Evidence for blatant dehumanization of mental illness and its relation to stigma

ABSTRACT

People with mental illness face stigma, and due to their low social status, they may also face blatant dehumanization that denies their status as fully evolved human beings. In the current research, three studies documented the existence of blatant dehumanization of mental illness. Study 1 (N = 112) showed that participants rated people with mental illness in general as being significantly less human than other dehumanized social groups such as Mexican immigrants and Muslims. Study 2 (N = 158) showed that dehumanization occurs for specific mental disorders but that the level of dehumanization varies widely among disorders. Study 3 (N = 223) documented significant correlations between dehumanization of mental illness and standard measures of stigma such as fear, pity, and social distance. Overall, the results establish the relevance of blatant dehumanization to mental illness stigma and suggest new directions for understanding stigma.     

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.     

Managing a stigmatized identity—evidence from a longitudinal analysis about people with mental illness

Previous research about coping with the stigma of mental illness mostly relied on cross‐sectional or qualitative research designs. In the present study, the consequences of ten identity management strategies for mental illness stigma were observed in a longitudinal design. Cross‐lagged analyses were used to describe the influence of the strategies on the frequency of stigma experiences and on mental health in a two‐wave panel of people with mental illness (n = 367, 79% repeated response rate). Selective disclosure and information seeking emerged as adaptive identity management strategies, whereas overcompensation and withdrawal led to lower mental health. Results were mostly unaffected by demographic and psychiatric variables. The results support an empowerment model of stigma resilience that portrays stigmatized people as active constructors of their social world.     

Evidence that anticipated stigma predicts poorer depressive symptom trajectories among emerging adults living with concealable stigmatized identities

People living with concealable stigmatized identities are vulnerable to experiencing greater depressive symptoms as a result of occupying a lower social status. In the present research, we examine the effect of changes in enacted stigma and changes in anticipated stigma on trajectories of depressive symptoms over time. A sample of 192 college-aged emerging adults (81.0% female, 81.9% Caucasian, M_age = 18.82 years) living with a concealable stigmatized identity (e.g., mental illness and sexual minority status) completed measures of enacted stigma, anticipated stigma, and depressive symptoms at two time points across eight weeks. Hierarchical linear modeling analyses indicate that increases in anticipated stigma, but not enacted stigma, predicted poorer trajectories of depressive symptoms, controlling for the effect of baseline rumination and other identity-related variables. These data are among the first to demonstrate that worries about future devaluation predict poorer depressive symptom trajectories over time among college-aged emerging adults.     

Efficacy of a Photovoice‐based video as an online mental illness anti‐stigma intervention and the role of empathy in audience response: A randomized controlled trial

This study examined the efficacy of a Photovoice‐based video as a novel online anti‐stigma video in reducing mental illness stigma, as well as the role of empathic concern in stigma reduction. Photovoice is a grassroots process by which members of a marginalized group, such as people with a mental illness, document and convey their experience; in this study’s context, the experience of living with a mental illness and the stigma associated with this experience. Canadian undergraduate university students (n = 303; average age = 21) were randomly assigned to view either a Photovoice‐based anti‐stigma intervention video (n = 156) or a control video (n = 147). Compared to the control condition, the Photovoice‐based video was efficacious in reducing mental illness stigma, including reduced fear and anger toward people with a mental illness, decreased perceptions of dangerousness, and decreased desired social distance. In addition, the intervention was efficacious in maintaining reduced desired social distance relative to the control at 1‐month post‐intervention. Finally, empathic concern was found to mediate the relationship between the Photovoice‐based video and reduced mental illness stigma, suggesting that one way the intervention reduced mental illness stigma was by eliciting empathy in the viewer.     

Imagined contact and mental illness stigma in an Asian context: Bolstering the effect and examining the impact of factual information

Imagined contact can be effective at reducing social stigma. However, the effect may depend on the strength of the stigma held. We tested the robustness of imagined contact in an Asian setting where stigmatization of mental illness is stronger than in Western countries. In Experiment 1 (n = 167) with five conditions, only an enhanced version of positive imagined contact was able to decrease stigma towards people with schizophrenia through decreasing intergroup anxiety. Given the potential discrepancy between imaginations and reality about experiences with stigmatized groups, in Experiment 2 (n = 121), we tested the hypothesis that after presenting participants with factual information about a mental illness group, imagined contact might backfire, resulting in more negative perceptions. However, enhanced imagined contact alongside factual message about schizophrenia did not increase stigma. The backfiring hypothesis was therefore not supported. Nevertheless, providing realistic information did negate the positive effects of enhanced imagined contact on stigma reduction. In both experiments, we also showed that intergroup anxiety mediated the effect of enhanced imagined contact on various measures of stigma.     

Psychological stigma costs as barriers to healthcare use in former soldiers of the German Armed Forces: A qualitative analysis

Individuals decide to use healthcare when the expected benefits outweigh the perceived costs. One of these cost factors in this decision can be stigma. So far, it has not been researched how former soldiers of the German Armed Forces with a service-induced mental illness perceive stigma and how it influences their healthcare use. As stigma is shaped by the socio-cultural context, the setting of the potential healthcare use must be considered. Narrative interviews were conducted with 33 former soldiers with mental health problems. The data were analyzed using a thematic analysis approach, in which codes were formed and emerging themes were systemized. The relationship between stigma and healthcare use was analyzed. Occupational discrimination and social exclusion were experienced in both in the military and civilian context, but stigma functioned differently in each context. In the military context, former soldiers’ self-stigma of mentally ill individuals being weak was in stark contrast to their internalized military standards. This contrast let them avoid disclosure and subsequent healthcare use. In civilian context, the participants perceived 2 different stigma costs: mental illness stigma and former soldier stigma (i.e., stigmatization because of their military past). Both were perceived as barriers to healthcare use. A model, illustrating these different stigma costs in the different contexts, was developed. Further research on the link between stigma and healthcare use of this group is urgently needed.     

心理疾病内隐污名：来自单类内隐联想测验的证据

以61名大学生为被试,采用三个独立的单类内隐联想测验（SC-IAT）考察心理疾病内隐污名的构成及其内隐效应。结果发现：（1）在认知评价、情感反应、行为倾向及其三者合并的4个SC-IATs中,被试在相容任务上的反应时均显著快于不相容任务;（2）总的SC-IAT和三个独立SC-IAT的内隐效应显著;（3）65.27%的被试的内隐效应值大于0,表现出对心理疾病患者负面的内隐态度;（4）研究采用的心理疾病内隐污名SC-IAT具有较好的信、效度指标。研究表明,被试倾向于将心理疾病与消极词联结在一起,心理疾病污名的内隐效应显著;心理疾病内隐污名包括自动化的负面认知、消极情感反应和歧视倾向。     

Family Contexts: Parental Experiences of Discrimination and Child Mental Health

Research on the mental health correlates of discrimination traditionally has been intra-individual, focusing exclusively on the individual directly experiencing discrimination. A small number of studies have begun to consider the links between parental experiences of discrimination and child mental health, but little is known about potential underlying mechanisms. The present study tested the independent mediating effects of parent mental health and household socioeconomic status on the associations between parental experiences of discrimination (past-year perceived discrimination and perceptions of being unaccepted culturally) and child mental health (internalizing and externalizing symptoms) using a bootstrapping analytic approach. Data were drawn from racial/ethnic minority (n = 383) and White (n = 574) samples surveyed in an urban Midwestern county. For all measures of discrimination and child mental health, findings supported an association between parental experiences of discrimination and child mental health. Whereas parent mental health served as a significant mediator in all analyses, socioeconomic status did not. Mediation findings held for both the White and racial/ethnic minority samples. Results suggest that parental experiences of discrimination and mental health may contribute to child mental health concerns, thus highlighting the role of family contexts in shaping child development.     

The Stigma of Mental Illness

Stigma surrounding major mental illness creates many barriers. People who experience mental illness face discrimination and prejudice when renting homes, applying for jobs, and accessing mental health services. The authors review the current literature regarding stigma and mental illness. They define stigma and review theories that explain its impact. Counselor training is a peak time to identify and begin to mitigate stigma related to people with mental illness. Implications for counselor training are addressed.     

基于连续体信念的精神障碍污名化干预探索

以往研究尝试阐明精神障碍患者污名化的产生机制,并提出相应的干预方案。然而,不同方案的干预效果却不尽如人意,并导致了众多理论纷争。解决上述争论的关键在于揭示污名化产生的核心认知机制,即精神障碍的污名化源于人类自发性的社会分类加工。上述核心认知机制的提出将引领以连续体信念为切入点的全新污名化干预路径。该干预路径能够整合精神障碍污名化消除的理论之争,进而衍生出完整的连续体信念干预理论模型和实践模式。     

Coping,social support,stigma, and gender difference among people living with HIV in Guangxi,China

The current study examined whether gender, HIV-related stigma, social support, and the interaction between gender and social support are associated with coping responses among people living with HIV and AIDS (PLWHA) in Guangxi, China. A total of 2987 PLWHA in Guangxi participated from October 2012 to August 2013. Multivariate analysis of covariance was conducted with gender and social support as main factors in the model, and stigma and other variables as covariates. After controlling for demographic variables and stigma, there were significant main effects of emotional social support (F = 1.61, p < .001), functional social support (F = 1.67, p < .001), and informational social support (F = 3.67, p < .001) on various coping strategies. The interaction between gender and informational social support (F = 1.33, p < .05), internalized stigma (F = 37.03, p < .001) and perceived stigma (F = 9.16, p < .001) were associated with various coping strategies. Findings signify the importance of HIV-related stigma and social support differences in the coping strategies among PLWHA in Guangxi, China.     

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.     

污名对大学生心理求助行为的影响

大学生群体的心理健康问题是全社会一个不容忽视的问题,然而,由于心理疾病的污名化,大学生为了避免自己和家人遭受歧视而回避求助,本文通过文献调查法,探讨污名的内涵、影响因素、污名的分类及对大学生心理求助行为的影响,提出对策减少心理疾病污名感,提高大学生心理求助行为,促进大学生心理健康。     

Mental health problems in rural contexts: A broader perspective: Response to Jackson et al. (2007) Mental health problems in rural contexts: What are the barriers to seeking help from professional providers?

The objectives of this article are to expand and comment upon a recent review in Australian Psychologist of the literature in relation to mental health problems in rural contexts by Jackson et al. (2007). In the present article we review recently published qualitative research on the help‐seeking attitudes and experiences of rural Australian adolescents. While we agree on the utility of the Macintyre, Ellaway, and Cummins (2002) conceptual framework based on notions of health and place, we note that this framework specifically emphasises the importance of the collective dimension. We present a broader perspective on health and place than Jackson et al. (2007) by incorporating social geographic research. We argue that rural mental health research has been hampered by a simplistic view of social stigma of mental illness and that a more thorough conceptualisation of the phenomenon is needed. Finally, we make some further recommendations based on a broader perspective of mental health in rural contexts: one that incorporates an in‐depth understanding of the help‐seeking attitudes and experiences of rural adolescents as well as an appreciation of the collective social functioning of rural communities.     

Virtual voices: social support and stigma in postnatal mental illness Internet forums

Many women with postnatal mental illness do not get the treatment they need and this is often because stigma prevents disclosure. The purpose of this study was to explore online social support for postnatal mental illness, how women experience stigma and potential disadvantages of using Internet forums. Interviews were conducted with fifteen participants who had suffered postnatal mental illness and had used forums. Systematic thematic analysis identified common themes in relation to social support, stigma and disadvantages of using forums. Most women felt they benefited from visiting forums by developing a shared understanding and discourse about their illness. Findings suggest future research should investigate if women benefit from using online social support provided by forums, if use challenges stigma and further explore potential concerns about using forums.