Stigma Scores Research Articles

Comparison of stigmatizing views towards COVID-19 and mental disorders among adolescent and young adult students in China.

Infectious diseases including COVID-19 and mental disorders are two of the most common health conditions associated with stigma. However, the comparative stigma of these two conditions has received less attention in research. This study aimed to compare the prevalence of stigmatizing views toward people with COVID-19 and mental disorders and the factors associated with these views, among a large sample of adolescent and young adult students in China. A total of 9,749 adolescents and young adults aged 15-24 years completed a survey on stigmatizing attitudes toward COVID-19 and mental disorders, as well as mental health-related factors, including general mental health status and symptoms of depression, anxiety, insomnia, and post-traumatic stress disorder (PTSD). Multivariable linear regression analyses were conducted to identify factors associated with stigmatizing views. The prevalence of COVID-19 and mental disorders-related stigma was 17.2% and 40.7%, respectively. COVID-19-related stigma scores were significantly higher among male students (β = 0.025, p < 0.05), those without quarantine experience (β = 0.035, p < 0.001), those with lower educational level (p < 0.001), those with lower family income (p < 0.01), and those with higher PTSD symptoms (β = 0.045, p < 0.05). Mental disorder-related stigma scores were significantly higher among individuals with average and lower-than-average levels of family income (p < 0.01), depression symptoms (β = 0.056, p < 0.001), anxiety symptoms (β = 0.051, p < 0.001), and mental health problems (β = 0.027, p < 0.05). The stigma of mental disorders is higher in the youth population than the stigma of COVID-19. Factors associated with stigmatizing attitudes toward people with COVID-19 and mental disorders varied across the youth. Stigma-reduction interventions among the youth should be targeted specifically to COVID-19 or mental disorders conditions.

Internalised stigma among people with mental illness in Africa, pooled effect estimates and subgroup analysis on each domain: systematic review and meta-analysis

BackgroundInternalisation of stigma occurs when people with a stigmatised attribute, such as a mental illness, supress negative but accepted societal attitudes. However, as far as is known, there is no comprehensive picture of the prevalence of and factors associated with, internalised stigma among people living with mental illness in Africa. This systematic review and meta-analysis provide new knowledge by examining the evidence on the prevalence of internalised stigma and associated factors among people living with mental illness in Africa.MethodsUsing the population, intervention, comparison, outcome, and type of study (PICOT) approach, PubMed, Scopus, MEDLINE, PsycINFO, CINAHL, ScienceDirect, and Google Scholar were searched using a structured search comprising terms associated with mental health, mental illness, internalised stigma, and a list of all African countries. To evaluate paper quality, the Joanna Briggs Institute Quality Appraisal Checklist was used. Subgroup analysis with country and diagnosis was tested using a random-effect model, and bias was checked using a funnel plot and an inspection of Egger’s regression test. A p-value, OR and 95% CI was used to demonstrate an association.ResultsThe pooled prevalence of internalised stigma was 29.05% (25.42,32.68: I2 = 59.0%, p ≤ 0.001). In the subgroup analysis by country, Ethiopia had the highest prevalence of internalised stigma at 31.80(27.76,35.84: I2 = 25.6%, p ≤ 0.208), followed by Egypt at 31.26(13.15,49.36: I2 = 81.6%, p ≤ 0.02), and Nigeria at 24.31(17.94,30.67: I2 = 62.8%, p ≤ 0.02). Based on domains of internalised stigma, pooled prevalence was stigma resistance: 37.07%, alienation: 35.85%, experience of discrimination: 31.61%, social withdrawal: 30.81% and stereotype: 26.10%. Experiencing psychotic symptoms (1.42(0.45,2.38)), single marital status (2.78(1.49,4.06)), suicidal ideation (2.32(1.14,3.49)), drug nonadherence (1.5(-0.84,4.00)), poor social support (6.69(3.53,9.85)), being unemployed (2.68(1.71,3.65)), and being unable to read and write (3.56(2.26,4.85)) were identified as risk factors for internalised stigma.ConclusionsInternalised stigma is common among people suffering from mental illnesses in Africa. This review determined that 29% of the sample population had elevated internalised stigma scores, and there were variations by country. People experiencing mental illness who have a single marital status, suicidal behaviours, poor social support, unemployed and have poor literacy levels were at a higher risk of internalised stigma. The finding points to populations that require support to address internalised stigma and improve the mental health outcomes.

Psychosocial Outcomes in Children with Cleft Lip and/or Palate: Associations of Demographic, Cleft Morphologic, and Treatment-Related Variables.

To determine associations of demographic, morphologic, and treatment protocol parameters with quality of life (QoL), appearance/speech satisfaction, and psychological adjustment. Observational study utilizing retrospective report of protocol variables and current outcome variables. Six North American cleft treatment clinics. Children, ages 8.0-10.99 years, with Cleft Lip ± Alveolus, Cleft Palate, Cleft Lip and Palate, and parents (N = 284). Pediatric QoL Inventory (PedsQL): Parent, Child, Family Impact Module (FIM); Patient Reported Outcome Measurement Information System (PROMIS); Child Behavior Checklist (CBCL); CLEFT-Q. Outcome scores were average with few differences by cleft type. Multiple regression analyses yielded significant associations (Ps < .05) between socioeconomic status, race, and age at assessment and parent- and self-reported measures. Females had higher PROMIS Depression (β=.20) but lower CBCL Affective (β = -.16) and PROMIS Stigma scores (β= -.24). Incomplete cleft lip was associated with lower PROMIS Depression, and more positive ratings of CLEFT-Q: Nose, Nostril, Lip Scar; CBCL Competence scores, (βs = -.17 to .17). Younger Age at Lip Closure was associated with higher CBCL School Competence (β= -.18). Younger Age at Palate Closure was associated with higher Child PedsQL Total, Physical, Psychosocial QoL, and better CLEFT-Q Speech Function (βs = -.18 to -.15). Furlow Palatoplasty was associated with more CBCL Externalizing Problems (β = .17) higher CBCL Activities (β = .16). For all diagnoses, fewer Total Cleft-Related Surgeries was associated with lower PROMIS Stigma and higher CBCL Total Competence and Activities (βs = -.16 to .15). Demographic characteristics, lip morphology, and treatment variables are related to later psychological functioning.

COVID-19-related stigma among infected people in Sweden; psychometric properties and levels of stigma in two cohorts as measured by a COVID-19 stigma scale.

Epidemics have historically been accompanied by stigma and discrimination. Disease-related stigma has often been shown to have severe consequences for physical, mental and social wellbeing and lead to barriers to diagnosis, treatment and prevention. The aims of this study were to investigate if a HIV-related stigma measure could be adapted and valid and reliable to measure COVID-19-related stigma, and also to investigate levels of self-reported stigma and related factors among people in Sweden with experience of COVID-19 and compare levels of COVID-19-related stigma versus HIV-related stigma among persons living with HIV who had experienced a COVID-19 event. Cognitive interviews (n = 11) and cross-sectional surveys were made after the acute phase of the illness using a new 12-item COVID-19 Stigma Scale and the established 12-item HIV Stigma Scale in two cohorts (people who had experienced COVID-19 (n = 166/209, 79%) and people living with HIV who had experienced a COVID-19 event (n = 50/91, 55%). Psychometric analysis of the COVID-19 Stigma Scale was performed by calculating floor and ceiling effects, Cronbach's α and exploratory factor analysis. Levels of COVID-19 stigma between groups were analysed using the Mann-Whitney U test. Levels of COVID-19 and HIV stigma among people living with HIV with a COVID-19 event were compared using the Wilcoxon signed-rank test. The COVID-19 cohort consisted of 88 (53%) men and 78 (47%) women, mean age 51 (19-80); 143 (87%) living in a higher and 22 (13%) in a lower income area. The HIV + COVID-19 cohort consisted of 34 (68%) men and 16 (32%) women, mean age 51 (26-79); 20 (40%) living in a higher and 30 (60%) in a lower income area. The cognitive interviews showed that the stigma items were easy to understand. Factor analysis suggested a four-factor solution accounting for 77% of the total variance. There were no cross loadings, but two items loaded on factors differing from the original scale. All subscales had acceptable internal consistency, showed high floor and no ceiling effects. There was no statistically significant difference between COVID-19 stigma scores between the two cohorts or between genders. People living in lower income areas reported more negative self-image and concerns about public attitudes related to COVID-19 than people in higher income areas (median score 3 vs 3 and 4 vs 3 on a scale from 3-12, Z = -1.980, p = 0.048 and Z = -2.023, p = 0.024, respectively). People from the HIV + COVID-19 cohort reported more HIV than COVID-19 stigma. The adapted 12-item COVID-19 Stigma Scale may be valid and reliable for measurement of COVID-19-related stigma. However, specific items may need to be rephrased or replaced to better correspond to the COVID-19 context. People who had experienced COVID-19 reported low levels of COVID-19-related stigma in general but people from lower income areas had higher levels of negative self-image and concerns about public attitudes related to COVID-19 than people from areas with higher income, which may call for targeted interventions. Although exhibiting more pronounced HIV stigma levels, people living with HIV who had experienced COVID-19 reported COVID-19-related stigma of the same low magnitude as their peers not living with HIV.

624-P: Portrayal of Perceived Stigma across Ages in Type 1 Diabetes—A BETTER Registry Analysis

Background: People with type 1 diabetes (PWT1D) perceiving high diabetes-related stigma are less likely to report in-target A1c levels. We hypothesized that people with higher levels of stigma have suboptimal psychosocial outcomes and that stigma would be perceived differently across age groups. Methods: Cross-sectional analysis of 709 PWT1D aged ≥14 years in the BETTER T1D registry (Quebec, Canada) who completed the T1D Stigma Assessment Scale (DSAS-1). The DSAS-1 (/95) includes 3 subscales; Blame &amp; Judgment (6 items), Identity Concern (7 items), and Treated Differently (6 items). Individuals who perceived more stigma compared to the total cohort (DSAS-1 mean score +1 standard deviation), were stratified into groups by age to determine associations with diabetes self-management behaviours and outcomes. Results: Across groups, youth (n=105; 14-24 years) had the highest stigma perception (20%), followed by 18% in middle-aged adults (n=401; 35-64 years), then 15% for both young adults (n=130; 25-34 years) and seniors (n=73; 65+ years). The majority of youth, young and middle-aged adults, and seniors perceived stigma as Blame &amp; Judgment (51%, 44%, 33%, and 19%, respectively). Stigma related to Identity Concern was highest among seniors (15%). In an age- and diabetes duration-adjusted models, 40% of adjusted variance in stigma score was explained by increased diabetes distress (p&amp;lt;0.001), depression (p=0.005), hyperglycemia avoidance behaviours (p&amp;lt;0.001), fear of hypoglycemia (p&amp;lt;0.001) and decreased social support (p&amp;lt;0.001). Conclusion: Interventions targeting diabetes-related stigma need to be tailored for different age groups to target suboptimal diabetes self-management behaviours and improve psychosocial outcomes. Disclosure A.Housni: None. A.Katz: None. J.C.Kichler: None. M.Nakhla: None. A.Brazeau: Other Relationship; Dexcom, Inc., Diabète québec, Ordre des diététistes nutritionnistes du Québec, Research Support; Canadian Institutes of Health Research, Fonds de recherche du Québec en Santé. Funding JDRF (4-SRA-2018-651-Q-R); Canadian Institutes of Health Research (JT1-157204)

657-P: Diabetes Stigma and Use of Diabetes Technologies among U.S. Adults Living with Type 2 Diabetes

Nearly 80% of adults with diabetes report experiences of diabetes stigma, varying by the use of insulin therapy. We aimed to examine associations between diabetes stigma and the use of diabetes technologies among adults with insulin and non-insulin-treated type 2 diabetes (T2D). In August 2022, 947 adults with T2D (mean age: 64±11 years; duration T2D: 19±9 years; 62% women; 61% insulin-treated) from the dQ&amp;A US Patient Panel completed an online survey. Questions included the Type 2 Diabetes Stigma Assessment Scale (DSAS-2) and diabetes and demographic characteristics. DSAS-2 total and subscale (Treated Differently, Blame and Judgment, Self Stigma) scores were compared by device use (independent samples t-test), and separately by treatment (insulin vs. non-insulin). Individuals with non-insulin-treated T2D using (vs. not using) CGM reported more stigma (Total; Treated Differently; Blame &amp; Judgment) but did not differ on Self Stigma (Table). Stigma did not differ by device use among participants on insulin treatment, but was higher overall than those on non-insulin treatment. Further research is needed to understand how the experience of diabetes stigma may be affected by the visibility of T2D, specifically via diabetes technologies. Disclosure M.Garza: Other Relationship; Sanofi. E.Shoger: Other Relationship; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Beta Bionics, Inc., Xeris Pharmaceuticals, Inc., MannKind Corporation. E.Holmes-truscott: Research Support; Sanofi, AstraZeneca. K.Joiner: None. A.Addala: None. D.Naranjo: None. E.A.Beverly: None. J.Speight: Research Support; Sanofi, Medtronic, Abbott Diabetes, Lilly, Novo Nordisk A/S, Speaker's Bureau; Sanofi.

694-P: Differences in Diabetes-Related Stigma by Demographic Group and Intensity of Diabetes Management

The social stigma surrounding diabetes refers to the negative attitudes, discrimination, or prejudice someone may face due to their diabetes. For many people with diabetes (PWD), stigma is a major challenge and often results in significant negative consequences, such as poor psychological well-being and worse clinical outcomes. This study aimed to identify groups who may be at greater risk of experiencing stigma. From October-December 2022, 10,338 adults living with diabetes in the United States, Canada, France, Germany, Italy, Netherlands, Sweden, and United Kingdom took an online survey assessing stigma associated with diabetes. Stigma was measured using four items about concealing or difficulty disclosing one's diabetes as well as diabetes-related embarrassment and isolation. These four items were averaged to create a composite variable on degree of stigma experienced (α = 0.87, M = 1.82, SD = 0.89). Subsequent responses were analyzed by various demographic factors and diabetes management strategies using SPSS. Stigma levels differ by intensity of diabetes management; respondents with more demanding diabetes management regimens experience greater levels of stigma. CGM users (p&amp;lt;0.001) and insulin users (p&amp;lt;0.001) experience more stigma than non-users, and PWD taking multiple daily injections experience more stigma than pump users (p=0.027). Stigma also varies across several demographic factors. French respondents report the highest stigma score, while German respondents report the lowest. Further, people with T1D experience more stigma than those with T2D (p&amp;lt;0.001). This research reveals differences in diabetes-related stigma by country and diabetes type and suggests that stigma becomes more prevalent with more intensive diabetes management. Additional research is needed to further explore experiences of stigma and identify methods of support, especially for at-risk groups. Disclosure A.Zeng: Employee; dQ&amp;A. E.Lin: Employee; dQ&amp;A. E.Cox: Employee; dQ&amp;A. E.Xu: Employee; dQ&amp;A. T.Bell: Employee; dQ&amp;A. T.L.Bristow: Employee; dQ&amp;A.

Lifestyle causal beliefs are associated with higher personal and perceived stigma regarding depressive disorders: results from a representative population survey

BackgroundDepression is a prevalent and severe disorder associated with considerable stigma. This stigma contributes to the suffering and impedes help seeking behaviour of those affected. Stigma can be influenced by causal beliefs about depression and personal contact with people suffering from depression. The aim of this study was to investigate (1) the associations between beliefs about the aetiology of depression and personal / perceived stigma, as well as (2) a possible moderating effect of personal contact with people with depression on these associations.MethodsStigma, causal beliefs, and contact with depression were assessed in a representative online survey among German adults (N = 5,000). Multiple regression analyses were performed with contact levels (unaffected vs. personally affected (diagnosed) vs. personally affected (undiagnosed) vs. affected by relatives with depression vs. persons who treat depression) and causal beliefs (biogenetic vs. psychosocial vs. lifestyle) as predictor variables for personal and perceived stigma as dependent variables.ResultsHigher personal stigma was associated with lifestyle causal beliefs (p < .001, f² = 0.07), lower personal stigma with biogenetic (p = .006, f² = 0.01) and psychosocial (p < .001, f² = 0.02) causal beliefs. A positive interaction between psychosocial beliefs and the contact group “relatives” (p = .039) further suggests that this contact group does not benefit so strongly from psychosocial causal beliefs regarding personal stigma. Higher perceived stigma was associated with psychosocial (p < .001, f² = 0.01) and lifestyle (p < .011, f² = 0.01) causal beliefs. Regarding contact levels, the “unaffected” had significantly higher personal stigma scores than each of the other contact groups (p < .001). The contact group “affected (diagnosed)” had significantly higher perceived stigma scores than “unaffected”.ConclusionsThe available data show that anti-stigma campaigns should clearly communicate, that depression is not caused by an unfavorable lifestyle. In general, psychosocial or biological explanatory models should be explained. Especially for the target group “relatives of depressive patients”, who can be an important support for patients, education about biogenetic explanatory models should be provided. However, it is important to note that causal beliefs are only one of many factors that impact on stigma.

Relationship between stigma and symptom burden in patients with multiple sclerosis

Background &amp; Objective: Patients with multiple sclerosis (PwMS) may experience discrimination and stigma. The aim of this study was to examine the relationship between stigma and the symptom burden in PwMS. Methods: This cross-sectional descriptive study was conducted between June 2020 and September 2021 on MS patients enrolled in the neurology outpatient clinic of a university hospital in Turkiye. Multiple Sclerosis-Related Symptom Checklist and Neuroquality of Life (Neuro-QoL)-Stigma Scale were used to collect data. Results: The mean age of the 195 study patients was 37.5 (± 9.7) years and 67.2% were female. One-fourth of the patients (26.2%) had a primary education level, and the unemployment rate was 9.7%. The patients reported that their private life (issues such as getting married, having boyfriend/girlfriend or problems in marital life) was affected the most (23.6%) by MS. The mean stigma burden scale scores of the patients were 37.9 (± 18.2). It was found that the stigma score of the patients was not significantly related to age, gender, education, and employment (p&gt; 0.05); but was worse in divorced/widowed patients (p = 0.039); and was worse in patients who reported that their work, school, and private life were affected due to MS (p &lt;0.05). The regression analysis showed that neuropsychiatric (p&lt;0.001), urinary (p&lt;0.001) and sensory (p=0.029) symptoms contributed the most to stigma. Conclusions: A study on PwMS in Turkiye showed a mild level of stigma. The symptom burden of the patients correlated with the stigma level suggesting that effective symptom control may help reduce the stigma level of PwMS.

Experience of stigma and harassment among respondents to the 2019 Canadian abortion provider survey

ObjectiveWe conducted a national survey to assess the experiences of stigma and harassment among physicians and nurse practitioners providing abortions and abortion service administrators in Canada. Study designWe conducted an exploratory, cross-sectional, national, anonymized, online survey between July and December 2020. Subsections of the survey explored stigma and harassment experienced by respondents, including the 35-item Revised Abortion Providers Stigma Scale and open-ended responses. We analyzed the quantitative data to generate descriptive statistics and employed a reflexive thematic analysis to interpret open-ended responses. ResultsThree hundred fifty-four participants started the stigma and harassment section of the survey. Among low-volume clinicians (<30 abortions/year, 60%, n = 180) 8% reported harassment; 21% among higher volume clinicians (≥30 abortions/year, 40%, n = 119) and 47% among administrators (n = 39), most commonly picketing. The mean stigma score was 67.8 (standard deviation 17.2; maximum score 175). Our qualitative analysis identified five themes characterizing perceptions of stigma and harassment: concerns related to harassment from picketing, protestors, and the public; wanting protestor “bubble zones”; aiming to be anonymous to avoid being a target; not providing an abortion service; but also witnessing a safe and positive practice environment. ConclusionsBeing a low-volume clinician compared to higher volume clinician and administrator appears to be associated with less harassment. Clinicians providing abortion care in Canada reported mid-range abortion-related stigma scores, and expressed strong concerns that stigma interfered with their abortion provision. Our results indicate that further de-stigmatization and protection of abortion providers in Canada is needed through policy and practice interventions including bubble zones. ImplicationsWhile Canadian abortion care clinicians and administrators reported relatively low incidence of harassment, our results indicate that they are concerned about stigma and harassment. However, as this was an exploratory survey, these data may not be representative of all Canadian abortion providers. Our data identify a need to support abortion clinicians and to bolster protections for dedicated abortion services.

Construction of the structural equation model of stigma, self-disclosure, social support, and quality of life of breast cancer patients after surgery-a multicenter study.

Stigma is common in patients with breast cancer after surgery, which has a negative impact on the quality of life (QOL). This study aimed to investigate the QOL of breast cancer patients after surgery and to analyze the multiple chains mediating effects of self-disclosure and social support between stigma and QOL. A total 292 patients of breast cancer patients after operation were recruited in this study. A questionnaire survey was conducted using the general information questionnaire, the consumer experiences of stigma questionnaire (CESQ), the distress disclosure index(DDI), the perceived social support scale(PSSS), and the functional assessment of cancer therapy-breast(FACT-B). Path analysis was conducted to test the hypothesized serial multiple mediation model. The total scores of stigma, self-disclosure, social support and QOL were 15 (10 ~ 22), 39 (31 ~ 46), 58 (50 ~ 67) and 88 (74 ~ 104) respectively. QOL of breast cancer patients after the operation was negatively correlated with stigma (p < 0.01), and positively correlated with self-disclosure and social support (p < 0.01). Self-disclosure and social support played a complete mediating effect between stigma and QOL, and the total mediating effect value was 85. 87%. Self-disclosure and social support play a complete intermediary role between stigma and QOL. In order to improve the quality of life of patients, medical staff should pay attention to the assessment of stigma, encourage patients to express their emotions, and encourage their families and friends to respond to their expression and needs of patients.

Mental Health Stigma in Active Duty Service Members Receiving Mental Health Services.

Mental health treatment is a service for military service members who have experienced psychological injury or trauma. Unfortunately, the stigma associated with treatment can prevent many service members from seeking and receiving treatment designed to help them recover. Previous studies have examined the impacts of stigma among military personnel as well as civilians; however, stigma among service members currently receiving mental health treatment is unknown. The purpose of this study is to understand the relationships between stigma, demographic variables, and mental health symptoms in a sample of active duty service members receiving mental health services in a partial hospitalization program. This cross-sectional, correlational study collected data from participants in the Psychiatric Continuity Services clinic at Walter Reed National Military Medical Center, which offers a four-week partial hospitalization program specializing in trauma recovery for active duty service members of all branches. The data from behavioral health assessments were gathered over a 6-month timespan, including the Behavior and Symptom Identification Scale-24, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-item scale, and Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Stigma was measured using the Military Stigma Scale (MSS). The demographic data collected included military rank and ethnicity. Pearson correlations, t-tests, and linear regression were used to further explore the relationships between the MSS scores, demographic covariates, and behavioral health measures. In unadjusted linear regression models, non-white ethnicity and higher behavioral health assessment intake measures were associated with higher MSS scores. However, after adjusting for gender, military rank, race, and all mental health questionnaires, only Post-traumatic Stress Disorder Checklist for DSM-5 intake scores remained associated with MSS scores. No relationship between gender or military rank and average stigma score was observed in either the unadjusted or adjusted regression models. One-way analysis of variance detected a statistically significant difference between the white/Caucasian group and Asian/Pacific Islander group and a near significant difference between white/Caucasian group and black/African American group. The rates of stigma were higher in non-whites than whites. In this active duty military cohort, greater mental health stigma was associated with greater severity of mental health symptoms, especially post-traumatic stress symptoms. Some evidence found that ethnicity may also play a role in stigma score differences, particularly in the Asian/Pacific Islander group. Service providers could consider assessing mental health stigma to meet the clinical needs of their patients within the context of their willingness to obtain and adhere to treatment. Anti-stigma efforts to reduce stigma and its impacts on mental health are discussed. Additional research investigating the effect stigma has on treatment outcomes would help guide the relative importance of assessing stigma, in addition to other behavioral health realms.

Shame and Stigma Over Long-Term Survival in Postoperative Cases of Head and Neck Cancer.

Surgical excision of the tumor remains the primary choice for the treatment of head and neck cancer patients, but it often leads to facial disfigurement, which further causes mutilation in the patients. Mutilation causes shame and stigma, which imparts significant psychological strain on patients, and tends to impair their quality of life. The present study aimed to assess the shame and stigma over long-term postoperative survival duration in head and neck cancer patients. Total 100 postoperative patients of head and neck cancer were recruited from the outpatient department of the host institute, and shame and stigma was assessed using the Hindi version of the shame and stigma scale. The global shame and stigma score was 22.67 ± 16.22, with the highest perceived stigma due to changes in appearance (11.94 ± 8.805), followed by impaired speech (4.490 ± 3.243), feeling of regret (3.950 ± 3.313), and feeling ofstigma (4.490 ± 3.243). The shame and stigma was found to be significantly higher in maxillary cancer patients (33.22 ± 16.60), followed by larynx cancer patients(22.06 ± 13.41) and oral cancer patients(21.53 ± 16.49). Patients with stage III and stage IV of cancer were found to perceive higher shame and stigma (35.91 ± 22.23 and 27.36 ± 14.71, respectively) compared to the patients having stage I and stage II cancer (9.583 ± 9.709 and 16.44 ± 11.82, respectively). A significantly declining linear trend was found between shame and stigma and postoperative survival duration. We concluded that shame and stigma act as important determinants of quality of life over long-term survival in head and neck cancer patients,and should be considered while designing psychological interventions and surgical reconstruction protocols. The present study will help clinicians to assess the mutilation among head and neck cancer patients in a better way and will help in devising new psychological strategies to manage psychological aspects associated with mutilation, which will ultimately enhance the quality of life of patients.

Mental illness stigma and associated factors among Arabic-speaking refugee and migrant populations in Australia

BackgroundArabic-speaking refugee and migrant populations form a significant proportion of Australia’s population. Despite high levels of psychological distress among Arabic-speaking populations, low uptake of mental health services has been demonstrated. Evidence suggests poor levels of mental health literacy (MHL) and high levels of stigmatising attitudes among Arabic-speaking populations, which may act as barriers to help-seeking behaviours. This study aimed to explore the relationships between measures of mental illness stigma, socio-demographic factors and psychological distress, as well as to determine the factors associated with MHL (i.e., correct recognition of mental illness and knowledge of causes) among Arabic-speaking refugee and migrant populations in Australia.MethodsParticipants were recruited from non-government organisations in Greater Western Sydney that provided support services to Arabic-speaking migrants and/or refugees. As this study is nested within an interventional pilot study evaluating a culturally tailored MHL program, only the pre-intervention survey responses for 53 participants were utilised. The survey measured key aspects of MHL (i.e., recognition of mental illness, knowledge of causes), levels of psychological distress (using K10 scale), and stigmatising attitudes towards mental illness (using Personal Stigma Subscales and Social Distance Scale).ResultsThe Personal Stigma subscale of ‘Dangerous/unpredictable’ was strongly positively correlated with participants’ K10 psychological distress scores and strongly negatively correlated with years of education completed. There were moderate negative correlations between two Personal Stigma subscales (‘Dangerous/unpredictable’ and ‘I-would-not-tell-anyone’) and the length of stay in Australia. Being female was associated with an increase in personal stigma demonstrated by higher scores for ‘I-would-not-tell-anyone’ subscale than males. Similarly, increase in age was associated with a decrease on scores of the personal stigma ‘Dangerous/unpredictable’.ConclusionsWhile future research with larger sample size are needed, the study findings can be considered as adding to the evidence base on mental illness related stigma in Arabic-speaking populations. Further, this study provides a starting point in developing the rationale for why population sub-group specific interventions are required to address mental illness stigma and improve MHL among Arabic-speaking refugee and migrant populations in Australia.

Functionality appreciation is inversely associated with positive psychotic symptoms in overweight/obese patients with schizophrenia

BackgroundWhile the relationship between negative aspects of body image and positive schizophrenia symptoms was extensively investigated and is relatively well-established, there is a dearth of literature on the relationship between positive symptoms and positive aspects of body image, such as body appreciation and functionality appreciation, in patients with schizophrenia. This study aimed to (1) compare weight stigma, body and functionality appreciation between obese/overweight and normal-weight patients with schizophrenia, and (2) explore the associations between these variables and positive psychotic symptoms in the obese/overweight group.MethodA cross-sectional study was conducted in the Psychiatric Hospital of the Cross, Lebanon during September 2022 recruiting selected in-patients diagnosed with schizophrenia. Patients were classified as overweight/obese if they had a BMI > 25 (N = 76 (37.25%), aged 55.57 ± 11.30 years, 42.6% females). The Weight self‑stigma questionnaire, the Functionality Appreciation Scale, and the Body Appreciation Scale, and the Positive and Negative Syndrome Scale (PANSS) were used.ResultsNo significant difference was found between overweight/obese and normal-weight patients for all variables, except for weight stigma; a significantly higher weight stigma score was significantly found in overweight/obese compared to normal-weight patient. In the bivariate analysis, higher functionality appreciation was significantly associated with higher positive PANSS scores. The results of the linear regression, taking the positive PANSS score as the dependent variable, showed that higher functionality appreciation (Beta = − 0.52) and higher social support (Beta = − 0.16) were significantly associated with lower positive PANSS scores, whereas having a secondary education level compared to illiteracy (Beta = 7.00) was significantly associated with higher positive PANSS scores.ConclusionAlthough based on cross-sectional data, these findings preliminarily suggest that higher functionality appreciation can help reduce the severity of positive psychotic symptoms in overweight/obese schizophrenia patients, and that interventions aimed at improving functionality appreciation could be regarded beneficial therapeutic targets in the treatment of psychosis.

Influencing factors analysis of adaptability of cancer patients to return-to-work

To clarify the adaptability of cancer patients to return to work and explore its influencing factors. A cross-sectional study. From March to October 2021, 283 cancer patients in the follow-up period were recruited from the oncology departments of four secondary and above hospitals and cancer friendship associations in Nantong city using self-developed scale of adaptability to return to work for cancer patients by convenience sampling method. The contents included general sociodemographic data, disease-related data, cancer patients' readability to work Scale, Medical Coping Style Questionnaire, Social Support Rating Scale, Family Closeness and Readability Scale, General self-efficacy Scale and Social impact Scale. Paper questionnaires were used for face-to-face data collection, and SPSS17.0 was used for statistical analysis. Univariable analyses and multiple linear regression analysis were conducted. The overall score of cancer patients' adaptability to return to work was (87.05±20.255), (22.54±4.234) for the dimension of focused rehabilitation, (32.02±9.013) for the dimension of reconstruction effectiveness, and (32.49±9.023) for the dimension of adjustment planning. Multiple linear regression analysis showed that the current return to full-time work (β =0.226, P 0.05), the current return to non-full-time work (β =0.184, P 0.05), yield response (β = -0.132, P 0.05), and general self-efficacy (β =0.226, P 0.05) could affect their return to work adaptation. The results of status quo and influencing factors showed that the adaptability of cancer patients to return to work was generally higher in this study. Cancer patients who had participated in work, had lower yield coping scores and stigma scores, and higher self-efficacy scores and family adjustment and intimacy scores had better adaptability to return to work again. It has been approved by the Human Research Ethics Committee of the Affiliated Hospital of Nantong University (Project No.202065).

Stigma and posttraumatic growth among COVID-19 survivors during the first wave of the COVID-19 pandemic in Malaysia: a multicenter cross-sectional study.

Contracting COVID-19 can cause negative and distressing psychological sequelae, but traumatic stressors may also facilitate the development of positive psychological change beyond an individual's previous level of adaptation, known as posttraumatic growth (PTG). As a result, studies have investigated the negative effects of COVID-19 on mental health, but data on PTG among patients who have recovered from COVID-19 remains limited. This study aims to evaluate the level of PTG and its associations with stigma, psychological complications, and sociodemographic factors among COVID-19 patients 6 months post-hospitalization. A cross-sectional online survey of 152 COVID-19 patients was conducted after 6 months of being discharged from Hospital Canselor Tuanku Muhriz, MAEPS Quarantine Center, or Hospital Sungai Buloh, Malaysia. Patients completed a set of questionnaires on sociodemographic and clinical data. The Posttraumatic Growth Inventory (PTGI-SF) was used to assess the level of PTG, the Kessler Psychological Distress (K6) was used to measure the degree of psychological distress, the General Anxiety Disorder-7 (GAD-7) was used to evaluate the severity of anxiety symptoms, the Patient Health Questionnaire (PHQ-9) was used to assess the severity of depression symptoms, and the Explanatory Model Interview Catalog Stigma Scale (EMIC-SS) was used to record the degree of perceived stigma toward COVID-19. The median PTGI SF score of the respondents was 40.0 (Interquartile range 16.0). Multivariable general linear model with bootstrapping (2,000 replications) revealed factors that significantly predicted PTG, which were at the higher level of the perceived stigma score, at 37 (B = 0.367, 95% CI = 0.041 to 0.691, p = 0.026), among the Malay ethnicity (B = 12.767, 95% CI 38 = 7.541 to 17.993, p < 0.001), retirees (B = -12.060, 95% CI = -21.310 to -2.811, p = 0.011), and those with a history of medical illness (B = 4.971, 95% CI = 0.096 to 9.845, p = 0.046). Experiencing stigma contributed to patients' PTG in addition to psychosocial factors such as ethnicity, history of medical illness, and retirement.

Impact of diabetes stigma in diabetes distress and diabetes self-care: The moderating role of diabetes social support and general self-esteem in Arabic-speaking adults with type 2 diabetes.

There is increasing evidence that diabetes stigma has negative impacts on behavioural and psychological outcomes among people with type 2 diabetes (T2D). However, research has focused largely on Caucasian and certain Asian groups. The aim of this study was to examine associations of diabetes stigma with diabetes distress and self-care, and investigate the moderating effects of self-esteem and social support, in Arabic-speaking communities. A cross-sectional study was conducted at 21 outpatient clinics and diabetes-specialist centres in the United Arab Emirates. Besides the Arabic Type-2 Diabetes Stigma Assessment Scale, participants completed other validated questionnaires assessing distress, self-care, social support, and self-esteem. General linear models were used to estimate the mean difference in diabetes-specific distress and self-care for every 1-point increase in diabetes stigma total score. Among 327 adults with T2D, the mean total score of diabetes stigma was 43.55 ± 13.95. Every 1-point increase in diabetes stigma was associated with significantly increased diabetes distress (β = 0.113, 95% CI: 0.078 to 0.147; p = 0.003) and decreased self-care behaviours: diet (β = -0.029, 95% CI: -0.048 to -0.009; p = 0.008), physical activity (β = -0.022, 95% CI: -0.038 to -0.006; p = 0.013) and foot care (β = -0.043, 95% CI: -0.059 to -0.026; p < 0.001). Self-esteem mitigated the effect of diabetes stigma on diabetes distress. Perceived and experienced diabetes stigma was independently associated with increased diabetes distress and decreased engagement in diabetes self-care among Arabic-speaking adults with T2D. These findings are crucial to help clinicians provide more effective assessment and counselling and guide public health interventions to decrease diabetes stigma in these communities.

Social and self-stigma during COVID-19 pandemic: Egyptians' perspectives.

Social stigma associated with infectious diseases existed throughout the history of pandemics due to fears of contagion and death. This study aims to assess social and self-stigma resulting from COVID-19 infection and other associated factors in Egypt during the pandemic. A cross-sectional study was conducted on 533 adult Egyptians via an online questionnaire. The questionnaire included social stigma toward current and recovered COVID-19 patients and the negative self-image of being a COVID-19 patient. The mean calculated overall COVID-19-related stigma score for the studied sample was 4.7±3.1. The highest reported stigma category was mild stigma: Social stigma towards current COVID-19 patients (88.2%), Social stigma toward recovered COVID-19 patients (64.2%), Negative self-image for being a COVID-19 patient; perceived self-stigma (71.6%) and total stigma score (88.2%) respectively. The overall stigma score was negatively associated with a higher level of education and getting information from healthcare workers and positively associated with getting information from social networks. Social and self-stigma related to COVID-19 infection was mild from the Egyptian perspective but found in a large proportion of the population and mainly affected by getting information from healthcare workers or through social media and being more among those with lower education levels. The study recommends more legislative control on social media for disseminating health-related information and conducting awareness campaigns to counteract these adverse effects.

Diyabet ve hipertansiyon hastalarında kronik hastalığa bağlı stigma düzeyinin değerlendirilmesi

Introduction and Aim: The two most common chronic diseases in primary care chronic disease follow-up are diabetes (DM) and hypertension (HT). The aim of this study is to evaluate the level of chronic disease stigma, perceived social support and depression in DM and HT patients, and to examine their effects on treatment regulation. Materials and Methods: A single-center, descriptive study was conducted with randomly selected 50 DM and 50 HT patients who applied to a Family Health Center between September and December 2020. Patients with DM were divided into regulated and non-regulated groups according to HbA1c level, and HT patients according to target cytolic/diastolic arterial pressure.The level of stigmatization with the Expected Stigma Scale in Chronic Diseases (CIASS), psychological health status with the Patient Health Questionnaire-9 Scale (PHQ-9), and perceived social support status with the Multidimensional Scale of Perceived Social Support (MSPSS) were questioned face-to-face. SPSS program was used in the analysis of the data. Results: One hundred patients with a mean age of 56.4±11.4 years and a diagnosis period of 10.4±7.2 years were included in the study. Stigma levels of patients with unregulated DM (38.0%) and unregulated HT (14%) were compared. DM patients had higher total expected stigma score of chronic diseases (p=0.001), related to work life (p&lt;0.001) and healthcare workers (p=0.007). In the linear regression analysis, it was determined that the current depression level of the patient is the determinant of the level of stigma in chronic diseases in both HT patients (F = 4.073, p=0.012, R² = 0.21) and DM patients (F = 3.154, p =0.012, R² = 0.30). Discussion and conclusion: The level of chronic disease stigma was found to be higher in DM patients than in HT patients, and the rate of treatment regulation was lower. The role of depression level, expected stigma level from work environment and healthcare professionals were pointed out in the regulation of DM.