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Sum MY, Wong CTW, Chu ST, Li A, Lee AHT, Chen EYH, Chan SKW. Systematic review and meta-analysis of internalised stigma and stigma resistance in patients with psychosis: The impact of individualism-collectivism culture and other individual factors. Int J Soc Psychiatry 2024:207640231216924. [PMID: 38279534 DOI: 10.1177/00207640231216924] [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: 01/28/2024]
Abstract
PURPOSE This study aimed to meta-analysis the level of internalised stigma experienced by individuals with psychosis worldwide, and the impact of cultural differences, economic status of the studied regions and duration of illness on their levels of internalised stigma. Clinical and individual level factors associated with internalised stigma and stigma resistance were also systematically reviewed. METHODS A systematic search of keywords on two scholarly databases were conducted. The individualism index of the countries or regions where the studies were conducted was retrieved from Hofstede's updated measurement of individualism. Economic status of regions was categorised based on their per capita gross national income. Meta-analysis and meta-regression were conducted using the 'metafor' package in R. Factors associated with internalised stigma and stigma resistance were also systematically consolidated. RESULTS Seventy-three articles were included in the meta-analysis and the pooled score of both internalised stigma and stigma resistance of individuals with psychosis were within the mild range (2.20 and 2.44, respectively). The meta-regression analysis found high collectivism culture is significantly related to a higher level of internalised stigma. Economic status was not significant. Thirty-five articles were included in the systematic review and clinical, psychological, psychosocial variables, cognition and sociodemographic factors were found to be associated with internalised stigma. CONCLUSION Internalised stigma in psychosis is ubiquitous worldwide and high collectivism culture may be related with high internalised stigma. With the presence of multiple individual factors related to internalised stigma, intervention programmes to reduce internalised stigma should consider focussing on both macro- and micro-level factors.
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Affiliation(s)
- Min Yi Sum
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Charmaine Tsz Wing Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Sin Ting Chu
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Angel Li
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Athena Hoi Ting Lee
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Eric Yu Hai Chen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Sherry Kit Wa Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
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Hogg LI, Smith LGE, Kurz T, Morrison AP. Social identification, identity integration and wellbeing in people who hear voices. Psychol Psychother 2023. [PMID: 37964710 DOI: 10.1111/papt.12509] [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: 12/21/2022] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES Hearing voices is associated with public stigma and this can influence readiness to identify as a voice hearer (VH) and psychological wellbeing. In this study, we investigated the relationships between a VH social identity, the integration of that identity with other important social identities and wellbeing. DESIGN Cross-sectional study, with a subset of longitudinal data across three time points. METHODS People who self-identified as voice hearers completed questionnaires (VH social identity, identity integration, wellbeing and perceptions of in-group and out-group empathy) at three time points, spaced at 3-monthly intervals. The final sample comprised 182 participants at T1, 91 at T2 and 75 at T3. Hierarchical linear multiple regression analyses were used to test all hypotheses. RESULTS The integration of a VH social identity was strongly associated with better psychological wellbeing at T1. Identity integration was also associated with static wellbeing scores at 6 months. Effects on wellbeing were not accounted for by either severity of voice-hearing or paranoia. Whilst perceptions of in-group empathy were associated with VH social identification, perceptions of outgroup empathy were important for identity integration. CONCLUSIONS Integrating a VH social identity with other important identities into a coherent sense of self is important for wellbeing in voice hearers; perceived in-group and outgroup empathy are important in this process.
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Affiliation(s)
- Lorna I Hogg
- Department of Psychology, University of Bath, Bath, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Harris Manchester College, University of Oxford, Oxford, UK
| | | | - Tim Kurz
- Department of Psychology, University of Bath, Bath, UK
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Anthony P Morrison
- School of Psychological Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Trust, Manchester, UK
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White R, Haddock G, Haarmans M, Varese F. Being more satisfied with romantic relationship status is associated with increased mental wellbeing in people with experience of psychosis. Front Psychiatry 2023; 14:1232973. [PMID: 37840795 PMCID: PMC10569177 DOI: 10.3389/fpsyt.2023.1232973] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Aims Romantic relationships represent one of the most salient sources of social support. In general population studies, they are associated with both physical and psychological benefits. Research suggests that for people with psychosis, romantic relationships may also have a positive impact on a range of outcomes, but the reasons for these associations are still unclear. This study aims to investigate whether satisfaction with romantic relationships status is associated with better wellbeing outcomes in people with experience of psychosis and explore three possible psychological mediators of this relationship. Methods Participants who had previously sought support for psychosis (n = 190) completed an online survey including measures of relationship status satisfaction (the Satisfaction with Relationship Scale) as well as measures of psychotic symptoms (the CAPE-42), general well-being (Short Warwick-Edinburgh Mental Wellbeing Scale) and several psychological variables relevant to the pathway between romantic relationships and well-being outcomes, namely loneliness, internalised stigma, self-esteem and attachment. Results Fearful attachment and partner criticism were negatively associated with relationship status satisfaction. Having a partner was positively associated with relationship status satisfaction. Higher levels of relationship status satisfaction were associated with lower psychotic symptoms and higher mental wellbeing. This relationship was mediated by loneliness, internalised stigma, and self-esteem. Conclusion Mental health services should be mindful of the associations between romantic relationship satisfaction and wellbeing. Service users with a fearful attachment style may particularly benefit from support in this area.
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Affiliation(s)
- Rebecca White
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Maria Haarmans
- Department of Sociology, School of Social Sciences, Faculty of Humanities, The University of Manchester, Manchester, United Kingdom
- School of Psychology, University of Liverpool, Liverpool, United Kingdom
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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4
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Matshabane OP, Appelbaum PS, Faure MC, Marshall PA, Stein DJ, de Vries J, Campbell MM. Lessons learned from the translation of the Internalised Stigma of Mental Illness (ISMI) scale into isiXhosa for use with South African Xhosa people with schizophrenia. Transcult Psychiatry 2023:13634615231168461. [PMID: 37331970 DOI: 10.1177/13634615231168461] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Internalised stigma is highly prevalent among people with mental illness. This is concerning because internalised stigma is often associated with negative consequences affecting individuals' personal, familial, social, and overall wellbeing, employment opportunities and recovery. Currently, there is no psychometrically validated instrument to measure internalised stigma among Xhosa people in their home language. Our study aimed to translate the Internalised Stigma of Mental Illness (ISMI) scale into isiXhosa. Following WHO guidelines, the ISMI scale was translated using a five-stage translation design which included (i) forward-translation, (ii) back-translation, (iii) committee approach, (iv) quantitative piloting, and (v) qualitative piloting using cognitive interviews. The ISMI isiXhosa version (ISMI-X) underwent psychometric testing to establish utility, within-scale validity, convergent, divergent, and content validity (assessed using frequency of endorsements and cognitive interviewing) with n = 65 Xhosa people with schizophrenia. The resultant ISMI-X scale demonstrated good psychometric utility, internal consistency for the overall scale (α = .90) and most subscales (α > .70, except the Stigma Resistance subscale where α = .57), convergent validity between the ISMI Discrimination Experiences subscale and the Discrimination and Stigma (DISC) scale's Treated Unfairly subscale (r = .34, p = .03) and divergent validity between the ISMI Stigma Resistance and DISC Treated Unfairly subscales (r = .13, p = .49). But more importantly the study provides valuable insights into strengths and limitations of the present translation design. Specifically, validation methods such as assessing frequency of endorsements of scale items and using cognitive interviewing to establish conceptual clarity and relevance of items may be useful in small piloting sample sizes.
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Affiliation(s)
- Olivia P Matshabane
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Social and Behavioral Research Branch, National Institutes of Health, Bethesda, MD, USA
| | - Paul S Appelbaum
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Marlyn C Faure
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Patricia A Marshall
- Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jantina de Vries
- Department of Medicine and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Megan M Campbell
- Psychology Department, Rhodes University, Grahamstown, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Torales J, Aveiro-Róbalo TR, Ríos-González C, Barrios I, Almirón-Santacruz J, González-Urbieta I, Caycho-Rodríguez T, Castaldelli-Maia JM, Ventriglio A. Discrimination, stigma and mental health: what's next? Int Rev Psychiatry 2023; 35:242-250. [PMID: 37267024 DOI: 10.1080/09540261.2023.2186218] [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: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 06/03/2023]
Abstract
Stigma and discrimination are a major ongoing problem in the field of mental health as these impact on patient outcomes, access to and acceptability of therapeutic interventions, their quality of life, general wellbeing, social inclusion and opportunities. Social stereotypes, culture and prejudices all contribute to continuing discrimination in mental health. Different settings where people function may also be sources of discrimination such as work and educational environments. The lack of knowledge and understanding of mental health/illness by individuals, their families, carers and policymakers as well as the social media reporting also impact on social attitudes to discrimination. It has been also described a relevant impact of stigma among specific social minorities reporting poor mental health such as elderly people, youths, sexual variants, persons with disability. Educational programs, raising awareness trainings and proper public policies may be developed in order to reduce stigma at social level with favourable outcomes for people with mental illness.
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Affiliation(s)
- Julio Torales
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Telmo Raúl Aveiro-Róbalo
- Department of Research Methodology, School of Medical Sciences, Universidad del Pacífico, Asunción, Paraguay
| | - Carlos Ríos-González
- National Institute of Health, Ministry of Health and Social Welfare, Asunción, Paraguay
| | - Iván Barrios
- Department of Statistics, School of Medical Sciences, National University of Asunción, Santa Rosa del Aguaray Campus, Santa Rosa del Aguaray, Paraguay
| | - José Almirón-Santacruz
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | | | | | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Fundação do ABC, Santo André, Brazil
- Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Jagan S, Mohd Daud TI, Chia LC, Saini SM, Midin M, Eng-Teng N, Ratnasingam S. Evidence for the Effectiveness of Psychological Interventions for Internalized Stigma among Adults with Schizophrenia Spectrum Disorders: A Systematic Review and Meta-Analyses. Int J Environ Res Public Health 2023; 20:ijerph20085570. [PMID: 37107852 PMCID: PMC10138403 DOI: 10.3390/ijerph20085570] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/09/2023] [Accepted: 03/12/2023] [Indexed: 05/11/2023]
Abstract
In recent years, psychological interventions have been used to alleviate internalized stigma in people with schizophrenia spectrum disorders, but outcomes have been inconsistent. The aim of this review was to examine the existing evidence regarding this matter. Four electronic databases (EMBASE, MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials) were searched from inception until 8 September 2022, using appropriate strategies. The eligibility, quality, and strength of evidence of each study were all evaluated against the predetermined standards. Further quantitative analyses were performed using the RevMan software. A total of 27 studies were included in the systematic review. Eighteen studies with extractable data for meta-analysis yielded a statistically significant overall effect (Z = 3.00; p = 0.003; 95% CI: -0.69 [-1.15, -0.24]; n = 1633), although there was considerable heterogeneity (Tau2 = 0.89; Chi2 = 303.62, df = 17; p < 0.00001; I2 = 94%). Subgroup analyses for Narrative Enhancement and Cognitive Therapy (NECT) produced a statistically significant and highly homogenous effect (Z = 3.40; p = 0.0007; 95% CI: -0.44 [-0.70, -0.19]; n = 241; Tau2 = 0.00; Chi2 = 0.14, df = 2 (p = 0.93); I2 = 0%). In conclusion, the majority of the psychological interventions are successful in lowering levels of internalized stigma, especially NECT, and interventions that integrate multiple therapies may be more beneficial.
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Affiliation(s)
- Shankar Jagan
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
- Department of Psychiatry & Mental Health, Sarawak General Hospital, Ministry of Health Malaysia, Sarawak 93586, Malaysia
| | - Tuti Iryani Mohd Daud
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
- Correspondence: ; Tel.: +60-3914-56143
| | - Lip Choy Chia
- Department of Psychiatry and Mental Health, Hospital Keningau, Peti Surat 11 Jalan Apin-Apin, Keningau 89007, Malaysia
| | - Suriati Mohamed Saini
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Marhani Midin
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Ng Eng-Teng
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Selvasingam Ratnasingam
- Department of Psychiatry & Mental Health, Sarawak General Hospital, Ministry of Health Malaysia, Sarawak 93586, Malaysia
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Han E, Scior K, Heath E, Umagami K, Crane L. Development of stigma-related support for autistic adults: Insights from the autism community. Autism 2023:13623613221143590. [PMID: 36597933 PMCID: PMC10374993 DOI: 10.1177/13623613221143590] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
LAY ABSTRACT Many autistic adults experience public stigma, which refers to negative attitudes and treatment from others. Because of that, some autistic adults may also apply unhelpful beliefs to themselves, which is known as internalised stigma. There is some evidence that both public stigma and internalised stigma are linked to poorer mental health in autistic adults. Clearly, it is crucial to change how society thinks and acts towards autistic people. There are several programmes that are trying to do this. But as change can be slow, support may also be needed to help autistic people cope with and challenge stigma. Using an online survey, we gathered the views of 144 autistic adults and parents/caregivers of autistic people in the United Kingdom on whether a stigma support programme for autistic adults is needed and, if so, what it should 'look' like. Most participants felt it was important for autistic adults to have support in managing stigma because of the harmful effects that stigma has on mental health and the challenges that autistic adults face in disclosing their diagnosis. However, participants were also concerned that such a programme could convey the message that autistic people, rather than society, need to change. Participants suggested that the programme should be positive and practical, helping autistic adults to understand and accept themselves, as well as learn context-specific strategies for responding to stigma and/or disclosing their diagnosis. They also stressed that the programme should be flexible and inclusive, recognising that autistic adults have very different needs and preferences.
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Affiliation(s)
- Emeline Han
- Centre for Research in Autism and Education (CRAE), IOE, UCL's Faculty of Education and Society, University College London, UK
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | | | - Kana Umagami
- Centre for Research in Autism and Education (CRAE), IOE, UCL's Faculty of Education and Society, University College London, UK
| | - Laura Crane
- Centre for Research in Autism and Education (CRAE), IOE, UCL's Faculty of Education and Society, University College London, UK
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Guan Z, Wiley JA, Tang S, Sun M. Internalised stigma, social support, coping and care-giving burden among Chinese family caregivers of adults diagnosed with schizophrenia: A parallel mediation analysis. Health Soc Care Community 2022; 30:2300-2310. [PMID: 35355363 DOI: 10.1111/hsc.13780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 01/22/2022] [Accepted: 02/27/2022] [Indexed: 06/14/2023]
Abstract
Care-giving burden and internalised stigma are prevalent among family caregivers of people diagnosed with schizophrenia. Internalised stigma has been regarded as a source of care-giving burden. But it remains unclear if high levels of internalised stigma directly contribute to an increased risk of care-giving burden or if the effects could be buffered by psychological factors. This cross-sectional study was to investigate the relationship between internalised stigma and care-giving burden, and to determine the mediating effects of coping styles and social support. Data were collected from 344 Chinese family caregivers of adults diagnosed with schizophrenia in a psychiatric outpatient department of a tertiary hospital in Changsha, Hunan between April and August 2018. A self-reported questionnaire was used to collect data anonymously. Instruments included the Simplified Coping Style Questionnaire, the Multidimensional Scale of Perceived Social Support, the Internalized Stigma of Mental Illness Scale and the Caregiver Burden Inventory. Data analysis was conducted using descriptive statistics, the Spearman correlation and regression analysis to estimate direct and indirect effects using bootstrap analysis. Results showed that internalised stigma, social support and passive coping were significant correlates of care-giving burden; social support partially mediated the relationship between internalised stigma and care-giving burden; active coping did not show impacts on internalised stigma and care-giving burden. This study provided social workers and healthcare providers with a better understanding of the development of care-giving burden. Comprehensive interventions should be designed to provide supportive resources and reduce the possibilities of internalisation of stigma and passive coping, to alleviate care-giving burden.
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Affiliation(s)
- Ziyao Guan
- School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - James A Wiley
- Xiangya School of Nursing, Central South University, Changsha, China
- School of Medicine, Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha, China
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Bonetto C, Pace D, Bodini L, Colombi M, Van Bortel T, Lasalvia A. Development and psychometric validation of new questionnaires assessing experienced discrimination and internalised stigma among people with Covid-19. Epidemiol Psychiatr Sci 2022; 31:e37. [PMID: 35616053 DOI: 10.1017/S204579602200021X] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS To develop and validate two new standardised measures assessing, respectively, experienced discrimination (Covid-19 Experienced DISCrimination scale, CEDISC) and internalised stigma (COvid-19 INternalised Stigma scale, COINS) in people who had been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or had developed coronavirus disease 2019 (Covid-19) disease. METHODS Both the CEDISC and the COINS were developed in Italian and tested for ease of use, comprehension, acceptability, the relevance of items and response options within a focus group session. Online cross-sectional validation survey was conducted among adults infected with SARS-CoV-2 or who developed Covid-19 disease, members of a closed Facebook discussion group in Italy. Exploratory factor analysis (EFA) with Promax oblique rotation; the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and the Bartlett's test of sphericity were used to assess the suitability of the sample for factor analysis. Reliability was assessed as internal consistency using Cronbach's alpha and as test-retest reliability using weighted kappa and intraclass correlation coefficient (ICC). Precision was examined by Kendall's tau-b coefficient. RESULTS Overall, 579 participants completed the CEDISC, 519 also completed the COINS, 155 completed the retest for both scales after two weeks. The 12 items of the CEDISC converged over a 2-factor solution ('social life' and 'close relations') accounting for 49.2% of the variance (KMO = 0.894; Bartlett's test p < 0.001); the 13 items of the COINS converged over a 3-factor solution ('self-perception', 'close relations' and 'social life') accounting for 67.7% (KMO = 0.827; Bartlett's test p < 0.001). Cronbach's α was 0.848 for the CEDISC, and 0.837 for the COINS. The CEDISC showed three items (25%) with kappa between 0.61 and 0.80 and seven (58.4%) between 0.41 and 0.60, with only two items scoring 0.21 and 0.40; the COINS had ten items (76.9%) with kappa ranging from 0.41 to 0.60, and three items below 0.31. ICC was 0.906 (95% CI, 0.871-0.932) for the, CEDISC and 0.860 (95% CI, 0.808-0.898) for the COINS. Kendall's tau-b ranged from 0.360 to 0.556 (p < 0.001) for the CEDISC and from 0.290 to 0.606 (p < 0.001) for the COINS. CONCLUSIONS Both the CEDISC and the COINS are two valid and reliable scales to be used in studies examining the role of stigma and discrimination of people infected with SARS-CoV-2 and Covid-19 patients, and in research evaluating interventions designed to mitigate stigma in this population.
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10
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Bongfen MC, Torpey K, Ganle J, Ankomah A. Level of adherence and associated factors among HIV-positive adolescents on antiretroviral therapy in Cameroon. Afr J AIDS Res 2021; 19:269-275. [PMID: 33337976 DOI: 10.2989/16085906.2020.1833055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aim: Globally, there were over 250 000 new HIV infections among adolescents in 2017, with a higher proportion of these in sub-Saharan Africa. In Cameroon, UNICEF estimated over 4 200 new HIV infections in adolescents in 2015; by 2016, there were over 40 000 adolescents who had HIV. Given that the number of adolescents living with HIV in Cameroon is on the increase, there is a need to better understand the factors influencing adherence to treatment. The objective of this study was to assess the factors associated with adherence among adolescents in Cameroon. Methods: A cross-sectional study was conducted. A total of 460 HIV+ adolescents who were receiving antiretroviral therapy were sampled randomly from nine health facilities. Questionnaires and data extraction forms were used to collect data. Descriptive (frequencies and proportions) and inferential (chi-square and multivariate logistic regression) statistical analyses methods were used to analyse the data. Statistical significance was set at p = 0.05 and 95% confidence level. Results: The level of adherence to antiretroviral therapy among the adolescents was 83%. Twelve out of 30 independent variables examined showed significant statistical association with adherence at the bivariate level. In the multivariable logistic regression analyses, however, only two variables significantly predicted adherence - experiencing side effects (AOR = 2.63; 95% CI = 1.14, 6.09; p = 0.02), and internalized stigma (AOR = 2.51; 95% CI = 1.04, 6.04; p = 0.04). Conclusion: Adherence to treatment among adolescents in Cameroon was found to be suboptimal. There is a need for more individualized, targeted medication counselling for adolescents and their guardians as well as strategies to reduce internalized stigma and improve adherence to antiretroviral treatment.
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Affiliation(s)
- Mbuwir Charlotte Bongfen
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - John Ganle
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Abstract
Introduction: Stigma is widely recognised as a major barrier to recovery. In schizophrenia, internalised stigma (IS) strongly impacts self-esteem, but the mechanisms underlying this phenomenon remain poorly understood. In this study, we suggest that IS alters self-esteem by leading people to perceive their cognitive functioning as inefficient. We investigated whether off-line metacognitive complaints mediate the effect of IS on self-esteem in schizophrenia.Methods: We included 78 participants diagnosed with schizophrenia or schizoaffective disorder. IS was measured with the Internalised Stigma of Mental Illness scale, self-esteem by the Rosenberg Self-Esteem scale, and off-line metacognitive complaints with the Subjective Scale to Investigate Cognition in Schizophrenia.Results: Mediation analysis revealed that the effect of IS on self-esteem was mediated by off-line metacognitive complaints.Conclusion: Results suggest that IS reduces self-esteem by negatively impacting metacognition, such as perception of cognitive difficulties. We suggest that taking metacognition into account in the form of metacognitive complaints may be relevant in interventions aiming at reducing IS in psychosis.
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Affiliation(s)
- Louis Violeau
- Laboratory of Psychology EA 4139, University of Bordeaux, Bordeaux, France.,Adult Psychiatric Hospital of Jonzac, Jonzac, France
| | - Anthony Dudilot
- Laboratory of Psychology EA 4139, University of Bordeaux, Bordeaux, France
| | - Solenne Roux
- Laboratory of Psychology EA 4139, University of Bordeaux, Bordeaux, France
| | - Antoinette Prouteau
- Laboratory of Psychology EA 4139, University of Bordeaux, Bordeaux, France.,Adult Psychiatric Hospital of Jonzac, Jonzac, France
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McLeod B, Meyer D, Murray G, Foley F, Jones N, Thomas N. Contact with recovered peers: buffering disempowering service experiences and promoting personal recovery in serious mental illness. BJPsych Open 2019; 5:e98. [PMID: 31699177 PMCID: PMC6854358 DOI: 10.1192/bjo.2019.72] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Mental health patients can experience involuntary treatment as disempowering and stigmatising, and contact with recovered peers is cited as important for countering stigma and fostering agency and autonomy integral to recovery. AIMS To advance understanding of the interaction between involuntary treatment and contact with recovered peers, and explore hypothesised relationships to mechanisms of self-evaluation relevant to recovery. METHOD Eighty-nine adults diagnosed with serious mental illness completed items to assess involuntary treatment experience and the extent of prior contact with recovered peers, the Internalised Stigma of Mental Illness Scale, the Self-efficacy for Personal Recovery Scale, the Questionnaire about the Process of Recovery and relevant demographic and clinical scales. RESULTS Contact with recovered peers was found to moderate the effects of involuntary treatment on internalised stigma. Sequential conditional process models (i.e. moderated mediation) then demonstrated that conditional internalised stigma (i.e. moderated by contact with recovered peers) mediated the indirect effect of involuntary treatment on recovery-specific self-efficacy, which in turn influenced recovery. Compared with those with low contact with recovered peers, recovery scores were 3.54 points higher for those with high contact. CONCLUSIONS Although study methods limit causative conclusions, findings are consistent with proposals that contact with recovered peers may be helpful for this patient group, and suggest this may be particularly relevant for those with involuntary treatment experience. Directions for future research, to further clarify measurement and conceptual tensions relating to the study of (dis)empowering experiences in mental health services, are discussed in detail.
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Affiliation(s)
- Bronte McLeod
- Centre for Mental Health, Swinburne University of Technology, Australia
| | - Denny Meyer
- Professor of Statistics, Centre for Mental Health, Swinburne University of Technology, Australia
| | - Greg Murray
- Professor of Psychology, Centre for Mental Health, Swinburne University of Technology, Australia
| | - Fiona Foley
- Project Manager, Centre for Mental Health, Swinburne University of Technology, Australia
| | - Nev Jones
- Assistant Professor, Department of Psychiatry, University of South Florida, USA
| | - Neil Thomas
- Associate Professor of Psychology, Centre for Mental Health, Swinburne University of Technology;andThe Alfred Hospital, Australia
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Brener L, Broady T, Cama E, Hopwood M, de Wit JBF, Treloar C. The role of social support in moderating the relationship between HIV centrality, internalised stigma and psychological distress for people living with HIV. AIDS Care 2019; 32:850-857. [PMID: 31482729 DOI: 10.1080/09540121.2019.1659914] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Research has documented the negative impact of stigma on health outcomes for people living with HIV (PLHIV). How central HIV is to the identity of the individual may increase the negative effects of stigma, including greater psychological distress, while having strong social supports may play a buffering role. This study aimed to establish whether internalised stigma mediates the relationship between the centrality of HIV identity and psychological distress, while also assessing the role of social support as a moderator. PLHIV (n = 181) responded to a survey assessing experiences of living with HIV focussed on centrality of HIV identity, internalised stigma, and wellbeing. After controlling for age and education, findings from the mediation analysis show that the more central HIV is to an individual's identity, the more stigma is internalised and the greater the negative impact on psychological wellbeing. However, this is only the case for people with low levels of social support. Regardless of how central HIV is to identity, social support appears to act as a buffer and promote positive wellbeing. For those working with PLHIV, promoting the importance of good social support systems may be one way to address some of the negative impacts of stigma.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
| | - Timothy Broady
- Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
| | - Max Hopwood
- Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
| | - John B F de Wit
- Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
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14
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Abstract
BACKGROUND Medical pluralism is common place in sub-Saharan Africa. The South African pluralistic health care environment is varied and includes traditionalist beliefs relating to the efficacy of African traditional medicine. Prior research indicates that traditionalism is associated with delays in testing for HIV and treatment interruption. Despite numerous reports about this in South Africa, there is a paucity of documented strategies to counter this trend. OBJECTIVES To develop a strategy to reduce the impact of non-adherence to antiretroviral therapy among traditionalists in Waterberg district, Limpopo Province, South Africa. METHODS Qualitative information was elicited from five face-to-face, dual moderated, semi-structured homogenous group discussions. The groups comprised of 50 purposively selected, rurally based, mixed gender traditionalists living with HIV. Grounded theory was applied to analyse qualitative findings that emerged from the group discussions. FINDINGS Self-reported increases in adherence to anti-retroviral therapy and a reduction in internalised stigma by the respondents. Both are attributed by the respondents to disease causation differentiation from a traditional explanation to an allopathic explanation. CONCLUSION A nascent strategy has been developed which is contributing to improved adherence and a reduction in internalised stigma among traditionalists living with HIV in Waterberg district, South Africa.
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Affiliation(s)
- Christopher Burman
- University of Limpopo, Rural Development and Innovation Hub, affiliated to the Turfloop Graduate School of Leadership
| | - Marota Aphane
- University of Venda, Department of Research and Innovation
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15
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Crockett KB, Kalichman SC, Kalichman MO, Cruess DG, Katner HP. Experiences of HIV-related discrimination and consequences for internalised stigma, depression and alcohol use. Psychol Health 2019; 34:796-810. [PMID: 30773914 DOI: 10.1080/08870446.2019.1572143] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: HIV stigma undermines health and well-being of people living with HIV (PLWH). Conceptual work on stigma mechanisms suggests that experiences of stigma or discrimination increase internalised stigma. However, not all PLWH may internalise the HIV discrimination they experience. We aimed to investigate the role of stress associated with events of HIV-related discrimination on internalised HIV stigma, as well as the downstream effects on depressive symptoms and alcohol use severity. Design: 199 participants were recruited from an HIV clinic in the southeastern United States. Main study measures: HIV-related discrimination was assessed using items adapted from measures of enacted HIV stigma and discrimination. Participants rated perceived stress associated with each discrimination item. Internalised HIV stigma was assessed using the internalised stigma subscale of the HIV Stigma Mechanisms Scale. Depressive symptoms were assessed with the Centre for Epidemiological Studies-Depression Index. Alcohol use severity was assessed with the Alcohol Use Disorders Identification Test. Results: In serial mediation models, HIV-related discrimination was indirectly associated with both depressive symptoms and alcohol use severity through its associations with stress and internalised HIV stigma. Conclusions: Understanding the mechanisms through which PLWH internalise HIV stigma and lead to poor health outcomes can yield clinical foci for intervention.
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Affiliation(s)
- Kaylee B Crockett
- a Department of Psychology , University of Alabama at Birmingham College of Arts and Sciences , Birmingham , AL , USA.,b University of Connecticut , Storrs , CT , USA
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16
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Huggett C, Birtel MD, Awenat YF, Fleming P, Wilkes S, Williams S, Haddock G. A qualitative study: experiences of stigma by people with mental health problems. Psychol Psychother 2018; 91:380-397. [PMID: 29345416 DOI: 10.1111/papt.12167] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 12/02/2016] [Revised: 12/01/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Prior research has examined various components involved in the impact of public and internalized stigma on people with mental health problems. However, studies have not previously investigated the subjective experiences of mental health stigma by those affected in a non-statutory treatment-seeking population. DESIGN An in-depth qualitative study was conducted using thematic analysis to investigate the experiences of stigma in people with mental health problems. METHODS Eligible participants were recruited through a local mental health charity in the North West of England. The topic of stigma was examined using two focus groups of thirteen people with experience of mental health problems and stigma. RESULTS Two main themes and five subthemes were identified. Participants believed that (1) the 'hierarchy of labels' has a profound cyclical impact on several levels of society: people who experience mental health problems, their friends and family, and institutional stigma. Furthermore, participants suggested (2) ways in which they have developed psychological resilience towards mental health stigma. CONCLUSIONS It is essential to utilize the views and experiences gained in this study to aid understanding and, therefore, develop ways to reduce the negative impact of public and internal stigma. PRACTITIONER POINTS People referred to their mental health diagnosis as a label and associated that label with stigmatizing views. Promote awareness and develop improved strategies (e.g., training) to tackle the cyclical impact of the 'hierarchy of labels' on people with mental health problems, their friends and family, and institutional stigma. Ensure the implementation of clinical guidelines in providing peer support to help people to combat feeling stigmatized. Talking about mental health in psychological therapy or health care professional training helped people to take control and develop psychological resilience.
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Affiliation(s)
- Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.,Stockport and District Mind, UK
| | - Michèle D Birtel
- Department of Psychology, Social Work and Counselling, University of Greenwich, London, UK
| | - Yvonne F Awenat
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.,Stockport and District Mind, UK
| | - Paul Fleming
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Sophie Wilkes
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | | | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
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Abstract
OBJECTIVE People living with HIV (PLWH) commonly report sleep disturbances which are associated with long-term health consequences, including disease progression. PLWH also experience internalised stigma as a result of their HIV status, which can be associated with increased loneliness and depression. Little attention focuses on the impact of these factors on sleep. Therefore, we examined whether internalised HIV-stigma was indirectly related to poorer sleep quality through higher levels of loneliness and depressive symptoms. DESIGN 181 PLWH from across the United States completed an online survey. Main Study Measures: Internalised HIV-stigma was assessed using the HIV-Stigma Scale, loneliness was assessed using the UCLA-Loneliness Scale-Short Form, depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression Index, and Sleep Quality was assessed using the Pittsburgh Sleep Quality Index. RESULTS Internalised HIV-stigma was indirectly associated with poorer global sleep quality and daytime sleep dysfunction through both loneliness and depressive symptoms. CONCLUSIONS PLWH who experience HIV-related stigma may experience greater feelings of loneliness, which are related to increased depressive symptoms and poorer sleep quality. Interventions focused on improving sleep in PLWH should focus on multiple factors that influence sleep, including psychosocial factors such as stigma, social isolation and depressive symptoms.
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Affiliation(s)
- Erin M Fekete
- a School of Psychological Sciences , University of Indianapolis , Indianapolis , IN , USA
| | - Stacey L Williams
- b Department of Psychology , East Tennessee State University , Johnson City , TN , USA
| | - Matthew D Skinta
- c Pacific Graduate School of Psychology , Palo Alto University , Palo Alto , CA , USA
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Abstract
INTRODUCTION Persecutory delusions are a very common symptom in psychotic disorders and represent a considerable cost for both patients and for society. The way in which a person faces their psychotic disorder (i.e., recovery style) has impact on their recovery. The impact of coping style as a moderator in the course of their illness has not been studied sufficiently in persecutory delusions. In addition, internalised stigma is a common process in psychosis that not only might affect emotional distress, but might also shape recovery style. The goal of this study was to examine the moderator role of recovery style between internalised stigma and emotional distress in people with persecutory delusions. METHODS All 50 people with persecutory beliefs were assessed by the Recovery Style Questionnaire, the Beck Anxiety Inventory, Beck Depression Inventory, Second Edition, and Internalised Stigma of Mental Illness. RESULTS Moderation analysis showed that participants with a sealing-over recovery style had high levels of depression when they experienced internalised stigma and low levels of depression only when internalised stigma was low. However, participants with an integration recovery style presented similar levels of depression regardless of the level of their internalised stigma. CONCLUSIONS Findings suggest the moderator role of recovery style between internalised stigma and depression in people with persecutory delusions.
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Affiliation(s)
- Regina Espinosa
- a School of Psychology , Universidad Complutense de Madrid , Madrid , Spain.,b Deparment of Psychology , Universidad Camilo José Cela , Madrid , Spain
| | - Carmen Valiente
- a School of Psychology , Universidad Complutense de Madrid , Madrid , Spain
| | - Alina Rigabert
- c Unidad de Investigación del Distrito Sanitario de Atención Primaria Málaga-Guadalhorce , Málaga , Spain.,d Department of Psychology , Universidad Loyola Andalucía , Sevilla , Spain
| | - Hanna Song
- e The Wright Institute , Berkeley , CA , USA
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