Estimating the Relationship Between Perceived Stigma and Victimization of People With Mental Illness

Self-stigma mediates the relationships between childhood maltreatment and symptom levels of PTSD, depression, and anxiety

Background: Childhood maltreatment is a risk factor for developing multiple forms of psychopathology, including depression, posttraumatic stress disorder (PTSD), and anxiety. Yet, the mechanisms linking childhood maltreatment and these psychopathologies remain less clear.Objective: Here we examined whether self-stigma, the internalization of negative stereotypes about one's experiences, mediates the relationship between childhood maltreatment and symptom severity of depression, PTSD, and anxiety.Methods: Childhood trauma survivors (N = 685, Mage = 36.8) were assessed for childhood maltreatment, self-stigma, and symptoms of depression, PTSD, and anxiety. We used mediation analyses with childhood maltreatment as the independent variable. We then repeated these mediation models separately for childhood abuse and neglect, as well as the different subtypes of childhood maltreatment.Results: Self-stigma significantly mediated the relationship between childhood maltreatment and depression, PTSD, and anxiety symptoms. For sexual abuse - but not physical or emotional abuse - a significant mediation effect of self-stigma emerged on all symptom types. For childhood neglect, self-stigma significantly mediated the relationship between both emotional and physical neglect and all symptom types.Conclusion: Our cross-sectional study suggests that different types of childhood maltreatment experiences may relate to distinct mental health problems, potentially linked to increased self-stigma. Self-stigma may serve as an important treatment target for survivors of childhood abuse and neglect.

Mental Illness, Gun Access and Carrying: A Test of Competing Hypotheses

Access to firearms among individuals with mental health problems has been a source of protracted debate among policymakers, the media, and the public, writ large. At the center of this controversy are questions about the nature and consequences of gun access in the context of mental illness. The lack of substantial empirical evidence, due in part to limited access to quality data, plays a significant role in perpetuating ongoing debate. To address this problem, this study uses data from the National Comorbidity Survey Replication to evaluate the relative importance of several clinical, cultural, and criminological factors in explaining gun access and carrying among adults with and without mental illnesses. Multivariate analyses reveal that, whereas past year disorder (of any type or severity) and other clinical characteristics were unrelated to firearm access, several cultural factors such as childhood rurality (e.g., ORrural vs. urban: 3.59; 95% CI: 2.52, 5.12) and the criminological experience of early intimate partner violence (e.g., ORvictim only vs. noexp: 1.84; 95% CI: 1.50, 2.26) were. None were predictive of carrying. Further, none of the relationships observed were conditioned on any of the clinical characteristics. These results indicate that people with mental illnesses likely own and carry guns for the same reasons and in the same contexts as others. Additional updated and quality data is needed to further explore these issues; however, these finding suggest that suicide and violence prevention efforts targeting people with mental illnesses need to be sensitive to the cultural and personal significance of guns.

A Systematic Review of Interpersonal Violence Perpetration and Victimization Risk Examined Within Single Study Cohorts, Including in Relation to Mental Illness

Rates of both violent victimization and violence perpetration are known to be elevated among individuals with mental illness compared with those in the general population, though the relative risk of each outcome is less well established. In this systematic review, PubMed, Embase, Web of Science, PsycINFO, and Criminal Justice Abstracts were searched for articles published any time before October 2021 that reported the prevalence or incidence of both violent victimization and perpetration. We performed two searches to identify studies using samples or cohorts of (1) persons with mental illnesses and (2) persons in the general population. A total of 25 studies (9 examining persons with mental illnesses, 13 examining persons in the general population, and 3 examining both sample/cohort types) were identified and data was extracted to describe the type and size of cohort or sample, definitions and terminology (i.e., mental illness, violence victimization, violence perpetration), data source(s), observation period, prevalence/incidence of victimization, and prevalence/incidence of perpetration. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data was used to conduct a quality assessment of all included studies. Due to marked study heterogeneity, results were presented using a narrative synthesis approach. Across studies, findings were mixed, and the methodological approaches varied greatly. Broadly, the review provides evidence for (1) higher rates of victimization than perpetration for both individuals with mental illness and those in the general population and (2) higher rates of both victimization and perpetration for those with mental illness compared to those in the general population.

Family caregivers' abusive behaviour and its association with internalized stigma of people living with schizophrenia in China

Family caregiving of people living with schizophrenia (PLS) can be burdensome, and some family caregivers may perpetrate abusive behavior that could be harmful to PLS. This study aims to examine the association of family caregivers' abusive behavior with internalized stigma of PLS and draw attention to this problem. PLS were recruited from four cities across China and completed measures of abusive behavior and internalized stigma. Linear regression analyses were used to determine the association between family caregivers' abusive behavior and internalized stigma of PLS. A total of 693 PLS were include in this study. 22.7% of the participants had experienced one or more of the abusive behaviors perpetrated by family caregivers. The most common type of abusive behavior towards PLS was verbal abuse and 4.2% of the participants reported physical abuse. 44.6 % of participants reported a high level of internalized stigma. PLS who experienced any abusive behavior by family caregivers had significantly higher levels of internalized stigma. Family caregivers' abusive behavior is positively associated with alienation and social withdrawal but not with stereotype endorsement and discrimination of PLS. To end all forms of stigma and discrimination against PLS, more attention needs to be paid to the families of PLS.

Association Between Self-Perceived Stigma and Quality of Life Among Urban Chinese Older Adults: The Moderating Role of Attitude Toward Own Aging and Traditionality

Background

Ageism is a global challenge, which leads to a range of adverse outcomes for elderly people worldwide, which maybe more severe among urban older adults in a competitive society. However, how self-perceived ageism influences the quality of life in a sample of urban older adults remains inconclusive.

Objectives

The current study aims to assess the status of self-perceived stigma among urban Chinese older adults, identify its relationship with quality of life, and further explore whether both attitude toward own aging and traditionality moderate this relationship.

Materials and Methods

Primary data were collected through cross-sectional surveys among urban older adults in three provinces of China from October 2019 to December 2020. A total of 764 urban older adults were valid participants (effective response rate = 81.28%) and completed questionnaires via anonymous face-to-face interviews. Socio-demographic factors, self-perceived stigma, attitude toward own aging, traditionality, and quality of life were assessed using questionnaires that included the Self-perceived Stigma, Attitude Toward Own Aging, Traditionality, and SF-8 Scales.

Results

For urban Chinese older adults, the average score of self-perceived stigma was 2.041 ± 0.726. Self-perceived stigma (β = −0.391, p < 0.05) and attitude toward own aging (β = −0.211, p < 0.05) both influenced quality of life. Additionally, attitude toward own aging (β = −0.530, p < 0.05) and traditionality (β = −0.525, p < 0.05) moderated the association between self-perceived stigma and quality of life. Simple slope analysis revealed that when the level of negative attitude toward own aging and traditionality was higher, the strength of the influence of self-perceived stigma on quality of life was stronger.

Conclusion

Urban Chinese older adults were aware of the self-perceived stigma, which contributes to decreased quality of life. Attitude toward own aging and traditionality could moderate the association between self-perceived stigma and quality of life. When negative attitudes toward own aging and traditionality are higher, self-perceived stigma has a greater effect on the quality of life. More interventions related to relieving self-perceived stigma, traditionality, and negative attitude toward own aging should be considered to build a new modern society that emphasizes health, friendliness, well-being, and dignity for all ages.

Exorcising memories of internalised stigma: The demons of lived experience

Public stigma and self-stigma impact negatively on the lives of people with mental health issues. Many people in society stereotype and discriminate against people with mental ill-health, and often this negative process of marginalisation is internalised by people with lived experiences. Thus, this negative internalisation leads to the development of self-stigma. In this article, I reflect on my own experiences of shame and self-stigma as a person with mental ill-health socially bullied by peers from my community and social groups. I present a personal narrative of both public and self-stigmatisation which I hope will enable me to exorcise memories of internalised stigma, which are encountered as my demons of lived experience. Using reflexivity, a process used widely in health and social care fields, I consider how social bullying shattered my fragile confidence, self-esteem, and self-efficacy in the early days of my recovery; the impact of associative stigma on family members is also explored. Following this, the potential to empower people who experience shame and stigma is explored alongside effective anti-stigma processes which challenge discrimination. I connect the concept of recovery with the notion of empowerment, both of which emphasise the importance of agency and self-efficacy for people with mental ill-health. Finally, I consider how the concepts of empowerment and recovery can challenge both the public stigma held by peers in the community and the self-stigma of those with lived experiences.