Stigmatization Process Research Articles

In and Out of the Homosexual Closet: Gay/Lesbian Liberation in Canada

With a substantive focus on Canada, this paper analyzes the sequential social processes involved in the movement for Gay/Lesbian liberation from a human rights perspective. In Phase One (Into the Closet), the paper examines the process of stigmatization of homosexuals whereby their minority status is socially created, institutionalized and perpetuated. In Phase Two (Out of the Closet), the paper examines the processes of destigmatization and “Coming Out” whereby a new and positive sense of collective, homosexual identity is generated. In Phase Three (Minority Liberation), the paper traces the evolution of homosexual organizations, from the early stage of self-help groups, through Gay/Lesbian Rights organizations seeking legal recognition and protection of the human rights of homosexuals, to the current movement for Gay/Lesbian Liberation seeking legitimation for the alternate lifestyles and sub-cultures of the Gay/Lesbian social collectivity.

Theorizing state stigmatization: A comparative perspective on South Africa and Israel

This article deals with state stigmas in the international arena, and addresses the question: why do state-stigmas develop and become sustained in some cases, whereas in other cases they wither away? For parsimonious, analytical purposes we view the process of state stigmatisation through two, interrelated stages: the stigma’s development – where transnational civil society activists and the engagement of mainstream international media play an important role; and the stigma’s sustenance where these elements are joined by the target state’s coping strategy. For theoretical consistency, we limit ourselves to exploring states that are (a) involved in conflicts and (b) aspiring to be part of the Western-led ‘club’ of states. Through the analysis of press articles and UN documents relating to two vastly different case studies: South Africa (1985–1994) and Israel (2000–2019), we demonstrate that states in conflictual situations have limited manoeuvring space in dealing with their developing stigmas; and that the choice of tools utilized in the implementation of the same coping strategy can lead to different results.

Depoliticisation, hybridisation and dual processes of stigmatisation: An examination of the civilising offensive in China’s rural areas through moral review councils

In this article, I examine the moral review councils (MRCs) established in China’s rural areas since the early 1980s. I show that MRCs create a liminal plebeian public sphere in the context of a civilising offensive that deals with the uncivil behaviours of individuals and disputes between neighbours. In this plebeian public sphere, the MRC incorporates techniques of the Maoist mass meeting, the democratic election, traditional mediation and a pedagogy of exemplars, all of which are depoliticised into purely technical instruments. Their institutional legitimacy comes from organised virtues based on councillors’ male seniority and the democratic method of their selection. MRCs, as an instrument of a civilising offensive, are a kind of paternalistic technology, which involves a complex strategy of a hybridity of acts, relationships, thoughts, desires and temptations of village residents in the context of the reform era. The people targeted in this civilising offensive often experience two levels of stigmatisation and their participation determines the effectiveness of the operation of MRCs.

Internalized stigma among people with schizophrenia: Relationship with socio-demographic, clinical and medication-related features

BackgroundPeople with schizophrenia are at high risk of suffering from stigma and internalizing it. Recently, a better understanding of the stigma process has shifted the attention from public stigma to self-stigma, which is deeply debilitating. This study aimed to assess factors associated to self-stigma by evaluating socio-demographic, clinical and treatment-related variables in a group of subjects diagnosed with schizophrenia and to identify predictors of high internalized stigma. MethodsNinety-four inpatients accessing rehabilitative centers with a diagnosis of schizophrenia were included in this cross-sectional study. Measures included both patient-rated scales, assessing internalized stigma, attitude toward medications, side effects experience and subjective well-being, and clinician-rated scales, assessing schizophrenia symptoms and global clinical severity and antipsychotic-related side effects. ResultsTwenty-one patients (22.3%) showed high internalized stigma while 73 (77.7%) did not. Patients experiencing more medication adverse effects and worse subjective well-being were more likely to suffer from internalized stigma according to a logistic regression analysis. Extrapyramidal, psychic and some autonomic reactions also emerged as individual predictors of self-stigma in a separate regression analysis. ConclusionsSelf-stigma and subjective medication side effects perception represent a relevant issue in patients' life and should be carefully taken into account in clinical practice.

Public Continuum Beliefs for Different Levels of Depression Severity.

Introduction: The notion that depression is a disorder that moves along a continuum is well-established. Similarly, the belief in the continuity of mental illness is considered an important element in the stigma process. Against this background, it is the aim of this study to examine whether public continuum beliefs vary with the severity of depressive symptoms.Methods: Analyses were based on computer-assisted telephone interviews (CATIs) conducted in winter 2019/2020 in Germany (N = 1,009, response rate 46.8%). Using three vignettes representing mild, moderate, and severe depressive symptoms, beliefs regarding the continuity of symptoms, specifically a fundamental difference, were assessed with seven items. Sociodemographic characteristics and own experiences with depression (affliction and contact) were introduced as covariates.Results: Significant differences between the three groups of severity were found for the majority of the items measuring continuum beliefs or perceived fundamental difference. However, only few items showed a linear trend indicating a parallel between symptom severity and beliefs. Multivariate regression models showed that a moderate degree of depression was positively associated with stronger continuum beliefs but also with greater perceived difference compared to the mild degree, while no significant associations emerged for the severe vignette.Limitations: Although a comparison of our sample with official statistics supports the external validity, we cannot rule out a selection bias. It is arguable in how far short case vignettes convey a holistic picture of a person affected by depressive symptoms.Conclusion: Our results do not indicate a parallel between symptom severity and public continuum beliefs.

Stigma Experiences in People with Chronic Obstructive Pulmonary Disease: An Integrative Review.

BackgroundPeople with chronic obstructive pulmonary disease (COPD) are stigmatized by smoking history. Although little is known about COPD-related stigma, it can adversely affect self-management and quality of life.ObjectiveTo synthesize relevant scientific literature exploring stigma experiences and their impacts on people with COPD.MethodsCINAHL/PsycINFO/PubMed/Scopus were searched for relevant studies. Findings were organized using Major et al’s conceptual model.ResultsFifteen studies documented COPD-related stigma processes: enacted, felt, internalized, and anticipated. Moderating factors included visibility, origin, and illness perception. Individual-level stigma responses included emotional distress, limited social interactions, and negative effects on medication adherence and help-seeking. Social/community-level stigma experiences included healthcare provider and employer behaviors. Smoking is interwoven throughout all domains of stigma processes and responses to stigma.ConclusionSubstantial evidence documents processes, moderating factors, and individual and social/community responses to the complex phenomenon of COPD-related stigma; however, prevalence of COPD-related stigma and its health effects are unclear.

Reducing Objectification Could Tackle Stigma in the COVID-19 Pandemic: Evidence From China.

Stigmatization associated with the coronavirus disease 2019 (COVID-19) is expected to be a complex issue and to extend into the later phases of the pandemic, which impairs social cohesion and relevant individuals' well-being. Identifying contributing factors and learning their roles in the stigmatization process may help tackle the problem. This study quantitatively assessed the severity of stigmatization against three different groups of people: people from major COVID-19 outbreak sites, those who had been quarantined, and healthcare workers; explored the factors associated with stigmatization within the frameworks of self-categorization theory and core social motives; and proposed solutions to resolve stigma. The cross-sectional online survey was carried out between April 21 and May 7, 2020, using a convenience sample, which yielded 1,388 valid responses. Employing data analysis methods like multivariate linear regression and moderation analysis, this study yields some main findings: (1) those from major COVID-19 outbreak sites received the highest level of stigma; (2) factors most closely associated with stigmatization, in descending order, are objectification and epidemic proximity in an autonomic aspect and fear of contracting COVID-19 in a controllable aspect; and (3) superordinate categorization is a buffering moderator in objectification–stigmatization relationship. These findings are important for further understanding COVID-19-related stigma, and they can be utilized to develop strategies to fight against relevant discrimination and bias. Specifically, reinforcing superordinate categorization by cultivating common in-group identity, such as volunteering and donating for containment of the pandemic, could reduce objectification and, thus, alleviate stigma.

HIV-Related Stigma Among Youth Living With HIV in Western Uganda.

We present an explanatory theory for HIV-related stigma from the perspectives of youth living with HIV/AIDS (YLWHA) in Western Uganda, on which the fight against this relentless stigma in this age group and locality can be founded. A constant comparative method was used to analyze textual data from in-depth interviews with 35 YLWHA, selected from three health facilities. A stigma process model for YLWHA was developed with the stigmatizing feelings and behaviors as the core category. Concepts delineating causes, consequences, and moderators of HIV-related stigma emerged from the data to complete the stigma process. The specific focus on YLWHA and contextual characteristics adds new dimensions to the understanding of HIV-related stigma that are scant in existing HIV-related stigma models. In light of our findings, research is necessary to identify context-specific strategies to overcome the deep-rooted causes of stigmatizing views and behaviors in all social spheres of YLWHA within Western Uganda.

A Mixed-Methods Exploration of Adolescents' Lived Realities of HIV Stigma: "It's Something You Wear, Something That's Like a Shadow All Over Where You Go".

This study aimed to explore how adolescents living with HIV experience stigma and the contextual factors influencing such. The authors used an exploratory, sequential, mixed-method design, including interpretive phenomenological individual interviews and focus groups with adolescents ages 13 to 18 years, their caregivers, and health care workers (n = 56) and a cross-sectional survey (n = 385) in health care facilities in the Western Cape, South Africa. Data were analyzed using an equal-status sequential mixed-methods analysis approach. Enacted, perceived, and anticipated stigma fueled fears of rejection and affected disclosure patterns of adolescents living with HIV. Experiencing HIV-related stigma was associated with being an older adolescent, being disclosed to after the age of 12 years, and residing with one's biological mother. Internalized stigma was associated with poor adherence and viral nonsuppression. Multifaceted interventions involving various individuals and groups across ecological systems are needed to interrupt the stigma process and mitigate its effects.

Understanding of Stigmatization and Death Amid COVID-19 in India: A Sociological Exploration.

The unanticipated outbreak of Coronavirus had proven detrimental to human existence. It had created waves of panic, anxiety, and fear among people hence facilitating stigmatization toward an infected person. This stigmatization further influences patients health-seeking behaviour due to the trust deficit in the public health system. The virus had placed the world in an impotent situation as people helplessly watched their loved ones pass away in the absence of effective treatment. Dead bodies are denied a dignified death due to mandatory guidelines prescribed by countries to control the pandemic. This article attempts to understand the process of stigmatization of Coronavirus and its mechanism of influencing the health-seeking behaviour of people. Moreover, the way this stigmatization, accompanied by fear and anxiety, led to the denial of having a dignified death in India.

Personality Factors Crucial in Internalized Stigma Understanding in Psychiatry.

Objective: The main purpose of this research was to establish the relationship between personality traits and internalized stigma in individuals living with severe mental illness. Additionally, the study aimed to identify individual differences that could be used to develop the theoretical socio-cognitive-behavioral equation model of internalized stigma. Methods: A total of 114 patients with diagnosis of nonorganic psychotic disorder or uni- or bipolar affective disorder took part in this study. The Internalized Stigma of Mental Illness (ISMI) scale, Eysenck Personality Questionnaire Revised (EPQ-R) and NEO Five-Factor Inventory (NEO-FFI) were administrated among all participants. Results: Patients presenting higher levels of neuroticism scored higher on the ISMI scale. Otherwise, those with higher levels of extraversion, openness to experience and conscientiousness had lower ISMI scores. With the use of multivariate linear regression, neuroticism, openness to experience and conscientiousness showed the strongest associations with internalized stigma. Conclusions: Intrapersonal factors such as personality traits might explain individual differences in responses to the stigmatization process. Moreover, sociodemographic conditions such as the place of residence and level of education can play a mediating role in reducing the level of internalized stigma. Adequate psychosocial interventions should consider demographics and personality traits when engaging patients with mental illnesses in activities aimed at understanding and accepting the disorders.

Redemption of travelers’ spoiled identity in a time of health crisis: The role of empathy and social distance

One consequence of an epidemic is the attachment of a spoiled identity to travelers from pandemic areas (hereafter referred to as “travelers”), resulting in severe damage to their psychological health. Guided by the stigmatization process model, this study examines the impact of tourism practitioners' perceptions of illness labeling toward travelers, social identification with travelers, and effects of spatial stigma. The moderating effects of empathy and social distance on this relationship are also analyzed. The results of a questionnaire survey of 754 tourism practitioners showed that illness labeling toward travelers negatively influences social identity with travelers and this leads to spatial stigma. Tourism practitioners’ empathy and the social distance between them and travelers are found to moderate the relationship between illness labeling toward travelers and spatial stigma. Finally, this study further finds that the two moderators are found to be more effective in alleviating social stigma than moral stigma.

Structural racism and reflections from Latinx heavy drinkers: Impact on mental health and alcohol use

BackgroundDiscrimination and social inequity increase risk for alcohol use disorders among Latinxs. An alcohol intervention trial that led to significant reductions in alcohol-related consequences also produced significant reductions in mental health symptoms for Latinx heavy drinkers. In the current qualitative study, we explore this trial's mental health effect by examining participants' perspectives on the social context of immigration, i.e., structural barriers, and associations among the immigrant experience, stigma, depressive/anxiety symptomatology, and alcohol consumption. MethodsStudy participants were eligible if they completed the clinical trial, exhibited levels of depressive and anxiety symptoms that exceeded the range for clinical depression (≥18, CES-D) and anxiety (≥12, BAI) at baseline, and demonstrated significant declines in depression and anxiety symptoms 12 months following their completion of the trial. The study coded 24 participant transcripts using ATLAS.ti and thematic analysis. ResultsParticipants reported their responses to structural barriers (e.g., a lack of educational supports, difficulties accessing safety net programs). Reported experiences of exclusion and discrimination were associated with depressive and anxiety symptoms. Stigmatization processes included feeling isolated and contributed to poor mental health. Participants reported drinking to cope with low mood. ConclusionsStructural barriers are exclusionary because they limit full participation and communicate who does/does not belong along race/ethnic lines, i.e., structural racism. Feeling stigmatized for being different was associated with feelings of anxiety and depression among our immigrant participants. Future interventions must focus on stressors associated with the constraints of being an immigrant. Understanding how structural barriers and structural racism impact health behavior can enrich the design and impact of interventions for socially disadvantaged Latinx individuals.

Mediators of the Disparities in Depression Between Sexual Minority and Heterosexual Individuals: A Systematic Review

Evidence suggests that sexual minorities (e.g., those identifying as lesbian, gay, or bisexual) experience increased rates of depression compared to heterosexual individuals. Minority stress theory suggests that this disparity is due to stigma experienced by sexual minorities. Stigma processes are proposed to contribute to reduced coping/support resources and increased vulnerability processes for mental health problems. This review provided a systematic examination of research assessing the evidence for mediating factors that help explain such disparities. A literature search was conducted using the databases PubMed, PsycINFO, and Web of Science. The review included 40 identified studies that examined mediators of sexual minority status and depressive outcomes using a between-group design (i.e., heterosexual versus sexual minority participants). Studies of adolescents and adult samples were both included. The most common findings were consistent with the suggestion that stressors such as victimization, harassment, abuse, and increased stress, as well as lower social and family support, may contribute to differing depression rates in sexual minority compared to heterosexual individuals. Differences in psychological processes such as self-esteem and rumination may also play a role but have had insufficient research attention so far. However, caution is needed because many papers had important methodological shortcomings such as the use of cross-sectional designs, inferior statistical analyses for mediation, or measures that had not been properly validated. Although firm conclusions cannot be drawn, the current evidence base highlights many factors potentially suitable for further exploration in high-quality longitudinal research or randomized studies intervening with the potential mediators.

COVID-19 and Stigmatisation Processes

In this Letter to Editor, we put forth a reflection on the stigmatisation processes shaped by the COVID-19 pandemic.
 
 Received: 30 November 2020 / Accepted: 8 January 2021 / Published: 5 March 2021

Structural determinants of stigma across health and social conditions: a rapid review and conceptual framework to guide future research and intervention.

Stigma has been identified as a key determinant of health and health inequities because of its effects on access to health-enabling resources and stress exposure. Though existing reports offer in-depth summaries of the mechanisms through which stigma influences health, a review of evidence on the upstream drivers of stigma across health and social conditions has been missing. The objective of this review is to summarize known structural determinants of stigma experienced across health and social conditions in developed country settings. We conducted a rapid review of the literature. English- and French-language peer-reviewed and grey literature works published after 2008 were identified using MEDLINE, Embase, PsycINFO, Google and Google Scholar. Titles and abstracts were independently screened by two reviewers. Information from relevant publications was extracted, and a thematic analysis of identified determinants was conducted to identify broad domains of structural determinants. A narrative synthesis of study characteristics and identified determinants was conducted. Of 657 publications identified, 53 were included. Ten domains of structural determinants of stigma were identified: legal frameworks, welfare policies, economic policies, social and built environments, media and marketing, pedagogical factors, health care policies and practices, biomedical technology, diagnostic frameworks and public health interventions. Each domain is defined and summarized, and a conceptual framework for how the identified domains relate to the stigma process is proposed. At least 10 domains of structural factors influence the occurrence of stigma across health and social conditions. These domains can be used to structure policy discussions centred on ways to reduce stigma at the population level.

Intersectionality and the Subjective Processes of LBQ Migrant Women: Between Discrimination and Self-determination

The article examines the identity profiles of LBQ migrant women living at the intersection of several factors of discrimination and oppression (related to gender, cultural affiliation, skin colour, sexual orientation, etc.). We combined two theoretical approaches – intersectionality and queer theory – to examine the identity strategies that these women put in place in their various relational circles of belonging, exploring how women react to the ‘labelling’ attempts by mainstream society, the network of compatriots, and the wider LGBT community. This highlights the power relations underpinning these relationships, the stigmatisation processes experiences, the attempts at accommodation and resistance undertaken by women to express – with regard to ethnic and sexual identity – both the need for belonging and that for self-determination.

Healthcare access barriers for FARC ex-combatants in Colombia: qualitative perspectives from healthcare providers and FARC health promoters

BackgroundFollowing the 2016 Peace Agreement with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate more than 13,000 guerrilla fighters into its healthcare system. Despite a subsidized healthcare insurance program and the establishment of 24 Espacios Territoriales de Capacitación y Reincorporación (ETCRs—Territorial Spaces for Training and Reintegration) to facilitate this transition, data has shown that FARC ex-combatants access care at disproportionately lower rates, and face barriers to healthcare services.MethodsSemi-structured interviews were conducted with FARC health promoters and healthcare providers working in ETCRs to determine healthcare access barriers for FARC ex-combatants. Analysis was completed with a qualitative team-based coding method and barriers were categorized according to Julio Frenk’s Domains of Healthcare Access framework.ResultsAmong 32 participants, 25 were healthcare providers and 7 self-identified as FARC health promoters. The sample was majority female (71.9%) and worked with the FARC for an average of 12 months in hospital, health center, medical brigade, and ETCR settings. Our sample had experiences with FARC across 16 ETCRs in 13 Departments of Colombia. Participants identified a total of 141 healthcare access barriers affecting FARC ex-combatants, which affected healthcare needs, desires, seeking, initiation and continuation. Significant barriers were related to a lack of resources in rural areas, limited knowledge of the Colombian health system, the health insurance program, perceived stigma, and transition process from the FARC health system.ConclusionsFARC ex-combatants face significant healthcare access barriers, some of which are unique from other low-resource populations in Colombia. Potential solutions to these barriers included health insurance provider partnerships with health centers close to ETCRs, and training and contracting FARC health promoters to be primary healthcare providers in ETCRs. Future studies are needed to quantify the healthcare barriers affecting FARC ex-combatants, in order to implement targeted interventions to improve healthcare access.

"I am what I am": a review of the assumptions of anti-self-stigma intervention.

The aim of this study is to discuss the validity of introducing an intervention based on anti-self-stigma in a group of patients with psychotic disorders. The article describes the assumptions of the proposed intervention and the approximate model of therapeutic work. In this article, the most important concepts in the area of stigmatization and self-stigma are presented and discussed. Self-stigma is part of a wider social phenomenon known as stigma. The process of stigmatization was first described in the 1960s and consists of ascribing undesirable features to certain social groups, which leads to many negative consequences such as social exclusion and discrimination. While every aspect of the human experience can be stigmatized, recent psychological research has focused mainly on the stigma and self-stigma associated with a diagnosis of mental illness. Self-stigma results in negative self-esteem and a vicious circle of the "why try" effect. Low self-esteem strengthens self-stigma. We predicted that therapy aimed at improving self-esteem may have a positive effect on reducing of self-stigma. Recent studies have shown that therapies targeting low self-esteem are more effective than those targeting self-stigmatizing beliefs. Self-stigma is an important problem among patients hospitalized due to psychotic disorders. No training aimed at working with this aspect of experience has been introduced in Poland to date. Our observations show that the proposed training can support the healing process of patients and positively affect the ways in which the patient deals with self-stigma. The proposed intervention requires the evaluation of the effectiveness in a clinical trial involving patients diagnosed with psychotic disorders.

The Main Sources and Potential Effects of COVID-19-Related Discrimination.

The outbreak of a new coronavirus disease (COVID-19), which appeared in late 2019 and eventually resulted in the announcement of a pandemic by the World Health Organization, led to global fear and panic as well as the spread of false information and fake news from different sources. As a result, a sharp increase in prejudice, discrimination, and xenophobia against different groups of people was observed in different geographical locations. This chapter presents the psychological and social sources of stereotypes and prejudices that take forms in the COVID-19 pandemic. These sources can be located in psychosocial processes, such as (i) socially generated and reinforced fears; (ii) human responses to stress induced by certain types of stimuli; (iii) sense of helplessness based on the lack of control over reality; (iv) psychological responses reinforced by conformism (crowd psychology); and (v) the stigmatization process. The chapter also presents the main groups of increased risk of experiencing prejudice and discrimination during the COVID-19 pandemic (Asians, health-care workers, COVID-19 patients, and their relatives). Moreover, it provides a documented example of such behaviors. The groups at higher risk of more adverse effects of COVID-19 due to pre-pandemic discrimination are also discussed. Finally, initiatives taken to mitigate the discrimination associated with COVID-19 are presented, as well as the recommendations and good practices for preventing these behaviors during future outbreaks and for limiting discrimination against COVID-19 until the disease can be contained.