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PubMed1997

Epilepsy in Pakistan: stigma and psychosocial problems. A population-based epidemiologic study.

PURPOSE: To assess the stigmatization and psychosocial problems of persons with epilepsy in Pakistan. METHODS: A population-based, cross-sectional epidemiologic study of 241 persons with epilepsy identified from an at-risk population of 24,130 individuals (64.7% from urban and 35.3% from rural areas). Of these patients, 77% suffered from recurrent non-febrile generalized convulsions. We evaluated degree of stigmatizations (i.e., avoidance by friends, neighbors, and others), and the effect of epilepsy on other psychosocial aspects (e.g., marriage), and also the relationships between gender and level of education of the patients, and stigmatization. RESULTS: Patients with epilepsy in Pakistan do not appear to be highly stigmatized, but their education and grades are affected by the disorder. They have difficulty performing activities of daily living and find it hard to make decisions about whether to marry or to have children. Women believed that they were more dangerous to others, received less help from their families, and, more frequently than men, encouraged others to avoid them. Women were also more likely than men to express the belief that people with epilepsy should not marry, but in fact, women more frequently married as compared men-a fact influenced by social and cultural pressures, including pressure from family, because it is nearly always the responsibility of the parents to arrange the marriage of a daughter. Influence of education indicates that people with epilepsy who have higher education, as compared with those with less education, had fewer children, were less often avoided by their classmates and neighbors, had fewer problems with plans for education, less frequently encouraged others to avoid them, were more frequently married, and believed that they were more dangerous to others. Most people believed that their conditions had a physical basis; only 3.1% attributed their epilepsy to supernatural causes. CONCLUSIONS: Stigmatization regarding epilepsy has not been proven to be an important feature in the culture of Pakistan because none of the observations are statistically significant as per P-value.

Attitude to Health↗
PubMed2006

Continuities and discontinuities in the experiences of felt and enacted stigma among women with HIV/AIDS.

In the post-1996 era, the effectiveness of antiviral therapies (such as highly active antiretroviral therapy [HAART]), which transformed HIV/AIDS into a more manageable disease, raised expectations that the disease's stigma would decrease. The authors compared focused-interview data from a pre-HAART (1994 to 1996) and a HAART-era (2000 to 2003) sample of African American, Puerto Rican, and White women living with HIV/AIDS to identify changes in stigma experiences and suggest reasons for continued stigmatization. In both eras, general stereotypes about HIV/AIDS, as well as gender- and race-related stereotypes about the disease, were identified. Internalizing any of these stereotypes was a necessary and sufficient condition for feeling stigmatized. Instances of enacted stigmatization were more frequent and intense in the pre-HAART era. Nevertheless, misinformation and irrational fears of contagion, which triggered stigmatizing behavior, persisted into the HAART era. This analysis revealed that although enacted stigmatization has decreased slightly, felt stigma remains a primary adaptational challenge facing women with HIV/AIDS.

Adult↗
PubMed2003

Courtesy stigma--a focus group study of relatives of schizophrenia patients.

BACKGROUND: Stigmatization of people with mental illness has been investigated in numerous studies. Little research, however, has been done to explore how relatives of people with schizophrenia perceive and experience stigmatization and how they can fight such stigmatization. METHOD: Aiming to explore stigma from the perspective of relatives of people with schizophrenia, focus group interviews were conducted with 122 members of advocacy groups from different parts of Germany. Focus group sessions were tape- and video-recorded and transcribed. Transcripts were coded using an inductive method, generating categories (domains) from the material. RESULTS: The analysis of focus group data shows that, contrary to previous research findings, discrimination and disadvantages encountered by relatives of schizophrenia patients reach far beyond the spheres of direct social interaction and access to social roles. Our study revealed two additional domains in which relatives encounter stigmatization: structural discrimination and public images of mental illness. Furthermore, psychiatry has been identified as one important source of stigma. Relatives also suggested numerous anti-stigma interventions. These can be grouped into five main categories: communication measures, support for the ill and their relatives, changes in mental health care, education and training, and control and supervision. DISCUSSION: Based on our findings,ways of how relatives of schizophrenia patients and mental health professionals can fight against stigma are discussed.

Adult↗
PubMed2006

Perceptions of a South African schizophrenia population with regards to community attitudes towards their illness.

BACKGROUND: With the worldwide shift towards a more community-based psychiatric service delivery approach, stigma and the issues surrounding it have received much attention. However, very little South African data exist and the aim of our study was therefore to investigate the experience of internalized stigma in a South African schizophrenia population with specific emphasis on abuse as a form of stigmatization. METHODS: A total of 100 subjects at various stages of schizophrenic illness were subjected to a the Internalized Stigma of Mental Illness scale (ISMI) that was modified to include six items focusing specifically on investigating the experience of stigmatization within the South African context. RESULTS: A high overall degree of stigmatization was perceived by most subjects, but not equally so for all ISMI areas. When looking at the modified items, 29% felt media-influence to be negative, this seemed to be specifically true for those with matriculation and higher as well as a home-language other than Afrikaans. Thirty nine percent indicated that they had been victims of physical abuse due to their mental illness, with the data suggesting that especially Xhosa-speaking patients, male subjects and those with more admissions and a longer duration of illness experienced this excessively. DISCUSSION: Our study confirmed a high overall degree of perceived stigmatization as well as suggesting some evidence for cultural influences on stigma. It was the first to provide South African data and as such can be regarded as central to our efforts in restructuring psychiatric services and clinical practices in a way that would minimize the effects of stigma and ultimately benefit our clients.

Adult↗
PubMed2004

[Stigma experiences of patients with obsessive compulsive disorders].

BACKGROUND: Only in recent years has research shown interest in stigma experiences of patients with mental disorders. However, subjective experiences of patients with OCD have not been published until now. METHOD: Fifty-one patients with OCD were questioned about anticipated and actual stigmatization experiences as well as their stigma coping strategies, using a questionnaire especially developed for this study. RESULTS: Most of the patients expected negative reactions from their environment. Eighty per cent of the respondents were convinced that they would be rejected at work when it became known that they are mentally ill. Two thirds of the respondents feared that they would be rejected in a partnership. Concrete stigmatization was rarely reported by patients with OCD. Contrary to patients with depression and schizophrenia, the group of patients with OCD showed some differences between anticipated and actually experienced stigmatization. Concealing is a relevant strategy for dealing with the illness for three quarters of the respondents. CONCLUSION: Possibilities of reducing stigmatization and discrimination because of mental illness in general and OCD in particular are discussed.

Adaptation, Psychological↗
PubMed2005

Transmitting tissue ECM distribution and composition, and pollen germinability in Sarcandra glabra and Chloranthus japonicus (Chloranthaceae).

BACKGROUND: and Aims Free-flowing surface exudates at the stigmatic (wet versus dry stigma) and adaxial epidermis at the site of angiospermy in carpels of Chloranthaceous species have been proposed to comprise a continuous extracellular matrix (ECM) operating in pollen tube transmission to the ovary. The aim of this research was to establish the spatial distribution and histo/immunochemical composition of the ECM involved in pollen tube growth in Sarcandra glabra and Chloranthus japonicus (Chloranthaceae). METHODS: Following confirmation of the pollen tube pathway, the histo/immunochemical make-up of the ECM was determined with histochemistry on fresh tissue to detect cuticle, esterase, proteins, pectins, and lipids and immunolocalization at the level of the TEM on sections from cryofixed/freeze-substituted tissue to detect molecules recognized by antibodies to homogalacturonans (JIM7, 5), arabinogalactan-proteins (JIM13) and cysteine-rich adhesion (SCA). KEY RESULTS: Pollen germinability is low in both species. When grains germinate, they do so on an ECM comprised of an esterase-positive cuticle proper (dry versus wet stigma). Pollen tubes do not track the surface ECM of stigma or adaxial epidermal cells at the site of angiospermy. Instead, tubes grow between stigmatic cells and subsequently along the inner tangential walls of the stigmatic and adaxial carpel cells at the site of angiospermy. Pollen tubes enter the ovary locule at the base of the funiculus. The stigmatic ECM is distinct by virtue of the presence of anti-JIM5 aggregates, lipids, and a protein recognized by anti-SCA. CONCLUSIONS: The Chloranthaceae joins a growing number of basal angiosperm taxa whereby pollen tubes germinate on a dry versus wet stigma to subsequently grow intercellularly en route to the ovary thereby challenging traditional views that the archetype pollen tube pathway was composed of the surface of stigma and adaxial epidermal cells covered with a free-flowing exudate.

Extracellular Matrix↗
PubMed1973

The Nutritional Role of Pistil Exudate in Pollen Tube Wall Formation in Lilium longiflorum: II. Production and Utilization of Exudate from Stigma and Stylar Canal.

Detached pistils of Lilium longiflorum were labeled with d-glucose-U-(14)C 24 hours after anthesis and then sampled for the next 6 days to determine the appearance of label into exudate from the stylar canal and the stigmatic surface of the pistil. Results were obtained with unpollinated cv. Ace pistils and pollinated cv. Ace pistils, selfed or crossed (cv. Croft pollen). Limited data were also obtained on cv. Croft pistils, selfed or crossed (cv. Ace pollen).Exudate appeared in the canal and on the stigmatic surface soon after anthesis. In unpollinated pistils it continued to accumulate for about 5 days in the canal and for the full term of the experiment, 7 days, on the stigmatic surface. Canal exudate eventually mixed with stigmatic exudate in unpollinated pistils. Pollination interrupted the flow of exudate, and a portion of the pistil secretion product was diverted toward the synthetic requirements of the developing pollen tubes. Two days after pollination, the specific radioactivity of pollen tube cytoplasm had reached a level comparable to canal exudate. Twenty-four hours later, the specific radioactivity of pollen tube wall substance was about 80% of the value found in canal exudate. Similar patterns of (14)C incorporation and similar carbohydrate contents were obtained from self- and cross-pollinated pistils, although the former contained pollen tubes of less than one-half the length of the latter.

Journal Article↗
PubMed1998

Identification of residues in a hydrophilic loop of the Papaver rhoeas S protein that play a crucial role in recognition of incompatible pollen.

The self-incompatibility response involves S allele-specific recognition between stigmatic S proteins and incompatible pollen. This response results in pollen inhibition. Defining the amino acid residues within the stigmatic S proteins that participate in S allele-specific inhibition of incompatible pollen is essential for the elucidation of the molecular basis of the self-incompatibility response. We have constructed mutant derivatives of the S1 protein from Papaver rhoeas by using site-directed mutagenesis and have tested their biological activity. This has enabled us to identify amino acid residues in the stigmatic S proteins of P. rhoeas that are required for S-specific inhibition of incompatible pollen. We report here the identification of several amino acid residues in the predicted hydrophilic loop 6 of the P. rhoeas stigmatic S1 protein that are involved in the inhibition of S1 pollen. Mutation of the only hypervariable amino acid, which is situated in this loop, resulted in the complete loss of ability of the S protein to inhibit S1 pollen. This clearly demonstrates that this residue plays a crucial role in pollen recognition and may also participate in defining allelic specificity. We have also established the importance of highly conserved amino acids adjacent to this hypervariable site. Our studies demonstrate that both variable and conserved amino acids in the region of the S protein corresponding to surface loop 6 are key elements that play a role in the recognition and inhibition of incompatible pollen in the pollen-pistil self-incompatibility reaction.

Alleles↗
PubMed2005

Living with Marfan syndrome: coping with stigma.

Social stigmatization can disrupt the ability of individuals with genetic conditions to successfully adapt to their situation. We offer data on perceptions of stigma from a cross-sectional survey of 174 adults with Marfan syndrome by self-report. Fifty-six respondents (32%) reported feeling discriminated against or socially devalued because of having Marfan syndrome. Endorsement of discrimination was significantly correlated with having depressive symptoms, low self-esteem, the view Marfan syndrome has had significant negative consequences on one's life, striae, and perceptions of workplace discrimination. Nearly 30% of respondents reported withdrawing from social situations that they anticipated would lead to feeling stigmatized, and 25% reported electing to keep their condition secret in potentially stigmatizing situations. Over 50% of respondents reported educating others about Marfan syndrome as a means of coping with their feelings of stigma, and endorsement of education was correlated with viewing involvement in the National Marfan Foundation as important. Instances of workplace discrimination were perceived by 20% of respondents, and 23% reported that they remained in a dissatisfying job due to having Marfan syndrome. Genetics professionals should actively engage patients with Marfan syndrome in discussions about social stigmatization and encourage use of coping strategies aimed at enhancing quality of life.

Adaptation, Psychological↗
PubMed2006

Production of reactive oxygen species and reactive nitrogen species by angiosperm stigmas and pollen: potential signalling crosstalk?

Angiosperm stigmas exhibit high levels of peroxidase activity when receptive to pollen. To explore possible function(s) of this peroxidase activity we investigated amounts of reactive oxygen species (ROS), particularly hydrogen peroxide, in stigmas and pollen. Because nitric oxide (NO) was recently implicated in pollen tube growth, we also investigated amounts of NO in pollen and stigmas. Reactive oxygen species accumulation was assessed with confocal microscopy and light microscopy using ROS probes DCFH2-DA and TMB, respectively. NO was assayed using the NO probe DAF-2DA and confocal microscopy. Stigmas from various different angiosperms were found to accumulate ROS, predominantly H2O2, constitutively. In Senecio squalidus and Arabidopsis thaliana high amounts of ROS/H2O2 were localized to stigmatic papillae. ROS/H2O2 amounts appeared reduced in stigmatic papillae to which pollen grains had adhered. S. squalidus and A. thaliana pollen produced relatively high amounts of NO compared with stigmas; treating stigmas with NO resulted in reduced amounts of stigmatic ROS/H2O2. Constitutive accumulation of ROS/H2O2 appears to be a feature of angiosperm stigmas. This novel finding is discussed in terms of a possible role for stigmatic ROS/H2O2 and pollen-derived NO in pollen-stigma interactions and defence.

Arabidopsis↗
PubMed1996

Women with noise-induced hearing-loss: an invisible group?

The aim of this qualitative study was to describe, from the perspective of women with noise-induced hearing loss (NIHL), their experiences of noise as a threat to health and their having to live with a hearing disability, i.e. behaviours, thoughts and emotions in auditory demanding situations. Ten women, patients with NIHL at the Department of Audiology, Borás' Hospital in Sweden, were selected to form a heterogeneous sample. A taped in-depth interview, lasting from 45 minutes to 1 hour, was conducted with each woman. The verbatim transcribed interviews were consecutively analysed using a method influenced by the tradition of grounded theory. Four categories emerged in the process of analysis. These categories were labelled: lack of awareness, ambivalence, controlling and avoiding coping strategies and stigmatization. The category 'lack of awareness' concerned the women's perceptions of the risks of noise on hearing, the lack of efforts on the part of the women to apply for financial compensation for their NIHL, the lack of an awareness of individual's right to have healthy work-place and to receive professional help for hearing impairment. Also lacking was the concept that hearing impaired individuals have the right to participate in the community on similar conditions as non-hearing impaired people. This lack of awareness was identified as a core category relating to the other categories: ambivalence, controlling and avoiding coping strategies and stigmatization. The women's expressions indicated ambivalence concerning the cause of the hearing disability and, also, how to manage the consequences of it: the women in the study seemed to alternate between feelings of hopelessness/resignation and a state of acceptance of the hearing disability. Furthermore, the women alternated between blaming themselves and blaming others for the cause of the hearing loss, indicating a change between internal and external locus of control. Also, the women alternated between controlling and avoiding strategies in coping with demanding auditory situations. The coping strategy chosen by the women in a specific situation intended to prevent or minimize stigmatization, i.e. 'to pass as normal' and thereby to maintain a positive self-image of normality. Despite this, the women often perceived negative and stigmatizing attitudes from others, which reinforced their feelings of ambivalence in how to manage the situation. The hypothesis based on the present pilot study, that women with NIHL are more likely to pass themselves off as normal hearing and therefore might be less likely to be reported in studies of NIHL than men, needs to be further tested in a larger sample.

Aged↗
PubMed2000

[Depression and stigma].

AIM: Until now, the interest of stigma research in psychiatry has been predominantly focused on schizophrenia. The fact that individuals suffering from depression may also be exposed to stigmatization, on the other hand, has received little attention. METHOD: Using the scales for the assessment of perceived stigma and stigma coping developed by Link et al., 39 patients who had received in-patient treatment for a depressive episode were questioned 4-7 months after their discharge from hospital. RESULTS: 45% of the respondents reported concrete instances of stigmatization. Respondents expected to find discrimination and devaluation on the part of their environment especially with regard to their changes on the labour market. The vast majority of those questioned was in favour of keeping the fact that one had experienced a mental illness or had received psychiatric treatment to themselves. Further, our results show a tendency to avoid situations which might imply an increased risk of stigmatization. While respondents considered it important to facilitate a better understanding of mental illness on the part of their closest friends and relatives, the idea of being actively involved in educating the lay public received comparatively little support. CONCLUSION: Although individuals suffering from depression may be confronted with less rejection or resentment than schizophrenic patients or patients with substance use disorder, this does not imply that they do not have to struggle with the problem of stigmatization.

Adaptation, Psychological↗
PubMed2005

A stigmatizating attitude towards psychiatric illnesses is associated with narcissistic personality traits.

UNLABELLED: This study investigates the personality characteristics of individuals who have stigmatizing attitudes towards people with mental illness. MATERIAL AND METHOD: 700 final-year university students completed the "Dangerousness Scale,' the "Affective Reaction Scale" and 88 items of the "Defense Style Questionnaire" (DSQ). RESULTS: The results showed that there is a strongly positive correlation between the use of narcissistic defenses and the tendency to stigmatize. In contrast, those with mature defenses have a strong tendency not to stigmatize. CONCLUSIONS: The findings suggest that personality traits should be considered in efforts to understand stigmatization.

Adolescent↗
PubMed1998

Perceived deprivation of social touch in psoriasis is associated with greater psychologic morbidity: an index of the stigma experience in dermatologic disorders.

Touch is a powerful medium of social validation. Patients with skin disorders often experience social rejection when people avoid touching them, possibly fearing contagion or filth. We examined the psychologic impact of the stigma experience among 137 patients with moderate to severe psoriasis; 26.3 percent of patients reported that during the previous month they had experienced an episode when "people made a conscious effort not to touch them" because of their psoriasis. The stigmatized group did not have greater psoriasis severity than the non-stigmatized control group. However, in contrast to the non-stigmatized group, the stigmatized group had higher (P = 0.0003) depression scores (in the range for clinical depression, as measured by the Carroll Rating Scale for Depression), by stepwise logistic regression analysis using a wide range of psychopathologic measures as the independent variables. These findings underline the profound impact of the stigma experience in psoriasis, and possibly other dermatologic conditions that are associated with social stigma.

Adaptation, Psychological↗
PubMed1990

The relationship between life events and mental health in homosexual men.

In a study to determine the extent to which stigmatization influences mental health in homosexual men, 80 homosexual men were administered the General Health Questionnaire and the Gay Affect and Life Events Scale. Data indicated that there were significant associations between life events and mental health; events related to AIDS had the highest correlations. However, general life event scales that included Finances and Work also were associated significantly with mental health, as previously reported in the general population. These data suggest that the impact of life events may be amplified by stigmatization and that degree of life change is associated closely with psychological dysfunction. It is concluded that life events that are related to both stigmatization and life change and related emotional distress are significant predictors of psychology dysfunction.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Losing face: sources of stigma as perceived by chronic facial pain patients.

The purpose of this paper is to identify potential sources of estrangement and feeling psychologically flawed as perceived by temporomandibular pain and dysfunction syndrome (TMPDS) patients. It is our hypothesis that a primary source of patients' perceived stigma results from pejorative labeling by clinicians. The data come from a study of 151 women TMPDS patients. The results show that the lack of a known etiology or pathogenesis for the condition allows the possibility of pejorative labeling by influential others such as physicians and dentists that in turn causes TMPDS sufferers to feel stigmatized. Stigmatization is not the result of clinical factors per se or personality problems. Perceived stigma associated with TMPDS leads to the same sorts of strained interactions and feeling estranged that have been shown to be typical of people with other stigmatized conditions. These strains and feelings in turn may contribute to ill health.

Adaptation, Psychological↗
PubMed1997

[Illness experience and treatment seeking behavior of psoriasis patients].

We analyzed how psoriasis patients sought professional help and correlated it to their illness attitudes and feeling of stigmatization. Semi-structured interviews of 400 patients were reanalyzed to identify homogeneous groups concerning initial reactions at first manifestations of the disease. Four groups ("isolated", "stigmatized", "socially supported" and "non-stigmatized" patients) were found and cross-tabulated with five resulting groups of a second cluster-analysis concerning the "style" of the seeking behaviour of professional and paraprofessional help and medical measures against the psoriasis ("multi-users", "arranged mini-users", "waiting-room patients", "optimists" and "self-therapists"). We were able to describe typical courses of illness behaviour depending on the initial reaction. The results are discussed with regard to the desirable identification of problematic patients within professional care units.

Adaptation, Psychological↗
PubMed2005

Isolation and characterization of a polymorphic stigma-specific class III peroxidase gene from Senecio squalidus L. (Asteraceae).

A novel stigma-specific class III peroxidase gene, SSP (Stigma-Specific Peroxidase), has been isolated from the self-incompatible daisy Senecio squalidus L. (Asteraceae). Expression of SSP in flower buds is developmentally regulated, with maximal levels of expression coinciding with anthesis, when stigmas are most receptive to pollen and when self-incompatibility is fully developed. In situ hybridization revealed SSP expression to be localized exclusively to the specialized secretory epidermal cells (papillae) of the stigma, which receive and discriminate pollen. SSP is therefore the first tissue-specific and cell-specific peroxidase gene identified in a plant. SSP belongs to a distinct clade of class III plant peroxidases that possess two introns, instead of the more normal situation of three conserved introns. The deduced amino acid sequence of SSP revealed a 27 amino acid signal peptide, suggesting that the SSP protein is secreted to the cell wall of the stigmatic papillae. In-gel peroxidase activity assays showed that SSP has relatively low peroxidase activity compared to other, as yet uncharacterized, peroxidases present in stigmatic extracts. Six SSP alleles have been cloned from different lines of S. squalidus carrying a range of self-incompatibility (S)-alleles but there was no consistent association between the presence of a particular SSP allele and S-genotype indicating that SSP is not the female determinant of SSI in S. squalidus. Nevertheless, the precise expression of SSP in stigmatic papillae suggests that it may have a more general function in pollen-stigma interactions, or alternatively in protection of stigmas from pathogen attack. Extensive database screens have identified homologues of SSP in other plant species, but available expression data for these genes indicates that none are flower-specific, suggesting that SSP represents a new functional type of class III peroxidase specific to the stigma. We discuss the possible function(s) of S. squalidus SSP in pollen-stigma interactions and in protection of stigmas from pathogen attack.

Alleles↗