Implicit Stigma Research Articles

Unmasking the Aversive Stigmatizer: Integrating Deliberate and Automatic Cognition in the Study of Mental Health Stigma and Perceived Dangerousness

Scholars posit that mental health stigma may be the product of both deliberate (i.e., intentional and conscious) and automatic (i.e., effortless and nonconscious) cognitive processes. Yet, few sociological studies have empirically tested this theoretical assumption with valid measures of automatic cognition. This study integrates explicit and implicit stigma measures to investigate the presence of a potentially unique actor in the stigma process, the aversive stigmatizer: individuals who deliberately reject negative cultural stereotypes but still hold implicit mental illness-related biases that may inadvertently influence discriminatory behaviors. Findings suggest that a substantial portion of the sample are aversive stigmatizers and that these actors are disproportionately present among certain social groups. Thus, this study sheds light on a previously hidden population that likely contributes to prejudice and discrimination, as well as advances our theoretical understanding of both public stigma and self-stigma.

Oxytocin modulation of explicit pandemic stigma in men with varying social anxiety levels

ObjectiveStigma can create divisions within societies, hindering social cohesion and cooperation. Notably, it has significant public health implications, especially during infectious disease outbreaks like COVID-19. However, little is known about the neural and molecular basis of disease-related stigma and their association with individual differences. MethodsTo address this gap, we performed a double-blind, placebo-controlled, within-subject design study with 70 males, to investigate the effect of intranasal oxytocin (OT) administration on the explicit and implicit processing of disease-related stigma (i.e., COVID-19 stigma). After self-administrated 24 IU of OT or placebo, participants completed a stigma evaluation task and an Implicit Association Test (IAT) to assess the explicit and implicit processes of stigma evaluation, respectively. ResultsThe results showed that oxytocin amplified the differences between participants with high and low social anxiety in explicit COVID-19 stigma, with a higher inclination to attribute the stigmatized status of the stigmatized targets (i.e., COVID-19 related group) to personal causes in high social anxiety individuals, but reduced blame towards the stigmatized targets in low social anxiety individuals under oxytocin compared to placebo treatment. Furthermore, oxytocin strengthened the connections between responsibility attribution and the other processes (i.e., emotional, approach motivation, social deviance). While no modulation of oxytocin on implicit stigma emerged, oxytocin did modulate the associations between specific dimensions of explicit stigma (i.e., social deviance and approach motivation) and implicit stigma. ConclusionIn conclusion, these findings demonstrated that intranasal oxytocin administration could temporally impact the explicit cognitive judgment in disease-related stigma but not the implicit aspect; furthermore, it modulated in distinct ways in individuals with different levels of social anxiety. These findings highlight the trait-dependent oxytocin modulation on disease-related stigma, implying that oxytocin is partly involved in the endocrine system of disease-related stigma. By unraveling the molecular basis of stigma and its association with individual traits, such as social anxiety, we can tailor interventions to meet specific needs of different individuals in the future.

First-Year Medical Students' Perceptions of Stigma Toward People With Opioid Use Disorder Before and After an Educational Intervention.

Stigma among medical trainees toward people with opioid use disorder (OUD) compounds the problems associated with opioid addiction. People with OUD who experience overt and implicit stigma from healthcare providers are less likely to seek and receive treatment, further restricting their access to already limited resources. The objective of our study was to assess an educational strategy to mitigate stigma toward people with OUD among first-year medical students. This study assessed perceptions of stigma toward people with OUD among first-year medical students using an adaptation of a brief, validated opioid stigma scale before and after an educational intervention. The intervention consisted primarily of a recorded panel in which people with a history of OUD shared their experiences with stigma followed by small group discussions. After the educational intervention, students were more likely to respond that (1) they believed most people held negative beliefs about people with OUD and (2) they personally disagreed with negative statements about people with OUD. Educational interventions addressing stigma toward people with OUD are potentially effective and should be integrated into medical curricula. Such interventions are a crucial part of the effort to improve the medical care of people with OUD.

Computational psychiatry approach to stigma subtyping in patients with mental disorders: explicit and implicit internalized stigma.

Psychiatric stigma has potentially controversial effects on patients health-related behaviors. It appears that both stigmatization and motivation in psychiatric patients are heterogeneous and multi-dimensional, and that the relationship between stigma and treatment motivation may be more complex than previously believed. To determine psychiatric stigma subtypes as they relate to treatment motivation among inpatients with various mental disorders. Sixy-three psychiatric inpatients were examined by the Treatment Motivation Assessment Questionnaire (TMAQ) and the Russian version of Internalized Stigma of Mental Illness scale (ISMI). K-Means cluster and dispersion analysis were conducted. Cluster 3 (25 subjects) was the least stigmatized. Cluster 1 (18 subjects) showed an explicit stigma. Cluster 2 (20 subjects) showed an implicit stigma that took the form of the lowest treatment motivation compared to other clusters. Implicitly stigmatized patients, in contrast to explicitly stigmatized individuals, showed a decline in 3 out of 4 TMAQ factors (Mean dif.=1.051.67). Cooperation with doctors, together with reliance on ones own knowledge and skills to cope with the disorder, might be the way to overcome an internalized stigma for patients with mental disorders.

The Role of Women’s and Men’s Body Shapes in Explicit and Implicit Fat Stigma

Beyond being painful, fat stigma might facilitate pernicious consequences; over and above one’s weight, fat stigma is associated with lesser wellbeing, poorer health, greater all-cause mortality, and weight gains that perpetuate the weight-stigma cycle. To combat fat stigma effectively requires an understanding of the perceptual calculus underlying it. Here, we seized upon new work asserting that importance of a previously overlooked variable in this calculus—fat deposition location (body shape)—and we examine basic but fundamental open questions about the role of body shape in fat stigma via two experiments (one pre-registered). We replicate and extend work investigating how body shape—over and above body size—drives stigma toward women, using a figure set created specifically to test predictions about the role of body shape as well as size. We asked: (1) Are findings of greater explicit stigma toward adult women with abdominal (gut) versus gluteofemoral fat depositions (hips, thighs, buttocks) replicated—and (2) does this same finding hold for implicit stigma?; (3) Are male targets similarly stigmatized as a function of shape? (4) Do individual difference factors known to predict anti-fat stigma, e.g., Protestant Work Ethic, play a role here? We examined these questions by presenting American participants with women and men targets varying in both body size and shape—assessing participants’ explicit stigma (via self-report) and implicit stigma (via the Attitude Misattribution Procedure; AMP). We replicated the pattern that explicit fat stigma toward women is shape-sensitive and extend that to implicit stigma—finding, for example, that, of two women with the same exact heights and higher weights, the woman with abdominal fat deposition is more stigmatized than the woman with gluteofemoral fat deposition. We found no consistent results regarding the role of body shape in driving fat stigma toward men. We also found that some individual difference factors predicting anti-fat stigma were also attuned to body shape as well as body size. The results underscore the importance of integrating body shape into future work on fat stigma (toward women).

Experiences of Pregnant and Parenting Female Students in Social Work Doctoral Programs

ABSTRACT Women in many fields have described challenges during their doctoral work due to pregnancy and parenting, but no research has explored these issues within social work education. This cross-sectional survey describes pregnant and parenting female students’ (N=75) experiences in social work doctoral education. Participants identified challenges in finding balance between family and academic responsibilities, a lack of supports and resources for pregnant and parenting students, decreased productivity, and less access to professional development opportunities due to pregnancy or parenting. While many received informal support from faculty, chairs, and mentors, few had access to accommodations, like parental leave, official lactation spaces, and childcare and some described implicit bias and stigma against caregiving. Implications for social work doctoral programs conclude the article.

Reducing Implicit Bias in Maternity Care: A Framework for Action

Reducing Implicit Bias in Maternity Care: A Framework for Action

“Nothing to mourn, He was just a drug addict” - stigma towards people bereaved by drug-related death

Background Although mortality attributed to illicit drugs is a significant contributor to the overall number of deaths worldwide, knowledge relating to the consequences for those bereaved by drug-related deaths (DRDs) is scarce. Since individuals with substance use disorders are prone to stigma, there is an urgent need for knowledge about the occurrence and content of stigmatization of those bereaved by DRDs. Method A mixed methods approach was used. In total, 255 participants (parents, siblings, children, partners, other family members and close friends) who had lost a person to a DRD were recruited. Thematic and descriptive analyses were undertaken on data derived from open-ended and standardized questions from a large survey exploring systematically the contents of interpersonal communication experienced by participants following their bereavement. Result Nearly half of the respondents reported experiencing derogatory remarks from close/extended family and friends, work colleagues, neighbors, media/social media and professionals. The main themes were dehumanizing labeling, unspoken and implicit stigma, blaming of the deceased and that death was the only and the best outcome. The remarks were negative and powerful despite being directed at people in crisis and originating from individuals close to the bereaved participants. Conclusion Individuals bereaved by DRDs experience harsh and stigmatizing communications reflecting the existing societal stigma toward drug users. This contributes to the marginalization of grieving individuals at a time when they may require support. Making people aware that stigma occurs, why it happens and how it is transmitted in society can help reduce it and its adverse consequences.

081 Implicit and Explicit Stigma Towards Evening Types

Abstract Introduction Negative explicit and implicit stigma surrounding mental and physical health conditions are endorsed by people with and without these conditions. Stigma can lead to adverse consequences such as higher levels of distress and isolation. People with insomnia report internalized stigma associated with their insomnia and often delay treatment as a result. Although anecdotal reports of a similar stigma exist for delayed chronotypes, particularly among emerging adults, this effect has not been empirically examined. The present study aims to examine explicit and implicit attitudes about chronotype in a sample of emerging adults. Methods Participants were undergraduates (M age=19.9 [SD=1.5], 83.7% female). Demographic, sleep, and circadian questionnaires, including the Morningness-Eveningness Questionnaire to assess chronotype, were collected. Explicit stigma was measured by rating morning and evening types from 0–100 on eight pairs of opposing characteristics (e.g., lazy/motivated) and means were compared with paired samples t-tests using correction for multiple comparisons. Implicit stigma was measured using the Implicit Association Test with attributes associated with “good” and “bad” and targets of “night owl” or “early bird” and the mean score was compared to benchmarks. Regression was conducted to determine whether chronotype predicted implicit or explicit attitudes. Results Analyses of explicit attitudes revealed evening types were rated as possessing significantly more of the following characteristics: Lazy (Cohen’s d=0.71), Unhealthy (1.22), Undisciplined (1.19), Immature (0.64), Creative (0.59), and Young (1.20), adjusted ps<.01. Analysis of implicit attitudes revealed a d score of 0.57 (SD=0.47), which indicates a moderate implicit bias of pairing “night owl” with “bad” and “early bird” with “good.” Chronotype was not significantly associated with implicit or explicit attitudes, F(1,47)=0.04, p=.849. Conclusion Overall, greater negative explicit and implicit stigma were found for eveningness tendency compared to morningness tendency. Creativity and youthfulness were also rated higher for eveningness. Individual chronotype did not predict implicit or explicit attitudes, suggesting a potential broad societal bias rather than a specific internalized bias. As explicit and implicit stigma often predict discriminatory behavior and lead to negative consequences for the target group, future studies should examine how negative stigma may impact evening types and the behavioral and psychological consequences of stigma. Support (if any):

Phenomenology of psychiatric stigma: A factor of patients’ motivation to treatment

IntroductionPsychiatric patients often are self-stigmatized and hardly involve in the treatment.ObjectivesAssociations of self-stigmatizing beliefs in psychiatric inpatients and their treatment motivation.Methods63 inpatients; ICD-10: F2–65%, F3–13%, F4+F6–14%, F06–8%; mean age 34±13, illness duration 12±11 years. Treatment Motivation Assessment Questionnaire (TMAQ), Internalized Stigma of Mental Illness scale (ISMI); K-mean cluster analysis; dispersion analyses; p≤0.05.Results18 patients of cluster 1 (C1) demonstrated explicit self-stigmatization. In comparison with 25 subjects from cluster 3 (C3) stigmatized patients (C1) had higher levels of overall ISMI scores (2.9±0.3) caused by alienation (3.1±0.5), stereotype endorsement (2.5±0.5), social withdrawal (2.7±0.4), and discrimination experience (2.7±0.4). 20 patients of cluster 2 (C2) had an implicit stigma. They were more self-stigmatized (ISMI score 2.7±0.3) in contrast with subjects from cluster 3 (1.9±0.2) due to a lower level of stigma resistance (C2: 3.8±0.5 and C3 3.1±0.6 – reverse scores). Patients with implicit self-stigma (C2) had the lowest intensity of treatment motivation (Z-scores -1.2±0.6) compering with others (C1 and C3) due to the lowest TMAQ factor 1 (reliance on own knowledge and skills to cope with the disorder: -1.0±0.6) and factor 4 (willingness to cooperate with doctor: -0.9±1.0). Differences between explicitly and implicitly stigmatized patients manifested also in lower TMAQ factor 3 for the second group (awareness of the psychological mechanism of maladaptation: -0.5±0.9).ConclusionsDespite alienation, stereotype endorsement, social withdrawal, discrimination experience some patients could sustain stigma due to cooperation with doctors and reliance on their own knowledge and skills to cope with illness.

The Ethics of Stigma in Medical Male Circumcision Initiatives Involving Adolescents in Sub-Saharan Africa.

Ongoing global efforts to circumcise adolescent and adult males to reduce their risk of acquiring HIV constitute the largest public health prevention initiative, using surgical means, in human history. Voluntary medical male circumcision (VMMC) programs in Africa have significantly altered social norms related to male circumcision among previously non-circumcising groups and groups that have practiced traditional (non-medical) circumcision. One consequence of this change is the stigmatization of males who, for whatever reason, remain uncircumcised. This paper discusses the ethics of stigma with regard to uncircumcised adolescent males in global VMMC programs, particularly in certain recruitment, demand creation and social norm interventions. Grounded in our own experiences gained while conducting HIV-related ethics research with adolescents in Kenya, we argue that use of explicit or implicit stigma to increase the number of VMMC volunteers is unethical from a public health ethics perspective, particularly in campaigns that leverage social norms of masculinity. Ongoing global efforts to circumcise adolescent and adult males to reduce their risk of acquiring HIV constitute the largest public health prevention initiative, using surgical means, in human history. VMMC programs in Africa have significantly altered social norms related to male circumcision among previously non-circumcising groups and groups that have practiced traditional (non-medical) circumcision. One consequence of this change is the stigmatization of males who, for whatever reason, remain uncircumcised. This paper discusses the ethics of stigma with regard to uncircumcised adolescent males in global VMMC programs, particularly in certain recruitment, demand creation and social norm interventions. Grounded in our own experiences gained while conducting HIV-related ethics research with adolescents in Kenya, we argue that use of explicit or implicit stigma to increase the number of VMMC volunteers is unethical from a public health ethics perspective, particularly in campaigns that leverage social norms of masculinity.

Impact of Service User Video Presentations on Explicit and Implicit Stigma toward Mental Illness among Medical Students in Nepal: A Randomized Controlled Trial.

This study evaluated the impact of didactic videos and service user testimonial videos on mental illness stigma among medical students. Two randomized controlled trials were conducted in Nepal. Study 1 examined stigma reduction for depression. Study 2 examined depression and psychosis. Participants were Nepali medical students (Study 1: n = 94, Study 2: n = 213) randomized to three conditions: a didactic video based on the mental health Gap Action Programme (mhGAP), a service user video about living with mental illness, or a control condition with no videos. In Study 1, videos only addressed depression. In Study 2, videos addressed depression and psychosis. In Study 1, both didactic and service user videos reduced stigma compared to the control. In Study 2 (depression and psychosis), there were no differences among the three arms. When comparing Study 1 and 2, there was greater stigma reduction in the service user video arm with only depression versus service user videos describing depression and psychosis. In summary, didactic and service user videos were associated with decreased stigma when content addressed only depression. However, no stigma reduction was seen when including depression and psychosis. This calls for considering different strategies to address stigma based on types of mental illnesses. ClinicalTrials.gov identifier: NCT03231761.

Changing Healthcare Professionals' Attitudes Towards Voice Hearers: An Education Intervention.

Despite being a relative common experience, hearing voices remains highly stigmatised, with serious consequences. Numerous interventions have been developed to reduce stigma towards mental illness in general, however most have failed to include implicit measures of stigma, and these have yet to be applied to hearing voices. The current study examined the efficacy of an education intervention in changing the explicit and implicit stigma held by healthcare professionals (N = 59) towards voice hearers. Results indicated that the education intervention led to significant decreases in explicit but not implicit measures of stigma, though participants demonstrated relatively positive baseline implicit attitudes towards voice hearers. These findings suggest that education interventions could be one way of reducing stigma towards voice hearers. Further research is necessary to explore the impact of education interventions in samples with more negative baseline attitudes, such as early career professionals, students, and the general population.

Do Implicit and Explicit Racial Biases Influence Autism Identification and Stigma? An Implicit Association Test Study.

Are implicit and explicit biases related to ASD identification and/or stigma? College students (N = 493) completed two IATs assessing implicit stigma and racial biases. They evaluated vignettes depicting a child with ASD or conduct disorder (CD) paired with a photo of a Black or White child. CD was more implicitly and explicitly stigmatized than ASD. Accurately identifying ASD was associated with reduced explicit stigma; identifying CD led to more stigma. Participants who identified as White implicitly associated the White child with ASD and the Black child with CD. A trend in the reverse direction was observed among Black participants. Implicit and explicit biases were unrelated. Findings highlight a need for trainings to ameliorate biases favoring one's in-group.

Proposal for an implicit stigma measure in mental illness: A multigroup study.

An Implicit Association Test was developed to assess the mental illness stigma in people from the general population, mental health professionals, people with a diagnosis, and family members. No differences were found between groups. Implicit stigma was found throughout the sample, with lower scores in the younger age group.

Intervention study on the stigma of mental illness in college students

Objective To investigate the automatic implicit attitude and explicit stigma of mental illness, and the intervention effectiveness on the stigma of mental illness in college students. Methods Single category implicit association test(SC-IAT) and questionnaire survey were used to study the degree of implicit and explicit mental illness stigma among 30 college students of Peking University, and investigated the effect of two strategies, education and contact.Data were analyzed by SPSS 22.0 with t-test and variance analysis. Results The D values of SC-IAT in the three dimensions of cognitive evaluation, emotional response and behavioral tendency of college students were 0.29±0.37, 0.24±0.43, and 0.10±0.43.There was a statistically significant difference between the cognitive evaluation dimension, the emotional response dimension and 0(t=4.069, P 0.05). The correct rates of questions Which of the following situations do you think are considered mentally unhealthy? and Which of the following disorders are mental illnesses (42±13)%, (54±13)%) increased after receiving educational intervention ((49±12)%, (64±13)%), the difference was statistically significant (F=3.682, P<0.05; F=3.576, P<0.05). Conclusion College students have implicit mental illness stigma, educational and contact intervention strategies can help improve college students' understanding of relevant knowledge, and cannot improve the level of implicit stigma of college students on mental illness. Key words: Mental illness stigma; Implicit stigma; Single category implicit association test; Stigma intervention

Implicit Stigma Recognition and Management for Health Professionals.

Stigma against individuals with mental illness has disastrous consequences for patient outcomes. Better approaches to reducing stigma in health care professionals are required. Implicit stigma education is an emerging area of research that may inform the design and implementation of stigma reduction programs. In this "in brief report," the authors describe the evaluation of a novel implicit stigma reduction workshop for health professionals. The authors conducted a realist evaluation using a longitudinal multiple case study approach. Once a conceptual model was established, three case studies were conducted on physicians and nurses (n = 69) at an academic health sciences center. Within each case, pre- and post-attitudinal scales and qualitative data from semi-structured interviews were used. Consistent with realist evaluation principles, context-mechanism-outcome configuration patterns were analyzed. An implicit stigma recognition and management workshop produced statistically significant changes in participant attitudes in two out of three contexts. The qualitative evaluation described the perceptions of sustainable changes in perspective and practice. The degree to which individual participants learned with and worked among inter-professional teams influenced outcomes. Implicit stigma recognition and management is a useful educational strategy for reducing stigma among health professionals. Once stigma is recognized, curricular interventions may promote behavioral change by encouraging explicit alternative behaviors that are sustained through social reinforcement within inter-professional teams.

Perceived Discrimination and Stigma in the Context of the Long-Term Care Insurance Law from the Perspectives of Arabs and the Jews in the North of Israel.

The Long-Term Care Insurance Law provides support to older Israelis who wish to remain in their home. The present study evaluated the experience of perceived discrimination and stigma in the context of the law among Arab older adults, their family members, and their paid home care workers. For triangulation purposes, we interviewed 15 National Insurance Institute workers (NII; responsible for implementing the law; 47% Arab), 31 older adults (81% Arab), 31 family members (87% Arab), and six paid home care workers (83% Arab) in the north of Israel. Respondents were queried about their home care experience and their encounter with the NII. Thematic analysis was conducted. Four main themes emerged: (a) a strong sense of perceived discrimination among Arab interviewees, (b) reports suggesting the internalization of stigma and the adoption of negative views regarding the Arab population by some Arab respondents, (c) implicit stigma manifested in claims concerning the Arab population (primarily) as “cheating” the system, and (d) the negation of discrimination of Arabs as reported by Jewish interviewees and NII workers. The findings show that a sense of perceived discrimination is common and colors the experience of service seeking among Arabs. On the other hand, the Jewish interviewees in this study completely negated any discrimination or stigma directed toward Arabs. The findings point to the importance of group affiliation (e.g., minority vs. majority) in interpreting the existence of discrimination. The findings likely have major implications for both service providers and policy-makers and legislators.

The Subtle Side of Stigma: Understanding and Reducing Mental Illness Stigma from a Contemporary Prejudice Perspective

AbstractAbleism, as it relates to mental illness, is a serious social issue that exists across nations and cultures. Implicit stigma caused by ableism can be especially problematic given that it is typically expressed subtly and automatically causing it to remain unnoticed and thus unchanged. This research illustrated across two studies that individuals have automatic ableist attitudes toward mental illness, yet the expression of stigma depends on the combination of their implicit and explicit attitudes. Furthermore, Study 2 was the first to demonstrate an effective intervention designed to specifically target implicit stigmatizing attitudes toward mental illness. The findings have implications for implementing social policies that serve to raise awareness of and reduce implicit stigma to ultimately improve the lives for those affected by mental illness.

Weigh More, Pay More? Public Opinion on Varying Health Insurance Contributions among Divergent Weight Groups

Background: The prevalence of obesity and its related costs has increased over the past decades. In Germany, obesity-related costs are merely covered by statuary health insurance. Within the statutory health care system, the health insurance contributions do not differ between people with and without health issues, such as being obese. This study aims to investigate the public’s opinion about whether people with obesity should pay a higher proportional health care contribution than people of normal weight. Methods: We conducted a pilot study and collected thereof data of a convenience sample. In total, 179 participants who perceived themselves to be of normal weight (51.40% female; mean age = 32.46, SD = 5.74) were surveyed using a questionnaire. Within this questionnaire, the participants had to rate how high the proportional health care contribution for people with and without obesity should be. Moreover, we assessed participants’ antifat attitudes by applying the Fat Phobia Scale and the Implicit Association Test. Results: A paired t test revealed that participants suggest a significantly higher proportional contribution for health insurance for people with obesity compared to people with normal weight (t(178) = 4.51, p < 0.001). Logistic regression analysis indicates that people with stronger explicit (OR = 8.77, p < 0.001) and implicit stigma (OR = 1.06, p = 0.018), and higher BMI (OR = 1.27, p = 0.04) are more likely to suggest an increased contribution rate for people with obesity. Conclusion: Although we found that participants suggested higher contribution rates for people with obesity, overall only one-quarter of the participants suggested higher contribution rates for people with obesity, whereas almost three-quarters of the participants did not distinguish the contribution rate for people with and without obesity. Moreover, we found that the participants called for higher insurance premiums for people with and without obesity. Therefore, future studies should consider giving more information about the statutory health care system or the health care contribution rate before asking participants about their opinion.