Levels Of Stigma Research Articles

Courtesy stigma in the families of patients with severe mental disorders: an obstacle to the recovery process?

The general concept of stigma finds wide application in the field of psychiatry by indicating prejudice, stereotypes and discrimination towards patients diagnosed with psychiatric illness. Among the different declinations of this concept, we find courtesy stigma: a form of stigma by association experienced by people in close contact with the stigmatised person.Those who are most likely to experience this type of discrimination are the family members of the psychiatric patient, as they are particularly connected to the person with mental health problems. This experience contributes to increasing levels of expressed emotion (EE), i.e. the index of the emotional climate within the family.This study is based on two samples: a group of users with a diagnosis of severe mental disorder from the Department of Psychiatry of the University of Campania “Luigi Vanvitelli” and another group of family caregivers. This study aimed to: a) assess the impact of courtesy stigma on the levels of recovery and EE perceived by the patient; b) assess the relationship between the latter and the recovery process.To this end, the RAS-DS (Recovery Assessment Scale - Domains and Stages) and LEE (Level of Expressed Emotion Scale) scales were administered to patients, whereas caregivers were administered the CPMI (Stigma scale for Caregivers of People with Mental Illness) scale.Data processing revealed that high levels of courtesy stigma reported by caregivers not only hinder the patients’ recovery process, but also contribute to increasing EE levels according to the patients. Furthermore, as the EE levels perceived by the patients increase, the recovery levels decrease.

Stigma towards people with mental conditions in healthcare workers: an Italian cross-sectional study

Abstract Background Stigma towards people with mental disorders (MD) in healthcare workers (HCWs) can negatively influence the quality of care provided and hinder patients from accessing healthcare. The aim of this study was to analyze stigma and its determinants among physicians and nurses in Italy, as a basis for future strategies to reduce its extent. Methods A cross-sectional study was conducted from April to September 2023. A sample of 1053 physicians and nurses working in Italy answered an online 52-item questionnaire. Variables explored demographic data, work context, burnout symptoms, and personal or family history of MD. The Opening Minds Scale for Health Care Providers (OMS-HC) was used to assess the level of stigma (score from 20 to 100, higher scores represent higher levels). Descriptive analysis and multivariable linear regression were performed. Results Females were 69.5% and median age was 48 years (IQR=37-58). Physicians were 60.5%. A total of 20% of the sample worked in psychiatric settings. Burnout symptoms were reported by 23.5%. Results showed a median OMS-HC score of 49 (IQR=43-54). Positive associations with stigmatizing attitudes were found for being a nurse (p = 0.020) and being in burnout (p = 0.017), while working in a psychiatric setting (p < 0.001) and having personal or family history of MD (p < 0.001) had negative associations. Conclusions This research unveiled a notable amount of stigma among Italian HCWs towards individuals with MD. Since people with MD experience higher rates of disability and mortality, it has to be a public health priority to develop targeted strategies to reduce stigma in HCWs, as it discourages patients from accessing healthcare. Future interventions should be tailored for different professionals and dealing with HCWs burnout. Key messages • Future interventions should consider that healthcare workers in burnout and nurses tend to have more stigma toward patients with mental conditions. • Healthcare professionals working in psychiatric settings and having personal or family history of mental disorders showed lower stigma.

Analysing the Impact of Socioeconomic Factors on Mental Health Differences in Chinese Society: Integrating Cultural, Psychological and Technological Perspectives.

Mental health (MH) differences remain an issue in contemporary Chinese society, with various factors influencing individuals' well-being. This study investigates the complex connection between results related to psychological wellness and social issues, integrating cultural, psychological and technological perspectives. Through a quantitative research methodology, data were collected from 1000 individuals using a questionnaire survey and analysed using SPSS software. The study's findings shed light on the impact of socioeconomic status (SES) on MH stigma, help-seeking behaviour and overall well-being. The findings identify that lower SES was associated with heightened levels of MH stigma and decreased the search for assistance actions. Cultural beliefs emphasising MH stigma and societal expectations were identified as mediators in the connection involve SES and MH outcomes. Digital technology use emerged as a moderator, indicating that higher levels of technology utilisation were linked to reduced disparities in accessing MH resources. The novelty of this study lies in its comprehensive examination of the multifaceted factors influencing MH disparities within Chinese society. Additionally, psychological factors such as resilience and social support were observed to mitigate the negative lower SES's effect on MH consequences. The interaction between SES and cultural factors was found to predict MH outcomes, with lower SES exacerbating the effects of MH stigma and cultural barriers.

Psychiatric and functional correlates of stigma associated with cognitive impairment in schizophrenia

Schizophrenia is the most strongly stigmatized psychiatric diagnosis, with negative stereotypes including assumptions of incompetence and inability to recover. Individuals with cognitive impairment associated with schizophrenia (CIAS) have reported stigma experiences, suggesting that CIAS carries stigma in addition to the stigma associated with schizophrenia as a diagnostic label. While research has established that mental illness stigma more generally is linked with poor psychiatric and functional outcomes, no research has explored correlates of CIAS stigma. This study evaluated cognitive, psychiatric, and functional correlates of CIAS stigma among 54 individuals with schizophrenia spectrum disorders participating in a cognitive remediation trial. Participants with greater estimated cognitive decline reported higher levels of CIAS stigma experiences. Participants who reported higher levels of CIAS stigma also scored higher on a measure of depressive symptom severity. No significant associations were found between CIAS stigma and positive and negative psychosis symptoms or general psychopathology ratings. CIAS stigma was not associated with performance-based functional capacity or ratings of community functioning. Findings suggest that CIAS stigma is linked with the degree of cognitive decline and depressive symptom severity among individuals with schizophrenia spectrum disorders. Additional research is needed to elucidate directionality and the relationship between CIAS stigma and functioning outcomes.

Identifying and Describing Mental Health Stigma Among Agricultural Youth Directors: Does Stigma Influence Practices?

ABSTRACT Objectives This exploratory study aims to: 1) evaluate mental health stigma levels among agricultural youth directors, 2) examine the influence of professional characteristics on stigma, and 3) investigate the relationship between agricultural youth directors’ stigma levels and their self-efficacy. Methods An online survey was administered from March to May 2022 to 642 agricultural youth directors in Illinois who work with youth aged 1–19. Directors’ personal and perceived stigmas toward mental illness were measured using the Depression Stigma Scale. Directors’ self-efficacy (perceived level of knowledge and confidence) across 19 mental health topics was measured using a 3-point Likert scale. Analyses were conducted by generating descriptive statistics and performing Mann–Whitney U tests on the data. Results The median personal depression stigma score was 7.57 (SD = 8.02). Our analyses identified significantly higher personal depression stigma scores among men, FFA advisors, agricultural educators, and those lacking personal experience with mental illness. A lack of self-efficacy correlated significantly with increased personal stigma. Conclusions This study underscores the critical need for targeted educational interventions to reduce stigma among agricultural youth directors and enchance mental health literacy. Anti-stigma and mental health literacy initiatives are essential for fostering a supportive environment that encourages open discussions about mental health issues with youth within the agricultural community.

The correlation between stigma and treatment adherence, quality of life in patients with rheumatoid arthritis: A mixed-methods study.

To investigate the current status of stigma in patients with rheumatoid arthritis (RA), and its correlation with treatment adherence and quality of life. The convenience sample of 266 patients diagnosed with RA was surveyed at the rheumatology and immunology outpatient department of a tertiary hospital in Jiangsu Province from May 2022 to September 2022. In addition to this, 20 RA patients were purposively sampled for semi-structured in-depth interviews, and the data were analysed using content analysis methods. The total stigma's score of the 266 participants was (47.8 ± 10.8), which indicates a moderate level of stigma. The mean scores for alienation, stereotype endorsement, perceived discrimination, and social withdrawal were (2.2 ± 0.7), (2.4 ± 0.7), (2.9 ± 0.6), and (2.2 ± 0.6) respectively. A comparison of the average family monthly income, family roles, duration, disease activity, duration of morning stiffness, visual analogue scale score, C-reactive protein, erythrocyte sedimentation rate, and total stigma score revealed significant differences (p < 0.05). The total treatment adherence score was negatively correlated with the total stigma's score and scores in each dimension (p < 0.05). Similarly, the total psychological health score and total physical health score were negatively correlated with the total stigma score and scores in each dimension (p < 0.05). The qualitative study identified six themes: self-denial, discrimination, lack of disease-related knowledge, high medical costs, increased life burden and resistance to stigma. Stigma affects RA patients' treatment adherence and quality of life negatively. Healthcare workers are advised to develop comprehensive intervention programs that address the current status of stigma, with the aim of controlling disease progression, reducing disability rates, and improving the quality of life for RA patients.

Development, validity and reliability of the “Multiple sclerosis stigma scale”

BackgroundStigma in multiple sclerosis (MS) refers to the negative attitudes, beliefs, and behaviors that patients may encounter as a result of their diagnosis. Patients who hold stigmatizing beliefs are more prone to experiencing anxiety and depression, social isolation, and poor treatment adherence. To mitigate the adverse effects of stigma, it is crucial to assess stigmatizing beliefs; however, there is currently no specific stigma scale available for MS. ObjectiveThe aim of this study was to develop and validate “Multiple Sclerosis Stigma Scale (MSSS)”. MethodsThis methodological study was conducted in three phases. In the first phase, the concept of stigma in MS was defined. In the second phase, an item pool was generated based on the findings from the first phase. In the third phase, psychometric properties of the scale were evaluated, including face and content validity, construct validity, convergent validity and reliability. ResultsAfter evaluating the validity (face, content, and construct validity) and reliability, the initial item pool of 276 items was reduced to 12 items. Factor analysis revealed two factors: discrimination and disclosure. The developed questionnaire had excellent reliability, with an internal consistency coefficient of 0.88 and a stability coefficient of 0.87. ConclusionThe 12-item MSSS is valid and reliable for assessing the level of stigma in Turkish people with MS.

Community perception towards mental illness and help-seeking intention in Southwest Ethiopian Peoples Regional State.

Community perception of mental illness is a collective belief system and attitude about mental disorders; it affects the availability of services, the level of stigma, and the help-seeking intention. This study assessed community perceptions towards mental illness and help-seeking intentions in Southwest Ethiopia. A community-based analytical cross-sectional study was done in Southwest Ethiopian People's Regional State (SWEPRS), from March 1st to June 30th, 2021. All adult individuals >18 years old living in the region were the source population, while all adult >18 years old living in the selected household were the study population. The calculated sample size was 1028. Participants were selected using a multistage sampling technique. A structured, interview-based questionnaire was used to collect the data. The data were entered into Epidata Manager and exported to SPSS for analysis. The response rate for this study was 95.4%. The prevalence of poor perception and unfavorable help-seeking intention of mental illness were 45.8%, 95% CI (42.6, 48.9), and 49.5%, 95% CI (46.4, 52.7) respectively. Being rural [AOR = 1.94 (95% CI:(1.41, 2.66)]c, lack of information [AOR = 4.82(95% CI: (3.39,6.83)], exposure to mental illness [AOR = 4.11(95% CI:(2.64,6.38)] were significantly associated with poor perception of mental illness. Also, gating mental illness information [AOR = 0.40 (95% CI: (0.19, 0.83)], and being exposed to mental illness [AOR = 0.56 (95% CI: (0.41, 0.79)] were significantly associated with unfavorable help-seeking intentions for mental illness. The high prevalence of poor perceptions and unfavorable help-seeking intentions for mental illness can be minimized through providing tailored information regarding the cause, type, and severity of the problem, particularly in the rural areas.

Differences in body dissatisfaction between individuals with and without stigma toward obesity: A study of preadolescents and adolescents.

Previous studies have focused on understanding the biopsychosocial implications of obesity stigma and have made proposals to minimize its negative consequences, as well as recommendations to eliminate or reduce this stigma; however, knowing which individuals stigmatize obesity and why will allow us to have a broader picture of stigmatization and thus help in planning interventions with greater impact. The aims were to describe the stigmatization toward obesity in preadolescents and adolescents and to determine whether there are differences in body dissatisfaction, abnormal eating behaviors and self-esteem among those with and without stigma toward obesity. A total of 307 preadolescents and 349 adolescents answered a set of questionnaires that evaluated abnormal eating behaviors, body dissatisfaction, self-esteem and stigma. Fifty-nine percent of the participants stigmatized individuals with obesity, with preadolescents having the greatest stigma levels. Differences were observed only in body dissatisfaction, where the group of preadolescents who stigmatized individuals with obesity and the group of adolescents who did not stigmatize individuals with obesity reported higher levels of body dissatisfaction. Obesity is stigmatized at early ages, regardless of sex; however, preadolescents with stigma toward obesity and adolescents without stigma toward obesity have greater body dissatisfaction, indicating that body dissatisfaction plays a crucial role in the stigmatization of obesity. Level V, cross-sectional analytical study.

Mental Health Literacy Reduces Mental Disorder Stigma in Society

The general background mental health issues remain a major global health challenge, including in Indonesia, where mental illness is often stigmatized. Specific background mental illness stigma is prevalent in society, manifesting in negative attitudes towards individuals with mental disorders, thus affecting their acceptance and treatment. Knowledge gap there is limited research exploring the relationship between mental health literacy and mental illness stigma within community settings in Indonesia. This study aims to investigate the correlation between mental health literacy and mental disorder stigma among residents of a selected community. Results the findings reveal a significant negative correlation between mental health literacy and mental disorder stigma, indicating that higher levels of mental health literacy are associated with lower levels of stigma. Novelty this study contributes to the limited body of knowledge by demonstrating that improving mental health literacy can effectively reduce mental disorder stigma in community settings. Implications these results suggest that public health interventions focusing on mental health education may help reduce stigmatization, fostering a more supportive environment for individuals with mental health disorders, which may ultimately lead to better access to mental health services and outcomes. Highlights: Higher mental health literacy lowers mental disorder stigma. Stigma reduction improves mental health support in communities. Public health education can reduce mental disorder misconceptions. Keywords: Mental Health, Mental Disorder, Stigma, Community Attitudes, Education

Examining dimensions of help-seeking intentions and associations with personal mental illness stigma among racial and ethnic minority immigrants.

This study examined the factor structure of the General Help-seeking Questionnaire and how personal mental illness stigma was associated with different types of help-seeking intentions among racial and ethnic minority immigrants in the United States. A sample of 202 immigrants aged 18-39 were recruited from a Qualtrics panel and completed the online survey. Confirmatory factor analysis and multiple linear regression were conducted. Results confirmed four dimensions of help-seeking intentions: informal, formal, semi-formal, and traditional sources. Immigrants with higher levels of mental illness stigma are more likely to seek help from traditional sources (e.g., religious leader or other community-based nonfaith resources) and semi-formal sources (e.g., web-based resources). Lack of awareness of service options is a key barrier to formal help-seeking. Results signal the importance of collaboration between mental health service providers. Adopting culturally sensitive care and web-based delivery formats may help address immigrants' concerns about mental health stigma.

A Moderated Mediation Analysis of HIV and Intersectional Stigmas and Antiretroviral Adherence in People Living with HIV in the Dominican Republic.

Experiencing HIV and intersectional stigmas in healthcare settings may affect antiretroviral treatment (ART) adherence among people with HIV (PWH), given their need for frequent interactions with clinical settings and healthcare providers. Considering the importance of reducing stigmas to promote well-being and the need to elucidate how stigma influences health across various settings, we examined how experienced HIV stigma in Dominican Republic healthcare settings impacts ART adherence through internalized HIV stigma and whether race or sexual orientation stigma moderates this relationship. Participants were 471 PWH (aged 17-71) who were recruited from two HIV clinics in the Dominican Republic in 2021-2022. Results revealed a significant mediation effect (B=-0.10, SE = 0.05, CI [-0.234, - 0.014]) after adjusting for effect of age and time since HIV diagnosis, suggesting that experienced HIV stigma in healthcare settings was associated with more internalized HIV stigma (B = 0.39, SE = 0.11, p = .001), subsequently linked to lower ART adherence (B=-0.26, SE = 0.11, p = .016). The indirect effect was significant at low levels of race stigma (B=-0.16, SE = 0.09, CI [-0.369, - 0.001]) but not at high levels of race stigma (B=-0.06, SE = 0.05, CI [-0.175, 0.038]). This indirect effect was also significant at low levels of sexual orientation stigma (B=-0.19, SE = 0.10, CI [-0.401, - 0.023]) but not at high levels of sexual orientation stigma (B=-0.04, SE = 0.06, CI [-0.160, 0.074]). These findings suggest that addressing experienced HIV stigma in Dominican Republic healthcare settings, along with various dimensions of HIV-related stigma (e.g., internalized stigma) and intersecting stigmas (e.g., race, sexual orientation), is vital for improving health outcomes, such as optimal ART adherence.

The Impact of Caregiver Affiliate Stigma on the Psychosocial Well-Being of Caregivers of Individuals with Neurodegenerative Disorders: A Scoping Review.

Background. Caregiver affiliate stigma concerning neurodegenerative disorders (NDDs) profoundly affects caregivers' well-being, though its full impact remains to be fully elucidated. Objectives. This scoping review aims to consolidate the current knowledge on caregiver affiliate stigma related to NDDs, explore its connection to caregiver psychosocial well-being, and pinpoint the gaps in the existing research. Methods. Adhering to the PRISMA-ScR guidelines, a comprehensive search of five databases was conducted for peer-reviewed, English language studies focusing on caregiver-affiliated stigma in relation to NDDs. Results. The initial search yielded 9033 articles, with 19 meeting the inclusion criteria after rigorous screening. Bronfenbrenner's ecological systems theory was employed to analyze various stigma conceptualizations, including public, courtesy, affiliate, and family stigma. Analysis revealed a correlation between elevated levels of affiliate stigma and increased caregiver burden, deteriorated mental health outcomes, and diminished quality of life. The internalization of stigma was found to vary across demographic groups, influenced by factors such as education level and social support. The review also highlighted the mediating role of coping strategies and the protective function of social support against stigma internalization. Conclusions, These findings underscore the necessity for targeted, culturally sensitive interventions that address caregiver affiliate stigma across multiple ecological levels. This review contributes to a more nuanced understanding of caregiver affiliate stigma in relation to NDDs, laying the groundwork for future research and intervention development aimed at enhancing caregiver well-being in diverse cultural contexts.

Exploring Effects of Race and Differential Item Functioning on PrEP Stigma Experiences: Implications for Latent Stigma Measurement in Racially and Sexually Diverse Populations.

PrEP stigma measurement remains a challenge to the validity of studies and interventions addressing HIV prevention. It may lead to inaccurate assessment of the relationship between PrEP stigma and health outcomes such as PrEP persistence and care retention in groups experiencing HIV-related inequities. The present research explored the psychometric properties of a novel IV pre-exposure prophylaxis (PrEP) stigma scalein a cohort of racially diverse men who have sex with men (MSM). Using item response theory, analyses explored presence of differential item functioning (DIF)among Black and White respondents. Participants completed baseline surveys measuring psychosocial factors, sociodemographic factors, and PrEP stigma items. The primary analysis used a machine learning approach to assess (a) the presence of DIF; and (b) compare latent stigma between Black and White respondents, after correcting for any DIF. The model identified four out of 13 scale items as having a high probability of DIFfor Black respondents, which is relatively good given that the original PrEP stigma scale was neitherdesigned nor tested for validation comparing Black and White respondents. The DIF-adjusted latent PrEP stigma measure reveals statistically and substantially significantly higher levels of stigma for Black compared to White respondents (Diff.: 1.05 +/- 0.19). While most items performed well, findings demonstrate the importance of assessing measurement error in populations where stigma is rampant and being studied or intervened upon (and in this case, where multilevel and intersectional stigma may be present).

Psychometric performance of tools to measure internalized drug use stigma among people who use drugs and people on medication-assisted treatment in Dar es Salaam, Tanzania

BackgroundPeople who use drugs (PWUD) and people who use medication-assisted treatment (MAT) to treat opioid use disorder face severe stigma. Stigma may manifest in delayed health-seeking behaviors, which adversely affects health and increases disease risk. Few validated measures assess internalized drug use stigma or MAT disclosure concerns in sub-Saharan Africa. This study examines the performance of internalized drug use stigma scales and characterizes the prevalence of these stigmas among PWUD and people who use MAT in Dar es Salaam, Tanzania. MethodsWe conducted a cross-sectional survey among 250 PWUD and 251 MAT clinic clients. Internalized drug use and MAT disclosure concerns were measured using scales adapted to the Tanzanian context. We conducted exploratory factor analysis to identify latent constructs and evaluate reliability of the scales. We then used confirmatory factor analysis to assess construct validity and reliability. ResultsThe six-item internalized drug use stigma scale (IDUSS) was unidimensional, reflected acceptable goodness-of-fit, and acceptable reliability (Cronbach’s α = 0.79). The eight-item internalized drug use stigma scale for people using MAT (IDUSS-MAT) was bidimensional. Allowing error terms of related items to covary improved goodness-of-fit. The IDUSS-MAT demonstrated acceptable reliability (Cronbach’s α = 0.79). Among PWUD and MAT clinic clients, higher levels of stigma were associated with increased depression and reduced social support and quality of life. ConclusionsBoth the IDUSS and IDUSS-MAT demonstrated good construct validity and acceptable reliability. These validated scales provide the foundation for collecting data to inform the development of stigma reduction interventions in Tanzania and among similar Sub-Saharan populations of PWUD and the tools needed to assess those interventions.

Intersectionality of HIV Stigma with Female Identity: An Investigation among Women Living with HIV/AIDS in Vietnam.

Women living with HIV/AIDS (WLHA) in Vietnam encounter challenges stemming from HIV-related stigma and gender disparities. This study delves into the intersectionality of HIV-related stigma and gender disparities as perceived by WLHA. A cross-sectional survey was conducted among 91 WLHA in Hanoi, Vietnam. Two sets of identically worded scales were used to measure awareness, agreement, and application of stigma towards people living with HIV/AIDS (PLHA) and WLHA. A larger difference between stigma scores towards WLHA and that of PLHA represents a higher level of female-specific stigma. Univariate analyses and multiple regressions were conducted to identify demographic and psycho-social factors associated with the gendered differences in stigma measures. Multiple linear regression showed that WLHA who were currently married were more likely to apply stigma concepts to themselves due to gender identity (adjusted beta coefficient (aBeta Coef) = 0.223). Psychological capital was negatively associated with awareness of stigma towards female identity (aBeta Coef = -0.261). A higher perceived norm in women's equity and power was associated with less self-application of female-specific stigma (aBeta Coef = -0.294). Our findings underscore the importance of addressing psychological well-being and promoting gender equity norms as essential components in the efforts to reduce female-specific HIV-related stigma in WLHA.

Symptoms and Psychosocial Factors on Quality of Life and Life Satisfaction in People with Parkinson’s Disease

Abstract Background Parkinson’s disease (PD) is one of the most common neurodegenerative diseases estimated to touch 9.3 million people worldwide by 2030. Motor and non-motor symptoms of PD have a debilitating effect on people with PD’s quality of life (QoL) and life satisfaction (LS). This study aims to explore the factors influencing people with PD’s lives in Ireland. Methods The sample comprised 827 participants, recruited through crowd-sourcing and snowball sampling. Participants were asked to complete a 30-minute survey online or on paper. The survey collected data on motor and non-motor symptoms, social connectedness, self-efficacy, stigma, QoL and LS. A series of linear and multiple regressions assessed the relationships between people with PD’s symptoms, psychosocial factors and their QoL and LS. Results Low self-efficacy and high levels of stigma were predictive of low QoL and LS, while low social connectedness was associated only with low QoL. Results showed reduced dexterity with hand/eye coordination, anxiety, apathy, pain and fatigue contributed to LS, whereas reduced dexterity with hand/eye coordination, shaking/tremors, stiffness of movement, freezing of gait, cognitive problems, hallucinations, apathy, compulsive behaviours, sleeping disorders, pain and urinary incontinence were contributors of QoL. Conclusion This study can provide insights into the factors influencing people with PD’s QoL and LS. Data can promote the development of therapeutic interventions targeting PD non-motor symptoms, which are often dismissed by clinicians. Finally, findings can inform the development of health and social policies and educate the general public to dissolve the stigma associated with PD.

A qualitative study exploring the acceptability of a telehealth intervention for family members of people experiencing a first episode psychosis: PERCEPTION.

Family members of people experiencing a first-episode psychosis (FEP) can experience high levels of carer burden, stigma, emotional challenges, and uncertainty. This indicates the need for support and psychoeducation. To address these needs during the COVID-19 pandemic, we developed a multidisciplinary, blended, telehealth intervention, incorporating psychoeducation and peer support, for family members of FEP service users: PERCEPTION (PsychoEducation for Relatives of people Currently Experiencing Psychosis using Telehealth, an In-person meeting, and ONline peer support). The aim of the study was to explore the acceptability of PERCEPTION for family members of people who have experienced an FEP. Ten semi-structured interviews were conducted online via Zoom and audio recorded. Maximum variation sampling was used to recruit a sample balanced across age, gender, relatives' prior mental health service use experience, and participants' relationship with the family member experiencing psychosis. Data were analysed by hand using reflexive thematic analysis. Four themes were produced: 'Developing confidence in understanding and responding to psychosis'; 'Navigating the small challenges of a broadly acceptable and desirable intervention'; 'Timely support enriches the intervention's meaning'; and 'Dealing with the realities of carer burden'. Broadly speaking, PERCEPTION was experienced as acceptable, with the convenient, safe, and supportive environment, and challenges in engagement being highlighted by participants. Data point to a gap in service provision for long-term self-care support for relatives to reduce carer burden. Providing both in-person and online interventions, depending on individuals' preference and needs, may help remove barriers for family members accessing help.

Assessing stigma: Health and social worker regard towards working with people using illicit drugs in Athens, Greece

BackgroundAfter the 2008 Global Financial Crisis and resulting economic austerity, the rise in illicit drug use engendered an increased need for people who use drugs (PWUD) to access medical care, compounded by the COVID-19 pandemic. Research shows that perceptions of medical staff towards PWUD facilitate or act as a barrier to accessing health care. This study provides a better understanding of health and social work professionals’ perceptions by assessing stigma levels towards PWUD in Athens, Greece.MethodsThis is a mixed-method study. It calculates the stigma score for professionals (n = 60) and the stigma score associated with specific drugs based on the Medical Condition Regard Scale through a quantitative analysis of responses to a semi-structured online survey about attitudes of health and social work professionals towards PWUD. It draws on the qualitative analysis of 12 semi-structured interviews with 16 service managers, providers, and health services advocates working in the charity sector to determine whether perceptions of PWUD affect writing and implementing policy and protocols for services.ResultsStigma towards PWUD exists amongst health and social work professionals in Athens. Professionals who have worked with PWUD for longer periods of time, professionals who have had specific training on working with PWUD, and professionals who feel that they have the necessary training to work with PWUD all demonstrated a higher stigma score than those reporting the opposite. Cannabis and opioids were associated with lower stigma scores while shisha had the highest level of stigma associated with it. Finally, professional environments are not conducive to alleviating stigma as the lack of training specific to stigma, the lack of professional supervision, and worker burn-out are key barriers faced by professionals in their everyday practice.ConclusionsReducing and eliminating stigma towards PWUD among health and social workers requires immediate action. Measures to be taken include: introducing training programs focused on stigma towards PWUD to healthcare providers, social workers, lawyers, police, the media; increasing professional supervision on field work for health and social workers; introducing low barrier health care and specialist units. Peers and field-focused organisations should meaningfully participate in drug and alcohol policymaking, program development, and implementation.

Cultural Tightness-Looseness and Individual Differences in Non-Normativeness Predict Stigmatization of Out-Groups: A Multilevel Cross-Cultural Study

Although a large body of research has focused on the determinants of stigma, multilevel approaches that can identify both micro- and macro-level influences are rarely employed. We adopted a multilevel perspective with data from 174,325 participants from 80 countries in two waves—Wave 5 (Study 1) and Wave 6 (Study 2) of the World Values Survey. We examined how country-level normative tightness-looseness and individual-level non-normativeness relate to stigma toward racial and ethnic out-groups and groups deviating from social standards. Preregistered analyses showed that for both waves individuals in normatively tighter (vs. looser) societies exhibited more stigma generally. Also, for both waves, individuals higher in non-normativeness demonstrated a greater level of stigma toward members of immigrant, racial, or ethnic out-groups while exhibiting a lower level of stigma toward groups deviating from social standards. The current work thus reveals how characteristics of both individuals and culture jointly affect stigma.