Anti-stigma Strategies Research Articles

Conceptualizing and Developing a Dynamic Stigma Theory

Stigma is a form of injustice that contributes to the worsening course of the symptoms associated with mental health problems. The paper discusses the conceptualization and development of a contemporary theoretical model of stigma. Building on the findings of an initial scoping review, the author developed a theoretical model after thoroughly analyzing and redefining the key concepts of interest. This article proposes that stigmatized individuals are impacted by the religiocultural and structural violence perspectives embedded within social spaces, leading to stigma perception appraisal and subsequent coping mechanisms, which could be adaptive or maladaptive. Current models of mental illness stigma have gaps. It is time to relook at existing stigma frameworks and fill these gaps that have existed for many years for effective anti-stigma strategies.

Awareness, attitudes, and beliefs of dementia in Indonesia.

Tackling dementia stigma is a policy priority. In Indonesia, we have little insight into the general public's knowledge and attitudes about dementia. Cross-sectional study of 4430 Indonesian adults recruited from Jakarta and North Sumatra, Indonesia. Measures included dementia knowledge and attitudes. A total of 86.3% (n=3,803) of adults had not heard of the terms dementia or Alzheimer's disease, and commonly viewed dementia as a normal part of aging. Being older, incorrect knowledge about etiology, not having heard of the terms dementia and/or Alzheimer's disease, having less than primary education, and being from North Sumatra were associated with more negative attitudes (p-values<0.05). Misconceptions and lack of awareness about dementia are common in Indonesia. Attitudes tended not to be negative, but our research highlights factors associated with dementia attitudes. Future research should use this information to better tailor and target potential anti-stigma strategies. Most Indonesians had not heard of the terms dementia and/or Alzheimer's disease and thought it was caused by normal aging.The majority of participants held mixed or positive attitudes towards dementia.A series of demographic factors alongside poor awareness were associated with negative attitudes towards dementia.

Perceptions of community mental health services among culturally diverse adult Singaporeans with major depressive disorder: A descriptive qualitative study.

Persons with major depressive disorder (PMDDs) often experience pernicious ramifications on the biopsychosocial aspects of their health. While community mental health services (CMHSs) in Singapore are increasingly leveraged to meet the escalating demand for mental healthcare, shortcomings such as a substantial treatment gap and the lack of holistic, culturally sensitive care have been highlighted. Of note, the perspectives of the service users, which have hardly been studied in the literature, are crucial to our understanding of their needs to continuously improve CMHSs. Accordingly, this qualitative descriptive study explored the perceptions and experiences of community-dwelling adults with major depressive disorder in their use of CMHSs in Singapore. Seventeen adults with major depressive disorder purposefully sampled from a CMHS providerwereinterviewed through a semi-structured guide between October and November 2021. Data analysis via Braun and Clarke's six-step thematic framework yielded five themes corresponding to three different phases: pre-CMHS encounter ((i) procrastination to seek help and (ii) factors influencing CMHS utilization); intra-CMHS encounter ((iii) incongruous perceptions of the impacts on biopsychosocial health and (iv) differing perceptions and experiences of culturally sensitive care); and post-CMHS encounter ((v) enhancing CMHSs for PMDDs based on end-users' experiences). Our findings underscore the need to improve the delivery of personalized mental healthcare services, use of settings- and culturally-specific anti-stigma strategies, and nationwide mental health literacy in symptom recognition and awareness of help-seeking resources.

Counteracting Stigma-Power: An Ethnographic Case Study of an Independent Community Food Hub

The need for emergency food aid is increasing across the United Kingdom (UK). Prior to the COVID-19 pandemic, an estimated 2.5% of UK households accessed food banks. As of June 2022, 15% of households were using food banks, and emerging evidence suggested increased stigma, shame and embarrassment associated with food aid use, food poverty, and food insecurity. This ethnographic study explored food aid user experiences of stigma-power, and antistigma strategies utilized by both food aid users and volunteers, at one North East of England Independent Community Food Hub (ICFH) during the COVID-19 pandemic. Findings revealed that stigma-power and the negative dominant narrative adversely affected food aid users, who created stigma avoidance techniques to reduce the perceived stigma of food bank usage. Findings also showed ways in which the ICFH implemented numerous antistigma strategies to reduce the stigma, shame, and embarrassment felt by food aid users.

Peer stigma, consequences, and anti-stigma strategies in adolescents with mental disorders: a qualitative investigation

PurposeThis paper aims to investigate the local perspectives, based on culture and beliefs about peer stigma, consequences and strategies to reduce mental health stigma among adolescents in Indonesia.Design/methodology/approachThis study included 30 participants, including students, teachers, health professionals and lecturers. Two sessions of focus group discussions and 14 sessions of in-depth interviews were performed to collect the data. A qualitative content analysis was carried out, and some related themes and sub-themes were explored.FindingsThis study found that peer stigma was prevalent and negatively impacted the psychological, social and intellectual development of adolescents with mental disorders (MD) in Indonesian society. Five strategies to tackle peer stigma were proposed, including increasing mental health literacy (MHL), reducing the harmful effects of stigma, fostering a supportive social environment, expanding access to and improving the quality of mental health care and advocating for public health policies.Research limitations/implicationsMore qualitative research on the experiences and perspectives of victims, perpetrators and society concerning mental health stigma in adolescents is required to fully understand why stigma arises, what causative factors and repercussions it has, as well as how to deal with it.Practical implicationsPeer stigma still exists among adolescents. It has negative impacts on their mental and psychological well-being. MHL, social environment, the harmful effects of stigma, as well as mental health access and policy were concerns of this study. A school is a place where adolescents spend most of their social time. Schools play a vital part in the stigma-reduction program.Originality/valueMental health stigma among adolescents with MD is an issue that has potentially hindered mental health recovery. Anti-stigma intervention based on local perspectives is valuable in increasing the effectiveness and acceptance of interventions.

The “goldfish bowl”: a qualitative study of the effects of heightened surveillance on people who use drugs in a rural and coastal Canadian setting

BackgroundA growing body of research has focused on contextual factors that shape health and well-being of people who use drugs (PWUD). However, most of this research focuses on large cities and less is known about the effects of social and structural contexts on drug use and associated risks in rural Canadian settings. Therefore, we undertook this study to examine rural-specific contextual factors that affect the day-to-day experiences of PWUD.MethodsTwenty-seven qualitative semi-structured interviews were conducted with PWUD in a rural and coastal setting in British Columbia, Canada. Participants had to be ≥ 19 years old, used illegal opioids and/or stimulants regularly, and lived in the qathet region. Interview transcripts were coded based on themes identified by the research team.ResultsParticipants described progressive shifts in politics and culture in the qathet region while also identifying resource scarcity, homelessness, and changes in the drug supply, where illicit drug contents have become highly toxic and unpredictable. Participants discussed the qualities of a small community where everyone knows each other and there is a lack of privacy and confidentiality around drug use, which resulted in experiences of stigma, discrimination, and surveillance. Participants also reported rural-specific policing issues and experiences of surveillance on ferries when traveling to larger cities to purchase drugs. This led to significantly higher drug prices for PWUD due to the time dedication and criminalized risks associated with drug possession and trafficking.ConclusionsOur findings illustrate the unique experiences faced by PWUD in a rural and coastal setting. The “goldfish bowl” effect in this rural community created heightened social and structural surveillance of PWUD, which led to a variety of negative consequences. There is a clear need for interventions to address the larger contextual drivers affecting people who use drugs in rural settings, including decriminalization and peer-led anti-stigma strategies, in order to improve the lives of PWUD.

Exploring the strategies to overcome diabetes-related stigma in patients’ family: A qualitative study

Introduction: Asian countries, including Iran, experience diabetes-related stigma. Since a stigma-free identity is necessary for optimal diabetes management, the necessity of efforts to reduce diabetes-related stigma has been emphasized. This study aimed to explore the strategies to overcome diabetes-related stigma at the family level in Iran. Methods: Seventy-four volunteered people (people with diabetes, family members, non-diabetic people, and healthcare personnel) participated in a qualitative content analysis study to extract the anti-stigma strategies. Data collection was done until data saturation through unstructured in-depth face-to-face interviews, focus groups, Email, short message service (SMS), and telephone interviews. All audio-recorded and transcribed verbatim data were analyzed using the conventional content analysis approach. Results: Participants were raised "empowering families of people with diabetes" that would be possible through "family education" and "family-group formation". Educating families about "stigmatizing behavior", "coping skills", "accepting the person with diabetes as the main responsible person for disease control", and "diabetes" is necessary to help families by creating a free-stigma atmosphere. All the training could be programmed in peer groups of families to facilitate goal achievement. Conclusion: Some obtained strategies have been suggested for other stigmatizing conditions like tuberculosis or mental health. However, it must be noticed that every condition is specific and also each stigmatized person is unique and is affected by complex factors. So it is impossible to develop generic stigma reduction interventions for all health conditions. Most studies on stigma have considered families a part of society and have proposed general strategies for them.

Charting an Alternative Course for Mental Health-Related Anti-Stigma Social and Behaviour Change Programmes.

Mental health-related anti-stigma strategies are premised on the assumption that stigma is sustained by the public’s deficiencies in abstract professional knowledge. In this paper, we critically assess this proposition and suggest new directions for research. Our analysis draws on three data sets: news reports (N = 529); focus groups (N = 20); interviews (N = 19). In each social context, we explored representations of mental health and illness in relation to students’ shared living arrangements, a key group indicated for mental health-related anti-stigma efforts. We analysed the data using term-frequency inverse-document frequency (TF-IDF) models. Possible meanings indicated by TF-IDF modelling were interpreted using deep qualitative readings of verbatim quotations, as is standard in corpus-based research approaches to health and illness. These results evidence the flawed basis of dominant mental health-related anti-stigma campaigns. In contrast to deficiency models, we found that the public made sense of mental health and illness using dynamic and static epistemologies and often referenced professionalised understandings. Furthermore, rather than holding knowledge in the abstract, we also found public understanding to be functional to the social context. In addition, rather than being agnostic about mental health-related knowledge, we found public understandings are motivated by group-based identity-related concerns. We will argue that we need to develop alternative anti-stigma strategies rooted in the public’s multiple contextualised sense-making strategies and highlight the potential of engaging with ecological approaches to stigma.

A situational analysis of primary health care centers in Brazil: challenges and opportunities for addressing mental illness and substance use-related stigma.

The detrimental impact of stigma toward people with mental illness and substance use problems (MISUP) is well documented. However, studies focusing on stigma reduction in Latin American primary health care (PHC) contexts are limited. This situational analysis incorporating a socioecological framework aims to provide a comprehensive understanding of MISUP-related stigma in PHC centers in Brazil. The objectives of this analysis are twofold: (1) to understand the current mental health and substance use service delivery context and (2) identify challenges and opportunities for addressing MISUP-related stigma in PHC centers in Ribeirão Preto, Brazil. Environmental scans of four Family Health Units were conducted in early 2018 to explore population needs and service delivery for individuals with MISUP. In addition, a symposium was organized in October 2018 to consult with diverse stakeholders and gather local perspectives about MISUP-related stigma conveyed in PHC settings. NVivo 12 software was used to conduct a thematic analysis of the qualitative data collected from the environmental scans and the symposium consultation. Themes identified at the national level in the socioecological framework indicate that political support for national policies related to reducing stigma is limited, particularly regarding social inclusion and the decentralization of mental health services. Themes at the regional, organizational, and interpersonal levels include insufficient mental health expertise and the limited involvement of those with lived experience in decision-making. Suggestions for stigma interventions were provided, including increased contact with individuals with lived experience outside of client-patient interactions, capacity building for professionals, and public education campaigns. Increased government support, capacity building, and promoting social inclusion will provide opportunities to reduce stigma and reach marginalized populations. These findings will assist with addressing current gaps in PHC mental health service provision and may inform anti-stigma strategies for Brazil and other Latin American low- and middle-income countries.

Stigma and Adults with Tourette’s Syndrome: “Never Laugh at Other People’s Disabilities, Unless they have Tourette’s—Because How Can You Not?”

Tourette’s syndrome (TS) is a condition that has been stigmatised and mocked in contemporary society, yet little is known about the subjective experience of those directly affected by it. Guided by Public and Patient Involvement (PPI) a mixed method design was used for this study to explore the experience of stigma in adults living with TS in the UK. A total of one hundred and ninety-nine adults participated in a cross-sectional online survey using an adapted version of the Discrimination and Stigma Scale (DISC-12) and the Perceived Quality of Life (PQoL) scale, twenty of whom were also interviewed using a semi-structured interview schedule. Quantitative findings indicated that participants experienced discrimination in numerous life domains; most prominently in education (75.4%), social life (71.4%), public transport (60.8%) and employment (54.3.%). The PQoL of adults with Tourette’s was found to be negatively correlated with both Enacted and Anticipated Discrimination from the DISC-12 scale. Qualitative findings illustrated the pervasive nature of TS stigma, which expanded beyond micro-interactions, and which could be observed at a structural level. The peculiar impact of disparagement humour in the construction and promulgation of “othering” individuals with TS was also highlighted. Concealment and self-stigma were mechanisms commonly utilised by individuals to manage their “spoiled identity”, inhibiting active and collective responses to stigmatisation. The study highlights how TS stigma acts as a barrier to social and economic participation for adults with the condition and helps identify factors that need to be considered when developing anti-stigma strategies.

Correlates and predictors of perceived stigma and self-stigma in Chinese patients with psychosis.

In patients with psychosis, perceived stigma (i.e., beliefs about discriminative viewpoints held by the public) and self-stigma (i.e., internalization of such perceived stereotypes) could have devastating consequences. Knowledge about their correlates bears importance for understanding individual differences in stigma experiences, and further, given the social nature of stigma, Asians may show more distinctive features than Westerners. A total of 142 Chinese patients who originally enrolled into a randomized controlled trial during their first-episode psychosis were followed up at 10 years. We explored potential demographics, clinical and psychosocial correlates of perceived stigma and self-stigma. Stepwise multiple regression analyses indicated that both perceived- and self-stigma were predicted by a more negative attitude to treatment, whereas differential factors including perceived recovery predicted perceived stigma, and quality of life and attention predicted self-stigma. These results can help identify individuals susceptible to experiencing perceived- or self-stigma, highlighting the need to consider factors such as attitude towards treatment when designing anti-stigma strategies.

Social Contact: Next Steps in an Effective Strategy to Mitigate the Stigma of Mental Illness

People living with mental illnesses and their families may conceal their conditions to avoid prejudice and discrimination. Stigma often prevents people from receiving adequate health care and other social support services which could exacerbate social and health consequences such as unemployment, homelessness, substance use, and compulsory hospitalization. In this paper, we discuss social contact as a promising anti-stigma strategy for enhancing social interactions among people with mental illnesses, their families, and those without mental illnesses. In particularly, we consider next steps for an approach that works to reduce the stigma-related burden of mental illness. For social contact to be effective in reducing mental illness stigma, it requires broad social buy-in as well as implementation within care systems. Engagement with this approach can be driven through diverse contact-based education using collaborative efforts of society, academic institutions, policy-makers, health professionals, media, and governments. Ultimately, this work aims to consider the next steps in enacting social contact as an anti-stigma strategy through direct interventions and contact-based education. The success of this approach requires pragmatic public policies to support its implementation.

Stigmatization from Work-Related COVID-19 Exposure: A Systematic Review with Meta-Analysis.

Stigmatization from work-related COVID-19 exposure has not been investigated in detail yet. Therefore, we systematically searched three databases: Medline, Embase, and PsychInfo (until October 2020), and performed a grey literature search (until February 2021). We identified 46 suitable articles from 24 quantitative and 11 qualitative studies, 6 systematic reviews, 3 study protocols and 1 intervention. The assessment of stigmatization varied widely, ranging from a single-item question to a 22-item questionnaire. Studies mostly considered perceived self-stigma (27 of 35 original studies) in healthcare workers (HCWs) or hospital-related jobs (29 of 35). All articles reported on stigmatization as a result of work-related COVID-19 exposure. However, most quantitative studies were characterized by convenience sampling (17 of 24), and all studies—also those with an adequate sampling design—were considered of low methodological quality. Therefore, it is not possible to determine prevalence of stigmatization in defined occupational groups. Nevertheless, the work-related stigmatization of occupational groups with or without suspected contact to COVID-19 is a relevant problem and increases the risk for depression (odds ratio (OR) = 1.74; 95% confidence interval CI 1.29–2.36) and anxiety (OR = 1.75; 95% CI 1.29–2.37). For promoting workers’ health, anti-stigma strategies and support should be implemented in the workplace.

Challenging stigma attached to mental disorders: A psychosocial perspective

Stigma attached to mental disorders represent one of the main obstacles to patients’ full recovery and empowerment. In the last decades, many anti-stigma programmes have been implemented worldwide, but stigma still represents a major obstacle for people with severe mental disorders, their family members, friends and also healthcare professionals. Stigma is a complex social phenomenon, which entails a lack of knowledge, discriminating attitudes and excluding behaviours in the general population, which deserves a multi-level approach. In particular, anti-stigma strategies combining the three most common approaches, including contact, education, and organization of protest activity, are the most effective. Interventions should contain age-appropriate information and should be provided at an early age (e.g., in schools). Interdisciplinary approaches are recommended. In particular, contact strategies are important to reduce prejudice and change attitudes towards people with mental disorders and may be implemented either by video (interviews/personal testimonies), but ideally in person with affected individuals, reporting their real life experiences. In this workshop, the role of advocacy associations together with all stakeholders of mental health will be discussed in the process of fighting stigma according to a psychosocial perspective.DisclosureNo significant relationships.

Stigma for common mental disorders in racial minorities and majorities a systematic review and meta-analysis

BackgroundThere is a strong stigma attached to mental disorders preventing those affected from getting psychological help. The consequences of stigma are worse for racial and/or ethnic minorities compared to racial and/or ethnic majorities since the former often experience other social adversities such as poverty and discrimination within policies and institutions. This is the first systematic review and meta-analysis summarizing the evidence on the impact of differences in mental illness stigma between racial minorities and majorities.MethodsThis systematic review and meta-analysis included cross-sectional studies comparing mental illness stigma between racial minorities and majorities. Systematic searches were conducted in the bibliographic databases of PubMed, PsycINFO and EMBASE until 20th December 2018. Outcomes were extracted from published reports, and meta-analyses, and meta-regression analyses were conducted in CMA software.ResultsAfter screening 2787 abstracts, 29 studies with 193,418 participants (N = 35,836 in racial minorities) were eligible for analyses. Racial minorities showed more stigma than racial majorities (g = 0.20 (95% CI: 0.12 ~ 0.27) for common mental disorders. Sensitivity analyses showed robustness of these results. Multivariate meta-regression analyses pointed to the possible moderating role of the number of studies with high risk of bias on the effect size. Racial minorities have more stigma for common mental disorders when compared with majorities. Limitations included moderate to high risk of bias, high heterogeneity, few studies in most comparisons, and the use of non-standardized outcome measures.ConclusionsMental illness stigma is higher among ethnic minorities than majorities. An important clinical implication of these findings would be to tailor anti-stigma strategies related with mental illnesses according to specific racial and/or ethnic backgrounds with the intention to improve mental health outreach.

Adapting Disclosure Programs to Reduce the Stigma of Mental Illness.

A 2016 report from the National Academy of Sciences describes strategies that reduce the stigma of mental illness. Prominent among these are contact between people with and without mental illness and strategic disclosure for lessening both public and self-stigma. The report also recognizes the complexity of stigma in the realm of psychiatric phenomena. As a socially constructed phenomenon, mental illness stigma intersects with race-ethnicity, gender, age, and sexual orientation to affect ways in which it is perceived and experienced. Stigma also differs by condition, such as mental illness versus substance use disorder. Hence, antistigma strategies need to actively incorporate diversity concerns into future adaptation. This Open Forum reviews adaptations of the Honest, Open, Proud (HOP) program to reflect adaptation challenges for age and condition. HOP is an evidence-based program that involves strategic disclosure to manage both self- and public stigma. This essay ends with consideration of the additional intersectionality challenges of adaptation.

Effect of direct and indirect contact with mental illness on dangerousness and social distance.

This study is based on the contact hypothesis that contact with mental illness is the most effective anti-stigma strategy. This study aims to analyze which form of contact can most effectively decrease the dangerousness and social distance associated with schizophrenia, depression and alcoholism. In total, 573 Korean adults ( Mage = 43.71 years, standard deviation ( SD) = 13.41; 54.1% male, 45.9% female) were surveyed about randomly assigned vignettes of schizophrenia, depression and alcoholism. The participants were questioned on the dangerousness and social distance associated with the assigned vignette, as well as direct and indirect contact experience with the mental illness. Two-way analysis of variance (ANOVA) was used to determine the main effect and interaction effect that the type of mental illness and contact experience have on the two dependent variables (dangerousness and social distance). The findings show that the type of mental illness has a significant main effect on dangerousness and social distance, but contact type only has a significant main effect on social distance. Moreover, the two independent variables (mental illness subtype and contact experience) have an interaction effect on two dependent variables (dangerousness and social distance). Therefore, the anti-stigma effect of contact varies according to the type of mental illness. Our findings suggest that appropriate anti-stigma strategies are required for each type of mental illness. Considering that opportunities for direct contact with persons with mental illness are highly limited, it is necessary to actively utilize indirect contact.

The Meaning of Stigma for People with Mental Disorders in Brazil

ABSTRACT Objective: To understand the meaning of stigma for people with mental disorders. Method: A qualitative study with 46 Brazilian adults with mental disorders. Data were collected through semistructured interviews and nonparticipant observation and submitted for a thematic analysis with symbolic interactionism. Results: Stigma was considered as an experience of incomprehension and suffering. The society has difficulty in empathizing, respecting differences and understanding the extent of the suffering of people with mental disorders. Participants recommended anti-stigma strategies that included promoting knowledge and respecting differences. Conclusions: The present study contributes new insights to be addressed in interventions to reduce the suffering and impact of stigma.

The predictive effect of empathy and social norms on adolescents’ implicit and explicit stigma responses

Research indicates that adolescents who experience mental health difficulties are frequently stigmatised by their peers. Stigmatisation is associated with a host of negative social and psychological effects, which impacts a young person's well-being. As a result, the development of effective anti-stigma strategies is considered a major research priority. However, in order to design effective stigma reduction strategies, researchers must be informed by an understanding of the factors that influence the expression of stigma. Although evidence suggests that empathy and social norms have a considerable effect on adolescents’ social attitudes and behaviours, research has yet to examine whether these factors significantly influence adolescents’ responses toward their peers with mental health difficulties. Thus, this study aims to examine whether empathy (cognitive and affective) and peer norms (descriptive and injunctive) influence adolescents’ implicit and explicit stigmatising responses toward peers with mental health problems. A total of 570 (221 male and 348 female; 1 non-specified) adolescents, aged between 13 and 18 years (M = 15.51, SD = 1.13), participated in this research. Adolescents read vignettes describing male/female depressed and ‘typically developing’ peers. Adolescents answered questions assessing their stigmatising responses toward each target, as well as their empathic responding and normative perceptions. A sub-sample of participants (n=173) also completed an IAT assessing their implicit stigmatising responses. Results showed that descriptive norms exerted a substantial effect on adolescents’ explicit responses. Cognitive empathy, affective empathy and injunctive norms exerted more limited effects on explicit responses. No significant effects were observed for implicit stigma. Overall, empathy was found to have limited effects on adolescents’ explicit and implicit stigmatising responses, which may suggest that other contextual variables moderate the effects of dispositional empathy on responding. In conclusion, these findings suggest that tackling the perception of negative descriptive norms may be an effective strategy for reducing explicit stigmatising responses among adolescents.

Self-Awareness of Disease Stigma: Reflections of Healthcare Professionals

People who suffer from disease frequently experience disease-related stigmas. Stigma presents in daily life during normal human interactions. The stereotypes promoted by the media often impact public opinion significantly. Moreover, healthcare professionals may exacerbate stigmatization due to their misunderstanding of patients and their disease issues. Therefore, the reflection on stigma of healthcare professionals cannot be ignored. The present article illustrates the issue of stigmas held by healthcare professionals, their related stigmas, and their self-awareness. It is hoped that all healthcare professionals may cooperate to develop an anti-stigma strategy and to become true spokespersons for their patients.