Disengagement and Engagement Coping with HIV/AIDS Stigma and Psychological Well-Being of People with HIV/AIDS

The stigma associated with HIV/AIDS poses a psychological challenge to people living with HIV/AIDS. We hypothesized that that the consequences of stigma-related stressors on psychological well-being would depend on how people cope with the stress of HIV/AIDS stigma. Two hundred participants with HIV/AIDS completed a self-report measure of enacted stigma and felt stigma, a measure of how they coped with HIV/AIDS stigma, and measures of depression and anxiety, and self-esteem. In general, increases in felt stigma (concerns with public attitudes, negative self-image, and disclosure concerns) coupled with how participants reported coping with stigma (by disengaging from or engaging with the stigma stressor) predicted self-reported depression, anxiety, and self-esteem. Increases in felt stigma were associated with increases in anxiety and depression among participants who reported relatively high levels of disengagement coping compared to participants who reported relatively low levels of disengagement coping. Increases in felt stigma were associated with decreased self-esteem, but this association was attenuated among participants who reported relatively high levels of engagement control coping. The data also suggested a trend that increases in enacted stigma predicted increases in anxiety, but not depression, among participants who reported using more disengagement coping. Mental health professionals working with people who are HIV positive should consider how their clients cope with HIV/AIDS stigma and consider tailoring current therapies to address the relationship between stigma, coping, and psychological well-being.     

An empirical examination of stigma toward mental health problems and psychotherapy use in Veterans and active duty service members

Although many Veterans and active duty service members experience mental health problems, most do not seek out any sort of mental health help. Stigma (a significant predictor of treatment-seeking) has been documented among Veterans and active duty service members; however, previous research on stigma in these groups has primarily utilized correlational and qualitative designs. The purpose of this study was to gain a better understanding of stigma toward mental health problems in Veterans and active duty service members using an experimental design. One hundred sixty-five Veterans and active duty service members were randomized to read a vignette that described a Veteran who either did or did not experience a mental health problem and did or did not seek psychotherapy. Results indicated that the participants held more stigmatizing attitudes toward the Veteran who was described as having a mental health problem, but not toward the Veteran who was described as seeking psychotherapy. Additionally, participants held more positive attitudes toward the Veteran, compared to the attitudes that they believed other military members would hold. Last, with this sample of Veterans and active duty service members, self-stigma toward seeking psychotherapy was found to partially mediate the relationship between perceived public stigma and attitudes. Implications for addressing stigma in military service members and Veterans are discussed.     

The impact of stigma on behavioral health care utilization among active duty service members

This study assessed the relationship between the stigma of seeking psychological help and use of outpatient behavioral health services over a 2-year period among active duty military service members initially referred for neuropsychological evaluation secondary to their histories of mild traumatic brain injury. Although research has examined how stigma predicts proxies for help-seeking (i.e., attitudes towards/intentions to use services), very little research has looked at actual behavior, and studies that do have largely focused on previous use. In this study, we examined the relationship between participants’ stigma and subsequent behavioral health use. Our results indicated that whereas greater self-stigma (i.e., negative self-judgments for seeking psychological help) was associated with attending fewer behavioral health care sessions, public stigma (i.e., perceptions of public attitudes towards people who seek psychological help) was not associated with service use. These findings support the need for addressing the self-stigma associated with seeking behavioral health care.     

Audit and family systems consultation: evaluation of practice at a child and family centre

This audit of practice at a child and family centre included a 16-month case note review covering 319 cases, a postal survey of 45 families and an interview survey of ten GPs who typically referred cases to the centre. The audit furnished information from three different perspectives on the referral process, the consultation process, and outcome for clients attending the centre. The referral rate was about one new case per day and peak referral times were the beginning of the autumn and winter school terms. Almost half the referrals came from GPs; the remainder were largely from Paediatrics, Education and Social Services. Most clients were seen within two months. Half of the families referred had serious psychosocial difficulties including multiple problem members, multi-problem children, multi-agency involvement, psycho-educational difficulties, child protection problems or child placement difficulties. The majority of cases received six hours of consultation. Families where child abuse had occurred or families containing a multi-problem adolescent received a more intensive service. Between a half and three-quarters of cases had positive outcomes as rated by staff and parents. The service was viewed by GPs to be highly satisfactory. On the negative side, many parents felt ill-prepared for the consultation process and most children did not enjoy the experience.     

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.     

Depression is not an inevitable outcome of disclosure avoidance: HIV stigma and mental health in a cohort of HIV-infected individuals from Southern India

Previous research has shown that HIV stigma in India can be characterized by a framework dividing manifestations into enacted (discrimination), vicarious (hearing stories of discrimination), felt normative (perceptions of stigma's prevalence), and internalized stigma (personal endorsement of stigma beliefs). We examined whether this framework could explain associations among stigma, efforts to avoid HIV serostatus disclosure, and depression symptoms in a cohort of 198 HIV-infected individuals from Southern India who were followed up for one year as part of a study of antiretroviral adherence. Prior studies had suggested that disclosure avoidance was a primary outcome of stigma and that impaired well-being was a primary outcome of disclosure avoidance. Analyses from our longitudinal research revealed that the pattern of associations among stigma, disclosure avoidance, and depression symptoms remained consistent over time. Enacted and vicarious stigmas were correlated with felt normative stigma beliefs. In turn, felt normative stigma was correlated with disclosure avoidance. And, enacted stigma, internalized stigma, and disclosure avoidance were all associated with depression symptoms. However, even though the overall framework held together, internalized stigma and depression symptoms dropped significantly over time while other components remained unchanged. These findings suggest that, although HIV stigma may limit disclosure, it does not invariably lead to psychological maladjustment. Amidst ongoing perceptions and experiences of stigma, HIV-positive individuals can achieve significant improvements in their acceptance of the disease and in mental well-being.     

Predictors of school engagement among same-sex and heterosexual adoptive parents of Kindergarteners

Little research has explored parental engagement in schools in the context of adoptive parent families or same-sex parent families. The current cross-sectional study explored predictors of parents' self-reported school involvement, relationships with teachers, and school satisfaction, in a sample of 103 female same-sex, male same-sex, and heterosexual adoptive parent couples (196 parents) of kindergarten-age children. Parents who reported more contact by teachers about positive or neutral topics (e.g., their child's good grades) reported more involvement and greater satisfaction with schools, regardless of family type. Parents who reported more contact by teachers about negative topics (e.g., their child's behavior problems) reported better relationships with teachers but lower school satisfaction, regardless of family type. Regarding the broader school context, across all family types, parents who felt more accepted by other parents reported more involvement and better parent–teacher relationships; socializing with other parents was related to greater involvement. Regarding the adoption-specific variables, parents who perceived their children's schools as more culturally sensitive were more involved and satisfied with the school, regardless of family type. Perceived cultural sensitivity mattered more for heterosexual adoptive parents' relationships with their teachers than it did for same-sex adoptive parents. Finally, heterosexual adoptive parents who perceived high levels of adoption stigma in their children's schools were less involved than those who perceived low levels of stigma, whereas same-sex adoptive parents who perceived high levels of stigma were more involved than those who perceived low levels of stigma. Our findings have implications for school professionals, such as school psychologists, who work with diverse families.     

Stigma by Association Among Family Members of People with a Mental Illness: A Qualitative Analysis

People with mental illness are not the sole recipients of stigmatisation; their immediate family members may be subjected to stigma by association. Through semi‐structured interviews, we investigated experiences of stigma by association among 23 immediate family members of people with mental illness. Participants reported experiencing stigma by association from community members, mental health professionals, and civil servants. Familial relationship, co‐residence, and the gender of participants appeared to play a role in their stigma experiences; parents and spouses reported different manifestations of stigma by association than siblings and children, participants who lived together with their family member with mental illness reported increased experiences of stigma by association, and in contrast to male participants, female participants reported others thinking they are overprotective and as such perpetuated, maintained, or sustained their family members' mental illness. The relevance of these factors points to the need for tailored education and emotional support provision to family members of people with mental illness. Moreover, in‐service training for mental health professionals should include the development of relevant social skills that enable the recognition of familial relationships and roles, and family members' fears, concerns, and problems. Copyright © 2014 John Wiley & Sons, Ltd.     

Community Service Experiences and Commitment to Volunteering1

University students who were involved in a community service field placement completed the Inventory of Service Experience (ISE), a measure that was designed to assess the extent to which they felt supported by family, friends, and the organizations with which they worked; and the extent to which they experienced positive outcomes (e.g., enhanced skills, a feeling of “having made a difference”) in their community service setting. Students who had a more supportive and positive experience, as assessed by the ISE, were more likely to have continued to work as volunteers in the setting 2 months after they had completed their course requirements. The implications of these results for community service programs are discussed.     

United States and Japanese college students' attitudes toward seeking professional psychological help

The purpose of the study was to find how nationality, sex, and past experience of seeking professional psychological services are related to attitudes toward seeking professional psychological help. Three hundred Japanese college students and 300 US college students responded to the Attitudes Toward Seeking Professional Psychological Help (ATSPPH) questionnaire. The ATSPPH consists of four subscales: Need (recognition of need), Stigma Tolerance (the degree of tolerance against stigma associated with help‐seeking action), Openness (interpersonal openness), and Confidence (confidence in mental health professionals). As predicted, past experience of seeking professional psychological service and sex were important predictor variables of performance on the ATSPPH scales. Those who had past experience of seeking professional psychological help had more favourable attitudes toward seeking professional psychological help than those who never consulted psychological professionals. Similarly, in testing the past experience separately with the two nation groups, past experience with seeking professional psychological services was found to be a predictor of the overall attitudes toward seeking professional psychological help among Japanese and US participants. Furthermore, Japanese participants with past experience also showed greater recognition of need for professional psychological help and confidence in psychological health professions than Japanese without past experience. The degree of stigma tolerance associated with help‐seeking behaviour and the tendency of interpersonal openness, however, did not differ between Japanese participants with and without the past experience of seeking professional psychological services. The same results were also found among the US participants. In terms of sex as a predictor variable, females tended to have more positive attitudes toward seeking professional psychological help than males. There was a significant nationality by sex interaction effect. US females had significantly more favourable attitudes than the other three groups, indicating that there was sex difference in help‐seeking attitudes in the US group, but not in the Japanese group. If the sex variable is ignored, Japanese students have less favourable overall attitudes toward seeking professional psychological services than US students. Other results and limitations of the study are discussed.     

Race,resource utilisation,and perceived need among urban community development workers from faith-based organisations

Organisations providing social services in communities of high crime and violence must address staff well-being. The current study surveyed 284 urban community development workers from faith-based organisations in five US cities. The study explored the effects of race and ethnicity on service utilisation and perceived need using binomial logistic regression. Race and ethnicity significantly predicted medical service utilisation, indicating that Caucasian participants were five times more likely and African-American participants were 3.8 times more likely than Latino/a participants to utilise medical services. Race and ethnicity did not predict differences in use of psychological or spiritual services, nor of perceived need for services. Furthermore, volunteer staffs were approximately four times more likely than paid staff to report self-addressing their psychological and spiritual needs rather than utilising services, despite a felt need for support. Barriers to resource utilisation and implications for policies and practices of urban community development organisations are discussed.     

What Makes Crohn's Disease Patients Difficult to Manage? The Role of Psychosocial Factors

Most GI clinicians face the problem of a small group Crohn's Disease (CD) patients who function poorly and consume inordinate amounts of service with poor outcome. This study examines the hypothesis that psychosocial factors differentiate the CD patients who function poorly from the typical CD patient. A prototypal sample of CD patients with problems functioning, more typical CD patients (not selected for having problems in functioning), and healthy controls each completed a battery of validated psychosocial measures of disease-specific quality of life, coping skills, social support and life stress, perceived medical symptoms and life history factors. Chart data on hospital admissions, ER, GI, Surgeon, and GP visits were also collected. The CD patients with problems functioning reported more symptoms (GI and non-GI) and had many more ER, GI, and GP visits than the typical group. Psychologically, those with problems functioning had poorer quality of life and were more likely to cope using emotional discharge and support seeking. They experienced significantly more stress and reported a more chaotic family history. No differences on an experimental method of information processing biases were found between the CD groups, however. These results indicated that patients with problems functioning, selected by GI staff because they were best-case examples of functional difficulties, shared little with a matched group of typical CD patients. These patients likely require psychological as well as medical intervention to best manage their illness.     

Perceived stigma,self-blame,and adjustment among lung,breast and prostate cancer patients

People who suffer from disease have often been stigmatised. The internalisation of stigma leads to the experience of self-blame. The relationship among stigma, self-blame and adjustment was framed with two theoretical perspectives: the looking-glass self and learned helplessness models. These models were studied in 96 lung, 30 breast and 46 prostate cancer patients. Consistent with the looking-glass-self model, we predicted that perceived stigma and self-blame would be associated with poorer psychological adjustment; the data supported these hypotheses. Consistent with the learned helplessness model, we predicted that self-blame would mediate the link between perceived stigma and psychological adjustment; data supported these hypotheses. The mediation model explained a greater percentage of the variance in adjustment in the lung cancer sample compared to the breast and prostate cancer sample. Participants who reported internal causal attributions reported poorer psychological adjustment. Lung cancer patients were more likely than breast or prostate cancer patients to report internal causal attributions for their cancer. Future research and cancer care are discussed in light of these findings.     

The Role of Psychological Factors in Medical Presentations

Research shows that a large number of medical presentations do not result in a medical diagnosis but rather are related to behavioral health problems. Factors such as age, lower education and economic status, health beliefs, and medical and psychological factors are linked to high medical service utilization. Research consistently shows that patients with psychological problems use more services than those without diagnosable psychological problems. The purpose of this paper is to provide a more detailed analysis of the roles of psychological factors in medical presentations. We present three kinds of pathways by which psychological factors lead to medical presentations. These include the (1) primary or direct medical presentation of a clinical problem, (2) secondary presentation or the impact of the clinical problem on patients general physical, psychological, or psychosocial health, and (3) the complex presentation or the impact of multiple diagnoses on the presentation of the clinical problem. Examples of each of these pathways are presented for each axis of the DSM-IV.     

Religious coping,stigma, and psychological functioning among HIV-positive African American women

The present study examined the role of religious coping in psychological distress and adjustment both cross-sectionally and longitudinally among 141 HIV-positive African American women. Cross-sectional analyses showed that negative religious coping was associated with poorer mental health and functioning, and greater perceptions of stigma and discrimination. Longitudinal analyses revealed that greater negative religious coping at baseline significantly predicted greater changes in mental health in a negative direction 12 months later. Positive religious coping was not associated with any measures of psychological well-being, nor did it predict any mental health outcomes at 12 months. However, participants who experienced high levels of HIV-related stigma and reported high levels of positive religious coping were less depressed than those who reported lower levels of positive religious coping. These results suggest that for this population, negative religious coping was a more salient determinant of psychological distress than positive religious coping was of psychological health.     

Preliminary Evidence of Differences Between Stigma Source Versus Type With Individual Functioning Variables in National Guard/Reserve Troops

Extant military studies show that stigma has a variable association with seeking mental health treatment and mental health distress. Previous studies used a general measure of stigma that does not differentiate between stigma source or type. Stigma source can be either self-perceived or perceived from others, and stigma type can include stigma for disorder or stigma for help-seeking. Civilian literature demonstrates that self-stigma is more detrimental to individual functioning than stigma perceived from others, and prior studies in National Guard service members (NGSMs) show that self-stigma and stigma perceived from unit leaders were associated with lower help-seeking intentions relative to stigma perceived from unit members or family members. No military study has simultaneously explored the associations of demographic and distress variables with various stigma types and sources. To determine if prior mixed findings were due to the use of a general measure of stigma, NGSMs (n = 163) completed demographic and distress measures, as well as stigma source (e.g., self, leader) and type (i.e., general, disorder, help-seeking) assessments. General stigma was positively associated with all stigma types and sources as well as a college education. Disorder stigma was positively associated with stigma from nonmilitary sources, and self-stigma for help-seeking was negatively associated with help-seeking intentions. Likelihood of deploying again was positively associated with disorder and help-seeking stigma when perceived from someone in authority. Given the unique associations observed, future studies should utilize specific measures of stigma when examining factors related to postdeployment functioning.     

Alcohol use affects sleep duration among military couples

Alcohol misuse and sleep disorders are highly comorbid, prevalent among service members and their romantic partners, and affected by relationship interdependence. As most military health research focuses on either service members or their spouses, the current study examined dyadic effects of alcohol use on sleep cycle duration in dating and married military couples (N = 149 dyads), using data from the National Longitudinal Study of Adolescent Health. Person-level results from a series of multilevel path models showed partial support for our focal hypothesis implicating high alcohol use in shortened average sleep duration for the service members and their romantic partners. Specifically, partners of service members who drank more regularly had shorter average sleep durations, as did female service members who drank more alcohol per drinking occasion. At the couple-level, a partner effect indicated that service members’ lower depressive symptoms were associated with their partner’s shorter average sleep durations. In addition, when service members reported relatively high alcohol-related problems, their partner tended to have a shorter average sleep duration. In contrast, when service members’ partners reported relatively high alcohol-related problems, they had a longer average sleep duration. This suggests the consequences of problematic alcohol use for service members’ partners depended on each dyad member’s drinking patterns. Taken together, these findings underscore the importance of viewing military couples as a dyadic unit in research studies and clinical interventions.     

Training parents of hyperactive children in child management: A comparative outcome study

Parents of 44 hyperactive children were assigned to either a behavior modification group (PAT), a communications group (PET), or a delayed-treatment control group. Parents in the treatment groups participated in 9-week training workshops. Parents and their children were assessed before and after the workshops on measures that included ratings of hyperactivity and severity of problems, a daily checklist of problem occurrence, parental attitudes, and direct observations in a laboratory situation. Both treatment methods were more effective than a no-treatment control condition in reducing hyperactivity ratings, problem severity ratings, and daily problem occurrence. Additionally, parents receiving behavior modification training rated their children as more improved than did PET parents, were more willing to recommend the program to a friend, felt the program was more applicable to them, and were less likely to drop out of the program. Nine-month follow-up assessments indicated that treatment parents continued to view their children's behavior more positively than did control group parents. Results are discussed with respect to the implications that an educational approach to teaching child management can be an effective means of reducing behavioral problems in children, that methods differing in theoretical background and actual skills taught may result in similar outcomes, and that a "psychological," as opposed to a medical, approach to the treatment of hyperactive children can have considerable merit.     

The role of community context and psychological well-being for physical health: A dyadic study of military couples

Drawing from the social organizational theory of community action and change (SOAC) within a systemic biopsychosocial perspective, associations between community context (military community connections and satisfaction with military life), psychological well-being (depressive symptoms, anxiety, and self-efficacy), and physical health were examined for a sample of active duty service members and their civilian spouses (N = 236 couples) using an actor partner interdependence framework. Service members with higher levels of military community connections reported better psychological well-being. When civilian spouses were more satisfied with military life, both partners reported better psychological well-being. In turn, both spouses’ psychological well-being was related to their own reports of physical health. Statistically significant indirect effects were found between community contexts and spouses’ physical health. Enhancing community connections may be an important leverage point for supporting health and family readiness.