Components Of Stigma Research Articles

Mental Illness Stigma in Black, Latina/o, and Asian Americans.

Mental illness stigma has significant psychiatric consequences and can impede mental health treatment seeking, especially among racial minority groups; who are understudied in stigma research and experience striking treatment disparities. Guided by a novel empirical model of racial minority stigma and treatment seeking, this study investigated stigma and its effects on treatment seeking in Black, Latina/o, and Asian American adults. Data were collected via national panel survey from 613 Black, Latina/o, and Asian American adults. Perceptions of mental illness including seriousness, treatability, causal attributions, desired social distancing, and perceived dangerousness were assessed. Data were analyzed and compared with a nationally representative sample of the U.S. public from the 2018 General Social Survey. Minority participants exhibited stronger mental illness stigma than the U.S. public, with Black, Latina/o, and Asian American participants largely perceiving mental illness as less serious, less treatable, and desiring greater social distance from individuals with major depression, who were perceived as potentially dangerous. Notably, different stigma components significantly associated with willingness to seek treatment differently across Black, Latina/o, and Asian American participants. Overall, study findings indicate that mental illness stigma is strong and associates with treatment seeking in Black, Latina/o, and Asian Americans, suggesting a need to develop culturally tailored interventions to reduce stigma and associated treatment utilization disparities in these underserved minority groups.

Validity and reliability of the Japanese version of the Substance Use Stigma Mechanism Scale.

Stigma against people who have alcohol and drug problems severely affects their health and well-being. An instrument based on stigma theory assessing individual-level stigma is essential for a comprehensive understanding of their stigma. We evaluated the validity and reliability of the Japanese version of the Substance Use Stigma Mechanism Scale (SU-SMS-J) among a population who had alcohol or drug use problems. Adults with experience in substance use disorders from psychiatry outpatient departments and rehabilitation facilities participated in the self-administered questionnaire survey. Confirmatory factor analysis was conducted to test the structural validity of the 5-factor model proposed in other language versions, and factor loadings and correlation between the subscales were confirmed. The correlations between the SU-SMS-J and psychometric properties related to substance use (e.g., severity of substance use, motivation to change) were investigated to assess concurrent validity. Internal consistency was assessed using Cronbach's alpha coefficients. Data from 126 participants were analyzed. The 5-factor model was acceptable with good or reasonable model fit indices. The correlations between subscales were weak to moderate, and this result suggested the SU-SMS-J assessed different but related components of stigma: enacted, anticipated, and internalized stigma from different stigma sources (family and healthcare workers). The SU-SMS-J and subscales showed moderate concurrent validity. Internal consistency was mostly sufficient, with Cronbach's alpha coefficients of 0.86 for all items and 0.66-0.93 for subscales. The SU-SMS-J is valid and reliable for use among populations with substance use problems in various settings in Japan.

Effectiveness of a digital single-session cognitive behavioral psychoeducational intervention in reducing public stigma associated with psychosis: A randomized controlled trial

Psychosis is a severe mental health condition that is highly stigmatized, significantly increasing the costs of mental healthcare and reducing the productivity of those affected. Due to public stigma, individuals with psychosis often delay seeking professional help, exacerbating the socioeconomic burden of their ill-health. Psychoeducation, delivered in a structured and systematic manner, has been a key part of evidence-based psychological treatments and has been gradually adopted in stigma reduction efforts. This study evaluated the effectiveness of a digital single-session cognitive behavioral psychoeducation intervention in reducing public stigma toward people with psychosis in a collectivist society through a randomized controlled trial. Stigma was assessed using standardized self-report tools at pre-intervention, post-intervention, and 1-month follow-up. A significant reduction was observed in stereotyping, prejudice, and discrimination on seven out of 10 public stigma components post-intervention. However, the desired effects were maintained for only two components at the 1-month follow-up. No significant changes were found in negative emotions, tolerance, and support from pre-intervention to post-intervention. Attribution of responsibility significantly increased after the intervention, contrary to predictions. The findings of this study provide empirical support for the short-term effectiveness of a brief cognitive behavioral psychoeducation intervention in reducing public stigma toward individuals with psychosis while highlighting the potential benefits of delivering this intervention digitally. At the same time, the limitations of individual-level interventions in sustaining long-term effects are discussed from a sociocultural perspective. This study also examined the relevance of these findings in the context of health economics.

Neuroimaging markers of phenomena of perceived stigmatization in people with and without mental disorders: a systematic scoping-review

Summary. Along with traditional research on psychiatric stigma, there has recently been increasing interest in the neurobiological factors associated with stigmatization.Aim: to study the most common research methods in the studies of the neurobiological correlates of stigmatization phenomenon and its components, as well as to systematize their results, taking into account their methodological limitations.Materials and Methods: The review was conducted in accordance with the PRISMA-ScR extension. Studies were searched in MEDLINE, EMBASE, PsycINFO using the Ovid platform. After evaluating 2358 articles according to inclusion, non-inclusion, and exclusion criteria, 20 articles were included in the final analysis.Results: The most of the studies were conducted on samples of healthy respondents without a control group (14 articles). The mean age of respondents ranged from 18.8 [1.0] to 42.7 [14.7] years. Psychiatric stigma was studied in 2 studies; in the remaining articles, various components of stigma were studied, among which social rejection sensitivity was most often studied (13 articles). Among fMRI paradigm the Cyberball social exclusion task was used more often (10 articles). Changes in neural activity, correlating with the severity of stigma and its constituent constructs, were found in the anterior cingulate cortex, prefrontal cortex, insula, thalamus, hypothalamus, hippocampus, parahippocampal gyrus, ventral region of the striatum, putamen, amygdala.Conclusion: Functional magnetic resonance studies can be an effective tool for verifying and assessing the dynamics of the psychological state of people experiencing the phenomenon of stigmatization.

Social Stigma Toward Individuals with Schizophrenia in a Lebanese Population.

Schizophrenia has been recognized as the most stigmatized mental disorder, imposing a substantial burden on affected individuals. However, no prior studies have investigated social stigma toward individuals with schizophrenia in Lebanon. We aimed to examine three components of social stigma including knowledge, attitude, and behavior toward individuals with schizophrenia in a Lebanese population and to explore associated factors with the level of social stigma. A cross-sectional online survey was administered, and data from 469 participants were gathered from January 31, 2023, to February 18, 2023. We used previously validated questionnaires to assess the knowledge, attitude (Social Distance Scale), and behavior (Reported and Intended Behavior Scale) of participants toward individuals with schizophrenia. The score for each section was calculated and used to explore the associations between sociodemographic factors and the levels of stigma in each domain. The study participants had a moderate understanding of schizophrenia. However, a substantial proportion showed negative attitudes and unfavorable behaviors toward individuals with schizophrenia. We identified several sociodemographic factors associated with the knowledge, attitude, and behavior scores. Notably, a higher knowledge score and more positive attitudes were positively correlated with improved intended behaviors. This study highlights the pervasive stigma encompassing issues in knowledge, attitudes, and behavior surrounding schizophrenia in a Lebanese population. Our study suggests a pressing need for targeted interventions to increase public awareness and decrease the social stigma of schizophrenia in Lebanon.

Stigma processes, psychological distress, and attitudes toward seeking treatment among pedohebephilic people.

While stigma theories predict that stigma relates to negative attitudes toward seeking help, previous studies found mixed results among pedohebephilic individuals. We tested whether different stigma processes (i.e., general anticipated stigma, anticipation of negative therapist behavior upon disclosure, and internalized stigma), psychological distress, previous treatment experiences, and knowledge about psychotherapy can clarify attitudes toward seeking professional psychological help for this population. We conducted a pre-registered, online survey of English-speaking pedohebephilic individuals (N = 283, 88% male). Expected links between variables of interest and attitudes toward seeking treatment were assessed via structural equation modeling. After modification, the final model showed acceptable fit to the data, χ2 = 2170.61, df = 1462, p < .001, CFI = .905, RMSEA = .04, [.04,.05]. Internalized stigma predicted more positive attitudes toward seeking treatment. Lower anticipation of negative therapist behavior upon disclosure and higher knowledge about psychotherapy were also significant predictors of positive attitudes toward seeking treatment. General anticipated stigma did not predict attitudes toward seeking treatment. Our results suggest a complex association between different stigma processes and treatment-seeking, which differs from associations found for mental illness stigma. Specificity in our understanding of the components of stigma and how they interact with attitudes toward seeking treatment is required to tailor clinical work as well as messages around treatment services.

Stigma and Discrimination of family care giver's (FCG) – A Barrier in mental illness: Scoping Review

Mental disorders are considered as invisible disorders as they are overlooked by patients, caregivers, health professionals, and policymakers yet cause significant health burdens. People with mental illness are subjected to high levels of stigma and discrimination because of widely held misconceptions about the causes and nature of mental illness. varies from 43% to 83%. Stigma and discrimination can occur in one or the other form. The co-occurrence of five components of stigma includes labelling, stereotyping, separation, status loss, and discrimination”. Literature identifies different types of mental health-related stigma, including self-stigma, public stigma, professional stigma, and institutional stigma. Stigma in mental illness is a serious social problem that has a multitude of consequences on the individual concerned and his or her family. This paper throws light on the extent, problems associated, consequence and strategies to overcome stigma and burden among family caregivers so that the family members consider mental illness as disease which requires treatment.

Causal Beliefs About and Perceptions of Illness in Persons Experiencing Schizophrenia and in Close Relatives of Such Individuals: An Exploratory Study.

The cause to which persons experiencing schizophrenia attribute their illness influences emotional and adjustment variables. This is also true for close relatives (CRs), who are important players in the affected individual's environment and whose mood can influence the person's day-to-day life or treatment adherence. Recent literature has highlighted a need to further explore the impact of causal beliefs on different aspects of recovery as well as on stigma. The objective of this study was to explore causal beliefs about the illness and their relationship to other illness perceptions and stigma among persons experiencing schizophrenia and their CRs. Twenty French individuals experiencing schizophrenia and 27 CRs of individuals with schizophrenia answered the Brief Illness Perception Questionnaire, which investigates probable causes of an illness and other illness perceptions, and the Stigma Scale. A semi-structured interview was used to collect information about diagnosis, treatment, and access to psychoeducation. The individuals with schizophrenia identified fewer causal attributions than the CRs. They were more likely to endorse psychosocial stress and family environment as probable causes, while CRs mostly favored genetic explanations. We found significant relationships between causal attributions and most negative perceptions of the illness, including components of stigma, in both samples. Among CRs, having received family psychoeducation was strongly correlated with viewing substance abuse as a probable cause. Relationships between causal beliefs about illness and perceptions of illness both in individuals experiencing schizophrenia and in CRs of such individuals should be explored further with harmonized and detailed tools. Assessing causal beliefs about schizophrenia as a framework for psychiatric clinical practice could prove useful for all those involved in the recovery process.

Formulation Containing Phytosomes of Carotenoids from Nyctanthes arbor-tristis and Tagetes patula Protect D-galactose Induced Skin Aging in Mice

• Gel containing phytosomes of crocin rich extract(equivalent to crocin 1% w/w) obtained from Nyctanthes arbor-tristis and Lutein rich extract (equivalent to lutein 0.5%w/w) from Tagetes patula indicated • Entrapment of crocin and lutein was found to be (60.20% w/w) and (50.81% w/w) respectively. • Improved stability of crocin and lutein through preparation of Phytosomes • Significant (P<0.01) increase in thickness of dermal and epidermal layer • Significant increase (P<0.05) in glutathione level and decrease (P<0.01) in MDA level • Upregulation of expression of elastin and Collagen gene by 0.26 and 0.03 fold respectively : Carotenoids play important role in delay of aging process. Orange coloured tubular calyx of flowers of Nyctanthes arbor-tristis. contains crocin, an apocarotenoid which forms a major component of stigma of saffron. Due to presence of crocin in orange coloured tubular calyx of Nyctanthes arbor-tristis, it can be used as an economical substitute to saffron for its medicinal and cosmetic utilities. Lutein from flower petals of Tagetes patula L , is another popular carotenoid which has antioxidant effect and many health benefits. The carotenoids are highly unstable when exposed to atmosphere, hence in the present study crocin and lutein rich extracts were entrapped into phytosomes to improve stability and efficacy of topical preparation. : Oxidative stress is considered to be a major contributor to the process of aging. Carotenoids viz, Lutein and crocin, being powerful antioxidants, can delay aging of skin through upregulating col type I gene and elastin gene. The carotenoids have very low oxidation potential, due to which they get oxidized fast and protect oxidation of other compounds which make them highly unstable. One of the ways to improve stability of these phytoconstituents, is their entrapment in phytosomes. Preparation of phytosomes will have dual advantages of improving stability as well as bioavailability of molecule. : The phytosomes of Carotenoid rich extract of tubular calyx of Nyctanthes arbor-tristis L. and the petals of Tagetes patula L. (standardized for crocin and lutein content) were prepared using lipid film hydration technique and these phytosomes were then incorporated into gel base. The gel formulation was evaluated for stability as per ICH guidelines. Efficacy of formulation was evaluated by D-galactose induced aging model. Aging in skin was induced by administration of D-Galactose (100mg/kg b.w.s.c.) to albino mice for 42 days. The gel formulation was applied topically for 42 days. Then the effect of formulation on skin aging was evaluated by estimation of biochemical parameters viz. glutathione and malondialdehyde (MDA) and histopathological studies of treated skin samples. Also expression of COL type I and elastin genes was carried out from the skin samples by RT-PCR method. : Percent entrapment (%w/w) of crocin and lutein in phytosomes were found to be 60.20 and 50.81 respectively. Accelerated stability studies showed improvement in stability of carotenoids viz. crocin and lutein and the content of crocin and lutein in formulation was found in the range of 99.98 % w/w to 99.85%w/w at the end of three months. The formulation containing extract of Phytosomes of carotenoid rich extracts of Nyctanthes arbor-tristis L. and the petals of Tagetes patula L. exhibited potent antiaging activity through significant (p<0.05)increase in dermal and epidermal layers, and increase in GSH levels of skin as compared to the untreated group. The treatment with the gel formulation revealed upregulation of col type I and elastin genes. There was significant reduction in lipid peroxidation as revealed through reduction in MDA levels as compared to untreated group. : Crocin and lutein have potential to prevent skin aging via upregulation of COL type I gene and elastin gene. Upregulation of genes resulted into increase in the thickness of epidermal and dermal layer along with reduction in oxidative stress in skin. Entrapment of carotenoid rich extracts of Nyctanthes arbor-tristis and Tagetes patula in Phytosomes enhanced the stability and efficacy of the formulation.

INTERNALIZED STIGMA – HOW WE VIEW OUR MENTAL ILLNESS

IntroductionStigma in mental health settings is described as a set of negative and unrealistic beliefs about those with mental illness. Authors suggest that stigma is consistently underdefined and overused, leading to resources toward preventing and managing this problem lacking intention and efficiency. Three interacting levels of stigma are defined: social, structural, and internalized or self-stigma. Internalized stigma refers to how people with mental illness see themselves as mentally unwell and, therefore, of lesser value.ObjectivesWe aim to discuss the impact of internalized stigma on psychiatric patients and ways of prevention and stigma resistance.MethodsWe performed a non-systematic literature review from the data base PubMed using the key words “internalized stigma” and “mental illness”.ResultsInternalized stigma is one of the major factors leading to delayed contact with psychiatric care up to two years in outpatients. In psychiatric patients, higher internalized stigma was associated with weakened social support and integration, hopelessness and lower self-esteem and sense of coherence. Low self-esteem is the most significantly associated factor and mediates lower quality of life and higher treatment avoidance. The risk of self-esteem loss seems higher in patients with more insight, especially if they also have a loss of valued social identity. Although some studies suggest higher levels of internalized stigma in female, single and lower educated patients, adjusted statistical analyses do not validate these sociodemographic variations. It is however more prevalent in those with depression and who had been hospitalized because of their mental illness. The impact of internalized stigma is often compared to the levels of the illness burden itself, leading to higher levels of depression and greater psychiatric symptom severity. Additionally, more self-stigma seems to predict suicidal ideation, particularly in young adults.ConclusionsThe internalization of negative stereotypes undermines empowerment and negatively impacts the evolution and recovery of psychiatric patients. There’s strong evidence that general stigma constitutes a risk factor for poor biopsychosocial health outcomes. Programs addressing multiple stigma components seem to be most effective in improving suicide prevention. However, most self-stigma interventions involve groups, which can create barriers for people who are not comfortable disclosing a mental health condition to others. Anti-stigma programs are most effective when they involve people with lived experience of mental health conditions in all aspects of development. Interventions from a younger age should focus on prevention of general stigma by improving understanding of mental illness and reducing self and outwards discrimination. Working on professionals own stigmatizing behaviors is also key to improve the way we communicate and educate populations on how to internally process mental health problems.Disclosure of InterestNone Declared

Stigma toward internalizing and externalizing disorders: How do adolescents perceive their peers? A network analysis approach.

This study's first aim was to explore whether stigma's facets differ between internalizing and externalizing disorders in adolescence. The second aim was to compare the relationships among stigma's facets toward these disorders. Two vignettes depicting a peer with Major Depressive Disorder (MDD) or Attention-Deficit Hyperactivity Disorder (ADHD) were used with 616 adolescents in Italy. A Repeated measure MANOVA showed biogenetic causes, social distancing, and discomfort were more attributed to depression, while dangerousness to ADHD. Furthermore, a Psychometric Network Analysis showed no differences between these disorders in the relations among stigma's components. However, dangerousness seemed to be among the nodes with the highest levels of "strength," confirming previous literature that shows that dangerousness plays a major role in stigma.

Stigma as a barrier to early intervention among youth seeking mental health services in Ontario, Canada: a qualitative study

BackgroundStigma associated with mental health challenges is a major barrier to service seeking among youth. Understanding how stigma impacts service-seeking decisions from the perspectives of youth remains underexplored. Such research is necessary to inform effective stigma reduction.ObjectiveThis study aims to understand how stigma influences service seeking among youth with mental health challenges.MethodsQualitative inquiry was taken using youth engagement, underpinned by pragmatism. Data were collected via 4 virtual focus groups with 22 purposively selected youth participants with lived experience of mental health challenges in Ontario, Canada. Focus group guides were developed collaboratively among research team members, including youth co-researchers. Data were analyzed inductively using reflexive thematic analysis.ResultsThree main themes were constructed from the data: point of entry into the system, being biomedicalized or trivialized, and paving the way for non-stigmatizing services. Initial contact with the mental healthcare system was seen to be affected by stigma, causing participants to delay contact or be refused services if they do not fit with an expected profile. Participants described a constant negotiation between feeling ‘sick enough’ and ‘not sick enough’ to receive services. Once participants accessed services, they perceived the biomedicalization or trivialization of their challenges to be driven by stigma. Lastly, participants reflected on changes needed to reduce stigma’s effects on seeking and obtaining services.ConclusionA constant negotiation between being ‘sick enough’ or ‘not sick enough’ is a key component of stigma from the perspectives of youth. This tension influences youth decisions about whether to seek services, but also service provider decisions about whether to offer services. Building awareness around the invisibility of mental health challenges and the continuum of wellness to illness may help to break down stigma’s impact as a barrier to service seeking. Early intervention models of care that propose services across the spectrum of challenges may prevent the sense of stigma that deters youth from accessing and continuing to access services.

A "patient as educator" intervention: Reducing stigmatizing attitudes toward mental illness among medical students.

This pre-post quasi-experimental pilot study aimed to assess the degree of stigma toward mental illness and whether a single, direct-contact "patient as educator" intervention with people with mental illness can reduce the degree of stigma among medical students. All second-year medical students from the University of Valencia were invited to voluntarily complete the Community Attitudes Toward the Mentally Ill (CAMI), Reported and Intended Behavior Scale (RIBS), and Mental Health Knowledge Scale (MAKS) questionnaires before and after participating in the formal medical psychology course. A "patient as educator" workshop with expert patients was organized in the middle of the semester. A total of 127 students completed the survey; 20 students participated in the workshop (workshop group), and the remaining 107 students only took the formal educational course, forming the control group. At baseline, the groups were demographically matched and did not differ in the components of stigma or knowledge of mental illness. After the intervention, a greater reduction in the CAMI subscales of authoritarianism and social restriction was observed in the workshop group than in the control group. In the workshop group, scores for the benevolence subscale of the CAMI decreased more among women than men. In the control group, scores for the authoritarianism and benevolence subscales of the CAMI increased and decreased significantly more, respectively, in women than men. No significant changes were observed in scores for the RIBS at post-intervention in either group. The results of this pilot study suggest that a brief, direct-contact intervention in addition to formal medical education may further help reduce stigmatizing attitudes during the first years of medical school.

Effects of social norms and message framing on reducing the stigma of gynecological diseases: A cognitive-affective-behavioral model.

This paper presents an experiment exploring message strategies to reduce the stigma of gynecological diseases and promote women's sexual and reproductive health. Drawing on the cognitive-affective-behavioral model of stigma, we propose that social norms and message framing as two message strategies, respectively, address the cognitive and affective components of the stigma of gynecological diseases, which lead to desired changes in the help-seeking intention as the behavioral component. We conducted a 3 (no norm vs. descriptive norm vs. descriptive plus injunctive norms) by 2 (gain-framed vs. loss-framed) between-subject experiment (N = 202). The results reveal that messages with the combination of descriptive and injunctive norms reduce the greatest cognitive components of stigma. Gain-framed messages induced fewer affective components than loss-framed ones. The results suggest that changes in the cognitive and affective components of stigma may sequentially lead to favorable changes in the behavioral component. This study contributes to public understanding of the stigma of gynecological diseases by disentangling the various components and identifying the specific message strategies for stigma reduction.

Fine-Mapping and Comparative Genomic Analysis Reveal the Gene Composition at the S and Z Self-incompatibility Loci in Grasses.

Self-incompatibility (SI) is a genetic mechanism of hermaphroditic plants to prevent inbreeding after self-pollination. Allogamous Poaceae species exhibit a unique gametophytic SI system controlled by two multi-allelic and independent loci, S and Z. Despite intense research efforts in the last decades, the genes that determine the initial recognition mechanism are yet to be identified. Here, we report the fine-mapping of the Z-locus in perennial ryegrass (Lolium perenne L.) and provide evidence that the pollen and stigma components are determined by two genes encoding DUF247 domain proteins (ZDUF247-I and ZDUF247-II) and the gene sZ, respectively. The pollen and stigma determinants are located side-by-side and were genetically linked in 10,245 individuals of two independent mapping populations segregating for Z. Moreover, they exhibited high allelic diversity as well as tissue-specific gene expression, matching the expected characteristics of SI determinants known from other systems. Revisiting the S-locus using the latest high-quality whole-genome assemblies revealed a similar gene composition and structure as found for Z, supporting the hypothesis of a duplicated origin of the two-locus SI system of grasses. Ultimately, comparative genomic analyses across a wide range of self-compatible and self-incompatible Poaceae species revealed that the absence of a functional copy of at least one of the six putative SI determinants is accompanied by a self-compatible phenotype. Our study provides new insights into the origin and evolution of the unique gametophytic SI system in one of the largest and economically most important plant families.

Components of stigma and its impact on maternal and child health service and outcomes: perspective of Akha hill tribe women in Thailand

BackgroundMaternal and child health (MCH) is crucial to the well-being of mothers and children. Stigma regarding access to MCH services is a major challenge, especially for hill tribe people in Thailand. The study aimed to understand the components of stigma and its impact on MCH service and outcomes including experiences and expectations to address the stigma in perspective of Akha hill tribe women in Thailand.MethodsA phenomenological qualitative approach was used to gather information from Akha women who had attended MCH service one year prior and had an experience with stigma. A validated question guide was used in the study. The interview was conducted in private and confidential rooms in the Akha hill tribe villages between June and September 2021. A thematic analysis was used to extract the major and minor themes and develop the findings.ResultsA total of 61 Akha postdelivery participants were recruited to provide information; the average age was 28.9 years, 32.8% had no Thai ID card, and 93.4% were married. Language, traditional clothing, poverty, and name were identified as drivers of stigma, while health care providers’ background, gender differences between clients and health care providers, and knowledge gaps facilitated the stigma. Being a member of a hill tribe acted as the stigma marker. Stigma manifestation was presented in the forms of verbal or physical abuse, refusal to provide treatment, and intentional disclosure of personal information to the public. Accepting the situation with no better option, defending oneself to receive better care and services, and using a private care service were experiences in addressing the stigma. Gender matching, active MCH service, mobile emergency clinics, and appropriate, permanent medical equipment in health care facilities located in their villages were the expectations.ConclusionAkha women face a variety of stigmas in access to MCH services, with substantial impacts on health outcomes, especially the rate of services in women and child health. Creating laws to prevent the occurrence of any forms of stigma and implementing gender matching in MCH services should be considered.

Recognizing and disrupting stigma in implementation of HIV prevention and care: a call to research and action.

IntroductionThere is robust evidence that stigma negatively impacts both people living with HIV and those who might benefit from HIV prevention interventions. Within healthcare settings, research on HIV stigma has focused on intra‐personal processes (i.e. knowledge or internalization of community‐level stigma that might limit clients’ engagement in care) or inter‐personal processes (i.e. stigmatized interactions with service providers). Intersectional approaches to stigma call us to examine the ways that intersecting systems of power and oppression produce stigma not only at the individual and interpersonal levels, but also within healthcare service delivery systems. This commentary argues for the importance of analysing and disrupting the way in which stigma may be (intentionally or unintentionally) enacted and sustained within HIV service implementation, that is the policies, protocols and strategies used to deliver HIV prevention and care. We contend that as HIV researchers and practitioners, we have failed to fully specify or examine the mechanisms through which HIV service implementation itself may reinforce stigma and perpetuate inequity.DiscussionWe apply Link and Phelan's five stigma components (labelling, stereotyping, separation, status loss and discrimination) as a framework for analysing the way in which stigma manifests in existing service implementation and for evaluating new HIV implementation strategies. We present three examples of common HIV service implementation strategies and consider their potential to activate stigma components, with particular attention to how our understanding of these dynamics can be enhanced and expanded by the application of intersectional perspectives. We then provide a set of sample questions that can be used to develop and test novel implementation strategies designed to mitigate against HIV‐specific and intersectional stigma.ConclusionsThis commentary is a theory‐informed call to action for the assessment of existing HIV service implementation, for the development of new stigma‐reducing implementation strategies and for the explicit inclusion of stigma reduction as a core outcome in implementation research and evaluation. We argue that these strategies have the potential to make critical contributions to our ability to address many system‐level form stigmas that undermine health and wellbeing for people living with HIV and those in need of HIV prevention services.

The psychometric properties of the Forensic Stigma Scale (FSS)

Three studies examined the psychometric properties of a new scale, the Forensic Stigma Scale (FSS), designed to measure public stigma of forensic patients. In Study 1, the initial item pool was derived to measure three components of stigma (stereotypes, prejudice, discrimination). An EFA (n = 218) identified a two-factor model with 12 items. In Study 2, this two-factor solution was confirmed using CFA with a separate sample (n = 326) which had good-excellent fit indices. All 12 items loaded (> 0.40) on the two latent factors (Dangerousness/Unpredictability [7 items] and Responsibility/Blame [5 items]) identified in the EFA. In Study 3, using the combined samples from the previous two studies, the 12-item FSS showed promising internal consistency reliability (0.75–0.80) and demonstrated satisfactory-good criterion validity; the scale was moderately correlated with a similar construct and was able to differentiate individuals who did and did not have specific education on forensic psychology. IRT analyses demonstrated that both subscales had discrimination parameters in the moderate-high range (α = 1.03 to 2.54), though the threshold parameters (bi) on the Dangerousness/Unpredictability subscale showed better distribution across trait levels. Overall, the 12-item FSS demonstrates strong psychometric properties, especially the Dangerousness/Unpredictability subscale. The scale may provide clinical and empirical uses for measuring public stigma of forensic patients.

Measurement of stigma and associated characteristics in people with tuberculosis in Medellín, Colombia: a cross-sectional study.

Stigma towards tuberculosis (TB) delays diagnosis and compromises adherence to treatment. We measured the degree of stigma and identified the sociodemographic and clinical characteristics that were associated with a higher degree of stigma in patients with pulmonary and extrapulmonary TB in Colombia. We conducted a cross-sectional study with 232 participants included in the TB control program in 2017. Sociodemographic and clinical variables were measured. The stigma component was measured through a validated scale and a multiple linear regression was used. The study analysed 232 patients, of which 52.2% were men, 53.5% were between 27 and 59y of age and 66.8% had a basic-medium education level. Two characteristics were significantly related to a higher stigma score: the basic-medium education level and homeless status. Homeless status increased the stigma score by 0.27. In contrast, the adjusted stigma score decreased by 0.07 if the patient's health status was perceived as 'healthy'. Stigma is maximized in homeless patients and patients with a low education level. It is minimized in patients who perceive their state of health as 'healthy'.

Public depression stigma does not vary by symptom severity

Background Previous studies on public depression stigma did not include different severity levels and thus, did not adequately consider the continuum notion of depressive disorders. Aims We address the following research questions: 1. Are there differences in public depression stigma according to different severity levels? 2. Is stigma associated with sociodemographic characteristics, experience with depressive symptoms, and symptom severity? Methods Computer-assisted telephone interviews were conducted in winter 2019/2020 in Germany (N = 1009). Three vignettes representing mild, moderate, and severe depressive symptoms were used. Three indicators of stigma were assessed: negative stereotypes, anger reactions, and desire for social distance. Age, sex, education, and experience with depression (own affliction, contact) were additionally introduced into multiple linear regression analyses. Results Overall, negative stereotypes, anger reactions, and desire for social distance do not significantly vary by depression symptom severity. All components of depression stigma showed positive associations with age, while anger was negatively associated with experiences. Conclusions Our results do not indicate that public depression stigma is more pronounced when symptoms are more severe. Conclusion is ambivalent: Persons with severe depression do not seem to be additionally burdened by increased stigma, but the German public holds stigmatizing attitudes even towards individuals with mild depressive symptoms.