Stigma In China Research Articles

Stigma, Trauma and Resilience During COVID-19 in China

The outbreak of the COVID-19 epidemic has caused a serious stigma in China. The purpose of this study was to explore the stigma in China against the background of COVID-19 and analyze its causes. This study also explores the negative consequences of trauma caused by stigma on people. Moreover, it explored the reasons for wound relief and identified the elements of resilience. Through analysis of existing relevant literature, it was found that the stigmatization phenomenon in China during COVID-19 was mainly targeted at people, patients, and medical staff in areas with severe epidemic situations. The main reasons for the emergence of stigma are improper information content used in mass media reporting and social media dissemination. The impact of trauma on people is in terms of self-identity and self-esteem, self-behaviour, and physical and mental health. Finally, the main factors contributing to resilience are family support, policy support, and personal regulation.

Application of interpersonal psychotherapy for late-life depression in China: A case report.

Interpersonal psychotherapy (IPT) is an effective treatment for late-life depression, but little is known about its acceptability and efficacy in Chinese patients. This case report describes the use of IPT in a depressed elderly Chinese man. The patient was a 79-year-old widower who lives alone in a large city in China. This was his first contact with a mental health specialist. His wife died one ago, and his only child lives in the United States with her husband and children. Due to the COVID-19 pandemic, his daughter could not visit him, and his usual social interactions decreased, leaving him feeling isolated, lonely, and depressed. He was diagnosed with a major depressive episode and initially prescribed venlafaxine. However, he failed to show an adequate response to medication and the side effects were intolerable. He was switched to a low dose of Duloxetine (60 mg) combined with IPT. The patient's baseline score on the 17-item Hamilton depression rating scale (HAM-D) was 29, suggesting severe levels of depression. He received 12 sessions of IPT. Role transition was the focus of therapy. Although the patient expressed discomfort in therapy, he developed a good rapport with the therapist and was compliant with treatment. Clinical recovery was achieved at the end of acute IPT treatment (HAM-D score = 1). Response to IPT was excellent in this elderly patient, but several points should be noted. First, mental health-related stigma in China can affect treatment engagement. Second, older Chinese are reluctant to speak openly about their personal experiences and feelings. Hence, repeated emphasis on the principles of confidentiality in psychotherapy and forming a strong therapeutic alliance are important. Third, the "empty-nest" household is an emergent phenomenon in China. Helping elderly Chinese navigate changes in traditional Chinese living arrangements and negotiate filial piety with offspring who have moved away are important issues to address in therapy.

“Premature” Girls with “Illegitimate” Diseases: A Qualitative Exploration of the Stigma of Gynecological Diseases for Unmarried Young Women in China

Stigma has been a prominent barrier in women’s pursuit of better sexual and reproductive health (SRH). Specifically, evidence supports the stigmatization of gynecological diseases (GDs) for unmarried young women. Drawing upon the model of social identity threats, this study explored the GD stigma and social identity threats faced by unmarried young women in China with 26 in-depth interview data. The interpersonal, socio-cultural, and intrapersonal layers of GD stigma were identified. First, participants’ disclosure and concealment of GDs concerning different significant others were contrasted as an interpersonal layer and voluntary response to social identity threats. In participants’ GD experiences, peers stood out for providing emotional, tangible, and informational support, while parents were most often avoided for anticipated stigma. Second, collective representations of GDs and the cultural rationale in the socio-cultural layer were probed. The traditional and modernized sexual norms centering on the legitimacy of premarital sex and SRH knowledge were unveiled. At last, the interpersonal layer was identified. Unmarried young patients suffered social identity threats regarding their independence, sexual agency, and bodily awareness. This is one of the first studies that investigated the underappreciated GD stigma in China. Theoretical and practical implications are discussed.

A Web-Based Gaming Approach to Decrease HIV-Related Stigma: Game Development and Mixed Methods Evaluation.

The stigma faced by people living with HIV causes difficulties in the treatment of HIV/AIDS. Decreasing this stigma is thus no less urgent than implementing behavioral interventions. Serious games are being increasingly adopted as an intervention mechanism to control HIV/AIDS around the world. However, the development and evaluation of these games in China are far from adequate. This research aimed to help decrease HIV-related stigma in China via the development and evaluation of a serious game, as well as promote a participatory gamification culture for health interventions. Initially, a serious game was developed using free resources from a user-generated content website. Then, quantitative and qualitative methods were employed for game evaluation. A randomized controlled trial was conducted to explore the game's effect on HIV-related stigma. The trial included 167 university students, who were randomly allocated to game and control groups. After the experimental evaluation, focus group discussions were held with 64 participants, who were invited to form 16 groups. The game was called The Second Kind of Life with HIV (SKLWH), which is a free online game that can be played on computers and smartphones. This game hopes to publicize that people living with HIV can live a normal life, that is, a second life different from that imagined by the public. Based on the gamification practice of SKLWH, the participatory serious game development model (PSGDM) was proposed, which guided the development of 3 other HIV-themed games. The trial showed that intimacy stigma was much more severe than morality stigma and personal interaction stigma. Females were more tolerant of morality stigma than males (mean score: 1.29 vs 1.50; P=.01). The game intervention showed an advantage in decreasing intimacy stigma (mean score [game vs control]: 2.43 vs 2.73; P=.04). The group discussions validated the quantitative results and provided further in-depth information. The game intervention was largely preferred by participants, and the belief in intimacy impossibility was commonly expressed by participants when considering their relationship with people living with HIV. HIV/AIDS education should adopt appropriate media interventions to mitigate different dimensions of HIV-related stigma. Serious games should be used to decrease intimacy stigma, which is the hardest form to diminish. It is expected that the PSGDM can promote the development of more health games. Furthermore, HIV/AIDS intervention requires interdisciplinary efforts and cooperation that will allow more people to participate and share the responsibility of promoting health.

Gay Dating on Non-dating Platforms: The Case of Online Dating Activities of Gay Men on a Q&A Platform

Gay dating applications, such as Grindr and SCRUFF, are considered the primary platforms for gay men to conduct online dating activities. However, on Zhihu, a Chinese question-and-answer website, tens of thousands of homosexual users have been searching for romantic partners, which suggests that Zhihu may have unique affordances in online dating activities for Chinese gay men. To better understand how Chinese gay men perceive the affordances of a non-dating platform for online dating, we conduct a mixed-methods study, including observations, interviews, and quantitative and qualitative analysis of users' self-presentations. We find that gay men users publish personal ads by answering "fishing questions" on Zhihu. Through our analysis, we examine how users perceive the affordances of Zhihu to satisfy their social and psychological gratifications at the self, community, and audience levels. Although gay users face the risk of disclosing homosexual identity on mainstream social media, they perceive such risk as acceptable for better online dating experience. We discuss how users respond to severe social stigma in China, and the gap between user needs and the design of gay dating applications. We elaborate on the implications of our findings to discuss the potential benefits for LGBTQ users if LGBTQ service providers collaborate with social media.

The Moderating Effect of Filial Piety on the Relationship Between Perceived Public Stigma and Internalized Homophobia: a National Survey of the Chinese LGB Population

Previous studies demonstrated that public stigma significantly contributes to internalized homophobia for lesbian, gay, and bisexuals (LGBs). Filial piety plays an important role in Chinese LGBs’ response to stressors related to their sexual orientation, but it is unclear whether reciprocal and authoritarian filial piety moderate the effect of perceived public stigma on internalized homophobia. A sample of 1453 (67.10% male; age: M = 25.16, SD = 5.60) Chinese LGBs participated in this study in June, 2019. They provided demographic variables and completed measures of perceived public stigma, reciprocal and authoritarian filial piety, and internalized homophobia. As expected, results from structural equation modelling analysis indicated that perceived public stigma and authoritarian filial piety had comparable and positive association with internalized homophobia. Reciprocal filial piety was negatively associated with internalized homophobia. In addition, the association between perceived public stigma and internalized homophobia was stronger when Chinese LGBs endorsed low reciprocal filial piety and high authoritarian filial piety. These findings suggest that authoritarian filial piety may be a risk factor that amplifies the deleterious impact of public stigma on internalized homophobia. In contrast, reciprocal filial piety may be a resilience factor that mitigates the negative effect of public stigma on internalized homophobia. These findings implicate that efforts should be made to reduce the public stigma in China in order to reduce internalized homophobia. In addition, the nature and level of filial piety should be considered when providing psychotherapeutic interventions to Chinese LGBs, and funding for relevant research and practice should be supported.

Effects of biogenetic beliefs for schizophrenia on potential caregivers in China: Exploring the role of affiliate stigma.

Schizophrenia affects more than eight million people in China. Stigmatization of schizophrenia may prevent family members and close others from providing social support to those with schizophrenia. This article aims to investigate the potential use of a biogenetic approach to reduce the stigma of schizophrenia using a cross-sectional (study 1, n=141) and an experimental design (study 2, n=100) in China. In the first study, mediation analysis reveals that perceived affiliate stigma, the negative prejudice, and discrimination towards family members of individuals with socially stigmatized identities due to their affiliation with the person mediates the path between biogenetic beliefs and desire for social distance. This pattern is replicated in study 2 in which two 10-min lectures were created and used to influence participants' beliefs in biogenetic causes of schizophrenia. Findings suggest that the biogenetic approach may increase Chinese participants' desired social distance towards their family members with schizophrenia through increasing their concerns about the negative consequences of being affiliated with the family member. Therefore, future research should investigate aspects of biogenetic anti-stigma campaigns that do not increase participants' perception of affiliate stigma in China.

Understanding Welfare Stigma in China: An Empirical Study of the Implementation of Urban Dibao

Understanding Welfare Stigma in China: An Empirical Study of the Implementation of Urban Dibao

Status of tuberculosis-related stigma and associated factors: a cross-sectional study in central China.

Tuberculosis (TB) poses a significant challenge to public health worldwide. Stigma is a major obstacle to TB control by leading to delay in diagnosis and treatment non-adherence. This study aimed to evaluate the status of TB-related stigma and its associated factors among TB patients in China. Cross-sectional survey. Thus, 1342 TB patients were recruited from TB dispensaries in three counties in Hubei Province using a multistage sampling method and surveyed using a structured anonymous questionnaire including validated scales to measure TB-related stigma. A generalised linear regression model was used to identify the factors associated with TB-related stigma. The average score on the TB-related Stigma Scale was 9.33 (SD = 4.25). Generalised linear regression analysis revealed that knowledge about TB (ß = -0.18, P = 0.0025), family function (ß = -0.29, P < 0.0001) and doctor-patient communication (ß = -0.32, P = 0.0005) were negatively associated with TB-related stigma. TB-related stigma was high among TB patients in China. Interventions concentrating on reducing TB patients' stigma in China should focus on improving patients' family function and patients' knowledge about TB.

Substance Use and Psychosocial Status among People Living with HIV/AIDS Who Encountered HIV Stigma in China: Stratified Analyses by Socio-Economic Status.

This study examined whether the impact of HIV stigma on psychosocial status and substance use among people living with HIV/AIDS (PLWHA) differed by their socio-economic status (SES) in a Chinese setting. A total of 2,987 PLWHA were recruited from 12 sites with the highest number of cumulative HIV incidence in Guangxi, China. Participants were asked to provide information regarding their psychosocial status (e.g., depression, anxiety), history of substance use (e.g., tobacco, alcohol and drug) and SES (e.g., education, monthly income, residence type, and job category). By employing stratified multivariate regression analyses, we assessed stratum-specific impacts of HIV stigma on PLWHA’s psychosocial status and behaviors of substance use based upon participants’ SES. The impact of HIV stigma differed significantly on psychosocial status across SES gradients. Psychosocial status among people with higher education was more sensitive to HIV stigma compared with PLWHA who were less educated. The odds of substance use behaviors were higher among people with better monthly income than their low-income peers. Our study is the first paper to document the paucity of SES stratified analyses between HIV stigma and psychosocial status and substance use among PLWHA in China. We call for tailored intervention programs to target PLWHA with different backgrounds and characteristics in order to help them to better manage their seropositivity.

Gendered aspects of perceived and internalized HIV-related stigma in China

ABSTRACTAlthough studies have demonstrated that females experience more HIV-related stigma than males do, questions remain regarding the different dimensions of the stigma (i.e., perceived versus internalized) in China. The present study investigated gender differences in perceived and internalized HIV-related stigma, taking into account the potential influence of education. The study was conducted between October 2011 and March 2013. A total of 522 people living with HIV (PLH) were recruited from Anhui Province, China. The PLH participated in a survey using the Computer Assisted Personal Interview (CAPI) method. The gender differences in perceived and internalized HIV-related stigma were calculated with and without stratifying by education level. Female participants had significantly less education than the male participants. No significant difference was observed between females and males with respect to perceived stigma. However, females reported significantly higher internalized stigma than males did (p < .001). When socio-demographic characteristics were controlled, the gender difference in internalized stigma remained significant among educated participants (p = .038). The findings suggested that gender differences in HIV-related stigma were primarily found for internalized stigma. Heightened intervention efforts are encouraged to reduce internalized HIV-related stigma, particularly among female PLH in China and other regions with similar gender dynamics.

Survey of hepatitis B knowledge and stigma among chronically infected patients and uninfected persons in Beijing, China.

Hepatitis B virus (HBV) infection carries substantial stigma in China. We surveyed HBV knowledge and stigma among chronic hepatitis B (CHB) patients and persons without HBV infection in Beijing, China. Four hundred and thirty five CHB patients and 801 controls at Peking University People's Hospital were surveyed. Chronic hepatitis B patients were older (mean 46 vs. 39 years) and more often men (71 vs. 48%) than controls. Mean knowledge score was 11.9/15 for CHB and 9.3/15 for control patients (P < 0.001). Average stigma score was 22.1/39 for CHB and 19.2/30 for control patients. Controls expressed discomfort with close contact (45%) or sharing meals with CHB patients (39%) and believed CHB patients should not be allowed to work in restaurants (58%) or childcare (44%). Chronic hepatitis B patients felt that they were undesirable as spouses (33 vs. 17%) and brought trouble to their families (58 vs. 34%) more often than controls. Despite legal prohibitions, 40% of CHB patients were required to undergo pre-employment HBV testing, and 29% of these individuals thought that they lost job opportunities because of their disease status. 16% of CHB patients regretted disclosing their HBV status and disclosure was inversely associated with stigma. Higher stigma was associated with older age, lower education and lower knowledge score among controls; and with lower education, younger age, having undergone pre-employment HBV testing and regret disclosing their HBV status among CHB patients. Despite high prevalence of CHB in China, our study shows knowledge is limited and there is significant societal and internalized stigma associated with HBV infection.

Public Stigma in China Associated With Schizophrenia, Depression, Attenuated Psychosis Syndrome, and Psychosis-Like Experiences.

Attenuated psychosis syndrome (APS) has recently been included in the appendix of DSM-5 as a condition for further study. This study compared public stigma associated with four mental health conditions among study participants in Hong Kong. The cross-sectional study involved 204 participants (154 members of the general public general public and 50 health care professionals) recruited through a public awareness campaign and the e-mail network of the University of Hong Kong. Participants read four vignettes describing persons with schizophrenia, depression, APS, or psychosis-like experiences. For each vignette, they used a scale to rate their level of stigma in seven domains: social distance, traditional prejudice, exclusionary sentiments, negative affect, perceptions of dangerousness, treatment carryover, and disclosure carryover. Analyses compared ratings within and across vignettes. Schizophrenia received the highest public stigma ratings, followed by APS, depression, and psychosis-like experiences. Total stigma scores were higher for the general public than for health care professionals. Public stigma associated with APS was similar to that associated with depression. Ratings of treatment carryover indicated that participants believed that being known to have received treatment for APS or depression would have lasting consequences. Stigma should be considered in the development of mental health services and research in China, particularly in regard to people with schizophrenia and those at risk of psychosis.

Emotional, physical and financial burdens of stigma against people living with HIV/AIDS in China

ABSTRACTNumerous researches have shown pernicious effects of stigma against people living with HIV/AIDS (PLWHA). However, no available studies have reported these negative effects including emotional, physical to financial burdens to PLWHA. In the current study, we aim to explore different types of stigma (e.g., perceived, internalized and enacted) and the relevant consequences among PLWHA in China. A cross-sectional study was conducted from 2012 to 2013 in the Guangxi Autonomous Region in China. The validated Berger HIV Stigma Scale was used to measure various types of stigma. We employed a series of linear, logistic and polytomous regression models to assess the association between stigma and different consequences while accounting for potential confounders for each specific model. Of the total sample, 2987 PLWHA provided valid responses with 63% being male and having an average age of 42.9 years. Perceived, internalized and enacted HIV stigma were prevalent among participants, and resulted in various burdens with different magnitudes in their life contexts. Specially, PLWHA who reported higher perceived and internalized stigma were more likely to be imposed on emotional and physical burdens (p < .05). People who reported higher enacted stigma had heavier financial burden compared to their peers (p < .05). Our findings revealed that devastating consequences of HIV-related stigma in China. The prevalent stigmatizing attitudes have pushed PLWHA to the fringes of society and affected them at multiple aspects in their life context. We call for tailored efforts to overcome stigma and discrimination against PLWHA.

Annual economic burden of hepatitis B virus-related diseases among hospitalized patients in twelve cities in China.

A nationwide survey of hepatitis B virus (HBV)-associated economic burden has not previously been performed in China. The purpose of this study was to examine the direct, indirect, and intangible costs of HBV-related diseases within the span of one year. A random sample was taken from specialty and general hospitals across 12 cities in six provinces of China. Intangible costs were estimated based on willingness to pay or open-ended answers provided by patients. The results showed that 27 hospitals were enrolled, with a sample population of 4726 patients (77.7% response rate). The average annual costs were $4454.0 (direct), $924.3 (indirect), and $6611.10 (intangible), corresponding to 37.3%, 7.7%, and 55.1% of the total costs, respectively. The direct medical fees were substantially greater than the non-medical fees. Annual indirect costs were divided into outpatient ($112.9) and inpatient ($811.40) loss of income. The intangible costs of chronic HBV were notably higher than either the direct or indirect costs, consistent with the social stigma in China. The comparison amongst individual cities for the average ratio of direct to indirect costs revealed that the sizes of ratios were negatively correlated with the socioeconomic status of the regions. This study suggested that as a whole in China, the HBV-related diseases caused a heavy financial burden which was positively associated with disease severity. Although the intangible costs coincided with a high prevalence of discrimination against CHB patients in Chinese society, our study may serve as future reference for detailed exploration.

Type 1 diabetes stigma in China: A call to end the devaluation of individuals living with a manageable chronic disease

Stigma is a significant barrier to improving care for individuals with type 1 diabetes mellitus (T1DM). This commentary describes this phenomenon in China, where stigma has led to labeling and devaluing of individuals with T1DM. Difficulties finding a spouse and regulations restricting admission to universities and government employment have forced many individuals to hide their diabetes. The shame, fear, and guilt stemming from stigma may preclude the use of insulin pumps; multiple daily injections, which require pre-meal insulin dosing at school or the workplace; participation in research studies; and general health-seeking behaviors. A multifaceted, multilevel approach is urgently needed and should involve improving public awareness and understanding of T1DM; adoption by health care providers of holistic rather than biomedical approaches to disease management; patient counseling on positive coping skills; and expansion of the scope of research to consider the psychosocial realities of diabetes care in China. Recent media attention in the form of a nationally broadcasted documentary on T1DM is an important step in the right direction. We believe that coordinated action by multiple stakeholders can lead to meaningful improvements in treatment, ultimately leading to better physical and emotional health outcomes for individuals living with this manageable chronic disease.

Responsibility judgments and responses to people living with AIDS in China: testing an attributional perspective

AbstractWith one in five individuals in the world living in China, there is an urgent need for HIV prevention and understanding HIV/AIDS stigma in China. This study applies an attributional analysis to Chinese students' responses to AIDS, examining effects of attributions of causal controllability for HIV infection on reactions to people living with HIV/AIDS. Students (n = 309) read one of two scenarios describing an AIDS patient and manipulating controllability of AIDS onset. Controllability of AIDS onset contributed to responsibility judgments, less positive affect, and lower desires to personally interact with the patient. Responsibility judgments predicted interaction wishes directly and indirectly through positive affect. Results provide support for Weiner's interpersonal attributional model. Implications for responses to AIDS in China are discussed.

Effects of labeling and interpersonal contact upon attitudes towards schizophrenia: implications for reducing mental illness stigma in urban China.

As mental illness stigma contributes to poor outcomes for schizophrenia in China, locating strategies to reduce public stigma is imperative. It is currently unknown whether diagnostic labeling and contact with different help-seeking sources increase or decrease public stigma in China. Further, it remains unresolved whether prior personal contact acts to reduce stigma in this context. Advancing understanding of these processes may facilitate stigma-reduction strategies. We administered an experimental vignette randomly assigning one of four labeling conditions to respondents to assess social distance towards a psychotic vignette individual in a sample of 160 Northern, urban Chinese community respondents. As expected, respondents given a "non-psychiatric, indigenous label"+"lay help-seeking" condition endorsed the least social distance. Unexpectedly, the labeling condition with a "psychiatric diagnostic label"+"lay help-seeking" condition elicited the greatest social distance. Unlike Western studies, personal contact did not independently decrease community stigma. However, prior contact reduced social distance to a greater extent in the labeling condition with a "non-psychiatric, indigenous label"+"lay help-seeking" condition when compared with all other labeling conditions. The results indicate that cultural idioms do provide some protection from stigma, but only among respondents who are already familiar with what mental illness is. Our finding that the condition that depicted untreated psychosis elicited the greatest amount of stigma, while the "treated psychosis" condition was viewed relatively benignly in China, suggests that improved access to mental health services in urban China has the potential to decrease public stigma via labeling mechanisms.

Interpersonal Relationships and HIV/AIDS Stigma in China

This study explores the implications of interpersonal relationships to HIV/AIDS stigma in Chinese society. The data were collected by 67 open-ended individual interviews. The study shows that HIV/AIDS stigma goes beyond fears about the risk of infection. Two interrelated themes, the social categorisation and bao, constitute the underlying principles in the structure of discourse. On the one hand, people with HIV/AIDS are typically represented as a deviant outgroup. They are believed to be retributed by the Heaven. However, the differentiation between ingroup and outgroup is not just simply based on HIV/AIDS infection. Instead, the boundary between the two is penetrable and is mediated by blood ties. One the other hand, the double-entendre of bao is called to play with respect to ingroup and outgroup. When a close kinship istaken into account, the belief of divine retribution fades out, and the belief of worldly reciprocation foregrounds. People with HIV/AIDS in this case straddle the very fine line between outgroup and ingroup. They are considered to be outgroup in the sense that HIV/AIDS as a virus/disease (a third party) found in their body is contagious, and the physical boundary between “them” and “us” is therefore needed. Yet they are considered to be the part of ingroup, because either they are innocent, or they make use of the profit for righteousness. In both cases, they deserve to be reciprocally cared for by their family. The reciprocity hereby acts as an invisible binding force between the infected and the uninfected within a close kinship.

"Excessive Thinking" as Explanatory Model for Schizophrenia: Impacts on Stigma and "Moral" Status in Mainland China

Although psychiatric stigma in China is particularly pervasive and damaging, rates of high expressed emotion ("EE" or family members' emotional attitudes that predict relapse) are generally lower than rates found in Western countries. In light of this seemingly incongruous juxtaposition and because Chinese comprise approximately one-fifth of the world's mentally ill, we examine how one of the most widely held causal beliefs of schizophrenia--excessive thinking (xiang tai duo)--may powerfully shape how those exhibiting psychotic symptoms pass from "normal" status to stigmatized "other." Using a framework by which stigma threatens an actor's capacity to participate in core everyday engagements, we examine how expressions of excessive thinking intersect with psychotic symptoms and how this idiom reduces stigma by preserving essential moral standing. Four focus groups with family members (n = 34 total) of schizophrenia outpatients, who had participated in psychoeducation, were conducted in Beijing. Open coding was conducted by 2 bilingual coders achieving high interrater agreement. Common expressions of excessive thinking--taking things too hard that is perceived as a causal factor and unwarranted suspicion that is used to benignly interpret paranoid symptoms encapsulated disruptive behaviors that closely overlapped with psychotic symptoms. Because excessive thinking is understood to occur universally, this idiom encourages socially accommodating behavior that signifies acceptance of these individuals as full-status community members. In contrast, due to beliefs implying moral contamination, those labeled mentally ill are threatened with both subtle and outright social exclusion. We discuss implications of this idiom for EE and the detection of schizophrenia "prodrome" in China.