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PubMed2003

From whence comes mental illness stigma?

BACKGROUND: This paper seeks to answer two fundamental questions: What is the basis of the current form of mental illness stigma? and Why do western cultures stereotype people with mental illness as dangerous, incompetent and blameful, rather than something else? MATERIAL AND DISCUSSION: We argue that a motivational model called system-justification offers several benefits for answering these questions. System-justification portrays stigma as a way of making sense of economic and political differences between the majority and stigmatized subgroups. We contrast system-justification with two cognitive models of stigma that seem to have strong support from naive psychology: mental illness stigma results as the normal perception of a group of people who are dangerous and/or blameworthy and there is a kernel of truth to the stigmatizing attitudes about people with mental illness. Although research supporting the latter two models is mixed, there are significant limitations to the models, as well as concerns that normal perception and kernel of truth might actually promote stigma. CONCLUSIONS: As an alternative, system-justification combines three paradigms that suggest its worthiness for future research: 1) a review of historical and economic forces that influence social phenomena; 2) the need of humankind to understand these forces and organize them into a unitary framework; and 3) the cognitive mechanisms that are essential for this comprehension. Implications of this model for stigma change are discussed.

Attitude to Health↗

PubMed2004

Body mass index, academic achievement, and school context: examining the educational experiences of adolescents at risk of obesity.

Reflected self-appraisal suggests that individual functioning is related to the fit between individual characteristics and the norms of their primary contexts. To apply this social psychological concept to the study of obesity, we hypothesized that adolescents at risk of obesity would have lower academic achievement overall than other students, especially in schools in which their weight status was most likely to elicit negative evaluations. Multi-level modeling of nationally representative data revealed that the negative longitudinal association between risk of obesity and achievement was stronger in schools with higher rates of romantic activity and lower average body size among students, two school contexts in which obesity was likely to be stigmatized, but weaker in schools with higher rates of athletic participation, a school context in which such stigmatization was also likely. Additional analyses suggested that this last, unexpected finding reflected a process of niche-picking.

Adolescent↗

PubMed2001

Stereotyping among providers and consumers of public mental health services. The role of perceived group variability.

The authors examine stigmatization and mental illness, focusing on the role of perceived group variability in stereotype use. Consumers' and providers' in-group and out-group stereotypes were assessed. Although providers had extensive experience, they judged consumers more stereotypically and just as negatively as did the consumers themselves. Consumers' education and involvement in services were weakly predictive of more stereotypic, less variable, and more negative views of providers, whereas providers' education and involvement in services predicted more stereotypic but also more variable views of both groups. Perceived group stereotypicality predicted more stereotypic judgments of individuals, whereas perceived variability predicted less confidence in judgments. Because providers perceived greater variability, they were less confident in applying the stereotype to individuals. We suggest that increasing perceptions of the variability among consumers may lead to more sensitive use of diagnostic criteria, more individualized treatment, and a decrease in the negative effects of stigmatization.

Adult↗

PubMed2003

Stereotype threat in the classroom: dejection mediates the disrupting threat effect on women's math performance.

Research on stereotype threat, which is defined as the risk of confirming a negative stereotypic expectation about one's group, has demonstrated that the applicability of negative stereotypes disrupts the performance of stigmatized social groups. While it has been shown that a reduction of stereotype threat leads to improved performance by members of stigmatized groups, there is a lack of clear-cut findings about the mediating processes. The aim of the present study is to provide a better understanding of the mechanisms that stereotype threat causes in women working on mathematical problems. In addition, the study set out to test stereotype threat theory in a natural environment: high school classrooms. The experiment involved the manipulation of the gender fairness of a math test. The results indicate that the stereotype threat effect exists in this everyday setting. Moreover, it appears that dejection emotions mediate the effect of threat manipulation.

Adolescent↗

PubMed2006

Sexual orientation identity and romantic relationship quality in same-sex couples.

Research suggests that the well-being of members of stigmatized groups is related to the ways that individuals understand, evaluate, and respond to their devalued collective identity. The present study extends this line of inquiry by investigating collective identity in the context of romantic relationship functioning, focusing on same-sex couples as a type of stigmatized relationship. In this cross-sectional study, the authors examined four identity-related variables (internalized homonegativity, stigma sensitivity, identity confusion, and identity superiority) in a sample of 274 female and 187 male same-sex couples. Results provided evidence of identity similarity between partners, particularly for internalized homonegativity and identity superiority. Each of the identity variables was associated with relationship quality, and actor effects of identity on quality were more common than partner effects. Perceived identity similarity mediated some of the links found between identity and quality and was positively associated with relationship quality regardless of actor identity.

Female↗

PubMed1992

Should the government pay? Caregiver views of government responsibility and feelings of stigma about financial support.

Financial support strategies to assist informal caregivers of the elderly have been implemented and/or experimented with in several states. Little is known about how receptive caregiving families are to receiving financial support from the government to assist with in-home care, particularly whether they feel stigmatized. Few existing programs have assessed caregivers' views. In examining caregivers' reactions to receiving means-tested financial assistance, it is important to assess whether they consider support of the disabled a government responsibility as well as a possible stigma. Caregivers (N = 155) of disabled veterans aged 65 and older who receive Veterans' Administration disability allowances (Aid and Attendance) were surveyed. Results indicate that caregivers feel the government is primarily responsible for supporting the long-term disabled who are cared for at home. For the most part, these caregivers did not feel stigmatized or uncomfortable receiving means-tested government assistance to support in-home care. An important implication of this study is that financial support can be a workable component of an integrated service delivery system to support informal caregiving.

Aged↗

PubMed2000

The patient's diagnosis: explanatory models of mental illness.

The purpose of the study was to develop a grounded theory about individuals' perception of the situation of being a psychiatric patient. Thirty-five inpatients (19 males, 16 females), ages 18 to 68, in two psychiatric units of an urban, public facility were interviewed on a biweekly basis from admission to discharge. Data were analyzed using the constant comparative method, and the data indicated that participants used the basic social process of managing self-worth to deal with the stigmatizing social predicament of being a mental patient. Events occurring before admission that shaped their responses were substance abuse, medication noncompliance, and the lack of social capital, which led to norm violations and subsequent hospitalization. Six attribution categories emerged: problem, disease, crisis, punishment, ordination, and violation. Findings support the need for professionals to improve their practice by acknowledging the effects of patients' subjective assessments on their response to hospitalization and by placing more emphasis on assisting patients to deal with the stigmatizing effects of a psychiatric diagnosis.

Adolescent↗

PubMed2002

Courtesy stigma in mothers of children with Attention-Deficit/Hyperactivity Disorder: a preliminary investigation.

Mothers of children with Attention-Deficit/Hyperactivity Disorder face an increased risk for depression, anxiety, and social isolation. In addition to stress due to children's behavior, mothers of children with ADHD may also feel stigmatized by their children's diagnosis. Fifty-one mothers participated in a study to assess attitudes toward ADHD. Although mothers of children with ADHD expected that parents of children without ADHD would hold harsh views of the disorder, this was not generally the case. This difference between perception and the actual self-reported views of mothers of children without ADHD supports the idea that mothers feel stigmatized but suggests that increased awareness might help mothers of children with ADHD feel less isolated.

Adult↗

PubMed2003

The attributions of children with Attention-Deficit/ Hyperactivity Disorder for their problem behaviors.

This study investigated the attributions children with ADHD make about their most problematic symptoms. Children were interviewed to determine the degree to which they felt their behavior was controllable, stable, global, and stigmatizing; and about the locus of the cause of their behavior. Participants were 16 children with ADHD (10 boys, 6 girls), and 16 children without ADHD (9 boys, 7 girls), ages 7 to 13. The present study demonstrated that children with ADHD viewed their most problematic behaviors as less within their control and more global across situations than children without ADHD. Children with ADHD were more likely than children without ADHD to view their most problematic behavior as always having been present, but were no more likely to view their most problematic behavior as persisting into the future. No significant group differences emerged on the locus of causality dimension. With regards to stigmatization, girls without ADHD reported that their behaviors can bother their teachers, parents, and peers, whereas girls and boys with ADHD did not perceive their behavior as bothersome.

Adolescent↗

PubMed2006

'When I am together with them I feel more ill.' The stigma of multiple sclerosis experienced in social relationships.

OBJECTIVES: We explored the stigma that people with multiple sclerosis (MS) experienced in social relationships. Informed by the symbolic integrationist paradigm, this sociological study focuses on the creation of personal identity through interaction with others. The symbolic interactionist account of stigma examines the meaning and reality being negotiated in communication with others. METHODS: Fourteen people with MS and their relatives were interviewed. The unstructured interviews were tape-recorded, transcribed and coded in accordance with the procedure of grounded theory. RESULTS: Informants reported being ignored or, in contrast, having people overemphasize MS in interpersonal encounters. Although people tried to act tactfully, these acts were experienced as crucial stigmatizing. Informants were coping to counteract stigmatizing experiences in social relationships. DISCUSSION: People with MS perceive that their bodily performance and impression management is being judged in interpersonal encounters. Being ignored or perceiving that MS is overemphasized indicates the dilemma of managing stigma in social networks. Consequently, during interaction and in social relationships, people with MS experience a sense of 'feeling more ill'. This paper describes strategies of networking to affirm self and identity.

Adaptation, Psychological↗

PubMed2004

Mental health first aid training in a workplace setting: a randomized controlled trial [ISRCTN13249129].

BACKGROUND: The Mental Health First Aid training course was favorably evaluated in an uncontrolled trial in 2002 showing improvements in participants' mental health literacy, including knowledge, stigmatizing attitudes, confidence and help provided to others. This article reports the first randomized controlled trial of this course. METHODS: Data are reported on 301 participants randomized to either participate immediately in a course or to be wait-listed for 5 months before undertaking the training. The participants were employees in two large government departments in Canberra, Australia, where the courses were conducted during participants' work time. Data were analyzed according to an intention-to-treat approach. RESULTS: The trial found a number of benefits from this training course, including greater confidence in providing help to others, greater likelihood of advising people to seek professional help, improved concordance with health professionals about treatments, and decreased stigmatizing attitudes. An additional unexpected but exciting finding was an improvement in the mental health of the participants themselves. CONCLUSIONS: The Mental Health First Aid training has shown itself to be not only an effective way to improve participants' mental health literacy but also to improve their own mental health. It is a course that has high applicability across the community.

Adolescent↗

PubMed2005

Mental health first aid responses of the public: results from an Australian national survey.

BACKGROUND: The prevalence of mental disorders is so high that members of the public will commonly have contact with someone affected. How they respond to that person (the mental health first aid response) may affect outcomes. However, there is no information on what members of the public might do in such circumstances. METHODS: In a national survey of 3998 Australian adults, respondents were presented with one of four case vignettes and asked what they would do if that person was someone they had known for a long time and cared about. There were four types of vignette: depression, depression with suicidal thoughts, early schizophrenia, and chronic schizophrenia. Verbatim responses to the open-ended question were coded into categories. RESULTS: The most common responses to all vignettes were to encourage professional help-seeking and to listen to and support the person. However, a significant minority did not give these responses. Much less common responses were to assess the problem or risk of harm, to give or seek information, to encourage self-help, or to support the family. Few respondents mentioned contacting a professional on the person's behalf or accompanying them to a professional. First aid responses were generally more appropriate in women, those with less stigmatizing attitudes, and those who correctly identified the disorder in the vignette. CONCLUSIONS: There is room for improving the range of mental health first aid responses in the community. Lack of knowledge of mental disorders and stigmatizing attitudes are important barriers to effective first aid.

Adolescent↗

PubMed2005

What should HIV/AIDS be called in Malawi?

HIV/AIDS is the leading cause of morbidity and mortality in the southern African country of Malawi. At the largest referral health facility in Blantyre, the Queen Elizabeth Central Hospital, the majority of patients hospitalized in medical wards and up to a third of those in the maternity unit are infected with HIV. Many patients in the surgical wards also have HIV/AIDS. Health professionals in Blantyre, however, often choose not to write down the diagnosis of HIV or AIDS; rather, they prefer to use 'SGOT', 'ELISA' and 'spot test' to represent the HIV test, while 'immunosuppression', '\CD4 disease' and 'ARC' are preferred instead of 'AIDS'. It is possible that health professionals' belief that mentioning HIV and/or AIDS will harm patients is encouraging them to use these euphemisms. The use of less than exact terms to label HIV and AIDS may not be without cost. For instance, future attempts to conduct retrospective case study research may be hampered by this practice, which is not in accordance with the international classification of diseases. It is suggested that, although stigmatization and discrimination could be important driving factors in the use of cryptic language, it may be more worthy to fight discrimination and stigmatization head-on, rather than create avenues where these reactions may be perpetuated.

Acquired Immunodeficiency Syndrome↗

PubMed2005

When is public disclosure of HIV seropositivity acceptable?

HIV/AIDS is a major public health problem in Africa. Stigmatization, discrimination and lack of appropriate health care are among the commonest challenges that HIV infected persons and their families face. It has been suggested that among the tools available in the fight against stigmatization and discrimination is public disclosure of a person's HIV seropositive status. While public disclosure of HIV status has a place in the fight against HIV and AIDS, especially by resulting in behavioural change among people who know of an HIV infected person, we argue that such disclosure also has potential attendant harms. The posthumous disclosure of HIV status is particularly problematic. Public disclosure should be accompanied by appropriate individual counselling and preparation of the community to deal with the situation, and should have regard for cultural sensitivity after consideration of the risks and benefits to individuals, families and the community. Health practitioners should keep in mind that their main duty is to the best interest of the patient, the family and the community, in that order.

Africa↗

PubMed2005

Promoting the "social" in the examination of social stigmas.

This review highlights the value of empirical investigations examining actual interactions that occur between stigmatizers and targets, and is intended to stimulate and help guide research of this type. We identify trends in the literature demonstrating that research studying ongoing interactions between stigmatizers and targets is relatively less common than in the past. Interactive studies are challenging, complex, and have variables that are sometimes more difficult to control; yet, they offer unique insights and significant contributions to understanding stigma-related phenomena that may not be offered in other (e.g., self-report) paradigms. This article presents a conceptual and empirical overview of stigma research, delineates the unique contributions that have been made by conducting interactive studies, and proposes what can be further learned by conducting more of such research.

Affect↗

PubMed2004

Parental mental disorder and children's functioning: silence and communication, stigma and resilience.

In this article I argue that narrative accounts of the effects of parental mental disorder (particularly mood disturbance) on children's functioning may provide unprecedented windows on crucial issues of silence, stigmatization, diagnosis, etiology, and treatment, which can mutually inform empirical research efforts. In publishing a book-length account of the life of my father, The Years of Silence are Past (Hinshaw, 2002b), I departed from my usual academic writings and gave voice to a complex and troubling life history, marked by misdiagnosed bipolar disorder and misguided treatment that lasted 40 years. Herein, I focus on the ramifications of this narrative for scientific and clinical efforts in the field, including the still-prevalent stigmatization and silence surrounding mental disorder, the great need for accurate diagnosis and responsive treatment, the complex and transactional web of biological and environmental risk factors that exist for mental disturbance, the blending of inner experience with social realities regarding symptom content, the resilience and strength that can accompany mental disorder, and the ways in which parents with mental disturbance can promote active communication with their offspring. Narrative accounts may be particularly important in reducing silence and in framing the next generation of empirical research questions; blending qualitative and quantitative methods may help address crucial goals related to child functioning in the presence of parental mental disorder.

Adult↗

PubMed2006

TB patients' perspectives on integrated TB/HIV services in South Africa.

There are few data describing patients' attitudes towards the integration of antiretroviral therapy for HIV-infected patients into existing TB services. We investigated this issue among patients receiving TB treatment at a primary care facility in Cape Town, South Africa. Of 85 patients interviewed, the vast majority (92%, n = 78) stated they would be willing to attend an integrated TB/HIV service; perceived stigmatization of TB and HIV was a significant predictor of negative attitudes towards a combined TB/HIV programme (adjusted odds ratio, 19.90, P = 0.02). While integrated TB/HIV services appear generally acceptable in this setting, continuing efforts to combat stigmatization are necessary to ensure maximum uptake.

Adolescent↗

PubMed1981

Effects of exogenous materials on pollen tube growth in Lilium longiflorum pistils.

With the use of stigmatic exudate or distilled water as carriers, various antimetabolites, inhibitors, and miscellaneous materials were injected into the hollow styles of detached Lilium longiflorum pistils before, at, or after compatible or incompatible pollination. Pollen tube lengths were measured 48 hr after pollination with pollinated styles incubated at 22-23 degrees C. Substances considered inhibitors of protein synthesis in microbial systems significantly retarded both compatible and incompatible pollen tube growth while inhibitors of RNA synthesis tended to significantly inhibit compatible pollen tube growth with less or no effect on incompatible pollen tubes. Application of the inhibitors in stigmatic exudate at or after compatible pollination produced significant results at the lowest concentrations. Significant retardation of pollen tube growth also occurred after injection of 2,4-dinitrophenol, mercaptoethanol, indoleacetic acid, naphthaleneacetic acid, benzyladenine, dimethyl sulfoxide, or potassium or sodium iodide. Pollen tube growth in detached pistils of L. longiflorum may be useful as a bioassay in situ for screening biologically active materials.

Amino Acids↗