Threat Of Stigma Research Articles

A qualitative of stable symptomatology for patients with schizophrenia: do they have adequate post-discharge rehabilitative resources?

Many patients diagnosed with schizophrenia face obstacles to rehabilitation and discharge into the community, particularly with regard to the way resources are structured. Clarifying the difficulties will help health care providers address rehabilitation shortcomings. Semistructured in-depth interviews and participatory observations were conducted in various locations (family home, hospital ward, outpatient clinic, and on the street) with families, social workers, doctors, nursing staff, and patients with schizophrenia. These patients met the medical facility’s hospital discharge standards and either had not been discharged or had been discharged within two weeks of meeting the discharge criteria. This study explores the complex and interdependent role of social differences in the rehabilitation of patients with schizophrenia after acute treatment. The study identified five topics related to structural difficulties in resources for the rehabilitation of patients diagnosed with schizophrenia: (1) the role of policy; (2) inadequate facilities and responsibilities; (3) rejecting communities; (4) difficult families; and (5) the threat of stigma. The rehabilitation of patients diagnosed with schizophrenia is a systemic problem. Systemic rehabilitation policies and integrated social support would be more conducive to the rehabilitation of patients. Perhaps cognitive remediation therapy or the Assertive Community Treatment (ACT) Model could benefit individuals with complex disorders.

Tainted by Stigma: The Interplay of Stigma and Moral Identity in Health Persuasion

The current research examines the interactive effect of consumers’ moral identity and risk factor stigma on health message effectiveness. The authors theorize that engaging in advocated health behaviors has moral associations; however, a stigmatized risk factor in a message “taints” the morality of the advocated health behavior. Thus, consumers with high (vs. low) moral identity are more likely to comply with health messages when risk factor stigma is low, and this positive moral identity effect is undermined when risk factor stigma is high. The authors test stigma's threat to moral identity by measuring defensive processing (Studies 1 and 2) and the attenuating effect of self-affirmation on the negative effect of stigma (Studies 3 and 4). They apply the stigma-by-association principle to develop and test a messaging intervention (Study 5). The studies suggest that, depending on whether a health message contains stigmatized risk factors, marketers could employ a combination of tactics such as activating moral identity, offering self-affirming message frames, and/or highlighting low-stigma risk factors to bolster message effectiveness.

IMPRESSION MANAGEMENT STRATEGY OF COPING WITH ENTREPRENEURIAL FAILURE STIGMA: A TWO-PATH THEORETICAL MODEL

Impression management strategy is an important way to cope with the stigma of failed entrepreneurial firms. However, most existing studies only focused on the process of impression management with a single strategy. Few studies have provided a systematic theoretical explanation on how to use different types of impression management strategies to cope with stigma. To fill this theoretical gap, a two-path model of impression management of entrepreneurial failure stigma was constructed, based on the two-component model of impression management. In addition, the mechanism of impression management strategy selection for failed entrepreneurial firms to cope with stigma was discussed. The findings of the theoretical model reveal two paths for the stigma management strategy of failed entrepreneurial firms: “avoidance motivation → defensive strategy of impression management” and “diluted motivation → acquisitive strategy of impression management.” Moreover, in the selection mechanism of strategy, the formation of impression motivation is affected by the stigma type of entrepreneurial failure, the social status of the firm organization, and the degree of stigma threat. In the face of justifiable stigma, the failed entrepreneurial firms form the avoidance motivation and then implement a defensive strategy of impression management. High social status firms adopt an acquisitive strategy of impression management to cope with the negative impact of entrepreneurial failure stigma. As the threat level of entrepreneurial failure stigma increases, the dilution motivation of the failed entrepreneurial firms to stigma becomes stronger, and the firms are more likely to adopt the acquisitive strategy of impression management. The two-path theoretical model provides decision support for failed entrepreneurial firms to formulate stigma management strategies and expands the research scope of entrepreneurial failure stigma.

Minding the (Age) Gap: The Identity and Emotion Work of Men and Women in Age-Discrepant Romantic Relationships

ABSTRACT People involved in an age-discrepant relationship, where one partner is significantly older than the other, are typically viewed with negative cultural tropes and stereotypes. Using a chain sampling technique to recruit participants, data were collected through 20 in-depth interviews with men and women who experienced being in a relationship with an age gap of 10 or more years between partners. Analyses revealed participants used common techniques to manage and overcome the stigma, both in self-interaction and in interaction with others. In self-interaction, participants drew from “love narratives” to reframe their involvement with someone much younger or older as something outside of their control. When interacting with others, participants used techniques of passing, lampooning, and dismissing. Passing involved participants’ ability to feel and appear closer in age to their partner. Lampooning involved the use of humor to deflect the threat of stigma. Dismissing involved repudiation of the stigma associated with age-discrepant relationships. Importantly, participants’ use of these techniques worked either in defense of or as a reaction against the inequality they faced in an age-discrepant relationship.

Rethinking the relationship between sex work, mental health and stigma: a qualitative study of sex workers in Australia.

Sex workers may experience stigma both related to their occupation as well as to mental health issues that they face. There is limited research on the lived experience of sex workers managing mental health and stigma. This study examined the experiences of sex workers in Australia in relation to stigma surrounding sex work, and sex workers' mental health, including self-management and experiences of accessing mental health services. Six focus groups and two interviews were conducted with 31 sex workers. Data collection was co-moderated by a sex worker and a university-based researcher. Analysis was informed by an approach which positioned sex workers as agential and capable, and which drew attention to structural aspects of stigma. Sex workers identified that the stigma surrounding their profession had a significant impact on their mental health. The need to manage risks through selective disclosure of sex work was a pervasive experience. Management of mental health and the stigma associated with sex work was described as a responsibility primarily of the individual through self-care activities and occasional access to mental health services. Participants reported poor treatment from mental health practitioners who saw sex workers as victims lacking agency, imposed beliefs that sex work was the pathological root cause of mental health issues, or approached the issue with fascination or voyeurism. Other presenting issues (especially mental health) were lost or obscured in therapeutic encounters resulting in suboptimal care. The threat of stigma is pervasive and has mental health implications for sex workers. Our findings point to the need for increased training and capacity development for mental health practitioners, funding for peer support services to ameliorate internalised stigma, and action from governments to introduce enabling legal environments, stigma reduction programs and structural protections from sex work stigma.

Yes, We Can (No, You Can’t): Weight Stigma, Exercise Self-Efficacy, and Active Fat Identity Development

ABSTRACTAn inverse relationship has been observed between body mass index and physical activity levels. In the present article, we draw from a range of literatures to construct a novel, theoretical dual-pathway model that identifies direct and indirect impacts of societal weight stigma on exercise behavior. The direct pathway operates via experiences or threat of stigma and discrimination, which create traumatic learning experiences and impair the development of exercise self-efficacy. The indirect pathway impedes engagement in physical activity due to the absence of positive representations of fat exercisers, and a glut of negative representations, resulting from societal anti-fat attitudes. Thus, fat people lack role models from whom they may develop vicarious self-efficacy. Low self-efficacy, in turn, hinders the development of active fat identities. We review the existing literature for evidence supporting such a model, identify directions for future research, and briefly consider the implications of this framework for public health and policy aims.

Active ageing, emotional care and the threat of stigma: Identity management in older adults using sleeping medication long-term.

Amid fears about the medicalisation of old age, the high prevalence of sleeping medication use in older cohorts is a significant public health concern. Long-term use is associated with a plethora of negative effects, such as cognitive impairment and risk of addiction. However, little is known about the lived experience of older adults using sleeping medication longer term. Episodic interviews lasting approximately 90 minutes were conducted with 15 independently living adults, aged 65-88 years, who were using sedative-hypnotic or tricyclic sleeping medication for more than 11 years on average. Thematic analysis shows that participants divided their rationale for use into two temporal periods: (1) to ensure physical ability in the daytime and (2) to ensure emotional stability at night. Long-term sleeping medication was thus characterised as a form of 'emotional self-management' of the negative emotions associated with later life, blotting out feelings of loss and loneliness by inducing sleep. Participants feared loss of access to their medication 'supply', employing strategies to ensure its continuity, while expressing shame about their dependence. However, identity management, in the form of explanations, minimisations and social comparisons, functioned to downplay their addiction. Through this, long-term sleeping medication users were able to elude the spoiled identities and multiple stigmas of both the 'out of control' addict and the unsuccessful older adult by asserting a positive identity; that of the 'new' older adult, actively medicating for success both day and night.

IM as a Goal-Oriented Response to Stigma Communication at Work: A Self-regulation Perspective

In responding to stigma communication at work, people are often under the influence of environmental constraints that may significantly curtail the availability of different identity management strategies. This paper highlights that identity management in workplace settings should be seen as a goal-driven, motivated, and norm-guided response. We present a conceptual model that opens up the black box of why people choose to accept or challenge stigma communication at work by integrating identity management and stigma literatures with self-regulation literature. Our model and associated propositions present how organizational norms and contextual features, individual difference variables such as identity centrality and self-efficacy, and multiple goals such as self- enhancement, self-verification, and belonging, together drive an individual’s choices of identity management strategies. We also discuss how individuals engage in multiple goal pursuit under stigma threat and how that may impact their self-regulatory reserves. We raise novel research questions to spur future research and present practical recommendations to help practitioners harness the value of diversity in organizations.

Rethinking super-confidentiality in the age of disclosure: The ethical and social implications of privacy protections in mental health data

Summary Two opposing impulses have marked efforts in medicine and global health to combat stigma and discrimination. Traditionally, threat of stigma leads to efforts to protect patients by enforcing privacy and confidentiality, while more recently, anti-stigma efforts have been dominated by arguments that the best way to fight stigma is through greater disclosure of the facts of illness. By this line of argument, the act of sharing patient experiences with stigmatized conditions will help dismantle stigma. The question of whether and/or when the threat of stigma warrants more privacy or more disclosure in medicine and public health is the topic of this paper. Tracing two historical cases – HIV and mental health – illustrates the shifting pendulum between privacy and disclosure as opposing, yet both well-intentioned responses to the fact of stigma in both medicine and public health. Public health responses to both HIV and mental health can be divided into periods marked by exceptionalism that eventually yielded to calls for greater integration. That the opposite policies of both eras were each justified the same argument that combat stigma makes these historical cases ethically important. Tracing the rise and fall of exceptionalism in these two cases – HIV and mental health – raises both empirical and normative questions about the impulse toward greater privacy as a strategy for stigma protection. These questions include: When is greater privacy an appropriate or effective response to combat stigmatized conditions? Might greater privacy sometimes actually lead to perverse consequences such as exacerbating or perpetuating, rather than mitigating stigma? And if that is indeed a risk, how should public health officials determine in what circumstances disclosure or privacy offers a better strategy toward stigma reduction? This paper concludes by considering the normative aspects of the policy implications raised by such cases of privacy and anti-stigma efforts. These two cases enumerate the social and medical costs of privacy and stigma so that better policy prescriptions can be developed to advance fairness and justice. They should serve to remind or teach us that there may be social and ethical costs associated with the cure (the privacy) as well as the illness (the stigma). Policy responses must evolve with changing social circumstances. The original impulse towards extreme privacy, confidentiality or exceptionalism, noble though it was, and even appropriate for that time, does not today result in its intended goal: reduction of stigma by demonstrating through practice and policy the moral equivalence of different medical conditions. Another lesson from these cases is that in many cases extreme privacy and vertical programs may even detract from that goal of stigma reduction by signaling that the stigmatized condition is so “other” its sufferers require special treatment or to be kept apart (in the isolated clinics of HIV/AIDS for example). More protection will not always be benign, even if well intentioned. The ironic lesson for global health is that privacy practices run the risk of perpetuating the very stigma they were designed to combat.

Dark clouds or silver linings? A stigma threat perspective on the implications of an autism diagnosis for workplace well-being.

This article unpacks the stigma associated with a developmental disability at work, specifically autism spectrum disorders (ASD), by presenting findings from 2 studies-one interview-based and the other survey-based. Drawing on in-depth interviews with individuals on the autism spectrum, the first study showed that a clinical diagnosis of autism is a milestone event that triggered both positive (silver linings) and negative (dark clouds) responses to work. These positive and negative responses were shaped by the age at which the diagnosis occurred as well as specific work-related contingencies-identity management (disclosing or not disclosing), the importance of the social demands imposed by the job, and organizational support policies for autism. The second study developed and tested propositions derived from the qualitative data by using survey data gathered from working adults with ASD. Results showed that, compared with individuals diagnosed later in life, individuals who were diagnosed at an earlier age experienced greater organization-based self-esteem and lower perceived discrimination when they disclosed their disability, worked in jobs that placed lower social demands on them, or were employed in organizations that offered policies to support workers with ASD. We conclude that, depending on the age of diagnosis, attributes of the employment context can trigger stigma-related threat in different ways and we outline important practical implications of these findings.

Look Up or Look Down: The Role of Social Comparison Orientation among Physically Dirty Workers

This study focused on physically dirty work: a pervasive and necessary job in society that has been insufficiently studied. Physically dirty work is characterized by physical contact with filthy and soiled matters, which may lead to negative job attitudes and outcomes. Ashforth and Kreiner (1999, 2007) argued that, in facing the threat of stigma, dirty workers form a strong group culture and use defensive strategies to protect their work-role identity. Drawing on social identity theory and social comparison literature, this study suggested a negative relationship between physically dirty workers' individual perceptions of their work dirtiness and job satisfactions, which would be weakened when the person with strong upward social comparison orientations. Previous studies (e.g, Ashforth & Kreiner, 1999; Adams, 2012) were mostly conducted at group level or occupational level, this study aimed to explore the effect of physical work dirtiness at the individual level. We found support for the hypotheses in a s...

Would You Like Fries (380 Calories) With That? The Effect of Weight Stigma Threat on Food Choice

Given the current obesity epidemic, weight bias is a growing problem. Although much is known about the nature of weight bias, relatively little is known about the consequences of weight stigma on the overweight. Recent studies suggest that the experience of weight stigma may contribute to psychological distress and unhealthy behaviors, but additional research is needed to better understand the consequences of this form of stigma. Stigma threat is a psychological phenomenon of being at risk of confirming, as self-characteristic, a negative stereotype about one’s group. Two studies examined weight stigma threat in a novel application using a menu-ordering paradigm. In Study 1 (N = 174), overweight participants under stigma threat ordered menu items for dinner that were higher in calories than overweight participants not under threat and nonoverweight participants. When calorie information was presented on the menu, however, overweight participants under stigma threat ordered menu items containing fewer calories than overweight participants who ordered from a conventional menu (Study 2, N = 100). Public health evidence of the overall effectiveness of menu-labeling has been mixed, and psychological processes may illuminate when, why, and how menu labeling influences food choices. This research suggests that weight stigma threat can lead to stereotype-disconfirming behavior when calorie information is used as a tool to assist self-regulation. At a time when obesity levels are high and weight bias is rampant, these findings have important implications for the obesity epidemic, weight loss efforts, and obesity intervention policies.

A Dark Side of Coping with Chronic Illness Stigma at Work

Workers with chronic health conditions may feel stigmatized at work, where ill health is thought to conflict with productivity and reliability. Threat of stigmatization is a stressor that can lead to strains. Certain responses to stigma threat (coping strategies) may also play a fundamental role in the strain process. We hypothesized that threat of stigmatization based on chronic illness would relate to job-induced tension and absenteeism, and that these relationships would be mediated by work-related engagement and disengagement coping. Additionally, we identified two potential moderators of these mediated relationships: work centrality and continuance commitment. We surveyed 315 individuals who were working at least 30 hours per week and had at least one chronic illness or health condition. As expected, stigmatization threat significantly related to both job-induced tension and absenteeism. Also, work-related engagement coping mediated the relationship between stigma threat and job-induced tension, and ...

Drinking and working in a cantina: misrecognition and the threat of stigma

Poor women are often compelled to accept jobs that jeopardise their health and their social reputations. Cantineras are recently immigrated Latinas employed in working-class Latino bars (cantinas) where they are hired as waitresses to earn sales commissions from beer purchased for them by male clients seeking female companionship. Narratives solicited from 31 cantineras revealed the work subculture of local cantinas, where drinking is a primary work obligation and where men expect sexual favours as a quid pro quo for beers they buy. This paper describes strategies that cantineras adopt to downplay their drinking and to disguise sex-trading practices. This distortion or ‘misrecognition’ of work-related practices functions to manage cantineras' fear of being stigmatised as workers and devalued as individuals. We argue that misrecognition in this context represents more than simple attempts at denial or to uphold a public image. Rather, it is a strategy employed by cantineras in order to function adaptively under oppressive work circumstances. Confronting stigma leads cantineras to adopt social and cognitive strategies that, while minimising social damage in the near term, can lead to devastating health and social consequences over time.

From personal tragedy to personal challenge: responses to stigma among sober living home residents and operators.

Sober living homes for people attempting to maintain abstinence from alcohol and drugs can act as a buffer against the high rates of substance misuse that are endemic to many urban environments. Sober living homes and other group homes for people with disabilities have faced persistent opposition from neighbourhood associations, which raises the question of stigma. This article describes the responses of sober living home residents and operators to the threat of stigma across a diverse set of neighbourhoods. Ten focus groups were conducted with 68 residents and operators of 35 sober living homes in Los Angeles County, California, between January 2009 and March 2010. Results showed that few residents reported experiences of blatant stigmatisation by neighbours; however, they were well aware of the stereotypes that could be ascribed to them. Despite this potential stigma, residents developed valued identities as helpers in their communities, providing advice to neighbours whose family or friends had substance use problems, and organising community service activities to improve the appearance of their neighbourhoods. With their attention to local context, sober living home residents and operators challenge the personal tragedy approach of much traditional advocacy on health-related stigma.

Stigma-Threat Motivated Nondisclosure of Sexual Assault and Sexual Revictimization

The purpose of the study was to assess sexual assault survivors' nondisclosure motivations, including stigma threat, and their impact on revictimization risk. The authors describe data from a prospective study of 144 female, undergraduate sexual assault survivors, most of whom had been assaulted by acquaintances and only one of whom had officially reported her experience to police. As part of a large-scale investigation, participants described during individual interviews why they had not reported their experiences to law enforcement authorities. Open-ended responses were coded into five reliable content themes, one of which was stigma-motivated nondisclosure, or stigma threat. Results indicated that stigma threat prospectively predicted sexual revictimization during a 4.2-month follow-up period. Moreover, results of mediation analyses suggested that decreased posttraumatic growth during the course of the study accounted for the relationship between stigma threat and survivors' revictimizations. Discussion focuses on advances to the sexual revictimization research (e.g., the importance of assessing subjective/perceptual in addition to objective/factual characteristics of assaults and their social repercussions) and to posttraumatic growth research, with data highlighting for the first time an important health correlate (i.e., sexual revictimization) of sexual assault survivors' perceived (lack of) posttraumatic growth. In addition, recommendations are provided for primary (social-level) prevention as well as for secondary prevention, that is, formal and informal support provided to sexual assault survivors.

`I'd rather not take Prozac': stigma and commodification in antidepressant consumer narratives

This article explores the idea that narrative is the primary vehicle through which antidepressant consumers negotiate their sense of identity and reality. Antidepressant consumers represent a unique consumer culture because of the stigma that society attaches to mental illness. Recent media attention, including direct to consumer (DTC) advertising, appears to decrease the stigma surrounding antidepressant use while at the same time commodifying and branding them for mass consumption. Antidepressant consumers must negotiate the threat of stigma and the threat of commodification through the process of constructing narratives. Exploring the narrative process of identity negotiation reveals how the interconnected cultural processes of stigma and commodification are undergoing historical shifts. Among these shifts are the intensification of branding and an expansion of consumer culture. Implications for health promotion and further research are discussed.

Calculating the Risks and Benefits of Disclosure in African American Women Who Have HIV

To identify the processes involved in and the patterns of disclosure of their HIV diagnosis reported by African American women. Qualitative descriptive. Southeastern United States; nurse visits in the homes of the participants. Forty-eight African American women who were HIV-positive and were primary caretakers of young children. Field notes were analyzed using content analysis. Once the women learned they had HIV, they were faced with the issue of determining "what is at stake" in telling others of their diagnosis. This dilemma was characterized by the threat of stigma, feelings of shame, and the concurrent need for support. The women determined a calculus of disclosure in determining to whom and when to reveal their HIV diagnosis. This calculus involved a careful evaluation of the risks and benefits involved in disclosing their illness. Risks of telling were fueled by societal and experienced stigma associated with HIV, whereas the benefits were primarily fueled by personal needs. The calculus of disclosure was a recursive process, with decisions made and remade over time. Disclosure patterns ranged from secretive to full disclosure. Issues related to stigma and therefore to disclosure of a diagnosis of HIV are highly relevant to HIV-positive African American women. Nurses have an important role in supporting women regarding their disclosure decisions.