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PubMed2007

Help-seeking behaviors of Chinese patients with schizophrenia admitted to a psychiatric hospital.

PURPOSE: To investigate the help-seeking behaviors and related factors of Chinese psychiatric inpatients with schizophrenia. METHOD: Two hundred and two patients with schizophrenia (ICD-10) were enrolled in this study. A locally-developed, semi-structured questionnaire was used to collect data, including data on illness and help-seeking histories from patients, informants, and medical records. RESULTS: Among 202 inpatients, 120 patients (59.4%) had sought help from at least one type of non-psychiatric facility (NPF), and 82 patients (40.6%) went to a psychiatric hospital directly. Among the NPFs they contacted, 66 patients (32.7%) tried traditional Chinese medicine (TCM) from licensed practitioners (including acupuncturists), 64 (31.7%) chose general hospitals (including 9 who went to emergency departments), and 52 (25.7%) sought help from qigong (breathing exercise) masters or other folk healing methods. The reasons for seeking treatment from NPFs varied; the most common ones included feeling shameful or stigmatized about going to psychiatric hospitals, inaccessibility to or unavailability of psychiatric hospitals, and fear of being incarcerated or receiving electric shock treatment. CONCLUSION: A substantial proportion of psychiatric inpatients in China seek help from non-psychiatric facilities and/or folk healing methods. Feeling shameful or stigmatized, inaccessibility to and/or unavailability of psychiatric services are among the most common barriers to seeking psychiatric treatment. Patients who sought psychiatric help directly are likely to be female, with a chronic onset of illness, a mixed syndrome of positive and negative symptoms, or a better economic status.

Adult↗
PubMed1987

Public awareness of AIDS in Rwanda.

AIDS is a rapidly growing epidemic in Kigali, Rwanda. To understand the level of public awareness of AIDS in that city, 33 informants (15 men and 18 women) were interviewed during September, 1985. Most (66.7%) said that they first heard of the disease only within the previous eight months. About half (46.9%) could not mention one or more AIDS symptoms. Younger informants and women reported less knowledge of AIDS symptoms. While nearly everyone recognized AIDS as a stigmatized disease, most informants apparently did not know why it is stigmatized. Only about one-third of the informants (34.4%) could correctly state the mode of AIDS transmission. People who are at greatest risk for the disease, unmarried men and women, were least likely to know how it is transmitted. Half (50.0%) of those informants who responded to the question of the origins of AIDS said that it began in 'America.' While many informants are frightened by the disease, no one has yet changed their sexual behavior as a response to the epidemic. All informants agreed that more information about AIDS should be made available in Rwanda. Preventive measures against the spread of AIDS are urgently needed in central Africa.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Culture, meaning and disability: injury prevention campaigns and the production of stigma.

The potential production of stigma through health promotion campaigns is a problem that has not received attention in the current literature on the sociology of health promotion. Cultural production studies can shed light onto the ways in which injury prevention campaigns, and public health campaigns more generally, may call for life-saving interventions at the social expense of people with disabilities or other stigmatized conditions. Questioned here are not only the presumed benefits of health promotion campaigns, but also our conventional understandings of 'health' and 'disability'. This paper examines the way in which cultural production studies can contribute to a theory of the production of stigma by public health professionals. One view of cultural production views culture as a reflection of economic relationships between the dominant and the dominated. A second approach emphasizes the 'reception' of cultural works, or how audiences experience culture. Third, cultural production is sometimes analyzed in terms of texts, or the content of cultural artifacts. Insight into the dilemmas of health promotion can be provided by analyzing health promotion strategies in terms of their production, reception, and content as cultural works. Focusing on the case study of injury control and disability rights, health promotion campaigns are seen as potentially contributing to the production of stigma for people who already possess the attributes targeted for prevention. This analysis moves toward a broader theoretical foundation with which to grasp the unintended, even harmful consequences of prevention strategies, and the shared and oppositional interests of people with stigmatized conditions, targeted audiences of prevention, and public health advocates.

Attitude to Health↗
PubMed1994

The boundaries of the self and the unhealthy other: reflections on health, culture and AIDS.

Most accounts of the cultural stigmas associated with AIDS have not adequately considered the meanings through which the stigmatizing self imagines his/her difference from the stigmatized other. This paper argues that 'health' is a key concept in the fashioning of identity for the modern and contemporary middle class and that the 'unhealthy' come to be represented as the other of this self. 'Healthy' and 'unhealthy,' however, must be understood both in their biomedical meanings and in their implicit metaphorical meanings. The 'unhealthy,' 'contagious,' 'sexually deviant,' and 'addicted-minority' other--all condensed in the negative symbolism of AIDS--have become images which are mobilized as part of a cultural politics of reconstructing the self in conformity with intensified mandates for self-control. The expulsion of 'unhealthy' meanings from the self, an act of patrolling the borders of identity, finds its projected physical location in the figure of the person with HIV-AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Prediction of attitudes towards restrictive AIDS policies: a structural equation modelling approach.

The purpose of the study was to test a prehypothesized structural equation model of predictors of attitudes towards restrictive AIDS policies. It was assumed that such attitudes ae under influence of both cognitive processes and more general attitudinal structures. The hypothesized model was tested against empirical data from a nation-wide survey of Norwegian adults, including 543 males and 577 females. The proposed model fit the data reasonably well. As expressed by total effect education was the most important predictor of AIS policy attitudes. However, the most notable findings appeared to be the strong direct effect exerted by attitudes towards minorities. Misinformation about AIDS transmission and sexual attitudes also exerted significant direct effects upon AIDS policy attitudes. The results clearly demonstrate that AIDS policy attitudes are not cognitively based alone but also reflect more general attitudinal structures. Thus choosing a strategy which is primarily based on increasing the flow of factual AIDS information in order to remedy casual contact beliefs, will not be sufficient to prevent stigmatized and negative AIDS attitudes. This is more evident in that beliefs about modes of AIDS transmission, as reported in this study, seem themselves to have a symbolic component. A perspective which includes the idea of the value expressive functions of AIDS related attitudes seem relevant. Consequently, educational strategies which directly address prejudiced attitudes towards minority groups may prove particularly appropriate in the prevention of stigmatized and restrictive AIDS attitudes.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Perception and social consequences of tuberculosis: a focus group study of tuberculosis patients in Sialkot, Pakistan.

Treatment defaulting is one of the major causes of the failure of TB control programs. In Bethania Hospital, Sialkot, defaulting rates are high: 72% for the standard 12 months course and 56% for the 8 months course. Attrition is especially important in the first weeks of treatment: < 70% of the patients start the 10th week of treatment. A focus group discussion study has been carried out to gain a better understanding of the impact of social stigmatization, treatment cost and pregnancy on defaulting. The study population consisted of 3 male and 3 female groups each with 8 hospitalized TB patients. The study shows that TB is perceived as a very dangerous, infectious and incurable disease. This perception has many social consequences: stigmatization and social isolation of TB patients and their families: diminished marriage prospects for young TB patients, and even for their family members: TB in one of the partners may lead to divorce. Due to fear patients often deny the diagnosis and reject the treatment. While both male and female TB patients face many social and economical problems, female patients are more affected. Divorce and broken engagements seem to occur more often in female patients. Females are usually economically dependent on their husbands and family in law, and need their cooperation to avail of treatment. The belief that pregnancy enhances the risk for relapse decreases their marriage prospects. Pregnancy is also a reason for stopping TB treatment as both are considered as incompatible. The findings of this study reveal the urgent need for a health education campaign to convince the general population that tuberculosis is curable. All health care providers should act as destigmatizers.

Adolescent↗
PubMed1994

Public reactions towards people with AIDS: an attributional analysis.

This article addresses the issue of stigmatization and discrimination towards people with AIDS (PWAs) using Weiner's attributional theory of motivation and emotion. In a field experiment, subjects responded to vignettes describing patients with AIDS, syphilis, lung cancer or tuberculosis. In these vignettes, the onset of the diseases was either described as personally controllable or as uncontrollable. Results show that although attributional variables do account for a significant amount of variance in helping behavior and emotions towards PWAs, other variables such as the incurability of the disease, the risk of infection and associations with (homo)sexuality, may be more useful in explaining reactions to PWAs. Implications for education tailored at the prevention of the stigmatization of PWAs are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Theory and methodology for utilizing genes as biomarkers to determine potential biological mixtures.

PURPOSE: Genetically determined mixture information can be used as a surrogate for physical or behavioral characteristics in epidemiological studies examining research questions related to socially stigmatized behaviors and horizontally transmitted infections. A new measure, the probability of mixture discrimination (PMD), was developed to aid mixture analysis that estimates the ability to differentiate single from multiple genomes in biological mixtures. METHODS: Four autosomal short tandem repeats (STRs) were identified, genotyped and evaluated in African American, European American, Hispanic, and Chinese individuals to estimate PMD. Theoretical PMD frameworks were also developed for autosomal and sex-linked (X and Y) STR markers in potential male/male, male/female and female/female mixtures. RESULTS: Autosomal STRs genetically determine the presence of multiple genomes in mixture samples of unknown genders with more power than the apparently simpler X and Y chromosome STRs. Evaluation of four autosomal STR loci enables the detection of mixtures of DNA from multiple sources with above 99% probability in all four racial/ethnic populations. CONCLUSIONS: The genetic-based approach has applications in epidemiology that provide viable alternatives to survey-based study designs. The analysis of genes as biomarkers can be used as a gold standard for validating measurements from self-reported behaviors that tend to be sensitive or socially stigmatizing, such as those involving sex and drugs.

Black or African American↗
PubMed2006

Stigma, discrimination and the health of illicit drug users.

Persons who use illicit drugs are stigmatized in the United States. The conferral of a deviant social status on illicit drug users may serve to discourage use. However, stigmatization may also adversely affect the health of those who use illicit drugs, through exposure to chronic stress such as discrimination and as a barrier to accessing care. We hypothesized that aspects of stigma and discrimination would be associated with mental and physical health among illicit drug users. Using street outreach techniques, 1008 illicit drug users were interviewed about stigma and discrimination related to their drug use, and their health. We measured discrimination related to drug use, alienation, perceived devaluation, and responses to discrimination and stigma. Health measures included mental and physical health measures from the Medical Outcomes Study Short Form-36, depression symptoms from the Center for Epidemiological Studies Depression scale, and a sum of health conditions. In adjusted models, discrimination and alienation were both associated with poorer mental health, and only discrimination was associated with poorer physical health. Angry responses to discrimination and stigma were associated with poorer mental health. The association of stigma and discrimination with poor health among drug users suggests the need for debate on the relative risks and benefits of stigma and discrimination in this context.

Adolescent↗
PubMed2005

Tuberculosis and urban growth: class, race and disease in early Phoenix, Arizona, USA.

Healthseekers [i.e., people seeking climactic cures from diseases, such as tuberculosis (TB)] migrated to the American West starting in the 19th century. Local officials, interested in promoting urban growth, capitalized on this phenomenon by aggressively advertising for healthseekers. This paper analyzes the case of TB in Phoenix, Arizona, USA during its period of early growth (1880-1946) to demonstrate how social constructions of disease intersected with political constructions of race and class to produce pathologized bodies and stigmatized places. Contradictions in Phoenix's pro-growth strategy are discussed in this paper, along with strategies employed by city leaders to 'solve' them. These strategies included an emergent discourse by those in power that served to construct race, class and place-based inequities. Further, ideological and spatial strategies were instantiated to ensure that other Phoenix residents did not 'see' the injustices being produced. The material results of these discursive strategies included dilapidated housing, a lack of urban infrastructure, and lack of health-care services for minorities and the poor in Phoenix. Those in power, in the name of private accumulation and urban growth, had constructed a context in which poor persons with TB were spatially isolated and socially stigmatized while wealthy whites with TB were socially, culturally and environmentally advantaged.

Arizona↗
PubMed2005

Stigma as a barrier to employment: mental disability and the Americans with Disabilities Act.

In a controversial expansion of workplace civil rights, the 1990 Americans with Disability Act (ADA) extended anti-discrimination protection to individuals with "mental impairments." One of the most critical barriers to the employment of individuals with mental disabilities is the degree of social stigma such disabilities incur, and there is compelling evidence that employers have stigmatizing attitudes and have discriminated against those with mental disabilities. This study examines the role played by stigma in employers' response to the 1990 Americans with Disability Act (ADA). A stratified sample of one hundred ninety employers were surveyed in 1996-1997 in a major Southern metropolitan area. Telephone interviews were completed with one hundred seventeen employers (response rate of 61.6%). The article describes employers' experiences with employees with mental disabilities and accommodations, specific employment practices, and attitudes towards those with mental disabilities. Stigma played an important role in conformity to the ADA (operationalized as either hiring or having specific recruiting policies for hiring individuals with mental disabilities). Furthermore, employers expressing coercive (fear of a lawsuit) as opposed to normative (belief that it is the right thing to do) rationales for compliance were more likely to hold stigmatized attitudes. Employers' beliefs about mental disability form a crucial foundation for truly supportive work environments (those that value difference and diversity), and further research is needed to determine if over time the ADA is successful in changing attitudes as well as behavior.

Commerce↗
PubMed2005

Emotional adjustment and concerns of Korean mothers of premature infants.

This study describes the emotional adjustment and concerns of 50 Korean mothers of premature infants from hospitalization through six weeks after discharge. Five themes emerged: self-blame, concern about the infant, reluctance to express negatives, fear of stigmatizing responses to the infant by others, and delayed joy in mothering. Three Korean cultural beliefs influenced mothers' responses to premature birth: maternal responsibility for infant outcomes, negative thoughts can lead to negative consequences, and stigmatization of prematurity. Results identify specific ways caregivers in Korea and other countries can provide culturally appropriate support for Korean mothers experiencing a premature birth.

Adaptation, Psychological↗
PubMed2006

A pilot of audio computer-assisted self-interview for youth reproductive health research in Vietnam.

PURPOSE: Several recent adolescent health studies in Vietnam have shown low levels of premarital sex among youth compared to neighboring countries and other regions of the world. One possible explanation for these findings is that adolescents in Vietnam are less willing to reveal their true behaviors. This study aims to assess the level of reporting of sensitive behaviors/events using three methods of survey data collection: face-to-face interviewer-administered (IA), paper-and-pencil self-administered (SA) and AudioComputerAssisted Self Interview (ACASI). METHODS: A randomized experiment was undertaken in Gialam, a suburb of Hanoi, among a sample of 2,394 youth ages 15 to 24 years. Respondents were randomly assigned to one of three interviewing methods, with females and males evaluated separately. RESULTS: ACASI showed certain advantages with regard to respondent attitudes and perceptions of sensitive topics. ACAI also revealed higher prevalence rates for sensitive and stigmatized behaviors. Among those in the pencil and paper survey group it is estimated that 12.9% of unmarried males and 3.4% of unmarried females have had premarital sex. The rate found by using ACASI is higher at 17.1% in males (95% CI: 13.5-21.4) and 4.5% in females (95% CI: 2.7-7.3). Using ACASI, unmarried males also reported higher levels of risky sexual relations. For example, 7.8% confirmed visiting sex workers compared with only 1.2% in SA group and 3.9% in IA group. Additionally, ACASI respondents reported having had more sex partners by age group, gender and marital status. CONCLUSIONS: When coupled with the emerging data from around the world, the present findings suggest that researchers should consider using ACASI for future studies dealing with sensitive and stigmatized topics.

Adolescent↗
PubMed2005

The experience of SARS-related stigma at Amoy Gardens.

Severe Acute Respiratory Syndrome (SARS) possesses characteristics that render it particularly prone to stigmatization. SARS-related stigma, despite its salience for public health and stigma research, has had little examination. This study combines survey and case study methods to examine subjective stigma among residents of Amoy Gardens (AG), the first officially recognized site of community outbreak of SARS in Hong Kong. A total of 903 residents of AG completed a self-report questionnaire derived from two focus groups conducted toward the end of the 3-month outbreak. Case studies of two residents who lived in Block E, the heart of the SARS epidemic at AG, complement the survey data. Findings show that stigma affected most residents and took various forms of being shunned, insulted, marginalized, and rejected in the domains of work, interpersonal relationships, use of services and schooling. Stigma was also associated with psychosomatic distress. Residents' strategies for diminishing stigma varied with gender, age, education, occupation, and proximity to perceived risk factors for SARS such as residential location, previous SARS infection and the presence of ex-SARS household members. Residents attributed stigma to government mismanagement, contagiousness of the mysterious SARS virus, and alarmist media reporting. Stigma clearly decreased, but never completely disappeared, after the outbreak. The findings confirm and add to existing knowledge on the varied origins, correlates, and impacts of stigma. They also highlight the synergistic roles of inconsistent health policy responses and risk miscommunication by the media in rapidly amplifying stigma toward an unfamiliar illness. While recognizing the intrinsically stigmatizing nature of public health measures to control SARS, we recommend that a consistent inter-sectoral approach is needed to minimize stigma and to make an effective health response to future outbreaks.

Adaptation, Psychological↗
PubMed2005

Epilepsy-associated stigma in sub-Saharan Africa: the social landscape of a disease.

Many studies in developed regions of the world have confirmed that stigma contributes substantially to the psychological and social burden of epilepsy. Relatively few studies of epilepsy-associated stigma have been conducted in Africa, where much of the world's burden of epilepsy exists. In sub-Saharan Africa (SSA), particularly in rural regions, close family ties, communal living situations, and traditional belief systems undoubtedly influence the expression of stigmatization. A review of the epidemiologic, anthropologic, and sociologic studies of epilepsy in SSA provides significant insights into how people with epilepsy (PWE) are perceived by their communities and families and how these perceptions translate into limited social and economic opportunities and possibly worsen the physical vulnerability of PWE in this region. The medical community is not exempt from the social process of stigmatization, and poor public health infrastructure and medical services undoubtedly contribute to the cycle of epilepsy-associated stigma through wide treatment gaps, poor seizure control, and high rates of seizure-related injury. In this review, we extrapolate data from existing studies of epilepsy in SSA coupled with our own experience providing epilepsy care in the region to give an overview of the social landscape of this common, devastating condition.

Africa South of the Sahara↗
PubMed2006

Zambian teachers: what do they know about epilepsy and how can we work with them to decrease stigma?

PURPOSE: Teachers play a central role in determining access to education and may mediate epilepsy-associated stigma. We developed and administered a teacher-specific survey to assess teachers' knowledge, attitudes, behaviors, and practices (KABPs) regarding epilepsy in Zambia and social and demographic determinants of KABPs. METHODS: In 2004, we surveyed 171 teachers in urban and rural regions using a 46-item questionnaire. Knowledge and tolerance composite scores were developed and analyses completed to identify demographic and social determinants of KABPs and evaluate whether generic tolerance questions were associated with stigmatizing practices. RESULTS: The response rate was 93% (n=159). Knowledge regarding epilepsy ranged broadly. Misattribution was evident for etiology (spirit possession 17.3%; contagion 28.2%; witchcraft 16.8%), and individuals with poorer knowledge were more likely to recommend traditional healers (p=0.0004) rather than physicians for epilepsy care. Higher knowledge was associated with higher tolerance (p=0.01). Tolerance was highest among urban residents (p=0.002) and individuals with personal familiarity/experience with epilepsy. More tolerant teachers were less likely to report stigmatizing practices, such as ejecting children with seizures from school. CONCLUSIONS: Teacher-targeted interventions aimed at reducing epilepsy-associated stigma and its sequelae in Zambia should include both an educational component and a social component in which teachers are exposed to a person or persons with the condition. Education programs led by person(s) with epilepsy may be ideal.

Adult↗
PubMedDate not supplied

Sexual dimorphism in minor physical anomalies in schizophrenic patients and normal controls.

The aim of the current study was to investigate the gender effecton minor physical anomalies (MPA) in schizophrenic patients and normal controls. Seventy-six schizophrenic patients (43 males and 33 females) and 82 normal control subjects (42 males and 40 females) were examined for MPA using a modified version of the Waldrop Physical Anomaly Scale. Men tended to be more stigmatized with MPA than women both in normal subjects and in schizophrenics (with this difference slightly expanding in schizophrenics). In both genders schizophrenic patients were significantly more likely to have MPA than normal controls, but the difference tended to be more pronounced in males. There was a tendency towards sex-related predilection for the increase of MPA in schizophrenics in terms of individual anomalies and topographic regions affected. Among schizophrenics, genders showed a somewhat opposite topography of MPA stigmatization, with relatively more pronounced peripheral dysmorphy in males and craniofacial dysmorphy in females. These data suggest greater vulnerability of the male fetus to endogenous or exogenous factors and different susceptibilities to developmental adversities in male and female schizophrenics. This finding is in accord with the increasing evidence that sex differences in the epidemiology of schizophrenia may be broader and more fundamental than previously thought.

Adolescent↗
PubMedDate not supplied

[Confusing clinical presentations and differential diagnosis of bipolar disorder].

An early recognition of bipolar disorders may have an important impact on the prognosis of this disorder according to different mechanisms. Bipolar disorder is nevertheless not easy to detect, the diagnosis being correctly proposed after, in average more than a couple of Years and three different doctors assessments. A short delay before introducing the relevant treatment should help avoiding inappropriate treatments (prescribing, for example, neuroleptics for long periods, antidepressive drugs each time depressive symptoms occurs, absence of treatment despite mood disorders), with their associated negative impact such as mood-switching, rapid cycling or presence of chronic side-effects stigmates. Furthermore, non-treated mood disorders in bipolar disorder are longer, more stigmatizing and may be associated with an increased risk of suicidal behaviour and mortality. Lastly, compliance, an important factor regarding the long term prognosis of bipolar disorder, should be improved when there is a short delay between correct diagnosis and treatment and onset of the disorder. We therefore propose to review the literature for the different pitfalls involved in the diagnosis of bipolar disorder. Non-bipolar mood-disorders are frequently quoted as one of the alternative diagnosis. Hyperthymic temperament, side-effects of prescribed treatments and organic comorbid disorders may be involved. Bipolar disorders have a sex-ratio closer to 1 (men are thus more frequently of the bipolar type in mood-disorders), with earlier age at onset, and more frequent family history of suicidal attempts and bipolar disorder. Schizo-affective disorders are also a major concern regarding the diagnosis of bipolar disorder. This is explained by flat affects sometimes close to anhedonia, presence of a schizoïd personality in bipolar disorder, persecutive hostility that can be considered to be related to irritability rather than a schizophrenic symptom. Rapid cycling, mixed episodes and short euthymia periods may also increase the risk to shift from bipolar to schizophrenia diagnosis. Schizophreniform disorder ("bouffée délirante" aiguë in France) is a frequent form of bipolar disorder onset when major dissociative features are not obvious. The borderline personality is also a problem for the diagnosis of bipolar disorder, some Authors proposing that bipolar disorder is a mood-related personality disorder, sometimes improved by mood-stabilizers. Phasic instead of reactional, weeks and not days-length, clearcut onset and recovery versus non-easy to delimit mood-episodes may help to adjust the diagnosis. Organic disorders may lead to diagnostic confusion, but it is generally proposed that bipolar disorder should be treated the same way, whether or not an organic condition is detected (with special focus on treatment tolerance). Addictive disorders are frequent comorbid conditions in bipolar disorders. Psychostimulants (such as amphetamins or cocaine) intoxications sometimes mimic manic episodes. As these drugs are preferentially chosen by subjects with bipolar disorder, the later diagnosis should be systematically assessed. Puerperal psychosis is a frequent type of onset in female bipolar disorder. The systematic prescription of mood-stabilizers for and after such episode, when mood elation is a major symptom, is generally proposed. Attention deficit-hyperactivity disorder also has unclear border with bipolar disorder, as a quarter of child hyperactivity may be latterly associated with bipolar disorder. The assessment of mood cycling and their follow-up in adulthood may thus be particularly important. Lastly, presence of some anxious disorders may delay the diagnosis of comorbid bipolar disorder.

Bipolar Disorder↗