Does getting stigma under the skin make it thinner? Emotion regulation as a stress-contingent mediator of stigma and mental health

Black Americans suppress emotions when prejudice is believed to stem from shared ignorance

Past research examining lay theories of the origins of prejudice has focused on white Americans and has not considered how Black Americans' lay theories of prejudice may impact emotion regulation following discrimination. Across three samples of Black Americans (N = 419), the present research examined relationships between endorsement of two lay theories of prejudice origins (1, beliefs that prejudice stems from shared social ignorance and 2, that prejudice stems from malice). Stronger beliefs that prejudice stems from shared ignorance were associated with greater expression suppression following experiences of racial discrimination (studies 1b and 2), which was, in turn, associated with psychological distress (study 2). By centering the beliefs and experiences of Black Americans in response to discrimination events, the present research has implications for understanding how emotion regulation following racial discrimination is impacted by marginalized groups' conceptualizations of prejudice. Future research should investigate how these factors impact health disparities.

A Bayesian network analysis to examine the effects of HIV stigma processes on self-concept and depressive symptoms among persons living with HIV

OBJECTIVE

This study examines the relationships between HIV stigma dimensions, self-related mechanisms, and depressive symptoms among persons living with HIV.

BACKGROUND

HIV stigma hinders the well-being of individuals living with HIV, which is linked to depressive symptoms and increased risk of poor clinical outcomes. However, the mechanisms underlying stigma's impact on depression are poorly understood. Psychosocial theories propose that experiencing HIV stigma leads to internalized stigma, impacting self-concept and mental health.

METHOD

Using Bayesian network analysis, we explored associations among HIV stigma processes (experienced, anticipated, internalized, perceived community stigma, and HIV status disclosure) and self-related mechanisms (self-esteem, fear of negative evaluation [FNE], self-blame coping, and social exclusion), and depressive symptoms.

RESULTS

Our diverse sample of 204 individuals, primarily men, gay/bisexual, Black, and lower-middle SES, who experienced stigma showed increased anticipated, internalized, and perceived community stigma, FNE, and depressive symptoms. Internalized stigma contributed to self-blame coping and higher depressive symptoms. Anticipated and perceived community stigma and FNE correlated with increased social exclusion.

DISCUSSION

This study investigates potential mechanisms through which HIV stigma may impact depression. Identifying these mechanisms establishes a foundation for future research to inform targeted interventions, enhancing mental health and HIV outcomes among individuals living with HIV, especially from minority backgrounds. Insights gained guide evidence-based interventions to mitigate HIV stigma's detrimental effects, ultimately improving overall well-being and health-related outcomes for people with HIV.

Association between Homophobia and Sociodemographic Characteristics in Health Workers in Southern Chile

Homophobic attitude in health workers is a social determinant in the health of the homosexual population because it affects healthcare and its access and equity. The objective was to determine the relationship between the level of homophobia and sociodemographic characteristics of primary health workers in southern Chile. This was an analytical cross-sectional study. The sample consisted of 491 public servants from health centers in southern Chile. The attitudes toward lesbians and gay men (ATLG) scale was applied, and a binary logistic regression model was performed to evaluate the association. The study participants were predominantly women (76.0%), under 40 years of age (63.5%), heterosexuals (93.5%), and unpartnered (68.2%) but with children (61.7%), and they also had an educational attainment ≥ 12 years (66.6%). About 87.6% of the participants held healthcare positions, and the majority were religious believers (74.3%) and had a centrist political affiliation (51.0%). Results indicated that 34% of the participants exhibited homophobic attitudes; there were statistically significant differences with respect to age, number of children, educational attainment, religion, and political affiliation (p < 0.01). These were higher in individuals ≥40 years of age, with ≥3 children, with educational attainment ≥ 12 years, holding a healthcare position, who were religious believers, and who had right-wing political affiliation.

Doubly Marginalized: Addressing the Minority Stressors Experienced by LGBTQ+ Researchers Who Do LGBTQ+ Research

Lesbian, gay, bisexual, transgender, and nonbinary, and queer people (LGBTQ+) experience significantly higher levels of stressors due to discrimination, stigma, and marginalization than do cisgender heterosexual people. These high levels of stressors have impacts on health and well-being as well as career impacts. Limited research suggests that within higher education LGBTQ+ faculty experience bullying, discrimination, and harassment within the workplace. There is also data to suggest that research on marginalized populations is perceived to be less objective and valuable than research on majority populations. Research on the challenges of being a member of a marginalized population who conducts research on the same population suggests potentially negative career and personal impacts. To my knowledge, there has been little to no research on the double marginalization related to being an LGBTQ+ researcher doing research within the LGBTQ+ community. To describe the potential impacts of being an LGBTQ+ researcher who does LGBTQ+ research, I apply the extant literature on marginalized researchers who do research among marginalized populations to LGBTQ+ researchers. I also describe the potential minority stressors that LGBTQ+ researchers may face and how that may impact careers. Finally, I offer multiple recommendations for improvements for our research community and argue that senior faculty, leadership, and mentors can take specific actions to lessen stressors for LGBTQ+ researchers studying LGBTQ-related topics.

Mechanisms linking distal minority stress and depressive symptoms in a longitudinal, population-based study of gay and bisexual men: A test and extension of the psychological mediation framework

OBJECTIVE

Gay and bisexual men have significantly higher rates of depression than heterosexual men. The minority stress theory (Meyer, 2003) proposed that distal minority stressors, like interpersonal discrimination, contribute to this disparity. The psychological mediation framework (Hatzenbuehler, 2009) posited several psychosocial mechanisms through which distal minority stress creates elevations in depression among sexual minorities. Despite accumulating support for this framework, there are a number of limitations to existing research, including largely relying on cross-sectional designs; focusing on a small subset of mechanisms and moderators; and using nonprobability samples.

METHOD

We recruited a sample of gay and bisexual men (N = 502) obtained from a population-based data set of U.S. adults. Participants completed validated measures of distal minority stress (i.e., interpersonal discrimination), psychosocial mechanisms (i.e., rumination, emotional clarity, and social support), identity-related moderators (i.e., identity centrality, stigma consciousness, and sexual orientation identity), and depressive symptoms at baseline, 6-month follow-up, and 1-year follow-up.

RESULTS

Rumination (b = 0.38, 95% CI [0.13, 0.84]), lack of emotional clarity (b = 0.43, 95% CI [0.11, 0.83]), and lack of social support (b = 0.21, 95% CI [0.04, 0.45]) each individually mediated the prospective relationship between interpersonal discrimination and depressive symptoms, controlling for initial symptoms, age, and education. These indirect effects were not moderated by identity-related characteristics or sexual identity.

CONCLUSION

Our study provides some of the strongest empirical evidence for the psychological mediation framework to date and suggests targets for interventions focused on reducing the mental health consequences of minority stress for sexual minority men. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Rethinking minority stress: A social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations

For over two decades, the minority stress model has guided research on the health of sexually-diverse individuals (those who are not exclusively heterosexual) and gender-diverse individuals (those whose gender identity/expression differs from their birth-assigned sex/gender). According to this model, the cumulative stress caused by stigma and social marginalization fosters stress-related health problems. Yet studies linking minority stress to physical health outcomes have yielded mixed results, suggesting that something is missing from our understanding of stigma and health. Social safety may be the missing piece. Social safety refers to reliable social connection, inclusion, and protection, which are core human needs that are imperiled by stigma. The absence of social safety is just as health-consequential for stigmatized individuals as the presence of minority stress, because the chronic threat-vigilance fostered by insufficient safety has negative long-term effects on cognitive, emotional, and immunological functioning, even when exposure to minority stress is low. We argue that insufficient social safety is a primary cause of stigma-related health disparities and a key target for intervention.

Examining stigma relating to substance use and contextual factors in social media discussions

Background

Stigma associated with substance use can have severe negative consequences for physical and mental health and serve as a barrier to treatment. Yet, research on stigma processes and stigma reduction interventions is limited.

Aim

We use a social media dataset to examine: 1) the nature of stigma-related experience related to substance use; and 2) salient affective and temporal factors in the use of three substances: alcohol, cannabis, and opioids.

Methods

We harvested several years of data pertaining to three substances - alcohol, cannabis, and opioids - from Reddit, a popular social networking platform. For Part I, we selected posts based on stigma-related keywords, performed content analysis, and rendered word clouds to examine the nature of stigma associated with these substances. In Part II, we employed natural language processing in conjunction with hierarchical clustering and visualization to explore temporal and affective factors.

Results

In Part I, internalized stigma was most commonly exhibited. Anticipated and enacted stigma were less common in posts relating to cannabis compared to the other two substances. Work, home, and school were important contexts in which stigma was observed. Part II showed that temporal markers were prominent; post authors shared stories of substance use journeys, and timelines of their experience with quitting and withdrawals. Shame, sadness, anxiety, and fear were common, with shame being more prominent in alcohol-related posts.

Conclusion

Our findings highlight the importance of contextual factors in substance use recovery and stigma reduction and offer directions for future interventions.

Leveraging Neuroscience to Fight Stigma Around Mental Health

Labels serve as identifiers and convenient descriptors of inanimate and animate objects. In humans, given labels can easily become part of an individual's self-perceived identity. Negative labels ascribed to a person can result in internalized stigma, a state that will shape the subject's biography. This can ultimately impact the person's mental and physical health since perceived and/or anticipated stigma discourages the use of social and health services. Per definition, stigma involves labeling of persons with physical, mental, or social characteristics that do not match the observer's arbitrarily conditioned and calibrated sense of norms (public stigma); such labeling may eventually become embedded in rules, regulations, and laws (structural stigma). Internalized stigma projects onto a person's emotions and actions. Public (enacted) stigma results from stereotyping (collectively agreed-upon notions about a group of persons that are used to categorize these people) and devaluation, which subsequently leads to social distancing, discrimination, and blatant abuse of human rights. Much of what we know about stigma results from research in the psychosocial sciences and, more recently, from social neuroscience. The stigma around mental health has generated much attention in the field of psychiatry where, to date, most research has focussed on epidemiology and anti-stigma interventions. This essay intends to stimulate thought, debate, and research within the behavioral neuroscience community and, therefore, to inform evidence-based design and implementation of neuroscience-based approaches by other professionals working towards the elimination of the stigma attached to mental illness. The article starts by considering the concept of stigma and the psychological processes that give rise to the phenomenon; it also considers how projected and perceived stigma are multiplied. Finally, after a brief review of the few existing neuroscientific explorations of stigma, gaps in our knowledge of the neurobiological basis of stigma are identified and discussed.

HIV-Related Stigma Research as a Priority at the National Institutes of Health

The National Institutes of Health (NIH) recognizes that, despite HIV scientific advances, stigma and discrimination continue to be critical barriers to the uptake of evidence-based HIV interventions. Achieving the Ending the HIV Epidemic: A Plan for America (EHE) goals will require eliminating HIV-related stigma. NIH has a significant history of supporting HIV stigma research across its Institutes, Centers, and Offices (ICOs) as a research priority. This article provides an overview of NIH HIV stigma research efforts. Each ICO articulates how their mission shapes their interest in HIV stigma research and provides a summary of ICO-relevant scientific findings. Research gaps and/or future opportunities are identified throughout, with key research themes and approaches noted. Taken together, the collective actions on the part of the NIH, in tandem with a whole of government and whole of society approach, will contribute to achieving EHE's milestones.

Interpersonal and Intersubjective Alienation in Social Stigmatization and Depression

The subjective experience of social stigma has been widely researched in terms of discrimination, rejection, isolation, etc. These are commonly understood within the traditional individualistic framework of affective experience and sociality, which fails to address the transformative effects of social stigma on how one experiences the social realm and the own self in general. Phenomenology and recent work on the relationality of affective experience acknowledge the central role interpersonal interactions play in subjectivity and offer a suitable approach towards addressing the complexity of the subjective experience of social stigma. Focussing on autobiographical accounts, I propose that the experience of social stigmatization is characterized by an affective atmosphere of interpersonal alienation. Its counterpart, an atmosphere of belonging, is closely related to social empathy, which is eroded by prejudicial attitudes and stereotypes. The breakdown of social empathy establishes a peculiar form of relationless relationality that radically transforms one's subjectivity. The transformation of subjectivity is structurally similar to disturbances of intersubjectivity in psychopathological conditions such as depression and feelings of disconnectedness, loneliness, and even shame are common in both cases.

Emotion in remediation: A scoping review of the medical education literature

OBJECTIVES

Remediation can be crucial and high stakes for medical learners, and experts agree it is often not optimally conducted. Research from other fields indicates that explicit incorporation of emotion improves education because of emotion's documented impacts on learning. Because this could present an important opportunity for improving remediation, we aimed to investigate how the literature on remediation interventions in medical education discusses emotion.

METHODS

The authors used Arksey and O'Malley's framework to conduct a scoping literature review of records describing remediation interventions in medical education, using PubMed, CINAHL Complete, ERIC, Web of Science and APA PsycInfo databases, including all English-language publications through 1 May 2020 meeting search criteria. They included publications discussing remediation interventions either empirically or theoretically, pertaining to physicians or physician trainees of any level. Two independent reviewers used a standardised data extraction form to report descriptive information; they reviewed included records for the presence of mentions of emotion, described the mentions and analysed results thematically.

RESULTS

Of 1644 records, 199 met inclusion criteria and were reviewed in full. Of those, 112 (56%) mentioned emotion in some way; others focused solely on cognitive aspects of remediation. The mentions of emotion fell into three themes based on when the emotion was cited as present: during regular coursework or practice, upon referral for remediation and during remediation. One-quarter of records (50) indicated potential intentional incorporation of emotion into remediation programme design, but they were non-specific as to how emotions related to the learning process itself.

CONCLUSION

Even though emotion is omnipresent in remediation, medical educators frequently do not factor emotion into the design of remediation approaches and rarely explicitly utilise emotion to improve the learning process. Applications from other fields may help medical educators leverage emotion to improve learning in remediation, including strategies to frame and design remediation.

Conceptual Framework to Guide Intervention Research Across the Trajectory of Dementia Caregiving

This article presents a comprehensive conceptual framework designed to foster research in the changing needs of caregivers and persons with dementia as they move through their illness trajectory. It builds on prior theoretical models and intervention literature in the field, while at the same time addressing notable gaps including inadequate attention to cultural issues; lack of longitudinal research; focus on primary caregivers, almost to the exclusion of the person with dementia and other family members; limited outcome measures; and lack of attention to how the culture of health care systems affects caregivers' quality of life. The framework emphasizes the intersectionality of caregiving, sociocultural factors, health care systems' factors, and dementia care needs as they change across time. It provides a template to encourage longitudinal research on reciprocal relationships between caregiver and care recipient because significant changes in the physical and/or mental health status of one member of the dyad will probably affect the physical and/or mental health of the partner. This article offers illustrative research projects employing this framework and concludes with a call to action and invitation to researchers to test components, share feedback, and participate in continued refinement to more quickly advance evidence-based knowledge and practice in the trajectory of dementia caregiving.

Effects of victimization on mental health and substance use trajectories in young sexual minority men

Young sexual minority men (YSMM) experience more victimization and are at higher risk for mental health and substance use problems compared with heterosexual youth. We attempt to understand change over time in the experience of these constructs among YSMM. Data were taken from a diverse community-based sample of YSMM (N = 450, baseline mean age 18.93) surveyed every 6 months for 2.5 years. Multilevel modeling was used to model within-person change in victimization, internalizing symptoms, externalizing symptoms, alcohol frequency, marijuana use, and illicit drug use. We tested the indirect effect of concurrent and time-lagged victimization on the association between age and mental health and substance use. Victimization, internalizing symptoms, and externalizing symptoms decreased over time. Concurrent victimization was associated with higher internalizing symptoms, externalizing symptoms, alcohol use, marijuana use, and illicit drug use. Analysis of indirect effects suggested that the association between victimization and mental health and substance use outcomes decreased as participants transitioned from adolescence into adulthood. This study found that the reduction in victimization that YSMM experience as they grow older is associated with a reduction in negative mental health and substance use outcomes. Prevention efforts to limit victimization exposure may reduce health disparities for YSMM.