Dimensions Of Stigma Research Articles

Exploring Experiences Responding to the Individual Level Abortion Stigma Scale: Methodological Considerations From In-depth Interviews.

Background: The Individual-Level Abortion Stigma (ILAS) scale is a tool to measure multiple dimensions of stigma among people who have abortions. Despite use of the scale globally, little is known about participant experiences completing the scale. We assessed reactions to and experiences with the scale among women who obtained abortions in Mexico, exploring how the items made them feel about themselves and their abortion.Methods: We conducted 10 in-depth interviews with women approximately 6 months after their abortion. We explored experiences answering the ILAS overall as well as each sub-scale (self-judgement; worries about judgement; isolation; community condemnation). We used thematic analysis to examine overall experiences with the ILAS and framework analysis to summarize responses by sub-scale.Results: Many respondents reported positive experiences responding to the scale or said it served a therapeutic purpose. Other participants said the scale caused strong or mixed emotions or generated doubts. Women generally described mixed and negative reactions to the “worries about judgement” and “community condemnation” sub-scales, and more neutral or positive reactions to the “isolation” and “self judgement” sub-scales. Nearly all respondents hypothesized that completing the ILAS at the time of their abortion would be more difficult than responding months after their abortion.Conclusions: People can experience both positive and negative effects when responding to abortion stigma scales. Use of the scales may cause discomfort and introduce concepts that further perpetuate stigma. This study highlights the importance of carefully considering when it is appropriate to implement the scale and exploring safeguards for participants.

Exploring first responders' perceptions of medication for addiction treatment: Does stigma influence attitudes?

Researchers have suggested that provider-based stigma of persons who suffer from opioid use disorder (OUD) in the criminal justice system serves as a barrier to fully implementing harm reduction strategies, such as the use of naloxone and medication for addiction treatment (MAT). While scholars have begun to explore the relationships between stigma and first responders' attitudes toward naloxone, little work has been done to assess first responders' attitudes toward other forms of harm reduction, including MAT. The goal of the current exploratory study was to help fill this gap in the literature by assessing first responders' (N = 282) attitudes toward MAT, as well as the correlates of these attitudes. The study specifically focused on examining the relationship between provider-based stigma and attitudes toward MAT. Results show that, in the aggregate, first responders held slightly negative attitudes toward the use of MAT. Moreover, the study found that certain dimensions of stigma (i.e., dangerousness and fatalism) to exhibit a negative relationship with attitudes toward MAT, while support for the disease model of addiction was associated with positive perceptions. Policy implications based on these findings are discussed within.

Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV 'test and treat' trial.

HIV-related stigma is a frequently cited barrier to HIV testing and care engagement. A nuanced understanding of HIV-related stigma is critical for developing stigma-reduction interventions to optimize HIV-related outcomes. This qualitative study documented HIV-related stigma across eight communities in east Africa during the baseline year of a large HIV test-and-treat trial (SEARCH, NCT: 01864603), prior to implementation of widespread community HIV testing campaigns and efforts to link individuals with HIV to care and treatment. Findings revealed experiences of enacted, internalized and anticipated stigma that were highly gendered, and more pronounced in communities with lower HIV prevalence; women, overwhelmingly, both held and were targets of stigmatizing attitudes about HIV. Past experiences with enacted stigma included acts of segregation, verbal discrimination, physical violence, humiliation and rejection. Narratives among women, in particular, revealed acute internalized stigma including feelings of worthlessness, shame, embarrassment, and these resulted in anxiety and depression, including suicidality among a small number of women. Anticipated stigma included fears of marital dissolution, verbal and physical abuse, gossip and public ridicule. Anticipated stigma was especially salient for women who held internalized stigma and who had experienced enacted stigma from their partners. Anticipated stigma led to care avoidance, care-seeking at remote facilities, and hiding of HIV medications. Interventions aimed at reducing individual and community-level forms of stigma may be needed to improve the lives of PLHIV and fully realize the promise of test-and-treat strategies.

Stigma towards schizophrenia in Cyprus: Does studying a mental health related programme make a difference?

Students from mental health related programmes may display stigmatising attitudes towards people of schizophrenia, however there are no data available on this population in Cyprus. The purpose of the present study was (a) to examine the levels of contact and stigma towards schizophrenia in Cypriot students of programmes related to mental health and students of other programmes and (b) to examine whether the successful recognition of a person with schizophrenia through a vignette and the estimation of severity levels was related to stigmatising attitudes. The participants were undergraduate students purposively selected across Cypriot universities (N = 152). A vignette depicting a person with schizophrenia, followed by the OMI to examine stigma and the BAE to examine contact with mental illness were used to collect the data. The results showed that studying a mental health related programme and being a man was associated with more positive views related to social integration. No further stigma dimensions were predicted by the included variables. Similarly, level of contact and being able to identify the mental condition and estimate its severity was not related to stigma. The results emphasise the need to develop educational interventions to tackle stigma across students independently of their study programme and enhance mental health related programmes with opportunities for structured contact with patients with mental illness.

Prescribing stigma in mental disorders: A comparative study of Portuguese psychiatrists and general practitioners.

Physicians, including psychiatrists and general practitioners (GPs), have been reported as essential sources of stigma towards people diagnosed with a mental disorder (PDMDs), which constitutes an important barrier to recovery and is associated with poorer clinical outcomes. Therefore, psychiatrists and GPs are key populations where it is crucial to examine stigma, improve attitudes and reduce discrimination towards psychiatric patients. This study is the first to explore mental health-related stigma among Portuguese psychiatrists and GPs, examining the differences between these two specialities and assessing whether sociodemographic and professional variables are associated with stigma. A cross-sectional study was performed between June 2018 and August 2019. A consecutive sample of 55 Psychiatrists and 67 GPs working in Porto (Portugal) filled a 25-item self-report questionnaire to assess their attitudes towards PDMDs in clinical practice. The instrument was designed by the authors, based on previous mental health-related stigma studies and validated scales. The questionnaire includes 12 stigma dimensions (Autonomy, Coercion, Incompetence, Dangerousness, Permanence, Pity, Responsibility, Segregation, Labelling, Diagnostic Overshadowing, Shame and Parental Incompetence), and its total score was used to measure Overall Stigma (OS). Sample characteristics were examined using descriptive statistics, and the factors affecting stigma were assessed through regression analysis. GPs exhibit significantly higher OS levels than psychiatrists, and present higher scores in the dimensions of dangerousness, parental incompetence, diagnostic overshadowing and responsibility. Besides medical speciality, several other sociodemographic variables were associated with sigma, including age, gender, having a friend with a mental disorder, professional category, agreement that Psychiatry diverges from core medicine and physician's interest in mental health topics. Our data suggest that both psychiatrists and GPs hold some degree of stigmatizing attitudes towards PDMDs. Overall, these results bring new light to stigma research, and provide information to tailor anti-stigma interventions to Portuguese psychiatrists and GPs.

Mental Illness Public Stigma and Treatment Seeking among University Students

ABSTRACT While stigma is a complex, multidimensional concept, research regarding mental illness stigma has not been clearly defined or consistently measured across studies, thus limiting the broad application of this research. The current study examined the relationship between several dimensions of public stigma and treatment utilization for mental illness in a university student population. We found significant differences in public stigma endorsement among different treatment utilization groups. Perceptions of dangerousness to others and exclusionary sentiments were the two stigma variables that predicted treatment usage. The implications for using this information about stigma on a university campus are discussed.

Ehud, Stigma, and the Management of Spoiled Identity

The story of Ehud, and his assassination of the Moabite King Eglon (Judges 3: 12–30), continues to entertain readers and hearers alike. The story also perplexes, largely on moral grounds. This paper utilises the sociology of Erving Goffman and insights from disability studies to re-tell the story of Ehud as someone who is doubly stigmatised. That is, Ehud not only carriers the stigma of left-handedness but is also disabled; moreover, the Moabite King is also disabled/immobile because of his obesity. I take the biblical text as conveying that Ehud is left-handed by necessity given the impairment in his right hand/arm. Adopting a social model of disability, I apply Goffman’s account of the management of spoiled identity developed in his book Stigma (1963) to explore how the narrative depicts various dimensions of social stigma and Ehud’s moral career as he attempts to manage his spoiled identity and the degrees of societal acceptance and rejection he experiences in different contexts. The key arguments of Goffman are summarised before I apply central concepts from Goffman to the biblical story. Concepts include “moral career,” the distinction between social, personal and ego (self-) identity, and the key distinction between a person with a stigma being discredited (because the impairment is obvious and seen by all), on the one hand, or bearing a stigma that is discreditable (that is, it would discredit them if found out), on the other.

Discrimination Persistent Barrier to Care for OUD Patients

Discrimination Persistent Barrier to Care for OUD Patients

Knowledge, contact and stigma of mental illness: Comparing three stakeholder groups in Hong Kong.

It remains unknown what the impacts of multiple dimensions of contact (e.g. level, quantity and quality) are on the stigma of mental illness. To explore the relationship between the multiple dimensions of contact and stigma of mental illness among family members (FM), mental health workers (MHW) and community residents (CR) in Hong Kong. The stigma, contact and knowledge were measured in FM, MHW and CR in Hong Kong. Multiple regression analyses were used. MHW (n = 141) had higher knowledge, more contact and lower stigma of mental illness than CR (n = 95) or FM (n = 62). Knowledge and contact quality were significantly associated with lower stigma of mental illness in the three groups. However, contact level and contact quantity were not significantly associated with most stigma components. The contact level was positively associated with stigma of mental illness among FM and CR. The results of this study highlight the differences in knowledge, contact and stigma of mental illness among different stakeholder groups. This study suggests that positive contact (e.g. equal, supportive, voluntary and pleasant contact) reduces stigma of mental illness, while negative contact (e.g. unfriendly, unsupportive, unpleasant contact) may increase stigma. The Enhancing Contact Model (ECM) should be tested in future anti-stigma interventions.

PERCEPTION OF HIV STIGMA PERCEPTION IN HIV INFECTED PEOPLE

HIV (Human Immunodeficiency Virus) is a virus that can attack the human immune system. In Garut infected with HIV during 2018 there were 251 and the number who died was 181, also the cause of high mortality and morbidity, which can cause psychosocial problems such as stigma. The purpose of this study to describe the perception of HIV stigma in Guntur Garut Army Hospital. The design of this study was descriptive quantitative with a population of people infected with HIV of 199 people. The sample collection technique used Accidental Sampling with a sample size of 45, the variable in this study was HIV stigma. The questionnaire used is the Berger stigma scale, with the results of the validity test of 0.98 and Cronbach's alpha reliability of 0.92. Using Univariate Analysis Techniques. Based on the results of the study, it can be seen that 57.8% of respondents have a bad HIV stigma, when viewed from several dimensions, the highest dimension is Disclosure Cocerns 55.6%. Then Public Attitude 53.3%, Personalized Stigma dimensions 68.9%, and Negative Self Image dimensions 64.4% B. Results. Conclusion Based on the results of research conducted on 45 respondents, it was found that the perception of HIV stigma at the TNI AD Guntur Garut Hospital had a bad stigma perception. In the Disclosure Cocerens dimension, it was the highest aspect that was perceived as lacking, followed by public attitudes, Personalized Stigma and Negative Self Image.

Stigma in visible skin diseases - a literature review and development of a conceptual model.

The burden of visible skin diseases (VSDs) includes not only physical symptoms but also psychosocial consequences such as depression, anxiety, impaired quality of life and low self-esteem. Stigmatization was shown to play a major role in people with skin diseases. The aim of the study was to review the evidence for the components, drivers and impacts of (self-)stigma, and to organize the data into a series of conceptual models. A targeted literature search was conducted to identify studies on (self-)stigma in relation to VSD. Conceptual models of stigma in VSDs were developed from existing generic conceptual models for VSD and of generic conceptual models of stigma and were refined after discussion with a board of experts, patient advocacy groups, clinicians and researchers. A total of 580 references were identified, of which 56 references were analysed and summarized. Two conceptual models of stigma were identified: one with external stigma and self-stigma dimensions, the other for self-stigma in mental health. These models were adapted to allow a complete description of stigma in VSDs. For this, a distinction was made between 'discrimination' and 'impact'. Finally, five models were developed: macro-overview; stigma, impact and socio-demographics; stigma, impact and disease characteristics; stigma, impact and quality of life; and stigma, impact and coping. Gaps were identified in available quantitative evidence. To our knowledge, this is the first conceptual model of stigma in VSDs. The model will help to standardize evaluation of stigma and to enhance empirical evaluation of anti-stigma interventions in VSDs. Further research should be conducted to develop a more complete model in stigma due to significant gaps in existing evidence, particularly including the stigma in others (external stigma) and also to cover a broader range of VSDs as their impact on particular dimensions of stigma differs.

Controlled Study of the Impact of a Virtual Program to Reduce Stigma Among University Students Toward People With Mental Disorders.

Stigma toward mental disorders is one of today's most pressing global issues. The Covid-19 pandemic has exacerbated the barriers to social inclusion faced by individuals with mental disorders. Concurrently, stigma reduction interventions, especially those aimed at university students, have been more difficult to implement given social distancing and campus closures. As a result, alternative delivery for programs contributing to stigma reduction is required, such as online implementation. This paper reports the results of a controlled study focused on an online multi-component program on reducing stigma toward mental illness that included project-based learning, clinical simulations with standardized patients and E-Contact with real patients. A total of 40 undergraduate students from the Universidad del Desarrollo in Santiago, Chile, participated in the study. They were randomly divided between an intervention and control group. The intervention group participated in the online multi-component program, while the control group participated in an online educational program on cardiovascular health. We assessed the impact of the program by using the validated Spanish-language versions of the Attribution Questionnaire AQ-27 and the Questionnaire on Student Attitudes toward Schizophrenia with both groups, before and after the intervention. In addition, an ad hoc Likert scale ranging from 0 to 5 was used with the intervention group in order to assess the learning strategies implemented. Following the intervention, the participants belonging to the intervention group displayed significantly lower levels of stereotypes, perception of dangerousness, and global score toward people with schizophrenia (p < 0.001). In addition, participants presented lower levels of dangerousness-fear, avoidance, coercion, lack of solidarity, and global score (p < 0.001). The control group displayed no statistically significant differences in the level of stigma before and after the evaluation, for all of the items assessed. Finally, the overall assessment of each of the components of the program was highly positive. In conclusion, the study shows that online programs can contribute to reducing stigma toward mental disorders. The program assessed in this study had a positive impact on all the dimensions of stigma and all of the components of the program itself were positively evaluated by the participants.

Intersecting Stigmas among HIV-Positive People Who Inject Drugs in Vietnam.

HIV-related stigma remains a barrier to ART adherence among people living with HIV (PLWH) globally. People who inject drugs (PWID) may face additional stigma related to their behavior or identity; yet, there is little understanding of how these stigmas may co-exist and interact among these key populations. This study aims to explore the existence of multiple dimensions of HIV-related stigma, and how they may intersect with stigma related to drug injection. The study took place in Vietnam, where the HIV epidemic is concentrated among 3 key population groups; of those, PWID account for 41% of PLWH. The vast majority (95%) of PWID in Vietnam are male. Data came from in-depth interviews with 30 male PWID recruited from outpatient clinics, where they had been receiving ART medications. Deductive, thematic analysis was employed to organize stigma around the 3 dimensions: enacted, anticipated, and internalized stigma. Findings showed that HIV- and drug use-related stigma remained high among participants. All 3 stigma dimensions were prevalent and perceived to come from different sources: family, community, and health workers. Stigmas related to HIV and drug injection intersected among these individuals, and such intersection varied widely across types of stigma. The study revealed nuanced perceptions of stigma among this marginalized population. It is important for future studies to further investigate the influence of each dimension of stigma, and their interactive effects on HIV and behavioral outcomes among PWID.

SARSCoV-2 Psychosomatic Effects and Fear of Stigma on the Discharge Day of Infected Individuals: SAPFO Study.

Although research has been mainly focused on effective treatment for SARS-COV-2 infection, psychosocial aspects of the infection it is vital to be taken into consideration. The aim of the present study is to evaluate the psychosomatic effects and the fear of stigma which patients may face after the end of treatment and discharge from hospital. This was a non-intervention perspective study conducted in the Department of Infectious Diseases of University General Hospital of Alexandroupolis (Greece). Patients on the discharge day completed questionnaires in which 5 topics were evaluated: pain/discomfort, anxiety/distress, fear/worries, stigma and tolerance of treatment. The questionnaires were derived from similar Quality of Life Tools. The total score of each patient was normalized as percentage. Females and younger than 40 years old had more worries and fears on discharge day. Significant factors were days of hospitalization, days of fever and need of oxygen therapy. Patients who hospitalized more than 10 days, particularly in isolation negative pressure rooms, with persistent fever more than 7 days and need of oxygen therapy had more anxiety, worries for their clinical condition and fear of stigma. The majority of patients (80%) were expecting to face moderate to severe problems with family members, friends and colleagues underlying the dimensions of stigma. It is crucial to evaluate the psychosocial aspects of this infection and limit the stigma which patients may face returning to their daily routine. Further studies are needed with larger patient series and with the usage of psychometric instruments.

Cannabis users and stigma: A comparison of users from European countries with different cannabis policies

Cannabis is commonly characterized as the most normalized illicit drug. However, it remains a prohibited substance in most parts of the world, including Europe, and users can still be subject to stigmatization. The objective of this study is to assess to what extent and how cannabis users in different countries with different cannabis policies perceive, experience and respond to stigmatization. We conducted a survey in the Dutch coffeeshops among 1225 last year cannabis users from seven European countries, with national cannabis policies ranging from relatively liberal to punitive. Three dimensions of cannabis-related stigma were investigated (discrimination, perceived devaluation and alienation) and a sum score was used to reflect the general level of stigmatization. Perceived devaluation was the highest-scoring dimension of stigma and discrimination the lowest-scoring. The general level of stigmatization was lowest in the Netherlands and highest in Greece. This indicates that punitive cannabis policy is associated with stigma and liberal cannabis policy is associated with de-stigmatization. Besides country, daily cannabis use was also found to be a significant predictor of stigma, but gender, age, household type and employment status were not.

A Preliminary Assessment of Stigma in Law Enforcement Officers’ Responses to Opioid Overdoses

Prior work has suggested that provider-based stigma of substance use disorders may be one barrier to fighting the opioid epidemic. However, to date, provider-based stigma has been afforded little attention in the context of the criminal justice system. The goal of the current study was to extend this line of research by examining the impact of provider-based stigma toward opioid using persons to beliefs about help that should be provided to persons experiencing an overdose among a sample of 208 police officers working in departments in the Northeastern Region of the United States. In addition, this study explores the relationship between provider-based stigma and the anticipated on-duty behavioral responses to opioid overdoses. Results from multivariable analyses indicate that certain dimensions of social stigma are significantly related to officers’ perceptions of help in varying directions, along with officers’ experiences with naloxone administration and departmental policy pertaining to the use of naloxone.

A US national randomized study to guide how best to reduce stigma when describing drug-related impairment in practice and policy.

Background and AimsDrug‐related impairment is persistently stigmatized delaying and preventing treatment engagement. To reduce stigma, various medical terms (e.g. ‘chronically relapsing brain disease’, ‘disorder’) have been promoted in diagnostic systems and among national health agencies, yet some argue that over‐medicalization of drug‐related impairment lowers prognostic optimism and reduces personal agency. While intensely debated, rigorous empirical study is lacking. This study investigated whether random exposure to one of six common ways of describing drug‐related impairment induces systematically different judgments.Design, Setting and ParticipantsCross‐sectional survey, US general population, among a nationally representative non‐institutionalized sample (n = 3635; 61% response rate; December 2019–January 2020).InterventionTwelve vignettes (six terms × gender) describing someone treated for opioid‐related impairment depicted in one of six ways as a(n): ‘chronically relapsing brain disease’, ‘brain disease’, ‘disease’, ‘illness’, ‘disorder’ or ‘problem’.MeasurementsMulti‐dimensional stigma scale assessing: blame; social exclusion; prognostic optimism, continuing care, and danger (a = 0.70–0.83).FindingsUS adults [mean age = 47.81, confidence interval (CI) = 47.18–48.44; 52.4% female; 63.14% white] rated the same opioid‐impaired person differently across four of five stigma dimensions depending on which of six terms they were exposed to. ‘Chronically relapsing brain disease’ induced the lowest stigmatizing blame attributions (P < 0.05); at the same time, this term decreased prognostic optimism [mean difference (MD) = 0.18, 95% CI = 0.05, 0.30] and increased perceived need for continuing care (MD = –0.26, 95% CI = –0.43, –0.09) and danger (MD = –0.13, 95% CI = –0.25, –0.02) when compared with ‘problem’. Compared with a man, a woman was blamed more for opioid‐related impairment (MD = –0.08, 95% CI = –0.15, –0.01); men were viewed as more dangerous (MD = 0.13, 95% CI = 0.06, 0.19) and to be socially excluded (MD = 0.16, 95% CI = 0.09, 0.23).ConclusionsThere does not appear to be one single medical term for opioid‐related impairment that can meet all desirable clinical and public health goals. To reduce stigmatizing blame, biomedical ‘chronically relapsing brain disease’ terminology may be optimal; to increase prognostic optimism and decrease perceived danger/social exclusion use of non‐medical terminology (e.g. ‘opioid problem’) may be optimal.

Pathways for reduction of HIV-related stigma: a model derived from longitudinal qualitative research in Kenya and Uganda.

IntroductionThe rollout of antiretroviral therapy (ART) has been associated with reductions in HIV‐related stigma, but pathways through which this reduction occurs are poorly understood. In the newer context of universal test and treat (UTT) interventions, where rapid diffusion of ART uptake takes place, there is an opportunity to understand the processes through which HIV‐related stigma can decline, and how UTT strategies may precipitate more rapid and widespread changes in stigma. This qualitative study sought to evaluate how a UTT intervention influenced changes in beliefs, attitudes and behaviours related to HIV.MethodsLongitudinal qualitative in‐depth semi‐structured interview data were collected within a community‐cluster randomized UTT trial, the Sustainable East Africa Research in Community Health (SEARCH) study, annually over three rounds (2014 to 2016) from two cohorts of adults (n = 32 community leaders, and n = 112 community members) in eight rural communities in Uganda and Kenya. Data were inductively analysed to develop new theory for understanding the pathways of stigma decline.ResultsWe present an emergent theoretical model of pathways through which HIV‐related stigma may decline: internalized stigma may be reduced by two processes accelerated through the uptake and successful usage of ART: first, a reduced fear of dying and increased optimism for prolonged and healthy years of life; second, a restoration of perceived social value and fulfilment of subjective role expectations via restored physical strength and productivity. Anticipated stigma may be reduced in response to widespread engagement in HIV testing, leading to an increasing number of HIV status disclosures in a community, “normalizing” disclosure and reducing fears. Improvements in the perceived quality of HIV care lead to people living with HIV (PLHIV) seeking care in nearby facilities, seeing other known community members living with HIV, reducing isolation and facilitating opportunities for social support and “solidarity.” Finally, enacted stigma may be reduced in response to the community viewing the healthy bodies of PLHIV successfully engaged in treatment, which lessens the fears that trigger enacted stigma; it becomes no longer socially normative to stigmatize PLHIV. This process may be reinforced through public health messaging and anti‐discrimination laws.ConclusionsDeclines in HIV‐related stigma appear to underway and explained by social processes accelerated by UTT efforts. Widespread implementation of UTT shows promise for reducing multiple dimensions of stigma, which is critical for improving health outcomes among PLHIV.

Breaking the silence: Determining Prevalence and Understanding Stillbirth Stigma

BackgroundThe 2011 and 2016 Stillbirth Lancet series made a call to action to identify mechanisms to reduce stillbirth stigma. This research answers that call, investigating the extent and dimensions of stillbirth stigma experienced by an international sample of mothers bereaved by stillbirth. ObjectiveTo determine the prevalence and type as well as explore explanatory variables associated with higher levels of stillbirth stigma with bereaved mothers in high-income countries (Australia, United Kingdom, The United States of America and New Zealand). MethodAn international survey of 889 bereaved mothers was conducted utilising the recently developed Stillbirth Stigma Scale to explore the extent and types of stigma experienced, as well as the association between stigma and self-esteem (Rosenberg Self- Esteem Scales), perinatal grief (Perinatal Grief Scale), and perceived social support (Perceived Social Support Scale). Demographic information (e.g. age, education, stillbirth history, sexual orientation and mental health) were collected to determine the association between individual demographic factors and stillbirth stigma. ResultsResults of the Stillbirth Stigma Scale indicated that a majority (54%) of bereaved mothers experienced stigma. Self-stigma was the predominant type of stigma experienced (80%), followed by perceived devaluation (64.9%). Bereaved mothers also experienced discrimination (29.1%) and issues with disclosing their stillbirth to their community (36.7%). Stillbirth stigma scores were higher in bereaved mothers who had experienced the loss of their first child. High scores were associated with the mother's mental health status (diagnoses prior to stillbirth, and/or after stillbirth (p<.05)).The other scales used indicated that higher stillbirth stigma scores were also associated with lower self-esteem (r (877) =-.304, p<.001), lower perceived social support (r (871) =-.448, p<.001) and higher levels of grief (r (829) =.609, p<.001). ConclusionThe current research was the first to identify that 54% of bereaved mothers experienced stigma, with self-stigma being the most prominent. Bereaved mothers endured discriminating experiences and had trouble disclosing their stillbirth to others within their community. The first-time mother with a self- reported history of mental illnesses appears to be the most at-risk of higher levels of stigma. Future longitudinal research needs to be conducted to determine the direction of the explanatory variables i.e. mental health, self-esteem and social support and develop interventions, which support the bereaved mother and reduce stillbirth stigma. RelevanceThis study is the first to demonstrate the prevalence, extent, type and explanatory variables of stigma reported by bereaved mothers and the association between this and poorer outcomes including increased grief and decreased self-esteem. This study begins a dialogue about prevalence and explanatory variables of stillbirth stigma and its impact, to inform future prevention and support potential stigma reduction programs for community and bereaved mothers.

Understanding explanatory mechanisms for racial and ethnic differences in mental health stigma: the role of vertical individualism and right-wing authoritarianism

Background Mental health (MH) stigma is pervasive worldwide. Culturally sensitive stigma reduction programs are needed to reduce MH stigma. Aims To determine racial/ethnic and cultural predictors of stigma. Method The current study examined the relationship between cultural orientation (individualism-collectivism beliefs), race/ethnicity, and political beliefs (right-wing authoritarianism [RWA]). Participants (N = 951) from the United States completed an online survey for this cross-sectional study. Results Findings indicated that vertical individualism is a consistent, though modest, predictor of multiple dimensions of MH stigma, controlling for other predictors. Contrary to what was hypothesized, vertical individualism did not mediate the relationship between Asian-American race/ethnicity and MH stigma, but was found to mediate the relationship between RWA and stigma. A novel finding was that RWA mediated the relationship between African-American race/ethnicity and multiple MH stigma domains. Conclusions Findings therefore indicate that the endorsement of authoritarian views, rather than vertical-individualism (which advances the idea that everyone is in competition), is the primary mechanism of MH stigma differences between African-Americans and individuals from other racial/ethnic groups. A major implication from this study is that efforts to address MH stigma among specific cultural groups should incorporate a sensitivity to the role of both RWA and vertical individualism in facilitating stigma.