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Long J, Hull R. Conceptualizing a less paranoid schizophrenia. Philos Ethics Humanit Med 2023; 18:14. [PMID: 37936219 PMCID: PMC10631169 DOI: 10.1186/s13010-023-00142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023] Open
Abstract
Schizophrenia stands as one of the most studied and storied disorders in the history of clinical psychology; however, it remains a nexus of conflicting and competing conceptualizations. Patients endure great stigma, poor treatment outcomes, and condemnatory prognosis. Current conceptualizations suffer from unstable categorical borders, heterogeneity in presentation, outcome and etiology, and holes in etiological models. Taken in aggregate, research and clinical experience indicate that the class of psychopathologies oriented toward schizophrenia are best understood as spectra of phenomenological, cognitive, and behavioral modalities. These apparently taxonomic expressions are rooted in normal human personality traits as described in both psychodynamic and Five Factor personality models, and more accurately represent explicable distress reactions to biopsychosocial stress and trauma. Current categorical approaches are internally hampered by axiomatic bias and systemic inertia rooted in the foundational history of psychological inquiry; however, when such axioms are schematically decentralized, convergent cross-disciplinary evidence outlines a more robust explanatory construct. By reconceptualizing these disorders under a dimensional and cybernetic model, the aforementioned issues of instability and inaccuracy may be resolved, while simultaneously opening avenues for both early detection and intervention, as well as for more targeted and effective treatment approaches.
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Affiliation(s)
- James Long
- Department of Psychology, Chestnut Hill College, 7113 Valley Avenue, Philadelphia, PA, 19128, USA.
| | - Rachel Hull
- Chestnut Hill College Department of Professional Psychology, 9601 Germantown Avenue, Philadelphia, PA, 19118, USA
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Fujii K, Hashimoto H. Socio-psychological factors associated with anticipated stigma toward COVID-19: a cross-sectional study in Japan. BMC Public Health 2023; 23:1245. [PMID: 37370015 DOI: 10.1186/s12889-023-16159-9] [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] [Received: 11/02/2022] [Accepted: 06/20/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The stigmatization against COVID-19 has become a public issue. However, it remains unknown which individual factor contributes to anticipated stigma formation. This study explored socio-psychological factors associated with anticipated stigma toward coronavirus disease 2019 (COVID-19). METHODS We obtained cross-sectional data regarding 1,638 middle-aged community residents (mean age, 48.5 years) from a population-based survey in metropolitan Tokyo, Japan during the third wave of the COVID-19 pandemic, when a regional public health emergency had been declared in December 2020 and January 2021. We hypothesized that perceived risk of infection, normative beliefs about preventive behaviors, and past experiences of stigmatization unrelated to COVID-19 would be associated with anticipated stigma. Modified Poisson regression was conducted to examine associations after adjustments for demographic and socioeconomic statuses. RESULTS Higher perceived risk (adjusted prevalence ratio [APR] = 1.17; 95% confidence interval [CI, 1.08-1.27]), past experiences of stigmatization (APR = 1.09; 95% CI [1.00-1.19]), and higher normative beliefs about preventive behaviors (APR = 1.18; 95% CI [1.11-1.26]) were independently associated with anticipated stigma. CONCLUSIONS These results suggest that intervention messages to increase risk perception and normative beliefs to enhance protective behaviors may have the unintended effect of increasing anticipated stigma in the context of the COVID-19 pandemic.
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Affiliation(s)
- Kana Fujii
- Department of Health and Social Behavior, The University of Tokyo School of Public Health, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Hideki Hashimoto
- Department of Health and Social Behavior, The University of Tokyo School of Public Health, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Coundouris SP, von Hippel C, Lehn AC, Henry JD. The antecedents and consequences of stereotype threat in Parkinson's disease. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:1-9. [PMID: 36124953 PMCID: PMC10087132 DOI: 10.1111/bjc.12390] [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: 02/16/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to examine what factors make people with Parkinson's disease more susceptible to stereotype threat (i.e., the concern of being evaluated in line with negative group-based stereotypes) and the clinical consequences of this. METHOD Forty-nine people with Parkinson's disease completed a measure of stereotype threat, as well as measures that indexed potential antecedents and clinical consequences of stereotype threat. RESULTS Younger age and greater communication difficulties emerged as significant predictors of stereotype threat. Higher stereotype threat was also associated with increased emotional distress. CONCLUSIONS These findings are an important first step in understanding stereotype threat in Parkinson's disease and may help to guide the development of intervention and educational efforts aimed at countering its effects.
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Affiliation(s)
| | | | - Alexander C. Lehn
- Department of NeurologyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
- The University of Queensland Princess Alexandra Hospital Clinical SchoolWoolloongabbaQueenslandAustralia
| | - Julie D. Henry
- School of PsychologyThe University of QueenslandBrisbaneQueenslandAustralia
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VanLandingham H, Ellison RL, Laique A, Cladek A, Khan H, Gonzalez C, Dunn MR. A scoping review of stereotype threat for BIPOC: cognitive effects and intervention strategies for the field of neuropsychology. Clin Neuropsychol 2021; 36:503-522. [PMID: 34233577 DOI: 10.1080/13854046.2021.1947388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Abundant evidence documents stereotype threat's (ST) detrimental effect on test performance across identities and contexts (i.e., eliciting underperformance). Review of the literature shows varied aspects of both stereotyped identities and cognition are inconsistently explored across studies. Only a portion of the literature focuses on ST's impact on Black, Indigenous, and People of Color (BIPOC). It is important to understand and learn to mitigate ST, particularly for historically marginalized and systemically oppressed BIPOC patients. Relevance exists for neuropsychologists, who engage in activities (i.e., assessments) that may activate ST, and should be aware of additional factors impacting testing results and clinical decision making. METHOD Using scoping review criteria (Peters et al., 2015) and Preferred Reporting Item for Systemic Reviews and Meta-Analysis (PRISMA) guidelines, we reviewed literature across multiple databases (Google Scholar, PubMed, PsychINFO) on ST and cognition with a focus on BIPOC. RESULTS The current literature suggests that race-based ST may be implicated in underperformance for executive functioning and separately working memory. There is limited research on the effects of ST for memory, language, attention, and visuospatial skills. CONCLUSION Research on ST requires additional attention to establish interventions to mitigate negative effects in practice. These results provide 1) an overview of the cognitive implications of ST, 2) address the scope of this impact for BIPOC, and 3) provide possible intervention and training strategies for neuropsychologists and other clinicians to work to mitigate the effects of ST on BIPOC.
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Affiliation(s)
| | - Rachael L Ellison
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Aamir Laique
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | | | - Humza Khan
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | | | - Megan R Dunn
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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5
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Castelli L, Carraro L, Valmori A, Uliana C, Paparella M. Social Perception in Schizophrenia: Evidence of Reduced Prejudiced Attitudes Among People With a Diagnosis of Schizophrenia. Front Psychol 2021; 12:644488. [PMID: 33986709 PMCID: PMC8110718 DOI: 10.3389/fpsyg.2021.644488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
Only recently research in social psychology has started to systematically investigate intergroup attitudes among members of stigmatized minority groups. In particular, the study of the way people with mental health problems perceive the social groups around them is so far very scarce. In this work, we focused on people with schizophrenia, analyzing their attitudes toward another stigmatized group, namely Black individuals. In Study 1, the attitudes toward White and Black people were assessed in a sample of respondents with a diagnosis of schizophrenia and in a sample of non-clinical individuals. Results showed the presence of less negative attitudes toward the minority outgroup (i.e., Black people) among the clinical sample. In Study 2, we aimed at investigating what members belonging to the majority group (i.e., White non-clinical people) believe about the attitudes toward Black people held by individuals with a diagnosis of schizophrenia. In general, results suggested a general awareness in lay persons that people with a diagnosis of schizophrenia, as compared to people with no history of mental disorders, hold reduced negative attitudes toward Black individuals. Overall, these results may help to enrich our knowledge about social cognition among members of stigmatized groups in general and, more specifically, among individuals with a diagnosis of schizophrenia.
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Affiliation(s)
- Luigi Castelli
- Department of Social and Developmental Psychology, University of Padua, Padua, Italy
| | - Luciana Carraro
- Department of Social and Developmental Psychology, University of Padua, Padua, Italy
| | - Alessia Valmori
- Department of Social and Developmental Psychology, University of Padua, Padua, Italy
| | - Chiara Uliana
- Department of Social and Developmental Psychology, University of Padua, Padua, Italy
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J D, N F. Neural and cognitive correlates of stigma and social rejection in individuals with Serious Mental Illness (SMI): A systematic review of the literature. Psychiatry Res 2019; 274:146-158. [PMID: 30784783 DOI: 10.1016/j.psychres.2019.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/09/2019] [Accepted: 02/09/2019] [Indexed: 12/15/2022]
Abstract
Stigma and self-stigma are major issues for people with Serious Mental Illness (SMI). This review's aims were to determine the cognitive and neural processes underlying the effects of stigma and social rejection in people with SMI. A stepwise systematic literature review (PRISMA) was conducted by searching PubMed, Medline and Web of Science using the following keywords: "cyberball" OR "stereotype threat" OR "implicit association test" AND "mental illness". The articles included met the following criteria: (a) reporting on social rejection, stigma or self-stigma (b) diagnosis of SMI (c) available data on the underlying mechanisms. Our search on July 31th 2018 found in 955 articles on PubMed and 3,362 on Web of Science. Hypersensitivity to acute social rejection was found and associated with more self-related negative emotions and more dysfunctional emotion regulation strategies. People with SMI under-performed in cognitive tasks when confronted with stigma. Stigma resistance was described with its neural correlates. Psychiatric symptoms, duration of illness and baseline non-specific distress influenced the response to acute social rejection or stigma. The samples, methods, and reported outcomes were heterogeneous and difficult to compare. Future studies should investigate the associations between self-stigma and responses to acute and chronic social rejection.
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Affiliation(s)
- Dubreucq J
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, France; Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, 1 place du Conseil National de la Résistance, Grenoble, 38400 Saint Martin d'Hères, France; Fondation FondaMental, Créteil, France.
| | - Franck N
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, France; Réseau Handicap Psychique, Grenoble, France; Centre Référent Lyonnais de Réhabilitation Psychosociale et de Remédiation Cognitive (CL3R), Centre Hospitalier Le Vinatier, France; Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Hospitalier Le Vinatier, France
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Dysfunction by Disclosure? Stereotype Threat as a Source of Secondary Neurocognitive Malperformance in Obsessive-Compulsive Disorder. J Int Neuropsychol Soc 2018; 24:584-592. [PMID: 29553002 DOI: 10.1017/s1355617718000097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES There is mixed evidence regarding whether patients with obsessive-compulsive disorder (OCD) display substantial neurocognitive deficits. Several studies implicate poor motivation, comorbid disorders, or distraction due to obsessive thoughts as potential causes of secondary malperformance. The present study examined the impact of stereotype threat (i.e., confrontation with a negative stereotype may impair performance) on neuropsychological functioning in individuals with OCD. We hypothesized that a stereotype threat cue emphasizing neurocognitive deficits in OCD (as is often conveyed in disclosure and consent documents that inform patients about the purpose of a study) would compromise patients' test performance relative to a control group who did not receive such cue. METHODS Fifty participants with either a verified or a likely diagnosis of OCD were recruited online and randomly assigned to either an experimental condition aimed to elicit stereotype threat or a control condition. Both groups underwent (objective) memory and attention (Go/NoGo task) assessments and completed questionnaires capturing psychopathology, cognitive complaints, and self-stigma. RESULTS As hypothesized, patients in the stereotype threat condition performed worse on the Go/NoGo task. Groups did not differ on any other measures. CONCLUSIONS Stereotype threat negatively impacted neuropsychological performance on an attention task. The threat cue was perhaps too weak or the stereotype threat was already internalized by the patients and "saturated" at baseline so that no effect emerged on the other measures. Implications for clinical trials are discussed. (JINS, 2018, 24, 584-592).
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Keen N, George D, Scragg P, Peters E. The role of shame in people with a diagnosis of schizophrenia. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 56:115-129. [DOI: 10.1111/bjc.12125] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Nadine Keen
- Psychological Interventions Clinic for Outpatients with Psychosis (PICuP); South London and Maudsley NHS Foundation Trust; UK
| | - Darren George
- Ganjuu Wellbeing Service; Okinawan Institute of Science & Technology (OIST); Japan
- Department of Clinical, Educational and Health Psychology; University College London; UK
| | - Peter Scragg
- Department of Clinical, Educational and Health Psychology; University College London; UK
| | - Emmanuelle Peters
- Psychological Interventions Clinic for Outpatients with Psychosis (PICuP); South London and Maudsley NHS Foundation Trust; UK
- Department of Psychology; Institute of Psychiatry, Psychology & Neuroscience; King's College London; UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London; UK
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von Hippel C, Henry JD, Terrett G, Mercuri K, McAlear K, Rendell PG. Stereotype threat and social function in opioid substitution therapy patients. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 56:160-171. [PMID: 28070918 DOI: 10.1111/bjc.12128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/06/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES People with a history of substance abuse are subject to widespread stigmatization. It seems likely that this societal disapproval will result in feelings of stereotype threat, or the belief that one is the target of demeaning stereotypes. If so, stereotype threat has the potential to contribute to functional difficulties including poor social outcomes. METHODS Eighty drug users on opioid substitution therapy and 84 demographically matched controls completed measures of mental health and social function. The opioid substitution therapy group were additionally asked to complete a measure that focused on their feelings of stereotype threat in relation to their drug use history. Bivariate correlations and hierarchical regression analyses were conducted to establish the magnitude and specificity of the relationship between stereotype threat and social functioning. RESULTS Relative to controls, the opioid substitution therapy group reported higher levels of negative affect and schizotypy, and poorer social functioning, with all three of these indices significantly correlated with their feelings of stereotype threat. The results also showed that stereotype threat contributed significant unique variance to social functioning in the opioid substitution therapy group, even after taking into account other background, clinical, and mental health variables. CONCLUSIONS Social functioning is an important aspect of recovery, yet these data indicate that people with a history of drug abuse who believe they are the target of stereotypical attitudes have poorer social functioning. This relationship holds after controlling for the impact of other variables on social functioning, including mental health. The theoretical and practical implications of these findings are discussed. PRACTITIONER POINTS Concerns about being stereotyped can shape the social experiences of opioid substitution therapy patients. Opioid substitution therapy patients who feel negatively stereotyped experience greater social function deficits, and this relationship emerges after controlling for important clinical and mental health variables. Understanding the relationship between feeling stereotyped and social function may assist practitioners in their treatment. The study is cross-sectional, and thus, experimental or longitudinal research is required to determine the causal direction between stereotype threat and social function.
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Affiliation(s)
- Courtney von Hippel
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | - Julie D Henry
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | - Gill Terrett
- Cognitive and Emotion Research Centre, Australian Catholic University, Melbourne, Victoria, Australia
| | - Kimberly Mercuri
- Cognitive and Emotion Research Centre, Australian Catholic University, Melbourne, Victoria, Australia
| | - Karen McAlear
- Cognitive and Emotion Research Centre, Australian Catholic University, Melbourne, Victoria, Australia
| | - Peter G Rendell
- Cognitive and Emotion Research Centre, Australian Catholic University, Melbourne, Victoria, Australia
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10
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The Influence of Causal Explanations and Diagnostic Labeling on Psychology Students' Beliefs About Treatments, Prognosis, Dangerousness and Unpredictability in Schizophrenia. Community Ment Health J 2016; 52:361-9. [PMID: 26081981 DOI: 10.1007/s10597-015-9901-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/10/2015] [Indexed: 12/31/2022]
Abstract
This study explored views of 566 Italian psychology students about schizophrenia. The most frequently cited causes were psychological traumas (68 %) and heredity (54 %). Thirty-three percent of students firmly believed that people with the condition could recover. Reporting heredity among the causes, and identifying schizophrenia were both associated with prognostic pessimism, greater confidence in pharmacological treatments and lower confidence in psychological treatments. Schizophrenia labeling was also associated with higher perception of unpredictability and dangerousness. Compared to first year students, fourth/fifth year students more frequently reported heredity among the causes, and were more pessimistic about schizophrenia recovery. Stigma topics should be included in future psychologists' education.
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"Social dangerousness and incurability in schizophrenia": results of an educational intervention for medical and psychology students. Psychiatry Res 2014; 219:457-63. [PMID: 25004873 DOI: 10.1016/j.psychres.2014.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 05/29/2014] [Accepted: 06/01/2014] [Indexed: 12/14/2022]
Abstract
This study explored the influence of an educational intervention addressing common prejudices and scientific evidence about schizophrenia on medical and psychology students' views of this disorder. The intervention--consisting in two three-hour lessons with an interval of a week between--was run at first for medical students and then for psychology students. Participants' views of schizophrenia were assessed at baseline vs. at post intervention by matched questionnaires. At medical school, participation was voluntary and also included a six-month online re-assessment, while at psychology school, participation was mandatory. A total of 211 students attended the educational initiative. At post intervention assessment, students more frequently mentioned psychosocial causes of schizophrenia, and more firmly believed that recovery in schizophrenia is possible and that persons with this disorder are not unpredictable and dangerous vs. their baseline assessment. The online six-month assessment confirmed favourable changes in medical students' views found at post intervention. These results confirm that an educational intervention including personal experiences and scientific evidence can be successful in reducing students' prejudices toward persons with schizophrenia.
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Magliano L, Read J, Sagliocchi A, Patalano M, Oliviero N. Effect of diagnostic labeling and causal explanations on medical students' views about treatments for psychosis and the need to share information with service users. Psychiatry Res 2013; 210:402-7. [PMID: 23916362 DOI: 10.1016/j.psychres.2013.07.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 04/24/2013] [Accepted: 07/07/2013] [Indexed: 11/15/2022]
Abstract
This study examines whether medical students' views of treatments for 'schizophrenia' and of patients' rights to be informed about their condition and their medication were influenced by diagnostic labeling and causal explanations and whether they differed over medical training. Three hundred and eighty-one Italian students attending their first or fifth/sixth year of medical studies read a vignette portraying someone who met diagnostic criteria for 'schizophrenia' and completed a self-report questionnaire. The study found that labeling the case as 'schizophrenia' and naming heredity among its causes were associated with confidence in psychiatrists and psychiatric drugs. Naming psychological traumas among the causes was associated with confidence in psychologists and greater acknowledgment of users' right to be informed about drugs. Compared to first year students, those at their fifth/sixth-year of studies more strongly endorsed drugs, had less confidence in psychologists and family support, and were less keen to share information on drugs with patients. These findings highlight that students' beliefs vary during training and are significantly related to diagnostic labeling and belief in a biogenetic causal model. Psychiatric curricula for medical students should include greater integration of psychological and medical aspects in clinical management of 'schizophrenia'; more information on the psychosocial causes of mental health problems.
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Affiliation(s)
- Lorenza Magliano
- Department of Psychology, Second University of Naples, Viale Ellittico 31, 81100 Caserta, Italy.
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Burgess DJ, Taylor BC, Phelan S, Spoont M, van Ryn M, Hausmann LRM, Do T, Gordon HS. A brief self-affirmation study to improve the experience of minority patients. Appl Psychol Health Well Being 2013; 6:135-50. [PMID: 24124121 DOI: 10.1111/aphw.12015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is evidence that Black patients may experience stereotype threat--apprehension about being negatively stereotyped--in healthcare settings, which might adversely affect their behavior in clinical encounters. Recent studies conducted outside of healthcare have shown that a brief self-affirmation intervention, in which individuals are asked to focus on and affirm their valued characteristics and sources of personal pride, can reduce the negative effects of stereotype threat on academic performance and on interpersonal communication. METHODS This randomised controlled trial examined whether a self-affirmation (SA) intervention would decrease the negative effects of stereotype threat (negative mood, lower state self-esteem, greater perceptions of racial discrimination) and increase communication self-efficacy among Black primary care patients. Self-affirmation was induced by having patients complete a 32-item values affirmation questionnaire. RESULTS Patients in the SA condition had lower levels of performance self-esteem and social self-esteem than patients in the control. There were no differences between the SA and the control groups on negative mood, communication self-efficacy, and perceptions of discrimination. CONCLUSIONS Our SA intervention lowered state self-esteem among Black patients. Future research is needed to determine the type of SA task that is most effective for this population.
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Affiliation(s)
- Diana J Burgess
- Minneapolis Veterans Affairs Healthcare System, Center for Chronic Disease Outcomes Research (CCDOR), USA; University of Minnesota, USA
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Differences in views of schizophrenia during medical education: a comparative study of 1st versus 5th-6th year Italian medical students. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1647-55. [PMID: 23117816 DOI: 10.1007/s00127-012-0610-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE This study explored medical students' causal explanations and views of schizophrenia, and whether they changed during medical education. METHOD The survey was carried out on medical students of the Second University of Naples, Italy, who attended their first-year and their fifth- or sixth-year of lessons. The 381 who accepted were asked to read a case-vignette describing a person who met the ICD-10 criteria for schizophrenia and then fill in the Opinions on mental illness Questionnaire. RESULTS The most frequently cited causes were psychological traumas (60%) and stress (56%), followed by misuse of street drugs (47%), and heredity (42%). 28% of students stated that persons with the disorder could be well again, and 28% that they were unpredictable. Labeling the case as "schizophrenia" and naming heredity among the causes were associated with pessimism about recovery and higher perception of social distance. First-year students more frequently reported psychological traumas among the causes (76 vs. 45%), and less frequently heredity (35 vs. 81%) and stress (42 vs. 69%), and they perceived less social distance from the "schizophrenics" than fifth/sixth-year students. In particular, 18% percent of first-year versus 38% of fifth/sixth-year students believed that these persons were kept at a distance by the other, and 45 versus 57% felt frightened by persons with the condition. CONCLUSIONS These results indicate a need to include education on stigma and recovery in schizophrenia in the training of medical students.
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Wang T, Tang ZH, Li JF, Li XN, Wang X, Zhao ZJ. A potential association between Toxoplasma gondii infection and schizophrenia in mouse models. Exp Parasitol 2013; 135:497-502. [PMID: 23999146 DOI: 10.1016/j.exppara.2013.08.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 08/13/2013] [Accepted: 08/19/2013] [Indexed: 11/18/2022]
Abstract
Schizophrenia is a serious neuropsychiatric disease of uncertain etiology, which causes human mental disorder and affects about 1% of the population. In recently years, some studies showed that some cases of schizophrenia may be associated with Toxoplasma gondii infection. In order to investigate a potential association between Toxoplasma infection and schizophrenia, we investigated the relative clinical symptom of schizophrenia such as learning and memory capability, depression and stereotypy to find some useful information by behavioral test in mouse models. Our results demonstrated that mice from Toxoplasma infection and MK-801 administration (as the model of schizophrenia) were impaired in learning and memory capability, and they had more serious depression and stereotypy compared with the control mice, especially the mice from congenital Toxoplasma infection. In addition, our results clearly showed that the number of cysts in brain tissue of congenital Toxoplasma infection mice was significantly low than in acquired Toxoplasma infected mice. Collectively, these results suggested a potential association between Toxoplasma infection and schizophrenia.
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Affiliation(s)
- Tao Wang
- Key Laboratory of Jiangxi Province for the Systems Biology Clinical Application, Jiujiang 332000, PR China; Department of Parasitology, School of Basic Medical Sciences, Jiujiang University, Jiujiang 332000, PR China.
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Oh H. Do Stereotype Threats Affect Peer Providers? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 41:569-71. [DOI: 10.1007/s10488-013-0507-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Earnshaw VA, Quinn DM, Kalichman SC, Park CL. Development and psychometric evaluation of the Chronic Illness Anticipated Stigma Scale. J Behav Med 2013; 36:270-82. [PMID: 22526525 PMCID: PMC4370181 DOI: 10.1007/s10865-012-9422-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 03/31/2012] [Indexed: 10/28/2022]
Abstract
The Chronic Illness Anticipated Stigma Scale (CIASS) was developed to measure anticipated stigma (i.e., expectations of prejudice, stereotyping, and discrimination) among people living with chronic illnesses. The CIASS is a 12-item scale with three subscales differentiating among sources of anticipated stigma, including friends and family members, work colleagues, and healthcare workers. Results support the reliability, validity, and generalizability of the CIASS in two samples of people living with chronic illnesses. The CIASS was correlated with other stigma-related constructs as well as indicators of mental health, physical health, and health behaviors. The CIASS can help researchers gauge the degree to which people living with chronic illnesses anticipate stigma, better understand the processes by which anticipated stigma contributes to the health and behavior of people living with chronic illnesses, and compare the extent to which people living with different types of chronic illnesses anticipate stigma.
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Affiliation(s)
- Valerie A Earnshaw
- Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, CT 06510, USA.
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18
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Jones PR, Taylor DM, Dampeer-Moore J, Van Allen KL, Saunders DR, Snowden CB, Johnson MB. Health-Related Stereotype Threat Predicts Health Services Delays Among Blacks. RACE AND SOCIAL PROBLEMS 2013; 5:121-136. [PMID: 24163710 PMCID: PMC3806300 DOI: 10.1007/s12552-013-9088-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
To our knowledge, no published research has developed an individual difference measure of health-related stereotype threat (HRST). We adapted existing measures of academic stereotype threat to the health domain on a sample of black college students (N = 280). The resulting health-related stereotype threat scale-24 (HRST-24) was assessed for internal consistency, construct and incremental validity, and whether it explains variance in self-reported delays among four preventive health behaviors-blood pressure and cholesterol assays, physical exams, and routine checkups. After adjusting for several control variables, the HRST-24's (full scale α = 0.96) perceived black health inferiority (18 items; α = 0.96) and perceived physician racial bias (6 items; α = 0.85) sub-scales explained unique variance in delays among two of the four behaviors including a blood cholesterol check (p < .01) and routine checkup-albeit at marginal levels (p = .063) in the case of the latter. Overall, these data provide preliminary evidence of construct and incremental validity for the HRST-24 among blacks. Recommendations for administering the scale are provided and future directions for HRST research are discussed.
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Affiliation(s)
- Paul R. Jones
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD 20705, USA
| | - Dexter M. Taylor
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD 20705, USA
| | - Jodi Dampeer-Moore
- Department of Nursing, Delaware State University, 1200 North DuPont Highway, Dover, DE 19901-2277, USA
| | - Katherine L. Van Allen
- Department of Psychology, Campbell University, 206 Taylor Hall Building, PO Box 369, Buies Creek, NC 27506, USA
| | - Darlene R. Saunders
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD 20705, USA
| | - Cecelia B. Snowden
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD 20705, USA
| | - Mark B. Johnson
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD 20705, USA
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Chen FP, Lai GYC, Yang L. Mental illness disclosure in Chinese immigrant communities. J Couns Psychol 2013; 60:379-91. [PMID: 23647389 DOI: 10.1037/a0032620] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Support from social networks is imperative to mental health recovery of persons with mental illness. However, disclosing mental illness may damage a person's participation in networks due to mental illness stigma, especially in Chinese immigrant communities where social networks (the guanxi network) have specific social-cultural significance. This study focused on mental illness disclosure in Chinese immigrant communities in New York City. Fifty-three Chinese psychiatric patients were recruited consecutively from 2 Chinese bilingual psychiatric inpatient units from 2006 to 2010. Two bilingual psychologists interviewed each participant once in a semistructured interview, including 6 questions on mental illness disclosure. Conventional content analysis was applied to conceptualize the phenomenon. Results showed that participants voluntarily disclosed to a circle of people composed primarily of family and relatives. The decisions and strategies to disclose depended on participants' consideration of 3 critical elements of social relationships. Ganqing, affection associated with relationship building, ultimately determined who had the privilege to know. Renqing, the moral code of reciprocal kindness, further influenced disclosure decisions and what participants anticipated as responses to disclosure. Lastly, concerns over preserving face (lian), a construct representing personal and familial dignity, oftentimes prohibited disclosure. Additionally, in this tight-knit network, involuntary disclosure could happen without participants' permission or knowledge. Participants commonly suffered from stigma after disclosure. However, half of our participants reported situations in which they experienced little discriminatory treatment, and some experienced support and care as a result of cultural dynamics. Recommendations for culturally sensitive practice to facilitate mental illness disclosure among Chinese immigrants were discussed.
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Affiliation(s)
- Fang-Pei Chen
- Columbia University School of Social Work, New York, NY 10027, USA.
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20
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Abstract
According to stereotype threat theory, negative stereotypes impair performance and can lead to reduced motivation. In the present study, we examined whether the female-mathematics stereotype not only impairs women’s performance but also buffers their self-esteem from negative feedback and reduces their motivation to improve. Before completing a mathematics test, 80 (54 female) participants were informed either that men outperform women on the test (stereotype threat condition) or that men and women perform equally well (no-stereotype condition). Following the test, participants received positive or negative feedback prior to rating their self-esteem. Finally, participants were invited to attend free mathematics tutorials and asked to indicate their likelihood of attending. Women under stereotype threat performed worse and were less motivated than non-stereotyped women to attend mathematics tutorials after receiving negative feedback. Furthermore, although men’s self-esteem was higher if they received positive rather than negative feedback, feedback valence had no effect on women’s self-esteem. These results suggest that the effect of stereotype threat on women’s mathematical performance is potentially compounded by its capacity to reduce motivation to improve. Practical implications are discussed, with a particular focus on the need for interventions that produce an identity-safe environment, foster an incremental view of mathematical ability, and provide information about successful role models.
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Affiliation(s)
| | - Kay Bussey
- Psychology Department, Macquarie University, Sydney, Australia
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21
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Understanding reduced activity in psychosis: the roles of stigma and illness appraisals. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1685-93. [PMID: 22366910 DOI: 10.1007/s00127-012-0475-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 01/04/2012] [Indexed: 12/17/2022]
Abstract
PURPOSE Increasing activity and social inclusion for people with psychosis is a primary goal of mental health services. Understanding the psychological mechanisms underlying reduced activity will inform more carefully targeted and effective interventions. Anxiety, depression, positive symptom distress and negative symptoms all make a contribution, but much of the variance in activity remains unaccounted for and is poorly understood. Appraisals of illness impact on adjustment to illness: mood, engagement in treatment and quality of life are all affected. It is plausible that illness appraisals will also influence activity. This study investigated the extent to which three components of illness appraisal accounted for variance in activity. METHOD 50 people with psychosis completed measures of activity, positive and negative symptoms, anxiety and depression, cognitive functioning, stigma, insight and illness perceptions. RESULTS Multiple regression revealed that internalised stigma, but not insight or illness perception, was significantly correlated with reduced activity. 42% of the variance in activity was accounted for by stigma, negative symptoms, positive symptom distress and social support. Affect, cognitive functioning and positive symptoms were not associated with activity. CONCLUSION For people with psychosis, activity levels appear to be compromised particularly by fears of what others think of them and how they will be treated by others. Directly targeting these fears should improve the impact of psychological interventions on functioning. Specific, individualised cognitive behavioural interventions could be a useful adjunct to recovery-focused narrative therapies and complement public information campaigns to reduce discriminatory attitudes and behaviours.
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22
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An individualized and everyday life approach to cognitive rehabilitation in schizophrenia: a case illustration. Rehabil Res Pract 2012; 2012:928294. [PMID: 22997585 PMCID: PMC3444915 DOI: 10.1155/2012/928294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/25/2012] [Accepted: 07/25/2012] [Indexed: 11/17/2022] Open
Abstract
Objective. The effectiveness of an individualized and everyday approach to cognitive rehabilitation for schizophrenia was examined in a case study. Method. After cognitive and functional assessment, concrete objectives were targeted for the person's everyday complaints. Strategies were constructed based on an analysis of the cognitive profile, daily life functioning, and processes involved in activities. They included a memory strategy for reading, a diary to compensate memory difficulties, and working memory exercises to improve immediate processing of information when reading and following conversations. Efficacy was assessed with outcome measures. Results. The program had beneficial effects on the person's cognitive and everyday functioning, which persisted at a 3-year follow-up. Conclusion. Findings provide suggestive evidence that an individualized and everyday approach may be a useful alternative in order to obtain a meaningfully lasting transfer of training to daily life, compared to the nomothetic ones which dominate the field.
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Burgess DJ, Joseph A, van Ryn M, Carnes M. Does stereotype threat affect women in academic medicine? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:506-12. [PMID: 22361794 PMCID: PMC3315611 DOI: 10.1097/acm.0b013e318248f718] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Multiple complex factors contribute to the slow pace of women's advancement into leadership positions in academic medicine. In this article, the authors propose that stereotype threat--under which individuals who are members of a group characterized by negative stereotypes in a particular domain perform below their actual abilities in that domain when group membership is emphasized--may play an important role in the underrepresentation of women in leadership positions in academic medicine. Research to objectively assess the impact of stereotype threat for women in academic medicine is feasible and necessary to confirm this hypothesis. Still, a number of conditions present in the academic medicine community today have been shown to trigger stereotype threat in other settings, and stereotype threat fits with existing research on gender in academic medicine. In the meantime, academic health centers should implement relatively simple measures supported by experimental evidence from other settings to reduce the risk of stereotype threat, including (1) introducing the concept of stereotype threat to the academic medicine community, (2) engaging all stakeholders, male and female, to promote identity safety by enacting and making faculty aware of policies to monitor potential instances of discrimination, and training faculty to provide performance feedback that is free of gender bias, (3) counteracting the effects of sex segregation at academic health centers by increasing exposure to successful female leaders, (4) reducing gender stereotype priming by avoiding stereotypically male criteria for promotion, grants, and awards, and (5) building leadership efficacy among female physicians and scientists.
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Affiliation(s)
- Diana Jill Burgess
- Center for Chronic Disease Outcomes Research, Department of Veterans Affairs Medical Center, Minneapolis, Minnesota 55417, USA.
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24
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Burgess DJ, Warren J, Phelan S, Dovidio J, van Ryn M. Stereotype threat and health disparities: what medical educators and future physicians need to know. J Gen Intern Med 2010; 25 Suppl 2:S169-77. [PMID: 20352514 PMCID: PMC2847106 DOI: 10.1007/s11606-009-1221-4] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients' experience of stereotype threat in clinical settings and encounters may be one contributor to health care disparities. Stereotype threat occurs when cues in the environment make negative stereotypes associated with an individual's group status salient, triggering physiological and psychological processes that have detrimental consequences for behavior. By recognizing and understanding the factors that can trigger stereotype threat and understanding its consequences in medical settings, providers can prevent it from occurring or ameliorate its consequences for patient behavior and outcomes. In this paper, we discuss the implications of stereotype threat for medical education and trainee performance and offer practical suggestions for how future providers might reduce stereotype threat in their exam rooms and clinics.
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Affiliation(s)
- Diana J Burgess
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
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