Infant feeding and internalized stigma: The role of guilt and shame

Globally the rates of breastfeeding duration are extremely low and postnatal mental health issues are common. As a result, it is important to examine the emotions that underlie these matters. Across two studies (one correlational study N = 160 and one experimental study N = 118), we examined participants’ experiences of shame and guilt when feeding their baby, and the relationship between these emotions with breastfeeding behaviors and internalized stigma. We also examined the psychosocial factors that predict internalized stigma, and whether shame and guilt mediate these relationships. We focused on three factors that have been shown to be associated with internalized stigma in other domains: self-esteem and social support (Study 1), as well as self-efficacy (Study 2). Multiple regression revealed that experienced guilt uniquely predicted a shorter duration of exclusive breastfeeding (Study 1). Higher self-efficacy (Study 2), self-esteem, and perceived social support (Study 1) predicted lower internalized stigma of feeding choice. We found that shame was a mediator for the self-esteem and internalized stigma relationship (Study 1), while guilt was a mediator for the self-efficacy and internalized stigma relationship (Study 2). Our findings highlight the importance of experienced shame and guilt in mothers’ infant feeding experiences. The current results can inform future research and the design of interventions to improve breastfeeding rates and reduce feelings of stigma.     

Effect of perceived public stigma on internalized homophobia,anticipated stigma,shame, and guilt: Outness as a moderator

Although previous studies found that distal minority stress contributes to proximal minority stress and shame/guilt among the lesbian, gay, and bisexual (LGB) population, it is unclear whether the extent to which LGB individuals' open display and discussion their sexual orientation moderates these relationships. A total of 1,452 Chinese LGB adults provided demographic information and completed measures of outness, perceived public stigma, internalized homophobia, anticipated stigma, shame, and guilt. Structural equation modelling was conducted to test the hypothesized moderation analyses. Perceived public stigma had positive associations with internalized homophobia, anticipated stigma, shame, and guilt. Outness played a moderating role in the associations of perceived public stigma with internalized homophobia, anticipated stigma, shame, and guilt. Specifically, when LGB individuals had higher levels of outness, the effects of perceived public stigma on internalized homophobia, anticipated stigma, shame, and guilt were lower. Moreover, such moderating effect did not differ by sexual orientation. The degree to which sexual minority individuals' sexual orientation is known by and openly discussed with others may lower the extent to which LGB individuals internalize sexual stigma, expect rejection after coming out, and develop shame and guilt as a result of perceived social prejudice and discrimination.     

Seeking help when transgender: Exploring the difference in mental and physical health seeking behaviors between transgender and cisgender individuals in Ireland

Abstract

Background: While there is growing awareness of the need to support the physical and mental wellbeing of transgender people, some may be reluctant to seek help from healthcare professionals. Little is understood about the mechanisms that influence help-seeking behavior in this group.

Aims: This study aimed to compare transgender and cisgender participants in their likelihood to seek help for both physical and mental health conditions, and to explore whether this help-seeking behavior is predicted by a range of sociodemographic and psychological variables.

Methods: 123 participants living in Ireland (cisgender= 67; transgender= 56) completed a questionnaire which included demographic questions, as well as measures of optimism (LOT-R), self-esteem (RSES), psychological distress (GHQ-12), attitudes towards seeking psychological help (ATSPPH-SF), and attitudes towards seeking help for a physical health problem (Attitudes Towards Seeking Medical Help Scale- Action/Intervention subscale). Associations between predictor variables and mental and physical health seeking were explored using correlation analysis and stepwise regressions.

Results: Transgender participants were less likely to seek help for a physical health issue than cisgender participants, but did not differ in mental health help-seeking behaviors. Results suggest that this may be due to differences in optimism, self-esteem and psychological distress. Transgender participants had significantly lower optimism and self-esteem, which were two factors linked to poorer physical health seeking behaviors. Optimism also emerged as a significant predictor in mental health seeking behaviors.

Discussion: The lack of a significant difference for mental health help-seeking between the transgender and cisgender participants is encouraging, as it suggests that there is less stigma surrounding mental illness than expected, however findings also contradict previous findings suggesting that physical health is less stigmatized. This could be due to stigma relating to gender-specific healthcare and suggests that healthcare professionals should acknowledge the specific healthcare needs and concerns among transgender individuals.     

How professional pilots perceive interactions of working conditions,rosters, stress,sleep problems,fatigue and mental health. A qualitative content analysis

IntroductionSo far, no qualitative content analysis (QCA) has analysed pilots’ experiences and perceptions regarding weaknesses of fatigue risk management (FRM), flight time limitations (FTL), rosters, fatigue-severity, sleep problems, and how they relate to pilots’ mental health and well-being.ObjectiveThis research analyses pilots’ described perceptions of stress, fatigue, aviation safety and how regulations like FTL can affect their health and well-being.MethodIn total, 119 international pilots described their perceptions of FTL, rosters, aviation safety, and how they relate to fatigue and health. The QCA was conducted to analyse interactions of working conditions, stressors, fatigue, sleep problems and mental health of EASA-based and Australian pilots.ResultsAlthough pilots were rostered for only 60.8% to 62.5% of the legally allowed duty and flight hours/month, 78.6% reported severe or very high fatigue, 22.8% significant depression, 12.3% significant anxiety symptoms, 10.5% reported significant depression and anxiety symptoms. Pilots uttered severe concerns about FTL, sleep restrictions associated with early starts, minimum rest, etc. Pilots also expressed distinct fears regarding more fatigue-related crashes, and how adverse working conditions, work-related and psychosocial stress could impair their health.ConclusionsThis QCA provided valuable insights into interactions of working conditions, fatigue, sleep restrictions, physical and mental health. Progressive health impairment due to lack of sleep and accumulated fatigue promote burnout, mental and physical health problems, which not only threaten flight safety, but also sustainability of aviation.     

Attitudes toward seeking professional psychological help among Chinese students at a UK university

Aim: In this study we aimed to investigate whether Chinese international and British home students at a university in the United Kingdom differed in their attitudes towards seeking psychological help. Method: The total sample comprised 323 participants. Participants completed measures to assess their attitudes toward seeking professional psychological help (recognition of need for psychological help, stigma tolerance, interpersonal openness, confidence in mental health practitioners). Results: Chinese students reported significantly less interpersonal openness than that reported by British students. Contrary to prediction, however, no significant group differences were found on any of the other mental health attitudes (i.e. recognition of need for psychological help, confidence in mental health practitioners or stigma tolerance). Within‐group contrasts also showed that Chinese students reported lower scores on interpersonal openness than on stigma tolerance and confidence in mental health practitioners. In contrast, British participants reported less confidence in mental health practitioners and recognition of the need for psychological help than reported for stigma tolerance and interpersonal openness. Conclusion: The findings highlight the need for a greater understanding of students' cultural inclinations toward mental health issues and cultural attitudes that may hinder and/or facilitate students' access and engagement with psychological services in higher education institutions.     

Stigma modifies the association between social support and mental health among sexual violence survivors in the Democratic Republic of Congo: implications for practice

Background and Objectives: The aim of this study was to further understanding of the relationship between social support, internalized and perceived stigma, and mental health among women who experienced sexual violence in the eastern Democratic Republic of Congo (DRC).

Methods: Drawing from baseline survey data collected in eastern DRC, researchers conducted a secondary cross-sectional analysis using data from 744 participants. Regression and moderation analyses were conducted to examine associations between social support variables, felt stigma, and depression, anxiety and posttraumatic stress disorder (PTSD).

Results: Emotional support seeking and felt stigma were positively associated with increased symptom severity across all three mental health variables. Stigma modified associations between emotional support seeking and depression (t?=??2.49, p?=?.013), anxiety (t?=??3.08, p?=?.002), and PTSD (t?=??2.94, p?=?.003). Increased frequency of emotional support seeking was associated with higher mental health symptoms of anxiety and PTSD among women experiencing all levels of stigma.

Conclusions: Enhancing understanding of social support and stigma may inform research and intervention among Congolese forced migrant populations across circumstances and geographic locations. Implications for practice and research are discussed.     

Perpetrators’ reactions to perceived interpersonal wrongdoing: The associations of guilt and shame with forgiving,punishing, and excusing oneself

We describe a model in which guilt and shame associate with reactions to wrongdoing among perpetrators of interpersonal harm. Individuals who reported wronging another person (N = 410) completed measures of perceived transgression severity, guilt and shame, and possible reactions to perpetration of wrongdoing (i.e., forgiving, punishing, and excusing oneself). Guilt positively predicted forgiving and punishing oneself, and negatively predicted excusing oneself of blame. Shame, in contrast, negatively predicted forgiving oneself and positively predicted punishing and excusing oneself. The observed patterns of associations between guilt and shame with perpetrators’ reactions to wrongdoing provide further support for the dual-process model of self-forgiveness. Implications for future basic and applied investigations are discussed.     

Does the Test of Self-Conscious Affect (TOSCA) measure maladaptive aspects of guilt and adaptive aspects of shame? An empirical investigation

The purpose of this study was to examine whether the Test of Self-Conscious Affect (TOSCA; Tangney, J. P., Wagner, P. E., & Gramzow, R. (1989). The Test of Self-Concious Affect. Fairfax, VA: George Mason University) measures maladaptive forms or aspects of guilt and adaptive aspects of shame that have been described in the literature. First, a judgmental and logical analysis showed that the TOSCA primarily measures mild and adaptive forms and aspects of guilt and maladaptive aspects of shame. Next, principal components analyses (PCAs) in a student (N=328) and adult (N=542) sample showed that items that had a high loading on the guilt factor primarily were items that referred to reparative behavior, while items that had high loadings on the shame factor consisted primarily of items that referred to low self-esteem. To investigate to which extent these items were responsible for correlations found with the TOSCA, we constructed a revised guilt scale containing only items that referred to reparative behavior and a revised shame scale consisting of items that only referred to negative self-esteem, and related these to indices of interpersonal and intrapersonal functioning. The revised TOSCA scales reproduced both the pattern and magnitude of correlations obtained with the original TOSCA scales. Thus, taken together, the results of this study support the interpretation of the TOSCA guilt scale as a measure of mild and adaptive forms of guilt and the TOSCA shame scale as a measure of maladaptive aspects associated with shame. Implications of these findings for further research on the nature of guilt and shame are discussed.     

Self-conscious emotions in patients suffering from chronic musculoskeletal pain: A brief report

Objective: The role of self-conscious emotions (SCEs) including shame, guilt, humiliation and embarrassment are of increasing interest within health. Yet, little is known about SCEs in the experience of chronic pain. This study explored prevalence and experience of SCEs in chronic pain patients compared to controls and assessed the relationship between SCEs and disability in pain patients.

Design and measures: Questionnaire assessment comparing musculoskeletal pain patients (n = 64) and pain-free control participants (n = 63). Pain was assessed using the McGill Pain Questionnaire; disability, using the Roland–Morris Disability Questionnaire; and six SCEs derived from three measures (i) Test of Self-Conscious Affect-3 yielding subscales of shame, guilt, externalisation and detachment (ii) The Brief Fear of Negative Evaluation Scale and (iii) The Pain Self-Perception Scale assessing mental defeat.

Results: Significantly greater levels of shame, guilt, fear of negative evaluation and mental defeat were observed in chronic pain patients compared to controls. In the pain group, SCE variables significantly predicted affective pain intensity; only mental defeat was significantly related to disability.

Conclusion: Findings highlight the prevalence of negative SCEs and their importance in assessment and management of chronic pain. The role of mood in this relationship is yet to be explored.     

Associations between Physical Self-Concept and Anticipated Guilt and Shame: The Moderating Role of Gender

Body-related emotions have been identified as important predictors of mental and physical health. Evaluations of the physical self are inextricably linked with body-related emotions. However, little research has addressed how physical self-concept is associated with anticipated emotions and how associations may differ between men and women. The current study examined associations between physical self-concept and anticipated guilt and shame and examined gender as a moderator of these associations. The sample consisted of 353 Canadian undergraduate students (55% female; M_age?=?21.94. range?=?18–64). Participants read a hypothetical scenario commonly associated with guilt and shame experiences and were asked to anticipate their emotional experience when imagining themselves in the scenario. Participants also indicated their gender and completed a measure of physical self-concept. Gender moderated the relationship between physical self-concept and anticipated shame but not guilt. Specifically, there was a negative association between physical self-concept and anticipated shame for women but not for men. Findings are consistent with the notion that gender role socialization shapes the emotional experiences, specifically feelings of shame, of men and women differently. The results demonstrate that even imagining a situation that runs counter to societal ideals for women’s bodies as thin and toned coincides with the anticipation of shame among adult women with more negative physical self-concept.

     

Identification Reduces Stigma of Mental Ill‐Health: A Community‐Based Study

The stigma surrounding mental ill‐health is an important issue that affects likelihood of diagnosis and uptake of services, as those affected may work to avoid exposure, judgment, or any perceived loss in status associated with their mental ill‐health. In this study, we drew upon social identity theory to examine how social group membership might influence the stigma surrounding mental ill‐health. Participants from two urban centers in Ireland (N = 626) completed a survey measuring stigma of mental health, perceived social support as well as identification with two different social groups (community and religion). Mediation analysis showed that subjective identification with religious and community groups led to greater perceived social support and consequently lower perceived stigma of mental ill‐health. Furthermore, findings indicated that high identification with more than one social group can lead to enhanced social resources, and that identification with a religious group was associated with greater community identification. This study thus extends the evidence base of group identification by demonstrating its relationship with stigma of mental ill‐health, while also reinforcing how multiple identities can interact to enhance social resources crucial for well‐being.     

From pleasure and pride to the fear of decline: Exploring the emotions in older women's physical activity narratives

ObjectivesThe purpose of this study was to explore the emotion narratives in older women's ageing body and physical activity-related stories.MethodThe study was informed by narrative inquiry. We conducted two semi-structured interviews with 21 women aged 65 to 94 and asked them about their physical activity engagement, and body perceptions, experiences, and management strategies. Using thematic narrative analysis, we analysed the content of participants’ stories pertaining to physical activity, the core patterns within them, and considered the cultural context in which they were embedded.ResultsEmotion narratives of anxiety/fear, shame, guilt, pride, and pleasure permeated the women's stories. Participants feared physical and cognitive decline, and engaged in physical activity to stave off the ageing process. Body-related shame and guilt transected their stories; they were frustrated by their inabilities to engage in certain activities and with their move away from the healthy and physically fit cultural ideal. To negotiate this body-related anxiety/fear, shame, and guilt, the women drew attention to their accomplishments in the physical domain with pride, reinforcing their efforts to take personal responsibility for their health. Participants were also physically active for pleasure, gaining satisfaction from the social connections and mindfulness derived from being active, and through their participation in challenging yet rewarding activities.ConclusionsThe findings are novel as they highlight the importance of cultural age and body norms coupled with complex emotional experiences in shaping later life physical activity experiences, and draw attention to the usefulness of stories to explore emotions in the physical domain.     

Shame,Guilt, and Suicide Ideation among Bondage and Discipline,Dominance and Submission,and Sadomasochism Practitioners: Examining the Role of the Interpersonal Theory of Suicide

To date, no study has examined rates of suicide ideation or theory‐based risk factors for suicide ideation among bondage and discipline, dominance and submission, and sadomasochism (BDSM) practitioners. Participants were 321 adults that endorsed BDSM involvement. Thirty‐seven percent of the sample indicated a nonzero level of suicide ideation. Thwarted belongingness and perceived burdensomeness (PB) were positively associated with suicide ideation and their interactive effect predicted additional variance in suicide ideation after adjusting for depressive symptoms. Overall, shame and guilt were positively associated with suicide ideation and these relations were mediated by thwarted belongingness and PB in parallel adjusting for depressive symptoms; however, there were some differences between demographic subgroups. Among BDSM practitioners, stigma‐related internalized feelings (i.e., shame and guilt) may be associated with increased thwarted belongingness and PB, which are associated with suicide ideation.     

Personality functioning in people living with HIV

This investigation adopted a multiple case study approach to determine the personality functioning in people living with HIV/ AIDS (PLWHA). Participants comprised a convenience sample of four PLWHA (male?=?3, female?=?1). The majority of the participants were white (n?=?3) and one was black African. Only one participant was married at the time of participation. Data on aspects such as their suicidal ideation, affect, problem solving styles, ego functioning, self-perception, and interpersonal functioning were collected using the Rorschach inkblot test and clinical interview. The data were actuarially analysed and organised under themes, namely; dominant personality style, capacity for control and stress, situational related stress, affect, interpersonal relations and self-perception. Findings revealed that participants had high levels of potential mood disorders and interpersonal difficulties for which targeted psychological services may be needed.     

How does education lead to healthier behaviours? Testing the mediational roles of perceived control,health literacy and social support

Abstract

Objectives: Educational attainment is increasingly recognised as a unique dimension of socioeconomic status (SES) and a powerful determinant of health behaviour—and thus physical health and mortality. However, very little is known about the specific pathways through which education influences these health behaviours. Design: The present study used a nationally representative US survey to test three potential psychosocial pathways (perceived control, health literacy and social support) through which education might influence intake of fruits and vegetables (FV), physical activity (PA) and sedentary behaviour (SB), controlling for other aspects of SES (income, health insurance status) and demographics (age, gender, race/ethnicity). Results: Both aspects of perceived control (locus of control, cancer fatalism) mediated the impact of education on FV and PA while only locus of control mediated the impact of education on SB. Further, only one aspect of health literacy (ability to understand recommendations) mediated education’s effect on any health behaviour (FV). Social support did not mediate any of the effects of education on health behaviors. Conclusion: Future work explicitly assessing and testing these mediational pathways is needed to better understand how education influences people’s health behaviours throughout their lives.     

Self‐criticism and self‐reassurance as mediators between mental health attitudes and symptoms: Attitudes toward mental health problems in Japanese workers

Japanese workers suffer high rates of mental health symptoms, recognised recently by the Japanese government, which has enacted workplace well‐being initiatives. One reason for poor mental health concerns negative attitudes about mental health problems such as shame, which may be mediated by self‐reassurance and self‐criticism. This study aimed to evaluate shame‐based attitudes toward mental health problems and explore the relationship between mental health attitudes, self‐criticism, self‐reassurance, and mental health symptoms. Japanese workers (n = 131) completed three measures: attitudes toward mental health problems, mental health symptoms, and self‐criticism/reassurance. A high proportion of workers reported negative attitudes about mental health problems. There were strong relationships between mental health attitudes, mental health symptoms, self‐criticism, and self‐reassurance. Path analyses revealed that the total and indirect effects (through self‐criticism and self‐reassurance) of mental health attitudes on mental health were larger than the direct effect alone. Hated‐self and family reflected shame were identified as predictors for mental health symptoms. The findings suggest the importance of self‐criticism and self‐reassurance in mental health and mental health attitudes. Implications for help‐seeking behaviours also are discussed. Interventions aimed at reducing self‐criticism and enhancing self‐reassurance are recommended to improve mental health attitudes and increase help‐seeking in Japanese workers.     

But I Still Feel Guilt: A Test of a Moral Disengagement Propensity Model

ABSTRACT

We explored the impact of moral disengagement on individual experiences of guilt. We modeled three forms of workplace deviance (withdrawal, interpersonal deviance, and work-family deviance) as mediators between the propensity to morally disengage and guilt, and also includes the moderating effects of perceived work hours culture. Data were collected from 226 employees matched with a colleague and spouse. Results demonstrated that moral disengagement released individuals who engaged in interpersonal and work-family deviance from subsequent feelings of guilt, but only reduced feelings of guilt for those who withdrew. We also found an interactive effect of perceived work hours culture on the relationships between moral disengagement propensity and all three forms of deviance. The indirect effect from moral disengagement propensity to guilt through withdrawal was stronger when perceived work hours was high.     

Validation française du test des émotions réflexives (French-TOSCA-3) : une mesure des tendances émotionnelles de honte et de culpabilité

IntroductionThis study sought to validate a French version of the Test of self-conscious affect-3 (TOSCA-3) (Tangney et al., 2000), which is a self-reporting measure of self-conscious emotions such as shame and guilt.MethodA sample of 431 undergraduates completed the French TOSCA-3 and other related psychological constructs.ResultsThe TOSCA-3 exhibited satisfactory internal, test-retest, and discriminant validity similar to the original American version. Moreover, the gender difference in shame and guilt was replicated.DiscussionThis dispositional measure of shame and guilt was the first made available in French and offers acceptable psychonometric qualities.     

Body-related state shame and guilt in women: Do causal attributions mediate the influence of physical self-concept and shame and guilt proneness

Guided by the process model of self-conscious emotions, this study examined whether physical self-concept (PSC) and shame and guilt proneness were associated with body-related self-conscious emotions of state shame and guilt and if these relationships were mediated by attributions of stability, globality, and controllability. Female participants (N = 284; Mean age = 20.6 ± 1.9 years) completed measures of PSC and shame and guilt proneness before reading a hypothetical scenario. Participants completed measures of attributions and state shame and guilt in response to the scenario. Significant relationships were noted between state shame and attributions of globality and controllability, and shame proneness, guilt proneness, and PSC. Similar relationships, with the additional predictor of stability, were found for state guilt. Mediation analysis partially supported the process model hypotheses for shame. Results indicate PSC and shame proneness are important in predicting body-related emotions, but the role of specific attributions are still unclear.