Explanatory Mechanisms Research Articles

Forecasting heart failure: Seasonal alignment of heart failure outcomes in New York.

Seasonal variations have been observed in heart failure (HF) hospitalization. Numerous explanatory mechanisms have been proposed, but no prior studies have examined potential contributors directly. Our objective was to identify specific factors that could contribute to seasonal variability using a large longitudinal dataset of HF hospitalizations. Hospital discharge data were obtained for all hospitals in the state of New York from 1994 to 2007. Records with a primary diagnosis of HF by the International Classification of Diseases-9 Clinical Modification (ICD-9-CM) code (428.xx and 425.xx) were included. Year and month of admission were used as predictors to evaluate outcomes of in-hospital mortality, population-adjusted daily rate of hospital admissions and length of stay (LOS) using univariable regression including a sinusoidal model to assess the seasonality of HF outcomes. Observations were then adjusted for multiple medical covariables as well as the average local monthly temperature and humidity at each hospital using data from the Global Historical Climate Network to identify potential modifiers of seasonal variability. Among 949907 records, the median age was 76 [inter-quartile range (IQR) 65-84years old], and the cohort was 54% female (510945 records). The population-adjusted rate of HF admissions per day increased by 1.1 admissions/day/year between 1994 and 2007, whereas in-hospital mortality and LOS decreased by -0.3%/year and -0.3days/year, respectively (P<0.001 for all). Seasonal trends were identified for daily HF admissions (February peak, P<0.0001), mortality (January peak, P<0.001) and LOS (January peak, P<0.01). Cosinor analysis revealed significant periodicity for HF admission rate (amplitude=±0.9 admissions/day/100000 people, P<0.001), in-hospital mortality (amplitude=±0.47%, P<0.001) and LOS (amplitude=±0.23days, P<0.01). No other patient characteristics were significant modifiers of seasonality. Odds of mortality were highest in July rather than January when adjusted for average local temperature but not humidity. Adverse outcomes in patients hospitalized with HF were significantly worse in the winter months even when adjusted for patient characteristics and concurrent acute diagnoses such as pneumonia. Local ambient temperature was the strongest modifier of the observed seasonality. Given the increasing frequency of extreme weather events, additional work to determine the mechanisms of this and other environmental risk factors is urgently needed.

Sense‐Making Through Hybrid Talk: High‐Achieving Secondary Students' Language Use during Practical Work

ABSTRACTThis study contributes to discussions on facilitating students' sense‐making in science by analyzing the utterances of high‐achieving students in dialogues during practical work and identifying characteristics of their language use and learning processes. The context of the study is a general science course at an upper secondary school in Norway. During four lessons, students from two classes conducted three exercises in electrochemistry. Data consist of video recordings from group work and whole‐class dialogues, students' written explanations, and their grades in science. Using the Bakhtinian concept of hybrid constructions (i.e., utterances including both vernacular and scientific elements), we analyze dialogues about scientific concepts and possible explanations for observations made during practical work. The analysis focuses on mixed‐ability groups that include one or two high‐achieving students. These students' successful learning processes enable the identification of language use that is part of sense‐making dialogues. We found that all students participating in dialogues used a mixture of vernacular talk, hybrid constructions, and scientific language during their learning processes. The content of scientific explanations proposed by high‐achieving students initially tended to be correct but superficial. The content then became more complex and hybrid and displayed errors and inaccuracies when students discussed detailed explanatory mechanisms, and finally, it became complex and largely correct. The results indicate that the high‐achieving students' use of hybrid constructions during practical work was beneficial for their learning. We discuss challenges related to creating situations in science teaching that encourage all students to engage in hybrid talk during sense‐making dialogues.

Habitat alters biogeographical and evolutionary patterns of body size in freshwater crayfishes

Abstract Biogeographical patterns explain variation in body size, although the strength and directions of these patterns vary. When researchers account for the micro- or macrohabitats that species inhabit, they often find that biogeographical relationships with body size are modified, especially in taxa that inhabit diverse environments. Freshwater crayfishes are an ideal group in which to study the interaction between habitat, biogeography, and body size, because there are &amp;gt;700 crayfishes that inhabit aquatic environments, semi-terrestrial burrows, and caves. Here, we explore evolution of body size across 452 species of crayfish by considering the interaction between their habitats (aquatic, semi-terrestrial/aquatic, semi-terrestrial, and cave-dwelling) and the mean temperature of their geographical range. We documented 64-fold variation in body length. Aquatic species were the largest and had the greatest variation in body size. Crayfishes that inhabit both semi-terrestrial and aquatic habitats exhibit a weak negative relationship between body size and environmental temperature; solely aquatic species reverse this relationship. Evolutionarily, our ancestral reconstruction suggests that the ancestral crayfish was an aquatic species with a body length of 81.1 mm, which aligns with data from fossil crayfish. Overall, our study highlights how uniting biogeographical and evolutionary approaches improves our ability to explore patterns of animal body size and unearth explanatory mechanisms.

Insomnia and Chronic Pain Mediate the Relationship Between Traumatic Brain Injury and Reduced Positive Airway Pressure Adherence Among Veterans.

To examine whether co-morbid insomnia, post-traumatic stress disorder (PTSD), depression, and chronic pain mediate the relationship between traumatic brain injury (TBI) and positive airway pressure (PAP) treatment adherence. One Veterans Health Administration (VHA) sleep medicine site. Veterans (n =8836) who were prescribed a modem-enabled PAP device. Secondary analysis of clinical data. We used path analysis to examine: (1) whether Veterans with a history of TBI were more likely to experience insomnia, PTSD, depression, and chronic pain; (2) in turn, whether Veterans with these co-morbid conditions exhibited lesser PAP adherence; and (3) whether Veterans with a history of TBI will exhibit lesser PAP adherence, even while accounting for such co-morbid conditions. Model estimates were adjusted for sociodemographic (eg, race/ethnicity) and clinical characteristics (eg, mask leakage). Health conditions were abstracted from the VHA medical record. PAP adherence was measured using average nightly use (hours). Among 8836 Veterans, 12% had a history of TBI. TBI history was not associated with PAP adherence when accounting for the presence of insomnia, PTSD, depression, and chronic pain. Indirect effect estimates indicated that a history of mild, moderate-severe, or unclassified TBI was associated with lesser PAP adherence, as mediated by the presence of co-morbid insomnia and chronic pain. Generally, TBI was associated with an increased likelihood of co-morbid insomnia, PTSD, depression, and chronic pain. In turn, insomnia and chronic pain, but not PTSD or depression, were associated with lesser PAP adherence. Our study offers empirical support for insomnia and chronic pain as potential explanatory mechanisms underlying the relationship between TBI history and suboptimal PAP adherence. While additional research is needed to confirm causality, findings offer preliminary evidence that can inform the development of tailored PAP adherence interventions for Veterans with TBI and obstructive sleep apnea.

Perceived economic inequality inhibits pro-environmental engagement.

We currently inhabit an era marked by increasing economic inequality. This paper delves into the repercussions of perceived economic inequality on individual-level pro-environmental engagement and puts forth an explanatory mechanism. Across three empirical studies encompassing an archival investigation employing a nationally representative data set (Study 1), an online survey (Study 2) and an in-lab experiment (Study 3), we consistently unearth the inhibiting effect of perceived economic inequality on individuals' pro-environmental involvement, whether assessed through pro-environmental intentions or behaviours. Furthermore, our findings reveal that individuals' identification with their country elucidates these results. Specifically, perceived economic inequality diminishes individuals' national identification, encompassing their concern for the country's well-being and their sense of shared destiny with fellow citizens, thereby curbing their pro-environmental engagement. Additionally, we conduct a single-paper meta-analysis (Study 4), revealing small to moderate effect sizes for our key findings. Theoretical and practical implications stemming from these novel findings are discussed.

Ethical leadership and followers’ job crafting: the mediating role of followers’ role-breadth self-efficacy and work engagement

PurposeThe objective of this study was to investigate the link between ethical leadership and followers’ job crafting. Based on social learning theory and the job demands-resources model, we expected that followers’ role-breadth self-efficacy and work engagement would serially mediate the association between this leadership style and followers’ job crafting.Design/methodology/approachA quantitative analysis was conducted among a sample of 458 subordinates that assessed the ethical leadership of their direct supervisor and reported on their own role-breadth self-efficacy, engagement and job crafting behaviours.FindingsEthical leadership was positively associated with followers’ increasing structural resources, increasing social resources and increasing challenging demands. The mediation hypothesis was supported for increasing challenging demands but not for increasing social resources. Results unexpectedly suggested that the indirect positive effect suppresses the direct negative effect of ethical leadership on followers’ increasing structural resources, the total effect becoming positive. This leadership style was not associated with followers’ decreasing hindering demands.Practical implicationsThe research highlights the possibility that ethical leadership trainings may stimulate followers' job crafting.Originality/valueThe study explores for the first time the relationship between this leadership style and job crafting behaviours of subordinates and, moreover, provides an explanatory mechanism for the relationship between these variables.

Linking early emotional abuse/neglect with young adolescents’ social (versus general) anxiety symptoms: A developmental cascade through emotion regulation

Despite the widely documented implications of childhood emotional abuse/neglect for subsequent anxiety symptoms, the implicated mechanisms remain under-revealed, especially the various transdiagnostic and specific pathways related to early experiences of emotional abuse versus emotional neglect and different types of subsequent anxiety symptoms (social versus general). Using three-wave data from 844 Chinese adolescents (Meanage = 13.21 at Wave 1, SD = 0.39; 53 % Boys), we tested emotion regulation strategies (cognitive reappraisal and expressive suppression) as explanatory mechanisms underlying the links between childhood emotional abuse/neglect and subsequent social anxiety symptoms (SAS), while simultaneously considering general anxiety symptoms (GAS) for the identification of possible specificity. Results indicated that expressive suppression played a mediating role in the links between emotional neglect and both forms of anxiety symptoms, whereas cognitive reappraisal served as a linking mechanism only for the link between emotional neglect and GAS. No effects were identified for emotional abuse. All associations were identified after controlling for the baseline levels of anxiety symptoms, the baseline uses of emotion regulation strategies, and covariates (age, gender, and family socioeconomic status). Our findings re-confirm that emotion regulation is an important intermediate process accounting for anxiety-related sequelae of early emotional deprivation, suggesting that expressive suppression appears to be a more developmentally transdiagnostic process shaped particularly by early emotional neglect to contribute to different types of subsequent anxiety symptoms. Accordingly, educational and clinical practices on emotion regulation likely benefit the affective well-being of young adolescents whose childhood has been clouded with emotional neglect.

To Sustainably Ride or Not to Ride: Examining the Green Consumption Intention of Ride-Hailing Services in the Sharing Economy by University Students

An increase in ride-hailing services in the sharing economy can help to reduce the number of vehicles on the road, which will lead to a decrease in air pollution and noise pollution, an improvement in environmental conditions, a decrease in travel costs, and an increase in social benefits to travelers. Hence, there is a great need to examine the consumer’s intention toward usage of ride-hailing services in the sharing economy. The current study aims to examine the green consumption intention of eco-friendly services as an outcome of environmental responsibility and environmental knowledge. It also attempts to examine the serial mediation of green concern, value co-creation, and mediated moderation of social support as an explanatory mechanism of green consumption intention of eco-friendly services. The research design was cross-section and deductive. The respondents of the study were registered university students in Islamabad who were active consumers of major ride-hailing services in Pakistan, i.e., Uber, Careem, Uplift, InDriver, B4U Cabes, and SUVL. A total of 402 responses were gathered using purposive sampling. Partial Least Squares Structural Equation Modeling (PLS-SEM) in Smart PLS is used to evaluate the reliability of measurement instruments and the validity of the research model. The current study results showed that environmental responsibility and knowledge positively and significantly affect motivation to engage in green consumption. Furthermore, environmental concern and value co-creation partially mediate the proposed relationship. In addition, social support also moderates the association between green concern and value co-creation such that it strengthens the connection. The current research findings are an addition to the existing literature and have managerial applications with limitations preceded by future research directions.

A hybrid self-supervised model predicting life satisfaction in South Korea.

Life satisfaction pertains to an individual's subjective evaluation of their life quality, grounded in their personal criteria. It stands as a crucial cognitive aspect of subjective wellbeing, offering a reliable gauge of a person's comprehensive wellbeing status. In this research, our objective is to develop a hybrid self-supervised model tailored for predicting individuals' life satisfaction in South Korea. We employed the Busan Metropolitan City Social Survey Data in 2021, a comprehensive dataset compiled by the Big Data Statistics Division of Busan Metropolitan City. After preprocessing, our analysis focused on a total of 32,390 individuals with 51 variables. We developed the self-supervised pre-training TabNet model as a key component of this study. In addition, we integrated the proposed model with the Local Interpretable Model-agnostic Explanation (LIME) technique to enhance the ease and intuitiveness of interpreting local model behavior. The performance of our advanced model surpassed conventional tree-based ML models, registering an AUC of 0.7778 for the training set and 0.7757 for the test set. Furthermore, our integrated model simplifies and clarifies the interpretation of local model actions, effectively navigating past the intricate nuances of TabNet's standard explanatory mechanisms. Our proposed model offers a transparent understanding of AI decisions, making it a valuable tool for professionals in the social sciences and psychology, even if they lack expertise in data analytics.

Power and Control Dynamics in Domestic Sex Trafficking: A Systematic Review

ABSTRACT U.S. citizens sex trafficked domestically (survivors of domestic sex trafficking, or SDSTs), a population comprising many cisgender women and girls, encounter complex power and control dynamics. The field of anti-sex trafficking research appears neither well-grounded in theory nor consistent in addressing the macro-level systems supporting sexual exploitation. The review objectives are to explore the application of the theory in studies with SDSTs that focus on the power and control dynamics and examine any patterns that may emerge across studies regarding theories and mechanisms used to explain these dynamics. Four electronic databases were systematically searched for research articles on power and control dynamics experienced by SDSTs identifying as cisgender women and girls. Eight studies, published between October 2000 and December 2023, in English-language peer-reviewed journals, met inclusion criteria. Criminological frameworks and the theory of coercive control were identified most frequently in included studies. Two quantitative studies used individualistic explanatory mechanisms, with the remaining six (two mixed methods and four qualitative studies) split evenly between a “middle ground” and using structural explanatory mechanisms. There was no discernible pattern of guiding theories and explanatory mechanisms; however, the synthesized findings offer research and social justice implications for promoting a more just and inclusive society.

Health-oriented Leadership and Employees’ Well-being: An Explanatory Mechanism of Person-job Fit and Psychological Empowerment

Health-oriented Leadership and Employees’ Well-being: An Explanatory Mechanism of Person-job Fit and Psychological Empowerment

Whose misbehavior is inexcusable—And which one? Job‐related discrimination against ethnic minority and majority women

AbstractBased on the model of intersectional invisibility, we tested the consequences of work‐related misbehavior for women of Turkish and German descent (i.e., misbehavior involving mistakes that are stereotypically associated with masculine or feminine traits, eliciting negative evaluations). Across a series of four preregistered experiments (Ns = 746, plus two pre‐registered experiments in an Additional Supplement), we investigated evaluations of female targets in a male‐typed, highly qualified job context. We focus on exclusion and promotion decisions. A single‐paper meta‐analysis substantiates findings across samples who have different experiences regarding racism and in personnel selection. Our findings reveal a nuanced picture: Misbehavior associated with stereotypically feminine traits led to more negative consequences for Turkish women than for German women, resulting in more frequent exclusion and less frequent promotion for Turkish women. In contrast, misbehavior associated with stereotypically masculine traits led to more favorable outcomes for Turkish than German women. Thus, revealing a complex relationship between type of misbehavior and ethnicity, we identify leader prototypes as an explanatory mechanism, rather than aversive racism or shifting standards. Results suggest that Turkish women are discriminated against most for showing stereotypically feminine behavior confirming gendered racialized steretoypes, but may experience less backlash when showing counter‐stereotypical behavior than German women. We find double standards in evaluations of highly qualified women of Turkish versus German descent, with interactions with the type of misbehavior suggesting complex interplays of gender, ethnicity, and information provided about the individual in career advancement and exclusion.

Childhood emotional maltreatment and emerging adults’ body dissatisfaction: Self-compassion and body surveillance as explanatory mechanisms

The association between childhood emotional maltreatment and body dissatisfaction has been widely identified. However, the explanatory mechanisms for this association remain unclear. Guided by the Stress Process Model, the present study tested the potential mediating roles of self-compassion and body surveillance in the associations between emotional maltreatment (i.e., emotional abuse and neglect) and body dissatisfaction. Three-wave, self-report survey data were collected from 668 Chinese young adults (66.8 % female, Mage = 19.96 years old, SD = 1.25) with a 6-month between-wave interval. Results demonstrated that childhood emotional neglect (recalled at Time 1) was positively associated with body dissatisfaction (at Time 3) through a serial mediating pathway from self-compassion (at Time 1) to body surveillance (at Time 2). In contrast, no links involving childhood emotional abuse were identified. Findings suggest that the compromised emotion regulation capacity related to self-care and the subsequent self-objectification could be key processes through which childhood emotional deprivation would be positively associated with later body dissatisfaction. Accordingly, prevention and intervention efforts aimed at combating young adults’ body image issues with early adversity of emotional deprivation could integrate emotion regulation training (that can enhance self-care) and cognitive-behavioral techniques (that may reduce body surveillance) into extant programs to enhance effectiveness.

Social mobility beliefs and attitudes toward redistribution: Potential explanatory mechanisms

AbstractEconomic inequality is a significant problem of modern society, and redistributive policies are one of the most effective tools for reducing it. Previous studies have highlighted the importance of social mobility to understand attitudes toward redistribution. Across three preregistered studies (N = 2475; one cross‐sectional and two experimental) in different countries (Italy and Spain), we investigated the relationship between upward and downward societal mobility beliefs and attitudes toward redistribution, as well as potential explanatory mechanisms. Results showed that when people believe that it is easy to improve the socioeconomic status in their society, they oppose redistributive policies; conversely, when people believe that is difficult, they support redistributive policies. Importantly, meritocratic beliefs explained the upward mobility effect on redistribution, and perceived personal economic risks accounted for the downward mobility effect. Implications of these results for the design of policies to reduce economic inequality are discussed.

Effect of negative emotional stimuli on working memory: Impact of voluntary and automatic attention.

Emotions are known to influence cognitive performance, particularly working memory (WM) in both its aspects, processing, and maintenance. One explanatory mechanism might be that negative stimuli capture attentional resources, leaving fewer resources for attentional maintenance and processing of information in WM. However, this attentional capture was only investigated using WM tasks in which participants were explicitly asked to process negative items. The aim of this paper was to determine whether explicit processing of emotional stimuli is necessary to impair WM performance, or if their mere presence is enough to capture attention. For this purpose, participants performed a complex span task in which they alternated between memorizing a series of neutral words and processing either emotional images or neutral ones. In Experiment 1, participants were instructed to explicitly process emotional images, whereas in Experiment 2, emotional images were presented without any processing being required. In both experiments, we observed a decrease in memory performance when the images were negative compared to neutral. Whether or not voluntary processing is involved, emotional images seem to capture attentional resources, which in turn leads to a decline in memory performance. These results were discussed in relation to attentional theories and the influence of emotion on the specific mechanisms of WM.

Interaction between the electrochemical properties of powdered activated carbon and the biochemical processes within bacteria in Azo dye biodecolorization: An explanatory mechanism

Drawing on prior reports highlighting the redox mediator properties of powdered activated carbon (PAC), this study was designed to evaluate these properties to enhance the decolorization of azo dye by Klebsiella quasipneumoniae GT7. It was found that the presence of 0.5 % PAC in the medium increased the biodecolorization rate early in incubation. Chemical analysis revealed that dye conversion into aromatic amines occurred in microbial systems both with and without PAC. However, at initial dye concentrations (Cid) of 2 mM or higher, some dye remained on the PAC surface and in the medium. In contrast, the PAC-free system achieved nearly 100 % biodecolorization at all initial dye concentrations. The negative impact of PAC on decolorization efficiency in microbial systems with high initial dye concentrations cannot be solely explained by its redox mediator function. This study used the amphoteric-Donnan model for PAC's electrical double layer (EDL) and Mitchell's chemiosmotic model for bacterial proton motive force (PMF) to explore this. It found that charge storage in PAC's EDL regulates electron transfer fluxes, and proton species enhance the proton motive force across the bacterial membrane. These observations improve the understanding of PAC's role in microbial decolorization and its potential future applications.

Sustaining organizational trust among restaurant employees after the crisis: Insights from a developing country

Sustaining trustful employee-organization relationships and improving job satisfaction are always significant challenges for managers, especially in the restaurant industry. For the purpose of fathoming the value of trust, an analytical framework examining organizational trust as an explanatory mechanism through which various organizational conditions influence job satisfaction has been proposed based on the guidance of the social exchange theory. Analysis of survey data from 302 restaurant employees in a celebrated tourist destination of Vietnam have shown both direct and indirect impacts of transformational leadership, internal communication, and career growth on job satisfaction via enhanced trust. Together these main findings have contributed to academic research on employees’ attitudes within the organization and provided a blueprint for creating a congenial working condition for employees in restaurant businesses, which results in employee trust towards their organizations and job satisfaction.

The relationship between insecure attachment and nicotine dependence among users of classic cigarettes, e-cigarettes, and heated tobacco products: a moderated mediation model

BackgroundPrevious research has investigated the association between attachment styles and smoking behaviors, indicating a positive association of insecure attachment styles with nicotine dependence. However, these links were mostly explored in adolescent and student samples. Moreover, the explanatory mechanisms and the variables influencing the strength of this relationship remained understudied. In this context, the present study aims to: (1) examine the associations between attachment anxiety, avoidance, and nicotine dependence; (2) investigate the mediating role of emotion dysregulation and metacognitions about smoking; and (3) test the moderating roles of psychological capital and type of tobacco product used by the participants.MethodThis cross-sectional study was conducted on a convenience sample of 447 participants who reported smoking. The age range of participants was 18 to 64 (M = 26.76; 59.7% women). All participants have completed five questionnaires measuring nicotine dependence, adult attachment, emotion dysregulation, metacognitions about smoking, and psychological capital. They also reported the type of tobacco product commonly used: classic cigarettes, e-cigarettes, or heated tobacco products.ResultsOur findings show that the direct link between insecure attachment and nicotine dependence is rather inconsistent. However, it was mediated by the metacognitions about smoking. Psychological capital can act as a protective factor against the effects of attachment on nicotine dependence, especially for those using alternative tobacco products alongside classic cigarettes.ConclusionsThe findings highlight the possibility of developing better-tailored interventions and treatments to discourage smoking and increase smoking cessation. These should focus on eliminating the dysfunctional beliefs related to the metacognitions about smoking and on improving the levels of psychological capital. In addition, targeting attachment insecurities in early adolescence can also function as a mean to prevent smoking.

Impact of psychological entitlement on engagement in learning activities and psychological anxiety: the mediating role of envy

Psychological entitlement has appeared as a significant topic for research in the field of management and Psychology. From the perspective of social comparison theory, the present study aimed to investigate the impact of psychological entitlement on engagement in learning activities and psychological anxiety in the hotel industry. Furthermore, benign and malign envy were examined as an explanatory mechanism between psychological entitlement and its outcomes. Based on a three-wave time-lagged design, data were obtained from 242 employees working in the different hotels in Pakistan. We found that psychological entitlement’s has no direct influence on hotel employees engagement in learning activities, and psychological anxiety. In addition, the indirect effect of psychological entitlement on both outcomes (engagement in learning activities and psychological anxiety) was found significant through the mediating effect of benign and malign envy. The implications for research theory and practice are discussed.

Predictors and mechanisms of self-stigma in five chronic skin diseases: A systematic review.

People with skin disease suffer due to disease-related physical symptoms, as well as due to significant psychosocial burden. A major contributor of this burden is the experience of stigmatization. Research indicates that people with visible skin diseases deal with both social stigma and self-stigma. This systematic literature review aimed to aggregate existing research on correlates and mechanisms that contribute to self-stigmatization among people with atopic dermatitis, psoriasis, vitiligo, alopecia areata or hidradenitis suppurativa and to, ultimately, identify targets for psychosocial interventions. The review followed PRISMA guidelines. Four databases, PubMed, OVID, Web of Science and PsycINFO were searched for peer-reviewed articles. Studies were identified by two independent researchers and were eligible if they (1) assessed adults with one of five chronic skin diseases-atopic dermatitis, psoriasis, vitiligo, alopecia areata or hidradenitis suppurativa, (2) measured self-stigma or relevant synonyms, (3) evaluated psychosocial correlates, predictors or explanatory mechanisms of self-stigma and (4) were published in German or English in a peer-reviewed journal. The Johanna Briggs Institute Checklist for Analytical Cross Sectional Studies was used to evaluate the quality of studies. Twenty-seven studies were included with a mean quality rating of 7.04 (outof 8). Social stigma, coping strategies (such as lack of acceptance) and lack of social support were identified as main predictors of self-stigma. Although study quality was good, all but one study had a cross-sectional design that does not allow examining causal relationships among the determinants of self-stigma. Findings from the present review revealed several psychosocial variables that are malleable and potentially suitable as intervention targets. Those variables such as acceptance should be targeted in evidence-based interventions specifically developed to reduce self-stigma to, ultimately, improve mental health of people affected.