Affiliate Stigma Research Articles

The Relationship between Affiliate Stigma in Parents of Children with Autism Spectrum Disorder and Their Children's Activity Participation.

Children with autism spectrum disorder (ASD) are reported to participate less in everyday activities, and their parents face stigma on account of having a child with ASD, which they often internalize as affiliate stigma. Studies have examined the impact of affiliate stigma on parents’ psychological well-being and social behaviors, but little is known about how affiliate stigma impacts their children’s activity participation. This study aimed to investigate the relationship between parents’ affiliate stigma and activity participation of their children with ASD. Sixty-three parents of children with ASD (aged 2–6 years) were recruited. They completed questionnaires, which captured affiliate stigma, their child’s participation (frequency and involvement) in home, preschool, and community activities, and demographic characteristics. Results indicated that these parents had a moderate level of affiliate stigma, which did not correlate with the frequency of their children’s participation in activities. However, the parents’ affiliate stigma was found to have negative impacts on their children’s involvement in overall community participation and participation in one particular activity at home. The findings highlight the importance of destigmatization of parents of children with ASD in order to promote their children’s participation in community activities.

Caregiver-Attributed Etiologies of Children's Attention-Deficit/Hyperactivity Disorder: A Study in Taiwan.

The aim of this survey study was to examine the etiologies of attention-deficit/hyperactivity disorder (ADHD) attributed by caregivers of Taiwanese children with ADHD, particularly factors affecting such attribution. This study had 400 caregivers of children with ADHD as participants. We examined the caregiver-attributed etiologies of ADHD and factors affecting such attribution. Caregivers completed the self-report questionnaire to rate how likely they perceived various etiologies of ADHD to be; the Affiliate Stigma Scale for the level of affiliate stigma; and the short Chinese version of the Swanson, Nolan, and Pelham, Version IV Scale for child’s ADHD and oppositional symptoms. Brain dysfunction (84.8%) was the most commonly attributed etiology, followed by failure of caregivers in disciplining the child (44.0%); a poor diet, such as a sugar-rich diet (40.8%); a poor living environment (38.8%); the child imitating their peers’ improper behavior (37.3%); failure of school staff in disciplining the child (29.0%); the education system’s overemphasis on academic performance (27.3%); and supernatural beings or divination-based reasons (3.8%). Caregivers’ affiliate stigma was significantly associated with the attribution of several nonbiological etiologies other than brain dysfunction. Caregivers’ education level and children’s sex, hyperactivity/impulsivity, and oppositional symptoms were significantly associated with various caregiver-attributed etiologies. Therefore, to deliver more accurate knowledge about ADHD in educational programs, health professionals should consider those etiologies that are attributed by caregivers of children with ADHD.

Application and Perceived Effectiveness of Complementary and Alternative Intervention Strategies for Attention-Deficit/Hyperactivity Disorder: Relationships with Affiliate Stigma

This cross-sectional questionnaire survey study was designed to examine the complementary and alternative intervention strategies (CAIS) employed by caregivers for their children’s attention-deficit/hyperactivity disorder (ADHD) and the associations of affiliate stigma with the employment and rated effectiveness of these strategies in Taiwan. A total of 400 caregivers of children with ADHD participated. CAIS that the caregivers employed and their effectiveness rated by the caregivers were surveyed. Associations of affiliate stigma with the application and rated effectiveness of the strategies were determined using logistic regression analysis. The results indicated that sensory integration (30.3%), exercise training (29.3%), sugar restriction (20.5%), and omega fatty acid supplementation (11.3%) were the most common CAIS that the caregivers employed. Caregivers with stronger affiliate stigma were more likely to employ sensory integration, exercise training, and omega fatty acid supplementation but also rated them as ineffective in treating their children’s ADHD. Various CAIS were employed by the caregivers to manage their children’s ADHD. Affiliate stigma was significantly associated with the application and rated ineffectiveness of several CAIS.

The influence of caregiver stress and affiliate stigma in community-based mental health care on family caregiver wellbeing

Previous studies have noted the inadequacies within Ghana’s mental health system. These studies highlighted challenges associated with caregiving before the passage of Ghana’s current Mental Health Act (Act 846) of 2012. Yet, there is paucity of research on the wellbeing of caregivers in community-based mental health care, following the passage of the Mental Health Act. This study investigated the influence of caregiver stress and affiliate stigma on family caregiver wellbeing. Further, it assessed the differences in stress, affiliate stigma, and wellbeing between community and institutional family caregiver groups in the Eastern Region of Ghana. Two hundred and eighty family caregivers of persons living with any type of mental illness were purposively sampled for the study. Results of Hierarchical Multiple Regression analysis showed that, caregiver stress negatively significantly influenced caregiver wellbeing. Moreover, results of a Multivariate Analysis of Covariance showed a significant difference between community and institutional family caregivers in the combined experience of stress, affiliate stigma and wellbeing, with community family caregivers scoring higher on wellbeing than did institutional family caregivers. Implications for caregiver interventions in the Eastern Region of Ghana are discussed.

Affiliate Stigma and Related Factors in Family Caregivers of Children with Attention-Deficit/Hyperactivity Disorder.

This cross-sectional questionnaire study examined factors related to affiliate stigma among caregivers of children with attention-deficit/hyperactivity disorder (ADHD) and the association of affiliate stigma with caregivers’ unfavorable attitude toward ADHD and moderators. The affiliate stigma of 400 caregivers of children with ADHD was assessed using the Affiliate Stigma Scale. Caregivers’ and children’s factors related to affiliate stigma were examined using multiple regression analysis. Associations of affiliate stigma with caregivers’ unfavorable attitudes toward children’s diagnoses, pharmacotherapy, behavioral therapy, and biological explanations of the etiologies of ADHD were examined using logistic regression analysis. Female caregivers and those caring for girls with ADHD had higher levels of affiliate stigma than did male caregivers and those caring for boys. Higher education levels in caregivers and more severe inattention symptoms in children were associated with higher levels of affiliate stigma. A higher level of affiliate stigma was also significantly associated with unfavorable attitudes toward children’s diagnoses, pharmacotherapy and behavioral therapy, and etiological explanations for ADHD. Multiple factors of caregivers and children were related to affiliate stigma in caregivers of children with ADHD. Affiliate stigma is significantly associated with caregivers’ unfavorable attitude toward ADHD.

FOSTERING COMPASSIONATE CARE FOR PERSONS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIAS

The aim of this study was to examine the impact of the implementation of a new Compassionate Care (CC) curriculum, designed by social workers, on the quality of care provided by Certified Nursing Assistants (CNAs) to residents with Alzheimer’s disease (AD). Additionally, the purpose was to create a collaborative network of CNAs that supported each other. The sample included residents and CNAs from an experimental nursing facility and a control nursing facility. At baseline and 12-weeks, data were collected on AD knowledge, self-efficacy, caregiving satisfaction, and affiliate stigma. CNA changes in terms of their knowledge of AD, self-efficacy, caregiving satisfaction and affiliate stigma were analyzed using a two-way mixed method MANOVA. The stress levels of the residents, specifically agitation and salivary cortisol levels, was examined by testing a hybrid multilevel growth model. The final models were able to show how the changes in the CNAs specifically affected these positive outcomes. CNA knowledge and self-efficacy had the most impact on changing agitation levels, and CNA knowledge and agitation levels had the most impact on salivary cortisol levels. The results of this study showed that integrating a compassionate care curriculum into the work that CNAs perform can lead to positive outcomes on knowledge, self-efficacy, caregiving satisfaction, affiliate stigma and a reduction of agitation and cortisol levels in persons with AD.

Affiliate Stigma and Psychosocial Adaption Among Adolescents Who Have a Parent With Serious Mental Illness: Mediation Role of Family Cohesion.

The current cross-sectional study examined the relationship between affiliate stigma and externalizing and internalizing problems by investigating the role of family cohesion among adolescents having a parent with serious mental illness (SMI). One hundred sixty-four adolescents were recruited from two community mental health centers. Family cohesion, affiliate stigma, and adolescent internalizing and externalizing problems were assessed. A significant relationship was found between adolescent externalizing and internalizing problems and family cohesion (r = -0.462, p < 0.01 and r = -0.534, p < 0.001, respectively) and affiliate stigma (r = 0.512, p < 0.01 and r = 0.656, p < 0.001, respectively). Family cohesion partially mediated the relation between affiliate stigma and externalizing problems (Z = -4.97, p < 0.001) and fully mediated the relation between affiliate stigma and internalizing problems (Z = -5.18, p < 0.001). The current study highlights the need for effective interventions aimed at families to support parents with SMI in their parenting role and enhance family cohesion. [Journal of Psychosocial Nursing and Mental Health Services, 57(12), 39-47.].

Effects of biogenetic beliefs for schizophrenia on potential caregivers in China: Exploring the role of affiliate stigma.

Schizophrenia affects more than eight million people in China. Stigmatization of schizophrenia may prevent family members and close others from providing social support to those with schizophrenia. This article aims to investigate the potential use of a biogenetic approach to reduce the stigma of schizophrenia using a cross-sectional (study 1, n=141) and an experimental design (study 2, n=100) in China. In the first study, mediation analysis reveals that perceived affiliate stigma, the negative prejudice, and discrimination towards family members of individuals with socially stigmatized identities due to their affiliation with the person mediates the path between biogenetic beliefs and desire for social distance. This pattern is replicated in study 2 in which two 10-min lectures were created and used to influence participants' beliefs in biogenetic causes of schizophrenia. Findings suggest that the biogenetic approach may increase Chinese participants' desired social distance towards their family members with schizophrenia through increasing their concerns about the negative consequences of being affiliated with the family member. Therefore, future research should investigate aspects of biogenetic anti-stigma campaigns that do not increase participants' perception of affiliate stigma in China.

Stigma among parents of children with autism: A literature review.

This literature review aims to summarize current findings from studies examined experiences of stigma among parents of children with autism. A systematic literature search was carried out to identify relevant studies. Two reviewers independently screened each records based on the selection criteria. Discrepancies were resolved through discussions. Included articles were classified by social-cultural settings. 25 studies were identified and included in the review, including 15 qualitative, 8 quantitative, and 2 mixed method studies. Parents do in fact experience courtesy stigma which subsequently develop into affiliate stigma. The study of stigma has not received enough attention for parents of children with autism. There lacked large prevalence studies and longitudinal studies examining stigma among parents of children with autism. Parents of children with autism perceived and experienced stigma and various consequences which were varied with behaviors of autism and the severity of symptoms. Further studies should focus on developing intervention that help to erase stigma among parents of children with autism.

Self-Compassion: a Protective Factor for Parents of Children with Autism Spectrum Disorder

Parents of children with autism spectrum disorder (ASD) face many unique challenges and experience higher parenting stress than other parenting groups. These parents also experience internalised stigma by association with their ASD affected child, known as affiliate stigma. These factors predict greater psychological distress and subsequently decreased well-being for parents. Recent evidence has suggested that the psychological construct of self-compassion may act as a protective factor against stigma, as well as positively influencing the experiences of parents. An online survey was conducted with parents of children with ASD (N = 237), administering standardised measures to investigate levels of stigma and self-compassion, as well as psychological outcomes. Self-compassion was positively correlated with subjective well-being and negatively correlated with psychological distress and parenting stress. Hierarchical multiple regression controlled for background factors, known predictors (child symptom severity and social support), and various aspects of stigma. Self-compassion and affiliate stigma significantly added to explained variance as a predictor of well-being, psychological distress, and parenting stress. Self-compassion was found to predict psychological well-being, lower distress, and lower parenting stress. If self-compassion is found to be causally related to these outcomes, interventions aimed at cultivating self-compassion and decreasing affiliate stigma may have benefits for parents of children with ASD.

Affiliate stigma, perceived social support and perceived stress in caregivers of children with autism spectrum disorder: A multiple mediation study

BackgroundAffiliate stigma negatively predicts social support, and positively predicts psychological distress, in caregivers of children with ASD. Whether the affiliate stigma-distress relationship occurs indirectly via social support however has not been explored. MethodsA correlational design was used. A sample of n = 124 caregivers of children with ASD completed an online survey assessing affiliate stigma, perceived support from family, friends and significant others, and perceived stress. ResultsThe relationship between greater affiliate stigma and increased perceived stress occurred indirectly via lower perceived support from family, but not from friends or significant others. ConclusionsThese findings underscore the importance of increasing caregivers' perceived family support. Whether interventions that alleviate affiliate stigma are beneficial for reducing perceived stress, and whether this effect is mediated by increased perceived availability of support, might be the subject of future research.

Role of Mindful Parenting, Affiliate Stigma, and Parents’ Well-being in the Behavioral Adjustment of Children with Autism Spectrum Disorder: Testing Parenting Stress as a Mediator

The present study aimed to elucidate the mediating vs. moderating role of parenting stress between parents’ characteristics, including parents’ disposition to mindful parenting, affiliate stigma, and mental well-being, and the behavioral adjustment of children with autism spectrum disorder (ASD). A total of 136 Chinese parents of children with ASD under 18 years of age participated in this cross-sectional study. Mediation findings showed that parenting stress mediated the relation between parents’ characteristics (i.e., parents’ disposition to mindful parenting and affiliated stigma) and behavioral difficulties in children with ASD. While parents’ mental well-being did not explain the variability of parenting stress, parenting stress undermined mental well-being. Parents’ mental well-being was also related to children’s prosocial behaviors. However, their mental well-being did not mediate between parenting stress and children’s prosocial behaviors. Competing test of parenting stress as a moderator did not yield significant findings. These findings inform applied intervention efforts to promote parents’ mindful parenting and mental well-being as resources that generate multiple outcomes in children with ASD. Relatedly, the present research suggests the importance of combating stigma in reducing parents’ stress and children’s behavioral difficulties.

Affiliate stigma among parents of children with autism in eastern India.

Parents of children with autism experience high levels of stigma. They often internalize stigma which results in high psychological distress and has negative impact on seeking and providing care. Qualitative methodology has been used to study stigma in Indian population while quantitative studies have not been reported. The authors report affiliate stigma perception among parents of children with autism in a tertiary care medical centre using Affiliate Stigma Scale. Thirty-eight parents participated in this cross- sectional study. We discuss predictors of stigma in terms of caregiver characteristics and symptom profile. Identification of predictors of stigma perception can help in identifying populations at risk.

Affiliate Stigma and Compassion Satisfaction Amongst Mental Health Service Providers at A Regional Psychiatric Hospital in Nigeria

Objective Just like their patients, mental health service providers also face stigma. Internalisation of these negative stereotypes could lead to the development of affiliate stigma, reduce their compassion satisfactionand reduce their effectiveness in delivering quality health care to their patients. This study investigated the relationships between affiliate stigma and compassion satisfaction in frontline mental health service providers in a mental health facility in Nigeria. Method This was a cross-sectional study which recruited 183 mental health service providers working in a mental health facility in Nigeria, and who completed questionnaires on affiliate stigma and compassion satisfaction. Results Affiliate stigma among mental health service providers in this study was relatively high (41.5%), and psychiatrists were significantly more likely A to report higher levels of affiliate stigma compared to the psychiatric nurses (p=0.03, OR=0.38,95% CI=0.15 – 0.94). Psychiatrists and Psychiatric nurses who worked for longer hours (&gt; 42 hours per week) reported significantly lower Affiliate stigma (t=2.148, df=28, p=0.04; t=2.118, df=135, p=0.04 respectively). Psychiatrists with high levels of affiliate stigma were more likely to have lower compassion satisfaction, but this was not true of Psychiatric nurses. Mental health service providers who endorse the psychosocial aetiology of mental illness, are significantly more likely to report having experienced high affiliate stigma (F=3.980, df=2, p=0.03). Conclusion The levels of affiliate stigma among mental health service providers in this study was relatively high, particularly among the professional group of psychiatrists. There is an urgent need to address internalization of negative stereotypes among mental health service providers in order to prevent experiences of discrimination among their patients.

Community-Based Mental Health Care: Stigma and Coping Strategies Among Professionals and Family Caregivers in the Eastern Region of Ghana

To a large extent caregivers perceive stigma through their social and community interactions by virtue of their association with persons with mental health problems. Meanwhile, evidence on their strategies for coping with potentially undesirable experiences linked with stigma is limited. Using a descriptive qualitative approach, the present study explored affiliate stigma among mental health professionals and family caregivers of persons with mental illness. Data, collected through one-on-one interviews with 10 mental health professionals and 10 family caregivers, were examined with content analysis. Findings revealed that, although stigma attached to mental illness was largely directed at sufferers and family caregivers, professionals sometimes had their fair share. To manage the negative impact of stigma, caregivers adopted various strategies including the use of realisation, tactical or planned ignoring, self-motivation, acceptance and religion. Implications of the findings necessitate the intensification of mental health education among the general populace, which must be targeted at demystifying mental illness.

Who internalizes courtesy stigma and how? A study among Israeli Arab family caregivers of persons with dementia

Objectives: The expected rise in the number of persons with dementia is accompanied by an increasing interest in understanding and reducing the stigmatic beliefs experienced by family caregivers of persons with the disease. While researchers have recently distinguished between family caregivers’ perceptions of public stereotypes (i.e., courtesy stigma) and the internalization of these perceptions (i.e., affiliate stigma), no study has yet assessed the characteristics of dementia caregivers who internalize courtesy stigma and how they do so. The aim of this study was to examine the characteristics of family caregivers of persons with dementia who internalize courtesy stigma, and to investigate this internalization process.Method: Structured face-to-face interviews were conducted with 175 Israeli Arab family caregivers (87.4% female; 71.4% adult children; mean age = 54.28) for persons with Alzheimer’s disease.Results: Overall, half of the participants reported experiencing affiliate stigma as a result of taking care of a relative with dementia. Regression analyses showed that lower educational level, increased courtesy stigma and lower levels of social support were the main predictors of affiliate stigma. Social support partially mediated the association between courtesy and affiliate stigma.Conclusion: Our findings provide important insights for the conceptual understanding and the development of interventions to reduce stigma among family caregivers of persons with dementia.

A Persian version of the Affiliate Stigma Scale in caregivers of people with dementia

Background: Dementia is prevalent among older adults and frequently causes dependence on family caregivers. Caregivers may experience a form of stigmatization called affiliate stigma that negatively affects their mental health. The current study sought to establish the psychometric properties of a tool to measure affiliate stigma among Iranian caregivers. Methods: Overall, 541 caregivers of older people with dementia were included in this cross sectional study. Several measures were used to assess the psychometric properties of the Affiliate Stigma Scale (ASS) including the Zarit Burden Interview (ZBI), Hospital Anxiety and Depression Scale (HADS), Short Form 12 (SF-12), Rosenberg Self-Esteem Scale (RSES), and Multidimensional Scale of Perceived Social Support (MSPSS). Convergent and discriminate validity were examined.Exploratory and confirmatory factor analyses were utilized to assess the factor structure of the Ass and a Rasch model was used to evaluate the measurement functioning of the scale. Results: Factor loadings ranged from 0.69 to 0.83 and test-retest reliability from 0.72 to 0.89.Item difficulty ranged widely from -0.66 to 0.89. No considerable differential item functioning (DIF) was found across gender. Confirmatory factor analysis confirmed the three cognitive,effective, and behavioral dimensions of the scale (comparative fit index [CFI]=0.931 to 0.995,root mean square error of approximation [RMSEA]=0.046 to 0.068). Internal consistency was acceptable (Cronbach’s α: 0.88 to 0.94). Significant and positive relationships were found between affiliate stigma and depression, anxiety, and care giving burden (β =0.35 to 0.46). Conclusion: The ASS is a psychometrically valid measure for assessing affiliate stigma in Iranian caregivers of people with dementia. Application of this tool among other caregivers, language sand cultures deserves further study.

Correlates of affiliate stigma among family caregivers of people with mental illness: A systematic review and meta-analysis.

WHAT IS KNOWN ON THE SUBJECT?: A growing body of qualitative and quantitative research has investigated the experiences of affiliated stigma for family members of PWMI. Some findings are contradictory and have not been considered systematically. WHAT DOES THE PAPER ADDS TO EXISTING KNOWLEDGE?: Family caregivers of PWMI may encounter affiliate stigma, but no systematic review or meta-analysis has been conducted to evaluate affiliate stigma among them. We identified eight variables significantly related to affiliate stigma among caregivers of PWMI. The findings can be used to help clinical practice to develop health promotion and prevention strategies. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Affiliate stigma was prevalent among the family caregivers of PWMI and is important for clinicians to consider. Health-focused interventions for family caregivers can mediate the impact of affiliated stigma through provision of social support by practitioners, such as respite care based on the "Senses Framework," self-help groups and online support program. And the caregivers of PWMI might benefit from further support (e.g., psychoeducation) to improve their knowledge about mental illness. ABSTRACT: Introduction Many studies have investigated the correlates of affiliate stigma among family caregivers of people with mental illness (PWMI). Thus far, no systematic review or meta-analysis has been conducted to synthesize these results. Aims/Question This review aims to identify the correlates of affiliate stigma among family caregivers of PWMI. Method We searched four databases including PubMed, PsycINFO, EMBASE and Web of Science for studies that investigated the association of affiliate sigma with socio-demographic, psychosocial and disease-related factors. Results Twenty-two studies including 3,381 participants met the inclusion criteria. Eighteen variables were included for the meta-analysis. For disease-related characteristics, only "disease attribution" and "care time/day" were associated with affiliate stigma. For psychosocial characteristics, "support from others," "burden," "depression," "stress," "distress" and "face concern" were related to affiliate stigma. Discussion This review is the first to assess the association of affiliate stigma with other characteristics of interest. However, the findings are limited due to a very small number of studies. Researchers should conduct in-depth study in this area and improve the quality of the literature. Implications for practice Health-focused interventions for family caregivers such as respite care, self-help groups, online support program and psychosocial education can mediate the impact of affiliated stigma.

The role of mothers’ affiliate stigma and child’s symptoms on the distress of mothers with ADHD children

Background: Mothers of ADHD children often display high levels of distress. Understanding the origin of such distress in a view to reducing it is an essential part of the clinical management of ADHD children. Studies have shown that children’s symptoms are linked to mothers’ stigma and that such stigma can cause mothers’ distress. However, no study has explored the links between symptoms, stigma and distress.Aim: We tested (1) whether children’s symptoms are sources of affiliate stigma, which in turn contributes to generating mothers’ distress and (2) whether such relationship is stronger in mothers of male ADHD children.Method: 159 French mothers of an ADHD child were recruited. Four indices were used to assess mothers’ distress: anxiety, depression, self-esteem and life satisfaction. Children’s ADHD symptoms and mothers’ affiliate stigma were also measured and contrasted with distress.Results: Mothers’ distress was positively related with both affiliate stigma and children’s ADHD symptoms, but this was only true in mothers of male ADHD children. The relationship between children’s symptoms and mothers’ distress was mediated by affiliate stigma.Conclusions: Psychosocial interventions in mothers of ADHD children must integrate affiliate stigma and should be adjusted according to child’s gender.

Caregivers’ characteristics and family constellation variables as predictors of affiliate stigma in caregivers of children with ASD

Affiliate stigma is one risk factor for psychological distress in familial caregivers. Few studies however, and none involving caregivers in the UK and US, have explored caregivers’ characteristics and family constellation variables as risk and protective factors for affiliate stigma. This study aimed to fill this gap. Moreover, we believe this study is only second to explore these relationships among caregivers of children with autism spectrum disorder (ASD), a group particularly vulnerable to affiliate stigma. A sample of n = 192 caregivers of children with ASD completed an online survey assessing caregivers’ characteristics and family factors, and affiliate stigma. Non-partnered caregivers were more likely to report affiliate stigma, as were caregivers with shorter sleep duration. These findings might help clinicians and other health professionals identify caregivers at risk for affiliate stigma and concomitant psychological distress.