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PubMed2003

GAMIAN-Europe/BEAM survey I--global analysis of a patient questionnaire circulated to 3450 members of 12 European advocacy groups operating in the field of mood disorders.

OBJECTIVES: GAMIAN-Europe is a pan-European federation of national patient organizations from 30 European countries covering the whole spectrum of psychiatry. To gain a better understanding of what it is like to live with bipolar disorder (BD), GAMIAN-Europe undertook a detailed patient-based questionnaire, known as 'GAMIAN-Europe/BEAM Survey', examining a variety of aspects. METHODS: The questionnaire was mailed to 3450 patients from 12 member organizations in 11 countries. A total of 1760 completed questionnaires were received but 28 were ruled out as inappropriate. Of the remainder, 1041 respondents stated that they had been, or were, suffering from BD. The remainder stated that they were suffering from depression, dysthymia or atypical depression. RESULTS: The findings indicate that, on average, a bipolar patient is expected to wait for 5.7 years for a correct diagnosis from the first onset of symptoms. Many patients have a family history of mood and anxiety disorders. They experience a high degree of stigmatization from all quarters. This is reflected in the difficulties they experience in obtaining employment despite high academic achievement. Most patients receive combination therapy. Compliance problems resulting from adverse side-effects are less significant than in the past. Overall, the level of satisfaction with pharmacotherapy was high yet, paradoxically, patients had reservations about dependency issues and possible long-term side-effects. CONCLUSIONS: There was a clear need for more patient education about pharmacological and psychosocial interventions, despite material progress having been made over the past decade. There is an urgent need for more information and education for both relatives and the public in most European countries to improve awareness and understanding of BDs and other mood disorders and the doctor-patient dialogue.

Adult↗
PubMed2000

Schizophrenia and quality of life.

OBJECTIVE: The purpose of this paper is to examine critically results of quality-of-life research in schizophrenic patients living in the community. METHOD: Based on the relevant literature results of specific studies are discussed in the light of the methodological problems of assessing quality of life in these people. RESULTS: Subjectively assessed quality of life was found to be higher in the less educated and in female patients, and when a sense of control is experienced. If negative or extrapyramidal symptoms are experienced and stigmatization is perceived, subjective quality of life is reported as being poorer. These results are discussed in view of the additional needs and fewer resources of this population, their stigma-dilemma and their occasional difficulties in adequately assessing quality of life. CONCLUSION: It is argued that subjective and quantitative measures of quality of life in schizophrenic patients should be supplemented by external assessment and qualitative methods.

Adult↗
PubMed2003

Self-reported psychotic experiences in the general population: a valid screening tool for DSM-III-R psychotic disorders?

OBJECTIVE: To examine the diagnostic value of self-reported psychotic-like experiences for DSM-III-R psychotic disorders. METHOD: A general population sample of 7076 subjects aged 18-64 years was interviewed with the Composite International Diagnostic Interview (CIDI) and, if there was evidence of psychotic experiences, the Structured Clinical Interview for DSM-III-R. RESULTS: The probability of having a psychotic disorder increased in a dose-response fashion with the level of self-reported psychotic experiences, but individual CIDI psychotic experience ratings had relatively low post-test probabilities (PPs) (range: 5.1-26.5%). However, limiting the sample to individuals who had been in contact with mental health services substantially improved PPs (range: 13.3-43.1%). CONCLUSION: Screening for psychosis in the population carries a high risk of stigmatization in false-positive cases and violation of the right 'not to know' in true-positive cases. However, in mental health care users, self-reported psychotic experiences may be a useful screening tool in individuals who have already developed help-seeking.

Adult↗
PubMed2003

Attempted suicide among young people: risk factors in a prospective register based study of Danish children born in 1966.

OBJECTIVE: In order to prevent suicidal behaviour among adolescents and young adults it would be valuable to know if altering the conditions of their upbringing could reduce their suicidal behaviour. The study surveys possible risk factors. METHOD: Population-based registers covering children born in Denmark in 1966 at the age span of 14-27 years and their parents for: health, education, family dissolution, suicidal behaviour, substance abuse, criminality and unemployment. A discrete-time proportional hazard modelling was used to analyse the longitudinal observations. RESULTS: First-time suicide attempts were associated with parental psychiatric disorder, suicidal behaviour, violence, child abuse and neglect. Increased risks were also found among adolescents and young adults who suffered from psychiatric disorder or physical handicap, had been legally imprisoned, were addicted to drugs, or without graduation, vocational training or employment. CONCLUSION: Stigmatization, social exclusion, and mental disorders in the adolescents or young adults and parents increased risks for attempted suicide.

Adolescent↗
PubMed1993

On sin versus sickness. A theory of perceived responsibility and social motivation.

Lack of effort as a cause of achievement failure evokes more punishment than does lack of ability. Perceptions of the controllability of these causes, inferences about personal responsibility, and affective reactions of sympathy and anger mediate between the causal perceptions of ability and effort and punishment responses. This general theory of social motivation explains some reactions to stigmatized persons as well as observations related to help giving, peer rejection, and aggression. The proposed conceptual system distinguishes the reactions to sin versus sickness.

Aggression↗
PubMed1995

Violent juvenile delinquents. Treatment effectiveness and implications for future action.

Traditionally, the juvenile justice system has emphasized the goals of treatment and rehabilitation of young offenders, while protecting them from punishment, retribution, and stigmatization. Violent juvenile offenders have posed a challenge to this rehabilitative ideal because of mounting public pressure to ensure societal protection. Juveniles who are perceived as dangerous or persistent in their criminal activity are increasingly transferred to the adult criminal justice system, where they may receive much harsher consequences. Whether violent delinquents can be successfully treated is a key point in the debate regarding the wisdom of this trend in juvenile justice. This article considers the available research to address the policy question of how society should reasonably invest in the treatment of violent juvenile offenders.

Adolescent↗
PubMed2002

Cognitive and behavioral distancing from the poor.

The author argues that distancing is the dominant response to poor people on the part of those who are not poor and that distancing, separation, exclusion, and devaluing operationally define discrimination. Such responses, together with stereotypes and prejudice, define classism. The article focuses on classism in the United States. Classism is examined in the context of theoretical propositions about the moral exclusion of stigmatized others and is illustrated by cognitive distancing, institutional distancing (in education, housing, health care, legal assistance, politics, and public policy), and interpersonal distancing. The adoption of the Resolution on Poverty and Socioeconomic Status by the American Psychological Association Council of Representatives in August 2000 is cited as an important step in the direction of eliminating the invisibility of low-income persons in psychological research and theory.

Humans↗
PubMed1994

Somatoform disorders: personality and the social matrix of somatic distress.

Personality traits that may contribute to somatization are reviewed. Negative affectivity is associated with high levels of both somatic and emotional distress. Agreeableness and conscientiousness may influence interactions with health care providers that lead to the failure of medical reassurance to reduce distress. Absorption may make individuals more liable to focus attention on symptoms and more vulnerable to suggestions that induce illness anxiety. More proximate influences on the selective amplification of somatic symptoms include repressive style, somatic attributional style, and alexithymia; however, data in support of these factors are scant. Most research on somatoform disorders confounds mechanisms of symptom production with factors that influence help seeking. Longitudinal community studies are needed to explore the interactions of personality with illness experience and the stigmatization of medically unexplained symptoms.

Adaptation, Psychological↗
PubMed2000

Effects of disclosure of traumatic events on illness behavior among psychiatric prison inmates.

To assess the health effects of writing about traumatic events in a clinical population, 98 psychiatric prison inmates were randomly assigned to 1 of 3 conditions in which they were asked to write about their deepest thoughts and feelings surrounding upsetting experiences (trauma writing condition), write about trivial topics (trivial writing control), or go about their daily routine without writing (no-writing control). Both writing groups wrote for 20 min per day for 3 consecutive days. Participants in the trauma condition reported experiencing more physical symptoms subsequent to the intervention relative to those in the other conditions. Despite this, controlling for prewriting infirmary visits, sex offenders in the trauma writing condition decreased their postwriting infirmary visits. These results are congruent with predictions based on stigmatization and inhibition.

Adult↗
PubMed1994

The practice and ethics of sexual orientation conversion therapy.

Sexual orientation conversion therapy was the treatment of choice when homosexuality was thought to be an illness. Despite the declassification of homosexuality as a mental illness, efforts to sexually reorient lesbians and gay men continue. The construct of sexual orientation is examined, as well as what constitutes its change. The literature in psychotherapeutic and religious conversion therapies is reviewed, showing no evidence indicating that such treatments are effective in their intended purpose. A need for empirical data on the potentially harmful effects of such treatments is established. Ethical considerations relative to the ongoing stigmatizing effects of conversion therapies are presented. The need to develop more complex models for conceptualizing sexual orientation is discussed, as well as the need to provide treatments to gay men and lesbians that are consonant with psychology's stance on homosexuality.

Adult↗
PubMed1987

In search of the false-uniqueness phenomenon: fear and estimates of social consensus.

An examination of the social perception literature yields little evidence for the false-uniqueness phenomenon (Valins & Nisbett, 1972), the perception that one's attributes are more unique than is the case. In contrast, the tendency for individuals to project their own characteristics onto other people and assume that more people are like themselves is a robust phenomenon. One reason researchers may not have found false uniqueness is that they have not looked at the accuracy of consensus estimates. A close look at the results of Tabachnik, Crocker, and Alloy (1983) and Sanders and Mullen (1983), who did assess accuracy, suggests that people possessing undesirable attributes over-estimate consensus, whereas people holding desirable attributes underestimate consensus. The latter pattern is a form of false uniqueness. In this study we looked at the accuracy of social consensus estimates in the context of psychological fears. A sample of subjects filled out an abbreviated version of a fear survey and made estimates of consensus. The results showed that both high- and low-fear respondents overestimated the incidence of high fear among their peers, but high-fear subjects were more inaccurate in their estimates. A false-uniqueness effect was found on the part of low-fear subjects, as they tended to underestimate the incidence of low fear among their peers. These findings are consistent with a motivational interpretation that emphasizes the individual's need to justify or normalize stigmatized behavior and to bolster perceived self-competence.

Adolescent↗
PubMed1993

The stigma of overweight: affective consequences of attributional ambiguity.

Attributing negative outcomes to prejudice and discrimination may protect the mood and self-esteem of some stigmatized groups. Thus, the overweight may be low in self-esteem because they blame their weight, but not the attitudes of others, for negative outcomes based on their weight. In an experiment, 27 overweight and 31 normal weight college women received either positive or negative social feedback from a male evaluator. Relative to other groups, overweight women who received negative feedback attributed the feedback to their weight but did not blame the evaluator for his reaction. This attributional pattern resulted in more negative mood for these overweight women in comparison with other groups. Dimensions of stigma that may account for differences in the tendency to attribute negative outcomes to prejudice, and implications of these findings for weight loss programs and psychotherapy for the overweight, are discussed.

Adult↗
PubMed1994

Prejudice against fat people: ideology and self-interest.

Prejudice against fat people was compared with symbolic racism. An anti-fat attitudes questionnaire was developed and used in several studies testing the notion that antipathy toward fat people is part of an "ideology of blame." Three commonalities between antifat attitudes and racism were explored: (a) the association between values, beliefs, and the rejection of a stigmatized group, (b) the old-fashioned antipathy toward deviance of many sorts, and (c) the lack of self-interest in out-group antipathy. Parallels were found on all 3 dimensions. No in-group bias was shown by fat people. Fatism appears to behave much like symbolic racism, but with less of the negative social desirability of racism.

Adult↗
PubMed1995

Stereotype threat and the intellectual test performance of African Americans.

Stereotype threat is being at risk of confirming, as self-characteristic, a negative stereotype about one's group. Studies 1 and 2 varied the stereotype vulnerability of Black participants taking a difficult verbal test by varying whether or not their performance was ostensibly diagnostic of ability, and thus, whether or not they were at risk of fulfilling the racial stereotype about their intellectual ability. Reflecting the pressure of this vulnerability, Blacks underperformed in relation to Whites in the ability-diagnostic condition but not in the nondiagnostic condition (with Scholastic Aptitude Tests controlled). Study 3 validated that ability-diagnosticity cognitively activated the racial stereotype in these participants and motivated them not to conform to it, or to be judged by it. Study 4 showed that mere salience of the stereotype could impair Blacks' performance even when the test was not ability diagnostic. The role of stereotype vulnerability in the standardized test performance of ability-stigmatized groups is discussed.

Black or African American↗
PubMed1998

Concealable stigmas and positive self-perceptions: feeling better around similar others.

In an 11-day experience-sampling study, 86 Harvard undergraduates rated their momentary self-esteem and affect and then described the who, what, and where of their daily lives. Those with concealable stigmas (students who indicated that they were gay, that they were bulimic, or that their family earned less than $20,000 each year) reported lower self-esteem and more negative affect than both those whose stigmas were visible and those without stigmatizing characteristics. Only the presence of similar others lifted the self-esteem and mood of students with concealable stigmas, and these particular students were the least likely to experience such occasions. Thus, contact with similar others protects the psychological self from negative cultural messages.

Analysis of Variance↗
PubMed1999

Abortion as stigma: cognitive and emotional implications of concealment.

This study examined the stigma of abortion and psychological implications of concealment among 442 women followed for 2 years from the day of their abortion. As predicted, women who felt stigmatized by abortion were more likely to feel a need to keep it a secret from family and friends. Secrecy was related positively to suppressing thoughts of the abortion and negatively to disclosing abortion-related emotions to others. Greater thought suppression was associated with experiencing more intrusive thoughts of the abortion. Both suppression and intrusive thoughts, in turn, were positively related to increases in psychological distress over time. Emotional disclosure moderated the association between intrusive thoughts and distress. Disclosure was associated with decreases in distress among women experiencing intrusive thoughts of their abortion, but was unrelated to distress among women not experiencing intrusive thoughts.

Abortion, Induced↗
PubMed2000

Putting the "affirm" into affirmative action: preferential selection and academic performance.

Two studies explored the relation between academic performance and preferential selection. In Study 1, female participants were led to believe that they had been selected to be leaders in a team problem-solving task because of their gender, because of their gender and ability, or at random. Results showed that women who believed they had been selected because of their gender performed significantly worse on a subsequent problem-solving test than women who believed they had been selected at random and women who believed they were selected because of both their gender and their ability. In Study 2, students' suspicion of having benefited from race-based preferences in college admissions was negatively related to their grade point average (GPA). Furthermore, this suspicion partially mediated the GPA gap between academically stigmatized (Black and Latino) and nonstigmatized (Caucasian and Asian) students.

Adult↗
PubMed2001

Implicit prejudice and stereotyping: how automatic are they? Introduction to the special section.

This special issue of the Journal of Personality and Social Psychology: Attitudes and Social Cogniition addresses issues of the measurement and the malleability of implicit prejudice and stereotypes. The findings raise fundamental questions about the assumptions underlying the assessment of implicit prejudice, particularly with regard to the widely used Implicit Association Test and the assumption of extant models of prejudice and stereotyping that implicit biases are automatically and invariantly activated when perceivers come in contact with members of stigmatized groups. Several of the articles show that contextual manipulations produce reductions in implicit manifestations of prejudice and stereotyping. The articles in this issue, in challenging conventional wisdom, are thought provoking and should be generative in the field's ongoing efforts to understand the role of implicit (and explicit) processes involved in prejudice and stereotyping.

Attitude↗