Stigma Of Illness Research Articles

Management of Depression in Black People: Effects of Cultural Issues.

Black people are disproportionately affected by mental illness, including depression. While the prevalence of depression is paradoxically lower among the Black population, the impact of depression on Black people results in greater severity of illness and higher chronicity. The main factors through which Black people experience worse mental health outcomes includes delayed treatment seeking, and poor access to mental health services. Mental illness stigma contributes to the delay in treatment seeking behavior. Stigma refers to negative attitudes, beliefs or behaviors about a particular characteristic of an individual such as their health status. Both patients and mental health professionals experience stigma that impacts health engagement, limits access to effective depression treatments, and compromises positive patient-clinician communication. A commitment to lifelong learning about the role of culture, history, and the psychosocial context of our patients is critical to closing public health gaps in the field of mental health.

Stay (Close to) Humble: Intellectual Humility Negatively Predicts Stigma Toward and Social Distance from Individuals with Posttraumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) remains a highly stigmatized disorder despite its prevalence. Given that the origin of stigmatization is rooted in cognitive representations that people hold, stigma may be differentially exhibited by people with varying degrees of cognitive flexibility. Intellectual humility, the recognition of one's own intellectual shortcomings or flaws, may allow for flexibility in how people navigate knowledge surrounding PTSD, which may reduce stigma and improve interpersonal interactions with individuals with PTSD. The present study investigated whether intellectual humility would negatively predict PTSD stigma and social distance, above and beyond demographic factors and personal or social experience with individuals with PTSD. Participants (N = 421, 67.2% men, mean age = 37.45, SDage = 9.99) completed a multidimensional measure for intellectual humility and the Mental Illness Stigma Scale adapted to assess PTSD stigma. Results confirmed our preregistered predictions. Bivariate correlations demonstrated that overall intellectual humility was negatively correlated with overall PTSD stigma, and overall intellectual humility was negatively correlated with overall social distance. That is, intellectually humble people reported less PTSD stigma and desired closer social distance with individuals with PTSD. Additionally, hierarchical multiple regression revealed that intellectual humility predicted unique variance in PTSD stigma and social distance above and beyond the contribution of demographic factors and personal experience or social relationships with someone with PTSD. These results may provide a useful framework for approaching and minimizing stigma toward PTSD.

Stigma, mental illness & ethnicity: Time to centre racism and structural stigma.

This article critically reviews previous research in the field of stigma, mental illness and 'race' and ethnicity, and argues for a shift of focus from individual and community blame, as inferred by mental illness stigma, to a more comprehensive view of how stigma operates against a backdrop of structural and institutional racism. Ethnic minority people have poorer mental health outcomes compared with White majority populations. Dominant narratives of greater mental illness stigma in ethnic minority populations, due to religious, spiritual or traditional beliefs and leading to a lower use of services, have taken centre stage in the explanations for these consequent poorer outcomes. This article argues that this 'fact' has become taken for granted as knowledge without corresponding comparative research evidence. Research in the field has also failed to robustly consider how racism might operate in conjunction with different forms of mental illness stigma (particularly structural stigma) to exacerbate mental illness and influence pathways to mental health treatment. Future research should centre the role of racism and structural stigma in explaining the poorer mental health outcomes for ethnic minority people.

Experts Address Cultural Challenges, Opportunities for Asian Indians

Back to table of contents Previous article Next article Annual MeetingFull AccessExperts Address Cultural Challenges, Opportunities for Asian IndiansSearch for more papers by this authorPublished Online:27 Jan 2023https://doi.org/10.1176/appi.pn.2023.02.2.39AbstractThe stigma of mental illness and cultural beliefs can impact the understanding of and willingness to seek mental health treatment in Asian Indian communities.During APA’s 2023 Annual Meeting, the Indo-American Psychiatric Association is sponsoring a presidential session on the mental health challenges that Asian Indians face in this country, as well as those faced by Asian Indian psychiatrists. South Asians are a fast-growing minority population in the United States, and while there are many Asian Indian psychiatrists, there is still a paucity of resources to meet the mental health needs of Asian Indians. In addition, they are underrepresented in research.The title of the session is “Indo-American Psychiatric Association and the Asian Indian: Trials, Victories and Opportunities.” Through individual presentations followed by a panel discussion, attendees will be able to reflect on the experiences and challenges of being Asian Indian in America, the wellness paradigm from an Asian Indian perspective, the provision of culturally informed care, and the factors influencing help-seeking or rejection behaviors.Bhagirathy Sahasranaman, M.D., president of the Indo-American Psychiatric Association (IAPA), will begin by describing the IAPA’s origins and growth. In 1979, six psychiatrists of Indian origin envisioned an organization to address the professional interests of psychiatrists with Indian heritage, and it has grown to become a leading organization for psychiatrists in the United States. Tanuja Gandhi, M.D., will follow with a discussion on her experience of becoming an Asian Indian psychiatrist in this country. She hopes to spark a discussion about the challenges of being Asian Indian, a critical but often uncomfortable discussion.Vani Rao, M.D., will examine the challenges, barriers, and opportunities to provide mental health treatment in Asian Indian communities. Mental health stigma and cultural beliefs can impact the understanding of and willingness to seek mental health treatment in Asian Indian communities. For this reason, it is important to examine the interplay between cultural and ethnic factors that affect their understanding of mental health and interactions with the mental health system.Tarak Vasavada, M.D., will follow with a discussion of wellness from an Asian Indian perspective through yoga, meditation, and alternative medications. Using culturally informed practices is vital to increasing awareness, acceptance, and participation in treatment.Ravi Chandra, M.D., will lead a panel discussion in which panelists and presenters will use their personal, professional, and cultural experiences to examine the barriers to accessing mental health care and ways to address some of the challenges experienced by Asian Indian psychiatrists and communities.The session will conclude with a discussion about the resources and supports available for Asian Indian trainees for their personal and professional growth.All psychiatrists are invited to attend this session, especially trainees and early career psychiatrists, and participate in stimulating discussions. ■ ISSUES NewArchived

Incorporating Anti-Stigma Training Into Psychiatric Mental Health Nursing Education

Anti-stigma interventions have become important worldwide in light of the negative consequences that the stigma of mental illness has on the recovery to health of individuals with mental illness as well as on general quality of care and public mental health. Thus, psychiatric mental health nursing courses are being targeted with early anti-stigma interventions to improve related awareness and skills among future nurses. This article firstly elaborates on the importance of the stigma issue in psychiatric care and assesses the empirical effectiveness of anti-stigma interventions in psychiatric mental health nursing education. Next, a pedagogical exemplar of integrating a "recovery patients as educators" and anti-stigma intervention into an innovative psychiatric mental health nursing course is demonstrated. Community psychiatric patients, who traditionally receive passive care from healthcare providers, were invited to attend psychiatric mental health courses with the goal of becoming educators in their communities. These courses offer nursing students and patients opportunities to interact as equals and helps these students become aware of their values, attitudes, and prejudices with regard to mental illness. This approach may help reframe their experience and learning, and guide them to clarify and integrate anti-stigma values and attitudes into their work and life. Through such experience sharing, nursing educators may be expected to brainstorm and implement the pedagogical value of anti-stigma.

Patient and Health Care Professional Perspectives on Stigma in Integrated Behavioral Health: Barriers and Recommendations.

Stigma related to mental health is well documented and a major barrier to using mental and physical health care. Integrated behavioral health (IBH) in primary care, in which behavioral/mental health care services are located within a primary care setting, may reduce the experience of stigma. The purpose of this study was to assess the opinions of patients and health care professionals about mental illness stigma as a barrier to engagement with IBH and to gain insight into strategies to reduce stigma, encourage discussion of mental health, and increase uptake of IBH care. We conducted semistructured interviews with 16 patients referred to IBH in a prior year and 15 health care professionals (12 primary care physicians and 3 psychologists). Interviews were transcribed and inductively coded separately by 2 coders for common themes and subthemes under the topic headings of barriers, facilitators, and recommendations. We identified 10 converging themes from interviews with patients and the health care professionals, representing important complementary perspectives, with respect to barriers, facilitators, and recommendations. Barriers included professionals, families, and the public as sources of stigma, as well as self-stigma or avoidance, or internalizing negative stereotypes. Facilitators and recommendations included normalizing discussion of mental health and mental health care-seeking action, using patient-centered and empathetic communication strategies, sharing by health care professionals of their own experiences, and tailoring the discussion of mental health to patients' preferred understanding. Health care professionals can help reduce perceptions of stigma by having conversations with patients that normalize mental health discussion, use patient-centered communication, promote professional self-disclosure, and are tailored to patients' preferred understanding.

Behavior or diagnosis? Effects of irritable patient behavior and a schizophrenia diagnosis on mental illness stigma.

Behavior or diagnosis? Effects of irritable patient behavior and a schizophrenia diagnosis on mental illness stigma.

Validation of the Italian version of the DISCUS (DISC-Ultra Short), a brief standardized scale for assessing experienced discrimination among people with mental disorders.

To evaluate the psychometric properties of the DISCUS (DISC-Ultra Short), a measure which assesses experienced discrimination among persons with mental disorders. Data collected in the three Italian sites (Brescia, Napoli, and Verona) participating at the international project INDIGO-DISCUS. Each Italian site recruited a sample of 50 individuals. Participants were evaluated with the DISCUS. This study evaluated: (a) reliability (internal consistency), (b) validity (convergent and divergent), (c) precision, and (d) acceptability. Participants were also asked to complete three additional measures: Stigma Consciousness, Brief Stigma Coping/Stigma Stress, and Internalized Stigma of Mental Illness (ISMI-10). Overall, 149 people participated; 55% were males, with mean age of 48 (±12.4) years and on average participants had 12 (±3.4) years of education; only 23% were employed. Internal consistency was found to be good (Cronbach α=0.79). Convergent validity was confirmed (all correlations between DISCUS score and the other measures' scores were greater than 0.30). There was evidence of divergent validity, as the overall DISCUS score was not associated with the variable "sex". Precision showed a high correlation coefficient between the various items and the overall DISCUS score, with only one exception (discrimination when looking for housing), which showed a particularly high frequency of "not applicable" responses. Acceptability [measured with Maximum Endorsement Frequencies (MEF) and Aggregate adjacent Endorsement Frequencies (AEF)] was found to be fair (MEF violated in 2 items; AEF partially violated in 5 item). The Italian version of the DISCUS is a reliable, valid, precise, and acceptable measure of experienced discrimination to be used in large scale studies in the evaluation of anti-stigma initiatives in Italy.

Cultivating contact: How social norms can reduce mental illness stigma in college populations.

Cultivating contact: How social norms can reduce mental illness stigma in college populations.

The association between mental health stigma and face emotion recognition in individuals at risk for psychosis.

Self-stigma has been associated with reduced accuracy of face emotion recognition in individuals at clinical high risk for psychosis (CHR). Stigma may also relate to slowing of performance during cognitive tasks for which a negative stereotype is relevant. This study aimed to investigate the association of mental illness stigma with face emotion recognition among CHR individuals. Participants were 143 CHR individuals identified using the Structured Interview for Psychosis-Risk Syndromes (SIPS). Face emotion recognition was assessed using the Penn Emotion Recognition Task (ER-40). Stigma was assessed using discrimination, stereotype awareness, and stereotype agreement subscales of the Mental Health Attitudes Interview for CHR. We tested associations of ER-40 accuracy and response times with these stigma variables, including the role of clinical and demographic factors. Racial/ethnic minoritized participants had higher attenuated positive symptoms than non-minoritized participants. Longer ER-40 response times were correlated with greater stereotype agreement (r=.17, p=.045) and discrimination (r=.22, p=.012). A regression model predicting ER-40 response times revealed an interaction of stereotype agreement with minoritized status (p=.008), with slower response times for minoritized participants as stereotype agreement increased. Greater disorganized symptoms and male gender also predicted longer response times. ER-40 accuracy was not associated with stigma. Overall, minoritized CHR individuals with greater internalized stigma took longer to identify face emotions. Future research is needed to assess whether slower response times are specific to social cues, and if internalized stigma interferes with performance in real-world social situations. Reducing stigma may be an important target for interventions that aim to improve social skills.

Mediators of improved PTSD symptoms in veterans and civilians following a yoga program.

Although yoga shows some promise as an intervention for post-traumatic stress disorder (PTSD), little is known about how yoga reduces PTSD symptoms. The current study hypothesised that aspects of interoceptive awareness would mediate the effect of a yoga intervention on PTSD symptoms. We used data from our recently completed randomised controlled trial of a 16-week holistic yoga programme for veterans and civilians diagnosed with PTSD (n = 141) that offered weekly 90-minute sessions. We conducted a mediation analysis using interoceptive awareness and other variables that were associated with PTSD symptom reduction at mid-treatment and treatment end. Although measures of anxiety, interoceptive awareness, and spirituality were identified in individual mediator models, they were no longer found to be significant mediators when examined jointly in multiple mediator models. When examining the multiple mediator models, the strongest mediator of the yoga intervention on PTSD symptoms was mental well-being at mid-treatment and stigma at the treatment end. The total effect of yoga on CAPS and PCL at the treatment end mediated by stigma was 37.1% (-1.81/-4.88) and 33.6% (-1.91/-5.68), respectively. Investigation of mental well-being and mental illness stigma as potential mediators is warranted in future studies of yoga as a treatment for PTSD as they may prove to be important foci for yoga interventions.

Mental illness stigmatization factors: Survey among caregivers in Mahajanga Madagascar

Introduction: Psychiatric patients' stigmatization is a major public health problem. The objective of this survey is to determine the factors reinforcing the stigmatizing behaviors of nursing staff towards psychiatric patients. Methods: This study is descriptive, cross-sectional and prospective analytic conducted in the Emergency Departments of the both Mahajanga University Hospitals and the CSB of the District of Mahajanga I from November to December 2021. Results: Toxic causes of mental illness were the most mentioned by caregivers (91.4%) followed by environmental causes (74.29%), neurobiological and genetic causes (74.29%) and supernatural causes (17.1%). Thirty-four point three percent of staff believed that mental disorders are not curable. In 73.08% of cases, the staff referred the patient directly. In our study, both groups of staff had high social distance scores with averages of 22.58 for physicians and 23.15 for nurses. High scores were found in 87.5% of cases for physicians and in 89.1% of cases for nurses. There was an association between social distancing and the following stereotypes as perceived by staff: craziness (p=0.002), dangerousness (p=0.031). The decision to treat or refer patients depends mostly on the acquisition of additional Training in Psychiatry (p=0.000). The Training improved skills to take care of the patients. Conclusion: Anti-stigma actions must be carried out in Mahajanga, particularly among healthcare staff, to improve the quality of life of patients.

Mental illness stigma and attitudes among university students: descriptive study

Introduction. Social stigma towards mental illnesses provokes discrimination and exclusion. It is important to detect this stigma for its evaluation to establish intervention strategies that respond to needs. Objective. This study has the objective of ascertaining levels of stigma among students from the University of Burgos (UBU) towards people with mental health problems at various university faculties and to analyze the right response in each case. Results. The study involved the administration of the Questionnaire on Community Attitudes towards Mental Illness (CAMI) to a sample of 268 students from 7 educational faculties (Sciences, Health Sciences, Economics, Law, Education, Huma- nities and the Higher Polytechnic School). The results showed that the stigma of university students was influenced by different sociodemographic variables (sex, age, studies and contact with people with mental illness). Conclusions. University students who participated in the study have elevated stigmatizing attitudes towards mental health pro- blems. Direct contact with people with mental health problems prompted less stigmatizing attitudes and, in general, men held the most discriminatory attitudes. Educational interventions must be designed for this population group to reduce stigma and so that stigmatizing attitudes are no longer obstacles to professional and social development.

Help-Seeking Intentions for Depression and Associated Factors among Chinese Perinatal Women: A Cross-Sectional Study.

A low help-seeking intention for depression is an important reason for the low number of women with perinatal depression who have sought professional help. However, evidence of help-seeking intentions for depression is still lacking in Chinese perinatal women. We aimed to investigate the help-seeking intention for depression and its associated factors among Chinese perinatal women. Participants were recruited from three comprehensive hospitals in Changsha. A total of 874 perinatal women were included in the study. The score for the help-seeking intention for depression in Chinese perinatal women was 3.65 ± 0.79, with about half of participants (58.3%) reporting that they were "likely" and "strongly likely" to seek professional help if they suffered from depression during the perinatal period. Favorable help-seeking attitudes and sufficient knowledge of mental illness help-seeking resources were positively associated with help-seeking intentions for depression. However, self-stigma decreased the help-seeking intention for depression. Chinese perinatal women had relatively positive help-seeking intentions for depression. Reducing the stigma of mental illness and help-seeking, enhancing mental health literacy, and improving attitudes toward professional psychological help-seeking of perinatal women may be the potential key components of interventions to encourage perinatal women to actively seek professional psychological help.

Involvement and burden of informal caregivers of patients with mental illness: the mediating role of affiliated stigma

BackgroundThe fear and lack of understanding of mental illness can lead to stigma. The stigma of mental illness affects not only individuals who suffer from it, but also the caregivers. Stigma among caregivers can lead to delay in seeking care, poor adherence to treatment and a high risk of relapse. Caregivers of patients with mental illness are at an increased risk of distress due to the burden to stigma and caregiving burden. An increase in caregivers’ burden can lead to a reduction in caregivers’ involvement. There is a relationship between caregivers’ involvement, burden, and affiliated stigma. The present study examined the mediating role of affiliated stigma in the relationship between caregivers’ burden and involvement among informal caregivers of hospital-admitted patients with mental illness in Uganda.MethodsA cross-sectional study was conducted among 428 informal caregivers (mean age: 39.6 years [SD±14.6]; females = 62.1%). Information was collected regarding sociodemographic characteristics, affiliated stigma, and the involvement and burden of informal caregivers. ResultsThe findings indicate that affiliated stigma serves as a full mediator between the caregiver’s roles and involvement (β=15.97, p<0.001). Being female increased the caregivers’ burden of caregiving (β= -0.23, p<0.001).ConclusionThe findings in the present study suggest that intervention to address affiliated stigma among caregivers of patients with mental illness should be incorporated into mainstream mental health care to reduce the caregiving burden.

Internalized stigma in mental health staff with lived experience of mental crises-Does the professional role protect against self-stigmatization?

The stigma of mental illness is widespread in the general population and also among healthcare and psychiatric professionals. Yet, research on the self-stigma of the latter is still limited. The purpose of this article was to assess self-stigma and its correlates in mental health professionals with lived experiences of mental crisis and treatment. In a cross-sectional exploratory research project, 182 mental health professionals with lived experiences of mental crisis and treatment from 18 psychiatric hospital departments in the German federal states of Berlin and Brandenburg were surveyed on their lived experiences, self-stigma, perceived stigma in the workplace, subjective vulnerability to crises, and meaningfulness of lived experiences. To investigate the relationships between the variables, manifest and latent correlation analyses were calculated. Results showed low levels of self-stigma and perceived public stigma in the workplace. Self-stigma was significantly and positively associated with workplace stigma and subjective vulnerability to crisis, but not with identification with lived experiences. The relationship between self-stigma, workplace stigma, and vulnerability should be investigated in terms of mutual causality in order to derive possible strategies of reducing self-stigma along with its detrimental effects. Possible reasons for the low levels of self-stigma are discussed in the light of limitations, including processes of self-selection, with highly self-stigmatizing individuals being possibly discouraged from participating. Strategies to enhance sampling quality are briefly discussed.

Factors associated with internalized stigma in people with common mental disorders using services of Family Health Strategy

PurposeTo identify factors associated with the presence of internalized stigma in people with Common Mental Disorders (CMD) using Family Health Strategy. MethodQuantitative study carried out with 529 users with CMD answered the sociodemographic questionnaire and the scales Self-Reporting Questionnaire and scale on Internalized Stigma of Mental Illness. ResultsInternalized stigma was associated with education level, medication use, treatment for mental disorders, suicidal ideation, attendance at a psychosocial care center and psychiatric hospital. ConclusionThe adequate identification and treatment of psychological distress constitute effective prevention strategies to safeguard life and ensure the stigma reduction and better quality of life.

An efficacy trial of a brief group based, single session intervention delivered through Australian community sport clubs to reduce mental illness stigma and increase help-seeking intention

ABSTRACT The Australian NRL’s State of Mind programme was evaluated; specifically, a 1.5-hour intervention for increasing knowledge of mental illness, reducing attitudinal components of mental illness stigma and increasing help-seeking propensity in a sample drawn from amateur rugby league clubs in Queensland. The National Rugby League (NRL) is the pre-eminent rugby league club competition in Australia and New Zealand. Participants, 16 years of age and older, completed a pre- and post-intervention survey capturing four mental illness knowledge measures, four attitudinal measures of stigma and one measure of help-seeking propensity. Results demonstrated that 1.5 weeks after intervention, the 1.5-hour targeted intervention associated with significant meaningful improvements in mental health knowledge, attitudinal components of mental illness stigma and help-seeking intention.

EXAMINING MENTAL ILLNESS STIGMA, HELP-SEEKING AMONG TAIWANESE YOUTHS: PERPETUATED BY CONVENTIONAL PUBLIC VIEWS AND TRANSFORMED BY CHANGING SOCIAL VALUES

To protect youths with mental distress, it is important to understand their help-seeking behaviors, explore potential help sources, and examine factors that deter them from seeking help, such as negative perceptions towards mental illness. In the current study, quantitative data was collected to examine mental illness stigma of Taiwanese college students. Students’ help-seeking behaviors were also assessed both quantitatively and qualitatively. A psychoeducational program on mental illness stigma reduction was implemented. The results showed that the participants had a moderately low level of mental illness stigma. The proposed intervention did not significantly reduce overall mental illness stigma. However, the intervention significantly decreased participants’ inclination to avoid people with mental illness. Generally, the participants scored moderate on willingness to seek help. The qualitative analysis indicated that although subscribing to the conventional stigmatizing belief of avoiding the mentally ill, Taiwanese youths have gradually abandoned the Chinese tradition of associating shame with counselling.

Mental illness stigma in Bangladesh: Findings from a cross-sectional survey.

Mental illness stigma is universally prevalent and a significant barrier to achieving global mental health goals. Mental illness stigma in Bangladesh has gained little attention despite its widespread impact on seeking mental health care in rural and urban areas. This study aimed to investigate mental illness stigma and the associated factors in rural and urban areas of Bangladesh. The study areas were divided into several clusters from which 325 participants (≥18 years) were recruited with systematic random sampling. The Bangla version of the Days' Mental Illness Stigma Scale was used to collect data. Independent-samples t-test, ANOVA, and multiple regression were performed. Results suggest that gender, age, geographical location, socioeconomic status, and occupation significantly differed across subscales of stigma. Age, gender, seeking treatment of mental illness, having knowledge on mental health, and socioeconomic status were predictive factors of mental illness stigma. The results also showed a high treatment gap in both rural and urban areas. This study supports that mental illness stigma is prevalent in Bangladesh, requiring coordinated efforts. Results can inform the development of contextually tailored mental health strategies to reduce stigma and contribute to the promotion of mental health of individuals and communities across Bangladesh.