Self-stigma and cognitive fusion in parents of children with autism spectrum disorder. The moderating role of self-compassion

Experiences of Affiliate Stigma and Depressive Symptoms in Caregivers of Autistic Children: The Moderating Effect of Social Support

Caregivers with an autistic child often experience stigma, which can lead to detrimental mental health consequences. Affiliate stigma is the internalization of, and psychological responses to, stigma experienced due to an individual's association with a person who is stigmatized. Social support has been shown to mediate the relationship between affiliate stigma and depression in caregivers of special needs children. However, research on social support as a moderator of this relationship in autistic children has not been completed. We examined the associations between affiliate stigma, social support, and depression as well as the moderating role of social support. Using online questionnaires, 110 caregivers of autistic children reported their child's autistic traits, affiliate stigma, perceived social support and depressive symptoms. A moderated regression was run to determine if social support significantly impacted the association between affiliate stigma and depression. Affiliate stigma was positively associated with depressive symptoms and social support was negatively associated with depressive symptoms. The moderating effect of social support on the relationship between affiliate stigma and depressive symptoms was not significant. Upon separating the social support variable into family, significant other, and friend subgroups, no additional significant moderators were found. This is one of the first studies to investigate affiliate stigma in North America and demonstrates that affiliate stigma is not only experienced by parents of autistic children but is significantly associated with depression. Clinicians working with these parents might focus on overcoming affiliate stigma to potentially ameliorate their client's depression.

Examining processes of change for acceptance and commitment therapy and cognitive behavioral therapy self-help books with depressed college students

Given the prevalence of depression, it is worthwhile to consider a variety of treatment approaches to reach as many sufferers as possible, including highly accessible formats such as self-help books. Books based in acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) propose to treat depression through distinct processes of change, though the degree to which these treatments are distinguishable in this format is unclear. Furthermore, it is possible that some individuals may respond better to therapeutic processes from one approach over the other based on personal preferences. We tested the effects of ACT and CBT self-help books on processes of change in a sample of 139 depressed college students in which some participants were given a choice of treatment and others were randomized. Cognitive fusion, which improved better in the ACT group, was the only process of change that distinguished the two treatments. Additionally, early improvements in cognitive fusion were associated with less depression-related stigma at posttreatment. Lastly, randomization, instead of choosing a treatment, led to greater improvements in almost all processes of change. We discuss how these findings inform personalized care, tangible differences between ACT and CBT, and effective practices for treating depression at large scale.

Perception of Internalized Stigma in Parents of Children With Autism Spectrum Disorder: Investigating the Effects of Depression, Anxiety, and Family Functioning

Introduction Autism spectrum disorder (ASD) is a pervasive neurodevelopmental disorder that impacts communication, behavior, and social interaction. It is well-documented that parents of children with ASD often experience psychiatric conditions like anxiety and depression. Nevertheless, research on the perception of internalized stigma, family functioning, and their interconnections is scarce. The main objective of our study was to analyze the internalized stigma perceptions, depression, anxiety, and family functioning among parents or caregivers of children diagnosed with ASD. Methods This study was conducted on 102 cases and 101 healthy controls in a cross-sectional case-control study involving patients aged 3-12 years. The research was carried out at the Child Psychiatry Clinic of Adana City Training and Research Hospital and three Family Health Centers in Adana from October 15 to December 15, 2022. Sociodemographic data, family history, families' knowledge levels about autism, and information about their social lives were collected using a face-to-face structured questionnaire. The Internalized Stigma of Mental Illness (ISMI), Hospital Anxiety and Depression (HAD), and Family APGAR scales were administered. Results The mean ISMI score of the case group was 67.31±8.91. According to the HAD Anxiety scale score, 60.8% of the case group and 14.9% of the control group were at high risk (p<0.001). According to the HAD Depression Scale, 52% of the case group participants and 25.7% of the control group were at high risk (p<0.001). The rate of severe familial dysfunction was 18.6% in the case group and 3.0% in the control group (p<0.001). Conclusion Stigma, anxiety, depression, and family functioning in parents of children diagnosed with ASD lead to various adverse outcomes. Further studies are necessary to prevent these negative experiences for families of children with ASD and to facilitate the integration of these children into society.

Moderating effects of general self-efficacy on courtesy stigma and anxiety and depressive symptoms of parents of children with autism spectrum disorder

Background

Stigma, anxiety and depressive symptoms are highly prevalent in parents of children with autism spectrum disorder (ASD) and may have a detrimental impact on the rehabilitation and treatment of children with ASD, ultimately leading to more behavioral issues and higher rates of disability. Therefore, the purpose of this study was to identify the association between general self-efficacy, courtesy stigma, and anxiety and depressive symptoms, and to further discuss whether general self-efficacy moderated the association between courtesy stigma and anxiety and depressive symptoms in parents of children with ASD.

Methods

A total of 409 parents of children with ASD from Lianyungang, Jiangsu Province, Eastern China participated in a cross-sectional survey. A structured questionnaire was used to collect sociodemographic characteristics, courtesy stigma, general self-efficacy, anxiety symptoms, and depressive symptoms. Hierarchical multiple regression was used to assess the associations of courtesy stigma, general self-efficacy and courtesy stigma × general self-efficacy interaction with anxiety and depressive symptoms. Simple slope analysis was used to visualize the interaction.

Results

The courtesy stigma of parents of children with ASD was positively correlated with anxiety (B = 0.374, P < 0.001) and depressive symptoms (B = 0.366, P < 0.001). General self-efficacy was negatively correlated with anxiety (B = -0.200, P < 0.001) and depressive symptoms (B = -0.210, P < 0.001). The association between courtesy stigma and anxiety symptoms was different in the high (1 standard deviation (SD) above the mean, b = 0.258, standard error (SE) = 0.056, t = 4.567, P < 0.001) and low (1 SD below the mean, b = 0.470, SE = 0.053, t = 8.870, P < 0.001) groups of general self-efficacy. In addition, the association between courtesy stigma and depressive symptoms was also different in the high (1 SD above the mean, b = 0.241, SE = 0.056, t = 4.268, P < 0.001) and low (1 SD below the mean, b = 0.469, SE = 0.053, t = 8.844, P < 0.001) groups of general self-efficacy.

Conclusions

General self-efficacy could moderate the impact of courtesy stigma on anxiety and depressive symptoms. Therefore, among parents of children with ASD who experienced high courtesy stigma, enhancing general self-efficacy could be an effective strategy to reduce anxiety and depressive symptoms in this population.

It is More Anxiousness than Role-playing: Social Camouflaging Conceptualization Among Adults on the Autism Spectrum Compared to Persons with Social Anxiety Disorder

PURPOSE

Autistic individuals consider social camouflaging, e.g., masking autistic traits or social skills compensation, as exhausting and effortful, often leading to diminished well-being or burnout, as well as adaptive for satisfying social interactions. Developing camouflaging may result in isolation, social avoidance, increased self-stigmatization, and misdiagnosis, including social anxiety disorder. The study's objective was to explore and conceptualize social camouflaging, with a particular focus on social anxiety symptoms, autistic burnout, and public stigma, among autistic individuals, with two comparative samples: with social anxiety disorder (SAD) and dual diagnoses (SAD + ASD).

METHODS

254 individuals participated in the study (including 186 females, 148 with ASD diagnosis). CAT-Q, AQ-10, AASPIRE's Autistic Burnout Scale, LSAS-SR, The Perceived Public Stigma Scale were used.

RESULTS

The findings suggest differences in the interrelation dynamics between the samples studied, with autistic burnout and social anxiety symptoms of essential significance in camouflaging strategies, and autistic traits being of secondary importance. Structural equation models showed that the proposed conceptualization, with camouflaging and autistic burnout as the outcome variables, exhibited acceptable fit, implying that this strategy is costly and may result in exhaustion.

CONCLUSION

The total score of camouflaging did not differ between the groups studied, suggesting that a tendency to camouflage is rather transdiagnostic, deriving from anxiousness and negative self-perception, not being autistic per se.

Factors predicting depressive symptoms in parents of children with autism spectrum disorder in eastern China

BACKGROUND

Parents of children with autism spectrum disorder (ASD) are at a higher risk of depression than parents of typically developing children and those of children with other developmental disorders. Depression affects the well-being and quality of life of parents of children with ASD and has serious consequences for the long-term health outcomes of children with ASD. Therefore, this study explored the current status of depressive symptoms in parents of children with ASD in eastern China and further analyzed multiple aspects of the predictors of depressive symptoms.

METHODS

A multicenter cross-sectional survey was conducted among parents of children with ASD in the rehabilitation department of a large specialized hospital and 10 rehabilitation centers for children with special needs in Lianyungang, Jiangsu Province, Eastern China. A structured questionnaire that focused on child-related factors, parent-related factors, depressive symptoms, courtesy stigma, and social support was used to obtain data. Binary logistic regression was used to identify the independent predictors of depressive symptoms in parents of children with ASD.

RESULTS

A total of 409 parents of children with ASD were recruited, of whom 18.8% had depressive symptoms. Parents of children with ASD who raised a child who spoke few to no words (odds ratio [OR]: 2.747, 95% confidence interval [CI]: 1.026-7.357), claimed a high economic burden (OR: 3.215, 95% CI: 1.234-8.379), reported no change or increased severity of ASD in their children (OR: 2.518, 95% CI: 1.108-5.720), and those with a higher courtesy stigma score (OR: 1.189, 95% CI: 1.093-1.294) were more likely to have depressive symptoms. Conversely, parents of children with ASD who were employed (OR: 0.427, 95% CI: 0.201-0.907), satisfied with their current marital status (OR: 0.429, 95% CI: 0.221-0.834), and those with a higher social support score (OR: 0.973, 95% CI: 0.950-0.996) were less likely to have depressive symptoms.

CONCLUSIONS

Depressive symptoms are common in parents of children with ASD in eastern China. Therefore, screening and intervention for depressive symptoms in parents of children with ASD is necessary, especially for those with high-risk factors.

Deviations from the balanced time perspective, cognitive fusion, and self-compassion in individuals with or without a depression diagnosis: different mean profiles but common links to depressive symptoms

Introduction

Prior research indicates that depressive symptoms in unselected or sub-clinical samples are associated with time perspective biases, including a more negative view of the past and a more fatalistic attitude toward the present. In the current study, we compared time perspective profiles for a clinical sample, with a depression diagnosis with that of a control group. Additionally, we considered a measure known as deviations from the balanced time perspective (DBTP) that capture deviations across time frames, not considered in previous studies. A second obejctive was to test a model involving DPTP as a mediator of the links between cognitive fusion and self-compassion with depressive symptoms.

Method

In total, 300 individuals participated in the study, 150 participants with a depression diagnosis and 150 without a depression diagnoses. All participants filled in questions regarding background variables together with Polish adaptations of ZTPI, CFQ, SCS-S, and DASS-21 using a web-survey.

Results

The results showed significantly higher scores on Past Negative and Present Fatalistic in the clinical sample. In line with the hypothesis the clinical group also displayed elevated DBTP scores (d = 0.75), a difference that remained significant when current symptoms were adjusted for. The results of structural equation modeling moreover indicate a major role of cognitive fusion (which, as expected, was strongly associated with DBTP) in predicting symptom burden, regardless of the clinical/non-clinical distinction, but. Still, DBTP accounted for significant (unique) variance in depressive symptoms. By contrast, the inclusion of cognitive fusion and DBTP eliminated the association of self-compassion and depressive symptoms.

Conclusion

Taken together, the results indicate that levels of DBTP/fusion for persons with depression diagnosis is present regardless of current symptom burden. Thus, DBTP could be regarded as a risk factor of developing depression. Prospective research designs are needed to further evaluate the associations of the main constructs in this study and the extent to which they are predictive of future diagnosis and changes in symptom level.

Courtesy stigma among primary caregivers of children with autism spectrum disorder in eastern China

Introduction

The experience and perception of stigma is a common problem among primary caregivers of children with autism spectrum disorder (ASD), and has a profound adverse impact on primary caregivers and children with ASD; however, few studies have explored courtesy stigma among primary caregivers of children with ASD in the Chinese context. The aim of this study was to explore the status of courtesy stigma among primary caregivers of children with ASD in Lianyungang, Jiangsu Province, Eastern China, and to conduct in-depth analysis of its predictors from multiple perspectives.

Methods

An institution-based multi-center cross-sectional survey was conducted in the rehabilitation department of a large specialized hospital and 10 rehabilitation centers for children with special needs in Lianyungang, Jiangsu Province, Eastern China, from October 2022 to February 2023. A structured questionnaire to assess child-related factors, primary caregiver-related factors, courtesy stigma, general self-efficacy, and social support, was used to collect data. Predictors of courtesy stigma among primary caregivers of children with ASD were identified by linear regression.

Results

A total of 428 primary caregivers of children with ASD were recruited. The mean ± standard deviation (SD) score for courtesy stigma was 7.49 ± 4.13. Multiple linear regression analysis revealed that primary caregivers of children with ASD who were not too satisfied with their current marital status (β = 1.21, 95% CI: 0.34-2.08, p < 0.05) were more likely to have a high courtesy stigma; however, significantly lower courtesy stigma was observed in primary caregivers of children with ASD who were not picky eaters (β = -1.33, 95% CI: -2.08 - -0.58, p < 0.05), and who reported low level challenge in caring for children with ASD (β = -1.16, 95% CI: -2.20 - -0.12, p < 0.05), good general self-efficacy (β = -0.16, 95% CI: -0.25 - -0.06, p < 0.05), and good social support (β = -0.04, 95% CI: -0.08 - -0.01, p < 0.05).

Conclusion

There is a high level of courtesy stigma among primary caregivers of children with ASD in eastern China, and it is affected by numerous factors. More resources should be directed to groups that are more likely to experience stigma.

Self-stigma predicts post-traumatic and depressive symptoms in traumatized individuals seeking interventions for dissociative symptoms: a preliminary investigation

Background: Previous studies showed that self-stigma is associated with poor clinical outcomes in people with serious mental illness, and is associated with post-traumatic stress disorder (PTSD). However, less is known about self-stigma in people with dissociative symptoms, which are often related to psychological trauma. This study examined whether baseline self-stigma would be associated with dissociative, PTSD and depressive symptoms at post-intervention, after controlling for treatment usage and baseline symptom severity, in a sample of traumatized Chinese adults undertaking a psychoeducation intervention for dissociative symptoms.Methods: We conducted a secondary analysis of data from a 60-day web-based psychoeducation programme. A total of 58 participants who provided data before and after the intervention were included for analysis. Hierarchical regression analyses were conducted.Results: In this highly traumatized, dissociative, and symptomatic help-seeking sample, baseline self-stigma was associated with PTSD (β = .203, p = .032) and depressive (β = .264, p = .025) symptoms at post-intervention, even after controlling for baseline symptom severity, age, location, number of sessions attended in the web-based psychoeducation programme, and use of psychological treatments for PTSD/dissociative symptoms. However, self-stigma was not associated with dissociative symptoms (p = .108).Conclusions: This is the first study showing that self-stigma is a significant predictor of comorbid symptoms (i.e. PTSD and depressive symptoms) in people seeking interventions for dissociative symptoms. The findings that post-traumatic and dissociative symptoms have different relationships to self-stigma also highlight the possibility dissociation might be an independent psychological construct closely associated with trauma, but not merely a PTSD symptom, although further studies are necessary. The preliminary findings call for more efforts to understand, prevent, and address self-stigma in people with trauma-related mental health issues such as dissociative symptoms.