Stigma Items Research Articles

A theoretical and empirical framework for constructing culture-specific stigma instruments for Chile.

Different cultural contexts contribute to substantial variation in the stigma faced by people with psychosis globally. We propose a new formulation of how culture affects stigma to create psychometrically-validated tools to assess stigma's culture-specific effects. We propose to construct culture-specific stigma measures for the Chilean context via: 1) open-ended administration of 'universal' stigma scales to a sample of individuals with psychosis, relatives, and community respondents; 2) qualitative analyses to identify how culture shapes stigma and to derive initial 'culture-specific' stigma items; 3) construction and pilot-testing of final 'culture-specific' stigma measures; 4) initial psychometric validation among a sample of individuals with psychosis. We identify initial hypotheses for how stigma might threaten the capacities to participate in fundamental activities that 'matter most' in the Chilean context. These include mental illness stigma threatening the man's ability to protect the honor of the family, and the woman's ability to be a 'holy and pure' mother. Mental illness stigma may further endanger the ability of the family to uphold reciprocal obligations within their social network. Developing such measures promises to aid efforts to address culture-specific forms of stigma, and to facilitate implementation of community mental health services, in Chile and other Latin American contexts.

Internalized stigma among patients with schizophrenia in Ethiopia: a cross-sectional facility-based study

BackgroundDespite the potential impact on treatment adherence and recovery, there is a dearth of data on the extent and correlates of internalized stigma in patients with schizophrenia in low income countries. We conducted a study to determine the extent, domains and correlates of internalized stigma amongst outpatients with schizophrenia in Ethiopia.MethodsThe study was a cross-sectional facility-based survey conducted at a specialist psychiatric hospital in Addis Ababa, Ethiopia. Consecutive consenting individuals with a diagnosis of schizophrenia were recruited and assessed using an Amharic version of the Internalized Stigma of Mental Illness (ISMI) scale.ResultsData were collected from 212 individuals, who were mostly single (71.2%), unemployed (70.3%) and male (65.1%). Nearly all participants (97.4%) expressed agreement to at least one stigma item contained in the ISMI; 46.7% had a moderate to high mean stigma score. Rural residence (OR = 5.67; 95% CI = 2.30, 13.00; p < 0.001), single marital status (OR = 3.39; 95% CI = 1.40, 8.22; p = 0.019) and having prominent psychotic symptoms (OR = 2.33; 95% CI = 1.17, 4.61; p = 0.016) were associated independently with a higher stigma score. Almost half of those who discontinued their treatment reported that they had done so because of perceived stigma. Those who had attempted suicide (45.3%) were more likely to have a high stigma score (OR = 2.29; 95% CI = 1.27, 4.11; p = 0.006). Over 60% of the variation in the experience of stigma was explained by four factors: social withdrawal (16.7%), perceived discrimination (14.1%), alienation (13.9%) and stereotype endorsement (12.7%).ConclusionInternalized stigma is a major problem among persons with schizophrenia in this outpatient setting in Ethiopia. Internalized stigma has the potential to substantially affect adherence to medication and is likely to affect the recovery process.

The generalised anxiety stigma scale (GASS): psychometric properties in a community sample

BackgroundAlthough there is substantial concern about negative attitudes to mental illness, little is known about the stigma associated with Generalised Anxiety Disorder (GAD) or its measurement. The aim of this study was to develop a multi-item measure of Generalised Anxiety Disorder stigma (the GASS).MethodsStigma items were developed from a thematic analysis of web-based text about the stigma associated with GAD. Six hundred and seventeen members of the public completed a survey comprising the resulting 20 stigma items and measures designed to evaluate construct validity. Follow-up data were collected for a subset of the participants (n = 212).ResultsThe factor structure comprised two components: Personal Stigma (views about Generalised Anxiety Disorder); and Perceived Stigma (views about the beliefs of most others in the community). There was evidence of good construct validity and reliability for each of the Generalised Anxiety Stigma Scale (GASS) subscales.ConclusionsThe GASS is a promising brief measure of the stigma associated with Generalised Anxiety Disorder.

P5-S1.03 HIV status disclosure in family and determinants of stigmatisation in a conservative society

BackgroundNational AIDS control of Pakistan and its development partner Canadian Government CIDA is seeking for effective AIDS surveillance. However, prevailing illiteracy and conservative societal norms are challenging factors in preventing...

Characterizing hepatitis B stigma in Chinese immigrants

Health-related stigma is a cause of stress, alienation and discrimination that can serve as a barrier to prevention and care for infectious diseases such as HIV. Hepatitis B virus (HBV)-related stigma is common in Asian immigrants, but has not been formally evaluated. The aim of this study was to develop and validate the first HBV stigma instrument and to begin to evaluate HBV stigma in Chinese immigrants. The HBV stigma instrument was developed based on constructs from validated HIV stigma scales and organized into five domains. A written survey was compiled to include demographic data, HBV knowledge questions and stigma items. The survey was pilot tested in English and Chinese and then finalized. Data were obtained from 201 patients seen in an urban Chinatown Internal Medicine practice. The stigma items showed a high degree of reliability when assessed in aggregate (α = 0.85) as well as within individual domains. Stigma was greatest in the Fear of Contagion domain. Knowledge questions showed a corresponding deficit in understanding of modes of HBV transmission. An inverse relationship between stigma scores and familiarity with HBV provided evidence of construct validity. In multivariable analysis, having a family member with HBV and higher HBV knowledge subset scores were associated with lower degrees of stigma. In conclusion, the hepatitis B stigma instrument showed reliability and construct validity. The relationship identified between familiarity and knowledge regarding HBV with lower stigma scores provides the basis for the development of interventions to reduce HBV stigma.

HIV-Related Stigma, Social Norms, and HIV Testing in Soweto and Vulindlela, South Africa: National Institutes of Mental Health Project Accept (HPTN 043)

HIV testing is necessary to curb the increasing epidemic. However, HIV-related stigma and perceptions of low likelihood of societal HIV testing may reduce testing rates. This study aimed to explore this association in South Africa, where HIV rates are extraordinarily high. Data were taken from the Soweto and Vulindlela, South African sites of Project Accept, a multinational HIV prevention trial. Self-reported HIV testing, stigma, and social norms items were used to study the relationship between HIV testing, stigma, and perceptions about societal testing rates. The stigma items were broken into 3 factors: negative attitudes, negative perceptions about people living with HIV, and perceptions of fair treatment for people living with HIV (equity). Results from a univariate logistic regression suggest that history of HIV testing was associated with decreased negative attitudes about people living with HIV/AIDS, increased perceptions that people living with HIV/AIDS experience discrimination, and increased perceptions that people with HIV should be treated equitably. Results from a multivariate logistic regression confirm these effects and suggest that these differences vary according to sex and age. Compared with people who had never tested for HIV, those who had previously tested were more likely to believe that the majority of people have tested for HIV. Data suggest that interventions designed to increase HIV testing in South Africa should address stigma and perceptions of societal testing.

The synergy between TB and HIV co-infection on perceived stigma in Ethiopia

BackgroundThe synergy between tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection on perceived stigma is not well studied. The objective of this study was to assess the effect of TB/HIV co-infection on perceived stigma in selected hospitals of Oromiya region, Ethiopia. A cross sectional study was conducted from February to April, 2009 in Adama, Nekemet and Jimma Specialized hospitals. Data were collected by trained HIV counselors. A structured questionnaire which consisted of socio-demographic variables, clinical information, perceived stigma, and depression was used to collect the dataFindingsA total of 591 participants were included in the study of whom 124 (20.9%) were co-infected with TB/HIV. The stigma items were highly reliable (Cronbach's alpha = 0.93) and had strong inter dimension correlation. Respondents who were co-infected with TB and HIV were more likely to have perceived stigma compared to non-co-infected HIV patients, [OR = 1.4, (95% CI: 1.2, 2.0)]. Non-literate individuals [OR = 1.9, (95% CI: 1.2, 3.0)] and females [OR = 1.6, (95% CI: 1.2, 2.3)] had also more perceived stigma.ConclusionsTB/HIV co-infected patients, non-literate individuals and females were more likely to have high perceived stigma. Behavioral Change Communication should focus on these segments of the population to rectify the high perceived stigma.

Stigma, Barriers to Care, and Use of Mental Health Services Among Active Duty and National Guard Soldiers After Combat

This study examined rates of utilization of mental health care among active duty and National Guard soldiers with mental health problems three and 12 months after they returned from combat in Iraq. Stigma and barriers to care were also reported for each component (active duty and National Guard). Cross-sectional, anonymous surveys were administered to 10,386 soldiers across both time points and components. Mean scores from 11 items measuring stigma and barriers to care were computed. Service utilization was assessed by asking soldiers whether they had received services for a mental health problem from a mental health professional, a medical doctor, or the Department of Veterans Affairs in the past month. Risk of mental problems was measured using the Patient Health Questionnaire, the PTSD Checklist, and items asking about aggressive behaviors and "stress, emotional, alcohol, or family" problems within the past month. A higher proportion of active duty soldiers than National Guard soldiers reported at least one type of mental health problem at both three months (45% versus 33%) and 12 months (44% versus 35%) postdeployment. Among soldiers with mental health problems, National Guard soldiers reported significantly higher rates of mental health care utilization 12 months after deployment, compared with active duty soldiers (27% versus 13%). Mean stigma scores were higher among active duty soldiers than among National Guard soldiers. Active duty soldiers with a mental health problem had significantly lower rates of service utilization than National Guard soldiers and significantly higher endorsements of stigma. Current and future efforts to improve care for veterans should work toward reducing the stigma of receiving mental health care.

Descriptive epidemiology of stigma against depression in a general population sample in Alberta

BackgroundMental health illnesses, such as depression, are responsible for a growing disease burden worldwide. Unfortunately, effective treatment is often impeded by stigmatizing attitudes of other individuals, which have been found to lead to a number of negative consequences including reduced help-seeking behavior and increased social distance. Despite the high prevalence of depression in Canada, little research has been conducted to examine stigma against depression in the Canadian general population. Such information is crucial to understanding the current state of stigmatizing attitudes in the Canadian communities, and framing future stigma reduction initiatives. The objectives of this study were to estimate the percentages of various stigmatizing attitudes toward depression in a general population sample and to compare the percentages by demographics and socioeconomic characteristics.MethodsWe conducted a cross-sectional telephone survey in Alberta, Canada, between February and June 2006. Random digit dialing was used to recruit participants who were aged 18-74 years old (n = 3047). Participants were presented a case vignette describing a depressed individual, and responded to a 9-item Personal Stigma questionnaire. The percentages of stigmatizing attitudes were estimated and compared by demographic and socioeconomic variables.ResultsAmong the participants, 45.9% endorsed that depressed individuals were unpredictable and 21.9% held the view that people with depression were dangerous. Significant differences in stigmatizing attitudes were found by gender, age, education, and immigration status. A greater proportion of men than women held stigmatizing views on each stigma item. No consistent trend emerged by age in stigma against depression. Participants with higher levels of education reported less stigmatizing attitudes than those with less education. Participants who were not born in Canada were more likely to hold stigmatizing attitudes than those who were born in Canada.ConclusionIn the general population, stigmatizing attitudes towards depression differ by demographic characteristics. Men, those with less education and immigrants should be the targets of stigma reduction campaigns.

Addressing stigma of depression in Latino primary care patients

Objectives To develop a validated stigma checklist to assist physicians in addressing depression in Latino patients. Method Two hundred low-income, Spanish-speaking, Latino patients in primary care clinics were screened for depression using Patient Health Questionnaires (PHQ-2 and PHQ-9), and medical records were reviewed. With the use of a wide pool of stigma items, empirical methods were used to develop a stigma checklist from this primary care sample and patient information was used to demonstrate construct validity. Results Patients reporting higher levels of perceived stigma using the stigma checklist were less likely to disclose their depression diagnosis to their family and friends ( P<.05) and also less likely to be taking depression medication (OR=.78; 95% CI, .62–.99). Patients with stigma were less likely to be able to manage their depression (OR=.79; 95% CI, .65–.96) and more likely to have missed scheduled appointment visits (OR=1.44; 95% CI, 1.03–2.02). Conclusion Given the strong relationship between stigma and care of depression, primary care clinicians should be aware of and address stigma among their depressed Latino patients. The stigma checklist presented for treating Spanish-speaking Latino patients in primary care may be used to assess depressed patients for stigma to help inform clinical management of patients.

AIDS-Related Stigma Among Black and Hispanic Young Adults

Telephone surveys with national probability samples of English-speaking adults have suggested that popular support for punitive policies toward people living with HIV/AIDS (PLWHA) declined in the 1990s, but AIDS-related stigma persists in the United States. Our aim was to assess the prevalence and impact of AIDS-related stigma in non-Hispanic Black and Hispanic communities. A cross-sectional computer-assisted telephone-interview survey was conducted in summer 2003 with African-American, Afro-Caribbean, Haitian, and Hispanic 18-39 year-old residents of 12 high AIDS-incidence areas in Broward County, Florida. Stigma items were adopted from national surveys, but interviews were conducted in Spanish and Haitian Creole as well as in English. Stigma scores were higher than those reported for national samples, especially among Haitians interviewed in Creole. AIDS-related stigma was associated with never receiving an HIV-antibody test (adjusted odds ratio [AOR] = 0.78, 95% confidence interval [CI]: 0.62-0.99, P = .046), an elevated perception of HIV risk (AOR = 1.32, 95% CI: 1.01-1.73, P = .045) and a failure to participate in HIV-prevention efforts (AOR = 0.53, 95% CI: 0.34-0.85, P = .008). Interventions are needed to mitigate the pernicious effects of AIDS-related stigma.

Felt stigma among people living with HIV/AIDS in rural and urban Kenya.

Individuals suffer from felt stigma when they internalize negative perceptions regarding themselves. People living with HIV (PLWH) employ diverse coping mechanisms when their self worth and networks are disrupted by stigma. The social network perspective suggests response to stigma is shaped by social context. This paper examines whether internalized HIV stigma among PLWH changes over time, and whether it differs with demographics and rural or urban location. Semi-structured interviews were conducted with support group members in two waves that were 12 months apart. Current analyses focus on examining whether HIV felt stigma differs with demographic characteristics and rural or urban location. Further, we explore whether there is variation in magnitude of change at the two sites over time. T-tests are used to compare each stigma item by waves and sites. Factor analysis is utilized to correlate and reveal the relationship between stigma items, while bivariate and logit models investigate the relationship between stigma items and site, gender, marital status and education. Study findings highlight a gender and rural-urban dichotomy that seems to influence the experience of HIV felt stigma. Being urbanite and being female significantly decreases agreement with selected stigma items. While the urban sample reveals significant difference between the two waves, the rural experience indicates insignificant change over time. The difference between the two sites reflects a distinction between modern and pre-modern social structures. This study suggests internalized feelings of HIV stigma may vary with social context and gender. Thus, interventions to support PLWH in Kenya must take into account gender and unique social configurations.

Perceived Stigma and Mental Health Care Seeking

There is limited empirical evidence on the extent to which perceived public stigma prevents individuals from using mental health services, despite substantial recent policy interest in this issue. This study investigated associations between perceived public stigma and mental health care seeking. This study used cross-sectional survey data from a representative sample of undergraduate and graduate students (N=2,782) at one university. A five-item scale was used to assess perceived public stigma toward mental health service use. Perceived need for help in the past 12 months and current presence of depressive and anxiety disorders were also assessed. Perceived stigma was higher among males, older students, Asian and Pacific Islanders, international students, students with lower socioeconomic status backgrounds, and students with current mental health problems. Perceived stigma was also higher among those without any family members or friends who had used mental health services and among those who believed that therapy or medication is not very helpful. Perceived stigma was negatively associated with the likelihood of perceiving a need for mental health services, but only among younger students. Among those with probable depressive or anxiety disorders, there was no evidence that perceived stigma was associated with service use. These results suggest that, at least in this population, perceived stigma may not be as important a barrier to mental health care as the mental health policy discourse currently assumes.

Does Stigma Keep Poor Young Immigrant and U.S.-Born Black and Latina Women From Seeking Mental Health Care?

Does Stigma Keep Poor Young Immigrant and U.S.-Born Black and Latina Women From Seeking Mental Health Care?

An exploratory study of people's reasons for delaying or avoiding helpseeking

Respondents from the general population rated the degree to which 25 different motives contributed to their decision to delay or avoid seeking help for a distressing personal problem. Multidimensional scaling analysis revealed five general clusters of motives to avoid helpseeking. These were labelled: Fear and Stigma, Problem Avoidance and Denial, Helper Evaluation, External Barriers, and Independence. Respondents who rated the Fear and Stigma items highly had problems that were seen as being intimate and internally attributed. Females were more likely to report Problem Avoidance and Denial motives than were males. Respondents with an external locus of control were somewhat more concerned with Helper Evaluation and External Barriers, and were somewhat less concerned with Independence, than were respondents with an internal locus of control. It is argued that a greater understanding of people's reluctances to seek help will facilitate the development of a general decisionmaking model of helpseeking behaviour.