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Adu J, Oudshoorn A, Anderson K, Marshall CA, Stuart H. Experiences of familial stigma among individuals living with mental illnesses: A meta-synthesis of qualitative literature from high-income countries. J Psychiatr Ment Health Nurs 2023; 30:208-233. [PMID: 36031879 DOI: 10.1111/jpm.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/29/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Mental illness stigma has been long acknowledged as a social problem that continues to persist and contribute to social exclusion of affected persons globally. Researchers have explored mental illness stigma in the general public and among health professionals, with little focus on stigma from family members and close relatives of persons with mental illnesses. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study appears to be the first meta-synthesis of familial mental illness stigma in high-income countries. Family members or close relatives of persons with mental illnesses may be perpetrators of stigma. That is, the family may enact stigma of mental illness against their relative to "save face" or by avoiding or narrowing their social contacts. Familial stigma is harmful due to the likely disaffection it brings within one's home environment. Familial mental stigma from the existing literature seems to be a by-product of public stigma and stigma by association WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further research is necessary to look at the existence of familial mental illness stigma as well as available policies to reduce its impact on affected individuals in high-income countries. Researchers in high-income countries should endeavour to examine the relationship between familial, public and associative stigma to establish baseline metrics to inform future anti-stigma programs seeking to reduce familial mental illness stigma. ABSTRACT INTRODUCTION: Familial mental illness stigma is a pervasive issue but very subtle in high-income countries. Familial mental illness stigma implies persons living with mental illnesses are discriminated against by their family members or close relatives. AIM/QUESTION This meta-synthesis explored the experiences of familial stigma among individuals living with mental illnesses in high-income countries, focusing on empirical literature, to understand the breadth of current literature and ways to reduce this form of stigma. METHOD We conducted a meta-synthesis through a structured search of qualitative data from six electronic databases (Sociological Abstract, CINAHL, Medline, PsycINFO, Google Scholar and Embase). Inclusion criteria comprised: empirical primary research, primary technique for data collection is qualitative, studies published in a peer-reviewed journal in the English language between 2000 and 2020, studies reported on experiences of familial mental illness stigma, and studies conducted in high-income countries. The exclusion criteria were as follows: all grey literature, studies not written in English and non-peer-reviewed, studies not focused on familial mental illness stigma, quantitative peer-reviewed articles on the related concept and peer-reviewed articles on the related topic before the year 2000. RESULTS The study identified only 28 peer-reviewed articles on the topic within two decades. Concealment of familial stigma was found to be detrimental due to the potential for alienation within one's home environment. Disclosure and social contact within the family system were considered as critical interventions to provide some safety nets for individuals with mental illnesses. DISCUSSION AND IMPLICATIONS FOR PRACTICE The paucity of studies over the review period highlights the need for further attention to support optimal environments for persons living with mental illnesses. Families' understanding of the difficulties of mental illness stigma is vital to supporting the development of policies and interventions towards the avoidance of social exclusion within societies. Families should make concerted efforts to reduce stigma, and this includes within the family system. Education and training approaches around mental illness-related stigma should involve individuals with lived experience and their families, as well as service providers and the general public.
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Affiliation(s)
- Joseph Adu
- Department of Health and Rehabilitation Sciences, Elborn College, Western University, London, Ontario, Canada
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Kelly Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Carrie Anne Marshall
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Heather Stuart
- Department of Public Health Sciences, Department of Psychiatry and the School of Rehabilitation Therapy, Queens University, Kingston, Ontario, Canada
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Helingoe KE, Cullum S, Ng L. Stigma in Consultation Liaison Psychiatry: A Qualitative Study of Trainee Psychiatrists. Australas Psychiatry 2022; 30:658-662. [PMID: 35139666 DOI: 10.1177/10398562211064221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Stigma related to mental illness can impact service-user care and clinician wellbeing. The aim of this study was to explore experiences of stigma in consultation-liaison psychiatry from the perspectives of trainee psychiatrists and suggest interventions to tackle stigma within a hospital environment. METHOD Ethics approval and consent were obtained for the study. In-depth interviews were conducted by telephone with six participants in four New Zealand district health boards. De-identified data was analysed using thematic analysis. An independent co-coder was employed to enhance analytic rigour. RESULTS Participants experienced stigma during their consultation-liaison rotations. Some felt isolated and undervalued. Education, intergration and role clarification within the hospital environment were identified as ways to reduce stigma. CONCLUSIONS Stigma experienced by trainee psychiatrists completing consultation-liaison rotations may lead to them feeling devalued and perceiving service-users to experience poorer care. Multidisciplinary education may potentially combat stigma and contribute to improved integration of services.
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Affiliation(s)
| | - Sarah Cullum
- Psychiatrist, Department of Psychological Medicine, 1415The University of Auckland, Auckland, New Zealand
| | - Lillian Ng
- Psychiatrist, Department of Psychological Medicine, 1415The University of Auckland, Auckland, New Zealand
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Traino KA, Baudino MN, Kraft JD, Basile NL, Dattilo TM, Davis MP, Buchanan C, Cheng EY, Poppas DP, Wisniewski AB, Mullins LL. Factor Analysis of the Stigma Scale-Parent Version in Pediatric Disorders/Differences of Sex Development. Stigma Health 2021; 6:390-396. [PMID: 35497259 PMCID: PMC9053364 DOI: 10.1037/sah0000346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Stigma is a salient experience for both caregivers/parents and individuals with Disorders/Differences of Sex Development (DSD) as evidenced through qualitative and preliminary quantitative reports. However, few validated measures of associative stigma (i.e., vicarious stigma experienced through close association with someone who is socially stigmatized) for parents of children with DSD exist. The present study aims to (1) determine the factor structure of the adapted Stigma Scale - Parent, and (2) examine convergent validity of the factor structure with measures of parent psychosocial adjustment. Confirmatory factor analytic results revealed two factors: a parent-focused factor and a child-focused factor. The parent-focused factor demonstrated convergent validity with parent adjustment measures, but the child-focused factor did not. Together, these results indicate that parent-focused and child-focused stigma are distinct factors, with parent-focused associative stigma being related to parent adjustment following DSD diagnosis. Future research should further refine this measure to determine predictive validity and clinical value.
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Affiliation(s)
| | | | - Jacob D. Kraft
- Psychology Department, Oklahoma State University, Stillwater, OK
| | - Nathan L. Basile
- Psychology Department, Oklahoma State University, Stillwater, OK
| | | | - Morgan P. Davis
- Psychology Department, Oklahoma State University, Stillwater, OK
| | - Cindy Buchanan
- University of Colorado Anschutz Medical Campus, Department of Psychiatry, Aurora, CO
| | - Earl Y. Cheng
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Department of Urology, Chicago, IL
| | - Dix P. Poppas
- Phyllis & David Komansky Center for Children’s Health of New York Presbyterian Hospital Weill Cornell Medical Center
| | | | - Larry L. Mullins
- Psychology Department, Oklahoma State University, Stillwater, OK
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Stanley N. Associative Stigma Against Mental Health Nursing: Ways Forward. Creat Nurs 2021; 27:172-177. [PMID: 34493637 DOI: 10.1891/crnr-d-20-00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In some countries, there is a serious public stigma against people with mental health disorders that is transferred to those in close association with people suffering from these disorders, such as family members and health-care professionals, a process called associative stigma. The stigma against mental health nurses comes not only from the general public but also from other health-care workers, including nurses themselves. Some nursing education curricula contain little information about mental health, such that prospective nurses graduate with poor knowledge of mental health, reflected in the small number willing to specialize in mental health nursing, especially in developing countries where this stigma is at its peak. Nurses who form a vital part of the mental health team must rise and defend themselves through advocacy for policies to protect world mental health.
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Chang S, Picco L, Abdin E, Yuan Q, Chong SA, Subramaniam M. Resilience and associative stigma among mental health professionals in a tertiary psychiatric hospital: a cross-sectional study in Singapore. BMJ Open 2019; 9:e033762. [PMID: 31888942 PMCID: PMC6937006 DOI: 10.1136/bmjopen-2019-033762] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The mental health profession exposes healthcare workers to unique stressors such as associative stigma (stigmatisation that is extended from the stigmatised patients to psychiatric professionals and is based on affiliation with an individual with mental illness). Enhancing resilience, or the ability to 'bounce back' from adversity, is found to be useful in reducing occupational stress and its negative effects. In view of the high burnout rates reported among mental health professionals, this study aimed to examine resilience in this group of professionals and to explore the association between resilience and associative stigma. DESIGN Observational study-cross-sectional design. SETTING Tertiary psychiatry hospital in Singapore. PARTICIPANTS The study was conducted among 470 mental health professionals (doctors, nurses and allied health professionals) working in the hospital. MEASURES Resilience was assessed using the Brief Resilience Scale (BRS) and participants completed questionnaires that examined associative stigma. Participants provided their sociodemographic information, length of service, and information on whether they knew of a close friend or family member who had a mental illness. RESULTS Mean resilience score for the overall sample was 3.59 (SD=0.64). Older age (β=0.012, 95% CI 0.004 to 0.019, p=0.003) and having known a family member or close friend with a mental illness (β=0.155, 95% CI 0.019 to 0.290, p=0.025) predicted higher BRS score. Associative stigma remained significantly associated with resilience score after controlling for sociodemographic factors whereby higher associative stigma predicted lower resilience scores. CONCLUSION The present finding suggests that resilience building programmes among mental health workers should target those of the younger age group, and that addressing the issue of associative stigma is essential.
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Affiliation(s)
- Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Qi Yuan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Picco L, Chang S, Abdin E, Chua BY, Yuan Q, Vaingankar JA, Ong S, Yow KL, Chua HC, Chong SA, Subramaniam M. Associative stigma among mental health professionals in Singapore: a cross-sectional study. BMJ Open 2019; 9:e028179. [PMID: 31300500 PMCID: PMC6629392 DOI: 10.1136/bmjopen-2018-028179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES (1) Investigate and explore whether different classes of associative stigma (the process by which a person experiences stigmatisation as a result of an association with another stigmatised person) could be identified using latent class analysis; (2) determine the sociodemographic and employment-related correlates of associative stigma and (3) examine the relationship between associative stigma and job satisfaction, among mental health professionals. DESIGN Cross-sectional online survey. PARTICIPANTS Doctors, nurses and allied health staff, working in Singapore. METHODS Staff (n=462) completed an online survey, which comprised 11 associative stigma items and also captured sociodemographic and job satisfaction-related information. Latent class analysis was used to classify associative stigma on patterns of observed categorical variables. Multinomial logistic regression was used to examine associations between sociodemographic and employment-related factors and the different classes, while multiple linear regression analyses were used to examine the relationship between associative stigma and job satisfaction. RESULTS The latent class analysis revealed that items formed a three-class model where the classes were classified as 'no/low associative stigma', 'moderate associative stigma' and 'high associative stigma'. 48.7%, 40.5% and 10.8% of the population comprised no/low, moderate and high associative stigma classes, respectively. Multinomial logistic regression showed that years of service and occupation were significantly associated with moderate associative stigma, while factors associated with high associative stigma were education, ethnicity and occupation. Multiple linear regression analyses revealed that high associative stigma was significantly associated with lower job satisfaction scores. CONCLUSION Associative stigma was not uncommon among mental health professionals and was associated with sociodemographic factors and poorer job satisfaction. Associative stigma has received comparatively little attention from empirical researchers and continued efforts to address this understudied yet important construct in conjunction with future efforts to dispel misconceptions related to mental illnesses are needed.
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Affiliation(s)
- Louisa Picco
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Qi Yuan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Samantha Ong
- Nursing, Institute of Mental Health, Singapore, Singapore
| | - Kah Lai Yow
- Allied Health, Institute of Mental Health, Singapore, Singapore
| | - Hong Choon Chua
- Chief Executive Office, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Yanos PT, Vayshenker B, DeLuca JS, O'Connor LK. Development and Validation of a Scale Assessing Mental Health Clinicians' Experiences of Associative Stigma. Psychiatr Serv 2017; 68:1053-1060. [PMID: 28617207 DOI: 10.1176/appi.ps.201600553] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mental health professionals who work with people with serious mental illnesses are believed to experience associative stigma. Evidence suggests that associative stigma could play an important role in the erosion of empathy among professionals; however, no validated measure of the construct currently exists. This study examined the convergent and discriminant validity and factor structure of a new scale assessing the associative stigma experiences of clinicians working with people with serious mental illnesses. METHODS A total of 473 clinicians were recruited from professional associations in the United States and participated in an online study. Participants completed the Clinician Associative Stigma Scale (CASS) and measures of burnout, quality of care, expectations about recovery, and self-efficacy. RESULTS Associative stigma experiences were commonly endorsed; eight items on the 18-item scale were endorsed as being experienced "sometimes" or "often" by over 50% of the sample. The new measure demonstrated a logical four-factor structure: "negative stereotypes about professional effectiveness," "discomfort with disclosure," "negative stereotypes about people with mental illness," and "stereotypes about professionals' mental health." The measure had good internal consistency. It was significantly related to measures of burnout and quality of care, but it was not related to measures of self-efficacy or expectations about recovery. CONCLUSIONS Findings suggest that the CASS is internally consistent and shows evidence of convergent validity and that associative stigma is commonly experienced by mental health professionals who work with people with serious mental illnesses.
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Affiliation(s)
- Philip T Yanos
- The authors are with the Department of Psychology, John Jay College of Criminal Justice, and the Graduate Center, City University of New York, New York
| | - Beth Vayshenker
- The authors are with the Department of Psychology, John Jay College of Criminal Justice, and the Graduate Center, City University of New York, New York
| | - Joseph S DeLuca
- The authors are with the Department of Psychology, John Jay College of Criminal Justice, and the Graduate Center, City University of New York, New York
| | - Lauren K O'Connor
- The authors are with the Department of Psychology, John Jay College of Criminal Justice, and the Graduate Center, City University of New York, New York
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