness components (cognitive and emotional) predicted three distinct indicators of stigma (stereotypes and discrimination on the individual and structural levels). A nonprobability sample of 149 students from one of the largest universities in Israel was drawn. Data were collected via a self-reported questionnaire. We found that five of the nine common sense model of illness variables predicted schizophrenia stereotypes, whereas very few predicted discrimination. Additionally, we found that greater belief in the effectiveness of schizophrenia treatment was associated with lower stereotypes and social-level discrimination. The less the perceived consequences of schizophrenia (the extent to which the illness is perceived to affect one's life), the lower the stereotypes and discrimination (individual and social). The perceived cause of schizophrenia and attribution of personal control over the illness did not predict any stigma dimension. The findings suggest that the common sense model of illness is more suitable for predicting stereotypes than discrimination. More research is needed to understand the unique drivers of different dimensions of stigma. The findings also imply the need to design separate programs to address different aspects of schizophrenia-related stigma.
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Mol MM, Visser MJ, Rai SS, Peters RMH. Measuring health-related stigma: Exploring challenges and research priorities to improve assessment. Glob Public Health 2023; 18:2264960. [PMID: 37801723 DOI: 10.1080/17441692.2023.2264960] [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: 03/10/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023]
Abstract
Despite the advances in stigma research, measuring health-related stigma continues to be challenging and knowledge gaps remain. This study gained insight into challenges and research priorities related to the assessment of health-related stigma. Interviews were conducted with 14 stigma researchers, followed by a survey that was completed by 36 respondents. The findings showed a diverse range of research priorities. Among the top ranked priorities were the need for robust measurement properties of existing scales (content validity, responsiveness, validation across settings), exploration and assessment of subtle changes in stigma, and investigation on ways to assess actual behaviour and discrimination. Various challenges with the cross-cultural use of measures were identified, along with a research opportunity to shorten the cross-cultural validation process. Other identified research priorities related to: studying multi-level intersectional stigma; focusing on positive features that counter stigma; rephrasing negative and offending scale items; developing generic measures; and, the further development of practical tools to support researchers with scale implementation. The defined research priorities can guide future studies to advance stigma measurements and, as our ability to measure is critical for our understanding, enhance our knowledge about the complex stigma processes.
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Affiliation(s)
- Marente M Mol
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marlies J Visser
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sarju S Rai
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ruth M H Peters
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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45
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Sprague C. What Matters Most? The Power of Kafka's Metamorphosis to Advance Understandings of HIV Stigma and Inform Empathy in Medical Health Education. THE JOURNAL OF MEDICAL HUMANITIES 2022; 43:561-584. [PMID: 35188615 PMCID: PMC8858723 DOI: 10.1007/s10912-022-09729-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
HIV stigma, a social-medical problem, continues to confound researchers and health professionals, while undermining outcomes. Empathy may reduce stigma; its absence may predict stigma. This research investigates: How does Kafka's Metamorphosis advance understandings of HIV stigma in medical health education? Metamorphosis amplifies the sociological-relational mechanisms fostering HIV stigma. It offers a multi-disciplinary, responsive space for ethical, humanistic and clinical inquiry to meet: enabling students to consider how social structures shape health inequities, moral, social experience, and their professional identity within. Metamorphosis may ultimately promote medical health humanities' social mission-allowing literature to unfold such revelations towards greater equity in health.
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Bian W, Wang Z, Wan J, Zhang F, Wu X, Li X, Luo Y. Exploring challenges to nutrition intervention adherence using COM-B model among patients with wet age-related macular degeneration: a qualitative study. BMJ Open 2022; 12:e064892. [PMID: 36446464 PMCID: PMC9710364 DOI: 10.1136/bmjopen-2022-064892] [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] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To explore challenges to nutrition intervention adherence using the Capability, Opportunity and Motivation-Behaviour (COM-B) model among wet age-related macular degeneration (AMD) patients. These factors should be considered in the development of potential support and intervention programmes to address these problems. DESIGN A qualitative study was conducted with one-to-one and face-to-face interviews with wet AMD patients using a semi-structured question guide. Data were analysed based on COM-B model: capability (physical and psychological), opportunity (physical and social) and motivation (reflective and automatic). SETTING Southwest Hospital of Chongqing Province in China. PARTICIPANTS A convenient and purposive sample of 24 wet AMD patients were recruited. RESULTS The themes and subthemes were identified: psychological capability: (1) insufficient knowledge of nutrition; (2) misconceptions about the disease and treatment; (3) knowledge conflict; physical capability: (1) physical restriction; (2) limited access to nutrition knowledge; physical opportunity: (1) communication between providers and patients; (2) health insurance and extra charges; (3) food environment; social opportunity: (1) stigma of disease; (2) family influence; reflective motivation: (1) self-efficacy; (2) attitude; (3) outcome expectancies; (4) lack of professional support; automatic motivation: (1) difficulties in changing eating habits; (2) mindset. CONCLUSION Medical staff should pay much attention to the process of patients' nutrition intervention. In addition, it is also necessary to develop professional and internet-based intervention to modify the dietary behaviour and improve the management skills of the patients.
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Affiliation(s)
- Wei Bian
- School of Nursing, Third Military Medical University/Army Medical University, Chongqing, China
- Southwest Eye Hospital, Third Military Medical University/Army Medical University, Chongqing, China
| | - Zonghua Wang
- School of Nursing, Third Military Medical University/Army Medical University, Chongqing, China
| | - Junli Wan
- Southwest Eye Hospital, Third Military Medical University/Army Medical University, Chongqing, China
| | - Feng Zhang
- Southwest Eye Hospital, Third Military Medical University/Army Medical University, Chongqing, China
| | - Xuemei Wu
- Southwest Eye Hospital, Third Military Medical University/Army Medical University, Chongqing, China
| | - Xin Li
- Southwest Eye Hospital, Third Military Medical University/Army Medical University, Chongqing, China
| | - Yu Luo
- School of Nursing, Third Military Medical University/Army Medical University, Chongqing, China
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Yufika A, Pratama R, Anwar S, Winardi W, Librianty N, Prashanti NAP, Sari TNW, Utomo PS, Dwiamelia T, Natha PPC, Salwiyadi S, Asrizal FW, Ikram I, Wulandari I, Haryanto S, Fenobilire N, Wagner AL, Jamil KF, Mudatsir M, Harapan H. Stigma Associated with COVID-19 Among Health Care Workers in Indonesia. Disaster Med Public Health Prep 2022; 16:1942-1946. [PMID: 33762053 PMCID: PMC8207538 DOI: 10.1017/dmp.2021.93] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/18/2021] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of this study was to assess the stigma associated with coronavirus disease - 2019 (COVID-19) among health care workers (HCWs) in Indonesia during the early phase of the pandemic. METHODS A cross-sectional study was conducted in 12 hospitals across the country in March, 2020. A logistic regression was employed to assess the association between stigma and explanatory variables. RESULTS In total, 288 HCWs were surveyed, of which 93.4% had never experienced any outbreaks. Approximately 21.9% of the respondents had stigma associated with COVID-19. HCWs who were doctors, had not participated in trainings related to COVID-19, worked in the capital of the province, worked at private hospitals, or worked at a hospital with COVID-19 triage protocols were likely to have no stigma associated with COVID-19. CONCLUSIONS The stigma associated with COVID-19 is relatively high among HCWs in the early phase of the COVID-19 pandemic in Indonesia. Adequate dissemination of knowledge and adequate protection are necessary to reduce stigma among HCWs.
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Affiliation(s)
- Amanda Yufika
- Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Rovy Pratama
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Wira Winardi
- Department of Pulmonology and Respiratory Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Nurfanida Librianty
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | | | | | - Prattama Santoso Utomo
- Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Putu Pangestu Cendra Natha
- Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia
- Department of Internal Medicine, Sanglah Hospital, Denpasar, Bali, Indonesia
| | - Salwiyadi Salwiyadi
- Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Department of Internal Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
| | | | - Ikram Ikram
- Dr H Yuliddin Away Hospital, Tapaktuan, Aceh, Indonesia
| | - Irma Wulandari
- M. Hatta Brain Hospital, Bukittinggi, West Sumatra, Indonesia
| | - Sotianingsih Haryanto
- Raden Mattaher Hospital, Jambi, Jambi, Indonesia
- Faculty of Medicine and Medical Sciences, Jambi University, Jambi, Jambi, Indonesia
| | | | - Abram L Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kurnia Fitri Jamil
- Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Department of Internal Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Mudatsir Mudatsir
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
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Chakraverty V, Zimmer H, Niehaus M. [Do Others Care about me and Encourage me to be Myself? A Propensity-Score Analysis on the Effect of Chronic Health Impairments on Work-Related Perceived Inclusion]. DIE REHABILITATION 2022; 62:94-103. [PMID: 36167327 DOI: 10.1055/a-1907-3585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE Our study evaluated the effect of chronic health impairments on work-related perceived inclusion. METHODS Using an online questionnaire, we collected data on employees' perceived inclusion (1807 with and 540 without impairments) and identified matched pairs based on propensity scores. RESULTS Employees with impairments perceived themselves as less included than their matched pairs without impairments, but only if they regarded themselves as severely limited in their work activities or if they regarded their impairment as severely stigmatized. Limitations and stigmata were found to be independent negative predictors of perceived inclusion. CONCLUSION Our findings suggest a need for measures to improve the work-related perceived inclusion of people with chronic health impairments. Such measures should aim at optimising workplace accommodations as well as changing performance-related social norms in organisations and stereotypical assumptions about employees with chronic health impairments.
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Affiliation(s)
- Veronika Chakraverty
- Lehrstuhl für Arbeit und berufliche Rehabilitation, Humanwissenschaftliche Fakultät, Universität zu Köln, Köln, Germany
| | - Heinz Zimmer
- Department Psychologie, Humanwissenschaftliche Fakultät, Universität zu Köln, Köln, Germany
| | - Mathilde Niehaus
- Lehrstuhl für Arbeit und berufliche Rehabilitation, Humanwissenschaftliche Fakultät, Universität zu Köln, Köln, Germany
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Veldhuis CB, Juster RP, Corbeil T, Wall M, Poteat T, Hughes TL. Testing whether the combination of victimization and minority stressors exacerbate PTSD risks in a diverse community sample of sexual minority women. PSYCHOLOGY & SEXUALITY 2022; 14:252-278. [PMID: 38549608 PMCID: PMC10978045 DOI: 10.1080/19419899.2022.2106147] [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: 10/04/2021] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
Informed by minority stress and intersectionality frameworks, we examined: 1) associations of sexual identity and race/ethnicity with probable diagnosis of post-traumatic stress disorder (PTSD-PD) among sexual minority women (SMW; e.g., lesbian, bisexual); and 2) potential additive and interactive associations of minority stressors (discrimination, stigma consciousness, and internalized homonegativity) and potentially traumatic childhood and adulthood events (PTEs) with PTSD-PD. Data come from a large and diverse community sample of SMW (N = 662; age range: 18-82; M = 40.0, SD = 14.0). The sample included 35.8% Black, 23.4% Latinx, and 37.2% White participants. Logistic regressions tested associations of sexual identity and race/ethnicity, minority stressors, and PTEs with PTSD-PD. More than one-third of SMW (37.2%) had PTSD-PD with significantly higher prevalence among bisexual, particularly White bisexual women, than lesbian women. Discrimination, stigma consciousness, and internalized homonegativity were each associated with higher odds of PTSD-PD, but only internalized homonegativity was additively associated with PTSD-PD in mutually adjusted models above and beyond effects of PTEs. No evidence for interactive effects between PTEs and minority stressors was found. In a diverse community sample of sexual minority women, PTSD is strongly associated with potentially traumatic childhood events and with minority stressors above and beyond the associations with other potentially traumatic events and stressors in adulthood. Our findings suggest a strong need for therapists to address the effects of stigma and homophobia in treatment for PTSD, as these minority stressors likely maintain and exacerbate the effects of past traumas.
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Affiliation(s)
| | | | - Thomas Corbeil
- Mental Health Data Science, New York State Psychiatric Institute
| | - Melanie Wall
- Mental Health Data Science, New York State Psychiatric Institute
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill
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Treloar C, Cama E, Lancaster K, Brener L, Broady TR, Cogle A, O'Donnell D. A universal precautions approach to reducing stigma in health care: getting beyond HIV-specific stigma. Harm Reduct J 2022; 19:74. [PMID: 35799296 PMCID: PMC9264680 DOI: 10.1186/s12954-022-00658-w] [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: 02/15/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Delivery of effective health care is hampered by stigma, the social processes that attach negative judgement and response to some attributes, conditions, practices and identities. Experiencing or anticipating stigma can lead to a range of practical impacts, including avoidance of health care. While we are concerned about the stigma that is attached to HIV, this commentary makes the argument that the health system is burdened by stigma of many origins. Main body Reducing stigma is a key issue in improving quality of health care. Our focus on HIV is about providing better care in a non-judgemental, respectful and dignified manner which enhances the health and well-being of individuals as well as delivering benefit to society at large through better population health outcomes. However, the same could be said for the numerous possible attributes, conditions, practices and identities that attract stigma. It is unrealistic to expect health systems to respond to siloed appeals for change and action. A unifying logic is needed to propel concerns about stigma to the front of the queue for action by health systems. Conclusion This commentary suggests the need for a universal precautions approach to stigma in health care, that focuses on recognising that all people may experience stigma and discrimination targeted at one or more aspects of their identities, attributes, practices and health conditions. Drawing on health system precepts of equity, access and quality of care, we argue that a universal precautions approach to reducing stigma of all origins can effect everyday aspects of policy, procedure and practice to improve outcomes for individuals and for population health.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kari Lancaster
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Aaron Cogle
- National Association of People With HIV Australia (NAPWHA), Sydney, Australia
| | - Darryl O'Donnell
- Australian Federation of AIDS Organisations (AFAO), Sydney, Australia
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