Changes In Stigma Research Articles

Temporal changes in HIV-related stigma and sexual behaviours: An examination of 22 African countries.

ABSTRACTDespite non-trivial success against the HIV epidemic, health experts in Sub-Saharan Africa (SSA) remain concerned about new infections, stigma attitudes, and increasing rates of higher-risk sexual behaviours (HRSBs). Although this concern has produced voluminous scholarship on the behavioural consequences of belonging to stigmatised populations, scholars have only recently examined the behavioural consequences of holding stigmatising attitudes. Existing work generally finds a positive relationship between stigmatising beliefs and the practice of HRSBs. Yet, it is unknown whether this relationship has changed for countries over the past two decades. We fill this gap using Demographic and Health Survey data from 22 SSA countries. We first find that in most countries, the practice of HRSBs has increased, while stigma beliefs have become more tolerant. Second, the relationship between stigma beliefs and HRSBs changed in only six countries: Nigeria, Kenya, Mozambique, Sierra Leone, Ethiopia, and Lesotho. It changed from non-existent or negative to positive in Nigeria, Kenya, Mozambique, and Ethiopia, but non-existent to negative in Sierra Leone. In Lesotho, the positive association weakened over time. These findings highlight the importance of social and epidemic contexts when considering how stigma impacts sexual behaviours and HIV rates in SSA.

Design and implementation of a Type-2 hybrid, prospective randomized trial of opioid agonist therapies integration into primary care clinics in Ukraine

IntroductionUkraine has high HIV prevalence, concentrated among people who inject drugs (PWID), mostly of opioids. Maintenance on opioid agonist therapies (OAT) is the most effective evidence-based treatment for opioid use disorder. As PWID experience high morbidity and mortality from preventable and treatable non-communicable diseases, international agencies recommend integrating OAT into primary care centers (PCC). MethodsA randomized, type-2 hybrid implementation trial was carried out to compare outcomes of OAT integration in PCC to OAT delivery at specialty treatment centers (STC) – standard-of-care. Tele-education supporting PCC providers in managing OAT, HIV, tuberculosis and non-communicable diseases along with pay-for-performance incentives were used to facilitate implementation. Consenting patients underwent 1:2 randomization to either STC or PCC. Quality health indicators (QHIs), a composite percentage of recommended primary and specialty services accessed by patients (blood/urine tests, cancer screenings, etc.), were defined as efficacy outcomes and were assessed by participant self-report at baseline and every 6 months over 24 months and electronic chart reviews after the completion of the follow-up. The primary outcome is defined as the difference in composite QHI scores at 24 months, in which a repeated measures likelihood-based mixed model with missing at random assumptions will be used. Providers at PCC completed surveys at baseline, 12 and 24 months to assess implementation outcomes including changes in stigma and attitudes towards OAT and PWID. Preliminary resultsAmong the 1459 participants allocated to STC (N = 509) or PCC (N = 950), there were no differences in clinical and demographic characteristics. Self-reported prevalences were available for HIV (42 %), HCV (57 %), and prior tuberculosis (17 %). Study retention at 6, 12, 18, and 24 months was as 91 %, 85 %, 80 %, and 74 %, respectively. ConclusionPWID have a high prevalence of medical comorbidities and integrating OAT into primary care settings has the potential to improve the health of PWID. Findings from this study can help guide implementation of integrated care in Ukraine and throughout similar low-resource, high-burden countries in the Eastern European and Central Asian region.

Feasibility of a cinematic-virtual reality training program about opioid use disorder for osteopathic medical students: a single-arm pre-post study.

Opioid use disorder (OUD) has a considerable morbidity and mortality in the United States. Healthcare providers are key points of contact for those with OUD; however, some providers may hold stigma toward OUD. Stigma toward OUD can lead to lower quality of care and more negative health outcomes. Thus, new trainings designed to reduce stigma toward OUD while increasing empathy are critical. We created a web-based cinematic virtual reality (cine-VR) training program on OUD for osteopathic medical students. The aim of this pilot study was to assess changes in stigma toward OUD and empathy before and after the online cine-VR training program on OUD. We employed a single-arm, pre- and posttest pilot study to assess changes in stigma toward OUD and empathy. Osteopathic medical students from one large medical school in the Midwest with three campuses were invited to participate in the online cine-VR training. Participants completed two surveys before and after the cine-VR training. We performed paired t tests to examine changes in stigma toward OUD and empathy scores before and after the cine-VR OUD training program. A total of 48 participants completed the training. We observed a decrease in stigma toward OUD posttraining (t=4.402, p<0.001); this change had a Cohen's d of 0.64, indicating a medium effect. We also observed an increase in participants' empathy scores posttraining (t=-2.376, p=0.023), with a Cohen's d of 0.40 signifying a small effect. Findings from this pilot study suggest that the online cine-VR training may reduce stigma toward OUD while increasing empathy. Future research employing a randomized controlled trial design with a larger, more diverse sample and a proper attention control condition is needed to confirm the effectiveness of the online cine-VR training. If confirmed, this cine-VR training may be an accessible approach to educating osteopathic medical students about OUD.

Illness perceptions, experiences of stigma and engagement in functional neurological disorder (FND): exploring the role of multidisciplinary group education sessions

BackgroundA critical first step in managing functional neurological disorder (FND) is a positive diagnosis and clear explanation using an understandable illness model. Multidisciplinary group education sessions are one way to...

Changes in Stigma and Social Support among Participants in a Randomized Trial of a Novel Expanded Social Network-based HIV Testing Intervention in KwaZulu-Natal, South Africa.

HIV-related stigma is a well-documented barrier to HIV testing in South Africa, and may be particularly likely to create reluctance to test among South African men, who have reported feeling blamed for HIV by their partners and communities. The present study presents a novel expanded social network recruitment to HIV testing (E-SNRHT) intervention explicitly designed to reduce stigma as a barrier to testing by asking people to recruit anyone they know to testing, thus allowing them to avoid the potential for increased stigma and/or blame associated with direct risk partner recruitment, and helping to normalize openly discussing HIV among social networks. We examined baseline and 6-10-week follow-up data from a 2022-2023 randomized trial in KwaZulu-Natal, South Africa that recruited 110 individuals who had been newly diagnosed with HIV and randomly assigned them to recruit people to HIV testing either via the E-SNRHT intervention or via risk network recruitment. Participants in the E-SNRHT intervention reported significant decreases in anticipated and enacted HIV-related stigma between baseline and follow-up; and the E-SNRHT intervention was more effective at decreasing enacted HIV-related stigma than was risk network recruitment. Individuals newly diagnosed with HIV by the E-SNRHT intervention reported significant increases in social support between intervention enrollment and follow-up, and all of these individuals reported participating in positive conversations about HIV services with peers in the 6-10 weeks after intervention enrollment. These findings suggest that E-SNRHT is a potentially important strategy to reduce HIV-related stigma as a barrier to HIV testing among peer networks in KwaZulu-Natal.

Changes in mental health stigma among healthcare professionals and community representatives in Northern Sri Lanka during an mhGAP intervention study.

Research indicates that exposure to conflict, natural disasters, and internal displacement can increase mental health conditions. Since the end of the civil conflict within Sri Lanka, the country has worked to increase access to mental health services to meet the needs of conflict-affected populations, however, gaps remain. To address this, integration of mental health services into primary care can reduce the strain on growing specialized care. As part of a larger study primary care practitioners (doctors), public health professionals (nurses, midwives), and community representatives (teachers, social workers) were trained to deliver mental health services in primary care across the heavily impacted Northern Province. The aim was to reduce mental health stigma among enrolled healthcare workers and community representatives by 50%. Stigma was measured across all participant groups at six time points: pre- and post- initial training at baseline, pre- and post- refresher training 3-months after initial training, and pre- and post- refresher training 6-months after initial training. Results indicate a small improvement in average stigma scores at the 6-month refresher point for primary care practitioners, and no meaningful difference in average scores across time points for public health professionals or community representatives. World Health Organization mhGAP training appears to reduce stigma among primary care practitioners and could be an effective strategy to counteract mental health stigma in low resource settings. Future research should investigate underlying mechanisms of stigma reduction to improve delivery of mental health services in primary care and community settings.

Visitor characteristics and changes in mental health stigma after attending the Mind Space mental health experience exhibition.

Mind Space is an experiential mental health exhibition in Hong Kong, aiming to raise public awareness and provide education regarding mental health. This prepost study aimed to 1) examine the relationships between visitors' characteristics and their mental health stigma at baseline, and 2) provide a preliminary evaluation of the effectiveness of Mind Space in reducing stigma and promoting help-seeking attitudes toward mental health conditions. We analyzed data from all consenting visitors who attended Mind Space between September 2019 and December 2021. Visitors' attitudes toward mental health conditions and their willingness to seek professional psychological help were measured through online questionnaires before and after visits. Multiple linear regression was used to identify the demographic predictors of outcome variables at baseline. Changes in outcome variables after attending Mind Space were assessed using paired sample t-tests. A total of 382 visitors completed the baseline questionnaires, among which 146 also completed the post-test. At baseline, higher socioeconomic levels and personal contact with people with mental health conditions predicted more positive attitudes and understanding toward mental disorders. Tentatively, the results also showed that after attending Mind Space, a significant reduction in negative attitudes about mental illness (t=4.36, p=<.001; d=.361) and improvements in the propensity to seek professional help (t=-5.20, p<.001; d=-.430) were observed, along with decreases in negative attitudes toward stereotypes (t=4.71, p=<.001; d=.421) and restrictions (t=2.29, p=.024; d=.205) among healthcare professionals. Our findings highlight the need for mental health education for people with lower socioeconomic status and the importance of direct contact in public mental health education initiatives. The present study also suggests that Mind Space may be a useful model for public mental health education, but the exhibition requires further evaluation to ascertain if any reductions in stigma are maintained over time.

Overcoming stigma: Community support for overdose prevention sites

Overdose prevention sites (OPS) are beginning to be examined for their feasibility of implementation in the United States to curb the fatality of overdoses. Support for these sites varies greatly and can impact local policy, implementation, and the long-term viability of such programs. This study examined two communications strategies – research and anecdotal evidence – and their effect on public support for an OPS. One group (n= 106) was presented with a summary of research evidence for the efficacy of implementing an OPS in their community. The other group (n= 109) received similar information framed as personal anecdotes from people who use drugs (PWUD), people who work with PWUD, and community members of neighborhoods with an OPS. Communicating the efficacy of OPS as research evidence was associated with increased support for implementation and a decreased belief that an OPS will attract crime. Lower stigma towards PWUD was also associated with increased support. However, neither condition was associated with changes in stigma towards PWUD. Jurisdictions implementing OPS should utilize research evidence in communicating the program proposal to the public. Further research is needed regarding best practices for reducing stigma towards PWUD and the subsequent support for the implementation of an OPS.

Evaluating the effectiveness of a school-based mental health literacy intervention from a comprehensive demographic and social-cognitive perspective

Childhood and adolescence are a critical period for the onset of mental and neurodevelopmental disorders and a time when many can be first identified. Research demonstrates that mental health literacy applied in school settings may be an effective approach to address these challenges. In contrast to many existing studies conducted in multicultural and multilingual settings that treated subjects’ language as a demographic feature, the present study recognizes English proficiency as a social-cognitive factor and views the school-based mental health literacy (MHL) intervention as a learning process. The present study aimed to assess the effectiveness of school-based mental health literacy intervention and explore how ethnicity and English proficiency as a social-cognitive factor, as a modified, rather than a fixed variable, impacted the intervention outcomes. Grade 9 students (n = 240) from schools in West Canada with diverse social/cultural background received the intervention in the classroom delivered by trained teachers and completed the pre-test and post-test over a 6-month period. The intervention was effective in improving knowledge and help-seeking attitudes among all students. Non-Chinese and native English-speaking students performed the best on all outcomes. Gender demonstrated an association with changes in stigma, stress and wellbeing. English proficiency was linked to knowledge acquisition, while ethnicity was connected to changes of attitude-related outcomes. These findings deepened our understanding of how demographic and social-cognitive factors underlie changes in mental health literacy outcomes, which will facilitate the development of mental health literacy interventions for diverse student populations.

An investigation of the associations between stigma, self-compassion, and pain outcomes during treatment based on Acceptance and Commitment Therapy for chronic pain.

Stigma adversely affects people with chronic pain. The qualities within self-compassion may be particularly useful for buffering the impact of stigma on people with pain. In the context of an Acceptance and Commitment Therapy-based (ACT) treatment for chronic pain, this study investigated the association between changes in stigma and self-compassion and pain outcomes, and the potential moderating role of self-compassion on the association between stigma and pain outcomes. Five-hundred and nineteen patients completed standardized self-report questionnaires of stigma, self-compassion, psychological flexibility, pain intensity and interference, work and social adjustment, and depression symptoms at the start of an interdisciplinary ACT-based treatment for chronic pain. The same measures were completed at post-treatment (n = 431). The results indicated that key pain outcomes and self-compassion significantly improved during treatment, but stigma did not. Changes in stigma and self-compassion were significantly negatively correlated and changes in these variables were associated with improvements in treatment outcomes. There were significant main effects of stigma and self-compassion for many of the pre- and post-treatment regression models when psychological flexibility was not controlled for, but self-compassion did not moderate the association between stigma and pain outcomes. Stigma remained significant when psychological flexibility variables were controlled for, while self-compassion did not. The findings add to our conceptual understanding of the inter-relationships between stigma, self-compassion, and psychological flexibility and can contribute to treatment advancements to optimally target these variables.

The impact of early direct-contact experiences on reducing mental health stigma among student pharmacists: A pilot study.

Mental health-related stigma is a barrier to treatment and recovery for serious mental illnesses (SMIs). Educational training programs demonstrate positive changes in health professional students' attitudes and stigma toward SMI; however, student pharmacists have minimal opportunity to directly engage with the SMI population. This study aims to assess and compare student pharmacists' stigma related to SMI before and after participating in a pilot series of direct-contact workshop experiences. The 15-item Opening Minds Scale for Healthcare Providers survey was administered to student pharmacists before and after the workshop experiences to measure stigma toward SMI. Five 2-hour workshops were provided to members of a local nonprofit organization serving people with SMI by student pharmacist volunteers detailing a health and wellness topic. The postworkshop survey included free text responses to obtain student feedback. Twenty-four complete preworkshop surveys were obtained, and most of them had positive attitudes and beliefs at baseline. Thirteen postworkshop surveys were obtained from student pharmacists who participated in a workshop event, and 9 were completed by student pharmacists who did not participate in a workshop event, which were used as a comparator group. Stigma decreased after participating in a workshop event, and those who participated demonstrated a lower degree of stigma versus the comparator group. Direct-contact experiences allow student pharmacists to interact with people with SMI earlier in their training and help reduce stigma toward those with psychiatric disorders. Future research is needed to identify large-scale changes in pharmacy student stigma.

A dual design thinking - universal design approach to catalyze neurodiversity advocacy through collaboration among high-schoolers.

Neurodiversity describes the fact that humans all have different brains with unique qualities that contribute to society. Though understanding of neurodiversity is gaining traction among the general public, there remains considerable stigma and prejudice toward neurodiverse people. One way to combat these issues is to teach individuals about neurodiversity and encourage them to develop advocacy skills. Development of such knowledge is especially important for adolescents, as they have the capacity to make small (e.g., interpersonal interactions) and large (e.g., school-wide) impacts. Eighty-nine high schoolers participated in a two-week virtual summer camp in 2022; research consent/assent was obtained from 19 (11 neurodiverse/neurodivergent). Campers learned about neurodiversity, Universal Design for Learning (UDL), and Design Thinking (DT) through lectures from researchers and neurodivergent people, as well as group activities and discussions. Campers worked in small groups to design a neurodiversity advocacy project based on the principles of UDL and DT. Each group was facilitated by camp counselors-some of whom were neurodiverse-who were all committed to neurodiversity advocacy. Participants completed questionnaires about autism, ADHD, and dyslexia pre- and post-camp. Some also completed optional post-camp interviews. Pre-camp stigma toward neurodiverse conditions was generally low. However, autism stigma was significantly higher than dyslexia stigma (Z = -2.24, p = 0.025). After camp, autism stigma decreased (Z = -2.98, p = 0.003;) and autism [t(13) = 3.17, p = 0.007] and ADHD [t(13) = 2.87, p = 0.013] knowledge improved. There were no significant changes in ADHD or dyslexia stigma or dyslexia knowledge. Participants reported enjoying collaborating with other campers and learning about UDL and DT. Thematic analysis of interviews generated four themes: Increased Understanding of Neurodiversity; Increasing Empathy and Becoming Less Judgmental; Creating a Neurodiverse Community; and More Awareness is Needed. This pilot investigation suggests that a virtual summer camp can be effective in improving attitudes toward and knowledge of neurodiversity. Qualitative analysis indicated participants became more accepting after the camp, both in terms of being less judgmental toward neurodiverse people and more self-accepting among neurodivergent campers. Future research should investigate the long-term effects of such a program, particularly with diverse samples of students.

COVID-19-related stigma within a rural South African community: A mixed methods analysis.

Infectious disease-related stigma is a pervasive global issue that impedes disease control efforts by increasing reluctance to seek treatment or engagement in prevention behaviors for fear of ostracism. Despite this, there is limited research on COVID-19 stigma in Africa, specifically rural South Africa, which has faced infectious disease-related stigma throughout the HIV epidemic. Population-based surveys were conducted among 1,662 adults living in the Agincourt Health and Socio-Demographic Surveillance System (AHDSS) area in Mpumalanga, South Africa, in August-October 2020 and August-October 2021. Surveys measured anticipated COVID-19-related stigma from low to high levels. Changes in stigma between surveys were compared using Wilcoxon ranked sign tests, and log-binomial models estimated the association between socio-demographic factors and anticipated stigma at both intervals. Qualitative interviews were conducted in 2022 among 31 adults who completed the original surveys, and the data were analyzed thematically to describe anticipated, perceived, and enacted stigma. Anticipated stigma significantly decreased from the first to the second survey (p-value:<0.0001). Stigma was significantly higher among older age groups. In 2020, those less knowledgeable about COVID-19 were 2.24 times as likely to have higher levels of anticipated stigma compared to those who were more knowledgeable (RR:2.24, 95% CI: 1.90,2.64). Fear of being stigmatized influenced willingness to disclose infection. Participants perceived COVID-19 stigma as similar to HIV/AIDS stigma, but concern and fear reduced over time, with differences observed across generations and sexes. For some, fear of death and mistrust of others endorsed enacting stigma toward others. While COVID-19 stigma decreased over time in rural South Africa, different forms of stigma persisted and influenced participants' willingness to reveal their COVID-19 infection status. Given South Africa's history with infectious disease-related stigma hindering public health efforts, it is crucial that government bodies prioritize strategies to mitigate stigma in rural communities.

Snapshot of knowledge and stigma toward mental health disorders and treatment in Spain.

Mental disorders significantly impact individuals and societies globally. Addressing societal stigma is crucial, as it affects help-seeking behaviors and the effectiveness of treatment for mental disorders. This study aims to explore the knowledge and perceptions of the Spanish population toward mental disorders and their treatment, assess changes in mental health stigma over time, and examine variations across sociodemographic variables by comparing current results with previous studies. A panel of three psychiatrists designed a questionnaire to collect public opinions about various aspects of mental illness in Spain, covering topics such as social perception, diagnostic reliability, causes, symptoms, treatment, suicide, and media influence. The survey, conducted from October to December 2022, involved 1,002 Spanish individuals aged 18-70. Our results indicated an improved general knowledge of mental health, reduced stigma, and greater acceptance of those affected by these disorders, compared to past research. Almost 80% of the participants have accurate knowledge regarding the complex and multifactorial nature of mental illnesses. Around 90% of the participants share the belief that stigma affects those affected by mental disorders. Psychological and pharmacological treatment are considered to be effective and helpful by more than 70% of the sample. More than 60% of the participants highlighted that suicide needs to be addressed appropriately in the media. These findings suggest a significant shift in how Spanish society views mental disorders, marking progress over decades of discrimination. Reducing the stigma associated with mental health can encourage individuals to seek assistance without the fear of judgment or discrimination, thereby increasing the likelihood of early intervention and treatment. Open conversations about mental health within families, communities, and workplaces can create a supportive environment that enhances recovery. However, continued efforts and awareness campaigns targeted to broader audiences remain necessary. Responsible media portrayals of mental health, avoiding stigmatizing language or sensationalism, are also essential.

Syphilis: Is it Back with a Bang?

Syphilis was brought under control with the advent of penicillin. However, in recent times, a rise in the incidence of syphilis has been reported by Centers for Disease Control and Prevention (CDC). To study the clinical and epidemiological profile of patients with syphilis attending sexually transmitted infection (STI) clinic at tertiary care center. Observational, cross-sectional analysis of sociodemographic, clinical, and investigational data of all syphilis patients visiting STI clinic from August 2019 to July 2021 was done and analyzed. Out of 1330 STI patients that attended the clinic, 15.04% (n = 200) were diagnosed with syphilis, among them 72% (n = 144) were males, and 28% (n = 56) were females, with male-to-female ratio of 2.5:1. Of these 24.5% (n = 49) had primary, 44.5% (n = 89) had secondary, 30.5% (n = 61) had latent, and 0.50% (n = 1) had congenital syphilis. Among secondary syphilis patients, rash was the most common presentation seen in 43 patients, followed by condyloma lata in 30, palmoplantar syphilis in 17, oral mucous patch in 3, and iridocyclitis in 3 patients. Human immunodeficiency virus (HIV) was positive in 16.5% (n = 33). Herpes genitalis was the most common coinfection among 25 patients who were diagnosed with mixed venereal disease. RPR titer was positive in all 200 patients, with 1:16 titer being most common. India is experiencing a new trend in the prevalence of syphilis, mainly due to the changes in risk behavior, misconceptions, and social stigma associated with STIs, improved laboratory diagnosis, and increased public awareness. Particularly secondary and latent stages have shown a rising trend over the past few years. Awareness about safe sexual practices and contraception is very important to control the current resurgence.

Psychological pathways explaining the prospective association between obesity and physiological dysregulation.

Obesity is associated with a range of negative psychological conditions that may also affect physiological health. Across two studies, we tested whether a range of psychological measures explain why obesity is prospectively associated with physiological dysregulation, measured via clinical indicators of cardiovascular, immune system, and metabolic function. We used comparable 4-year follow-up representative longitudinal data of U.K. and U.S. older adults (≥50 years) from the English Longitudinal Study of Ageing (2008/2009-2012/2013; Study 1; n = 6,250) and the Health and Retirement Study (2008/2010-2012/2014; Study 2; n = 9,664). A diverse range of psychological measures (e.g., depressive symptoms, life satisfaction, weight stigma, positive affect) were tested as candidate mediators in Studies 1 (n = 14) and 2 (n = 21). Obesity predicted physiological dysregulation at follow-up across both studies. In Study 1, only weight stigma (measured between baseline and follow-up) explained 37% of the association between obesity and physiological dysregulation. In Study 2, only changes in weight stigma from baseline to follow-up (not baseline weight stigma) explained 13% of the effect of obesity on future physiological dysregulation. Mediation by weight stigma in both studies was partially attenuated when changes in body mass index from baseline to follow-up were controlled for. No other psychological measures explained the association between obesity and physiological dysregulation in either study. The prospective association between obesity and physiological dysregulation was largely not explained by psychological factors. However, experiencing weight stigma is associated with increased weight gain and this process may explain obesity-related declines in physiological health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An initiative to improve mental health practice in primary care in Caribbean countries.

The aim of this initiative was to assess whether a novel training program - Understanding Stigma and Strengthening Cognitive Behavioral Interpersonal Skills - could improve primary health care providers' confidence in the quality of mental health care they provide in the Caribbean setting by using the Plan-Do-Study-Act rapid cycle for learning improvement. We conducted a prospective observational study of the impact of this training program. The training was refined during three cycles: first, the relevance of the program for practice improvement in the Caribbean was assessed. Second, pilot training of 15 local providers was conducted to adapt the program to the culture and context. Third, the course was launched in fall 2021 with 96 primary care providers. Pre- and post-program outcomes were assessed by surveys, including providers' confidence in the quality of the mental health care they provided, changes in stigma among the providers and their use of and comfort with the tools. This paper describes an evaluation of the results of cycle 3, the official launch. A total of 81 participants completed the program. The program improved primary care providers' confidence in the quality of mental health care that they provided to people with lived experience of mental health disorders, and it reduced providers' stigmatization of people with mental health disorders. The program's quality improvement model achieved its goals in enhancing health care providers' confidence in the quality of the mental health care they provided in the Caribbean context; the program provides effective tools to support the work and it helped to empower and engage clients.

Structural Stigma and 7-Year Improvement in Life Satisfaction among Diverse Groups of Sexual Minority Individuals: A Repeated Cross-Sectional Study across 28 Countries

Abstract Structural stigma toward sexual minority individuals, in the form of discriminatory laws and prejudicial population attitudes, varies widely across countries and is associated with psychosocial health outcomes. Yet, the association of changes in country-level structural stigma over time, as has recently characterized many European countries, with such outcomes is largely unknown. Using data from sexual minority respondents (2012: n=82,668; 2019: n=96,576) living in 28 European countries, this study analyzes the association between change in structural stigma from 2012 to 2019 and change in life satisfaction among sexual minority individuals during the same period. Results showed that life satisfaction had improved among sexual minority individuals in all countries between 2012 and 2019 (β = 0.33, 95% confidence interval: 0.30, 0.36), but the improvement was stronger among those living in higher-stigma, compared to lower-stigma, countries and more as a function of changing laws than attitudes. Changes also varied by relationship status; the strongest improvement in life satisfaction as a function of decreased structural stigma was found among partnered sexual minority individuals. The findings support the relevance of structural stigma for sexual minority individuals’ life satisfaction and call for further research to understand the differential impact of structural stigma across sexual minority subgroups.

Evaluation of a Community Suicide Prevention Project (Roots of Hope): Protocol for an Implementation Science Study.

Roots of Hope (RoH) is a multisite Canadian community-based suicide prevention initiative developed by the Mental Health Commission of Canada (MHCC), which is based on evidence for intervention effectiveness and World Health Organization recommendations. Seven communities developed local activities in the following 5 pillars: specialized supports, training and networks, public awareness, means safety, and evaluation research. We aim to use an implementation research approach to understand the RoH model for reducing suicidal behaviors and their impacts in communities, and the lessons learned for the equitable development and implementation of RoH in different contexts. Moreover, we want to understand how the program is implemented in relation to the context, the causal pathways, and the factors influencing successful implementation. The evaluation includes assessments of short-term and intermediate effects at each site and overall. The principal investigator (PI) developed a consensus among local research coordinators on common approaches and indicators through ongoing participation in an online community of practice, and regular virtual and in-person meetings. At the completion of the pilot phase, the PI will summarize evaluation results across sites and conduct pooled analyses. The RoH theory of change and evaluation model shows how evaluation activities from the planning phase through the implementation of activities in each of the pillars can help clarify the viability of the RoH model and identify factors that facilitate and inhibit effective and equitable implementation in different contexts. Beginning with a situational analysis to identify resources in each community and local specificities, we will examine the implementation characteristics of conformity, dosage, coverage, quality, utility, equity, appreciation, facilitators, and impediments. Evaluation of short-term effects will focus on changes in knowledge, attitudes, behaviors, help-seeking, service use, stigma, media reports, empowerment, and care experiences. Intermediate effects, long-term effects, and impact will include assessments of the changes in suicides, suicide attempt rates, and suicide risk indicators. A variety of data sources, both quantitative and qualitative, will be used. The quantitative and qualitative data from all sites will be summarized by the PI in March 2023 to draw conclusions to help the MHCC in its improvements to the RoH model, and to inform communities about how to better implement RoH. Since the COVID-19 pandemic occurred at the beginning of program implementation, its impact and influence will be documented. The validity of RoH in contributing to the prevention of suicides and suicidal behaviors will be clarified in a variety of contexts. The final evaluation report will be available in September 2023. The evaluation results, including the identification of factors that facilitate and inhibit the implementation of RoH and the adaptations to challenges, will be useful to the MHCC, current RoH communities, and those considering adopting the RoH model. DERR1-10.2196/39978.

It’s Time to Bring Mental Health Literacy Education into the Postsecondary Curriculum

In the last twenty years, research on post-secondary students’ mental health and well-being has grown substantially, with a dramatic increase in publications over the past decade. Likewise, concerns about declining mental health on our campuses have risen; the mental well-being of postsecondary students is now widely recognized as a major public health issue. Over the last two decades, Canadian higher education has largely addressed these concerns by promoting mental health awareness through extracurricular means. Critically, a new movement towards mental health literacy has emerged across the nation: not just supplementary outreach, but education embedded into the curriculum. To put recommendations into practice, in 2020, one of the authors [CZ] developed and taught an undergraduate course on mental health literacy with a class of 106 students. In the first offering, we conducted a pre-post study to examine if this new course would be associated with changes in mental health knowledge, stigma, and help-seeking. Of the forty students who participated in the study, ten completed measures at both the start (T1) and the end of the course (T2). Within-subjects analyses showed that students made significant gains from T1 to T2, with a large effect size, in terms of attitudes toward seeking mental health services. Feedback on the course was very positive, both in students’ ratings and their comments. Looking ahead, student well-being will depend on how institutions approach and engage with mental health literacy. We recommend firmly integrating mental health literacy education into the post-secondary curriculum.