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.     

The stigma of mental illness: Explanatory models and methods for change

For people with mental illness, diminished quality of life and loss of personal goals does not result solely from the symptoms, distress, and disabilities caused by their psychiatric disorder. Quality of life and personal goals are also hindered by people who embrace the stigma that accompanies mental illness and mental health care. This paper reviews evidence of the impact of mental illness stigma and strategies for seeking to ease its impact. To achieve these goals, we (a) describe the ways in which stigma harm people with mental illness, (b) summarize models that explain the development and maintenance of these stigmatizing effects, and (c) review strategies that have been shown to decrease the impact of stigma. Concerns about stigma are on the political agendas of many mental health advocacy groups. It has recently also become the focus of extensive research. Our goal in this paper is to balance the practical concerns raised by mental health advocates against data that support or contradicts specific assertions.     

Erasing the Stigma: Where Science Meets Advocacy

One of the greatest barriers to individuals with mental illnesses in achieving their life goals is the stigma of mental illness. A major focus of mental health advocates is tearing down this stigma. Approaching this task from a research-informed perspective is important to ensure that resources are wisely spent, and adopted strategies are effective. This article provides a review of existing research regarding public stigma reduction, looking at approaches within mental health and other stigmatized communities. Recommendations are made for adopting approaches involving Targeted, Local, Credible, and Continuous Contact.     

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。     

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。     

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.     

心理疾病污名形成理论述评

心理疾病污名是加诸于患者身上的耻辱标记,妨碍患者的治疗和康复。心理疾病污名的成因理论包括功能主义和生物文化两个派别,污名的发展模型解释了污名的形成过程,身份威胁模型对污名的作用机制进行了阐述。通过抗议、教育和接触可以有效地减少污名。在中国开展相关研究应注重分析传统文化、心理疾病类型与污名的关系,探讨各种减少污名策略的可行性     

Perceived Stigma and Self-Stigma in College Students: A Literature Review and Implications for Practice and Research

Perceived and self-adopted forms of stigma are omnipresent. Although stigma is often discussed alongside mental illness, constructs such as race, ethnicity, and sexuality can also cause individuals to adopt feelings of stigma within themselves. The literature has called for further inquiry examining the effects of perceived and self-stigmas among different populations. In response, this literature review examines the influence of perceived and self-stigmas on college student populations. Overall, perceived and self-stigmas have the potential to negatively affect students’ psychological well-being, willingness to seek treatment, cocurricular experiences, and academic performance. Implications for future research are presented based on the review’s findings.     

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.     

Self‐Stigma,Mental Health Literacy,and Health Outcomes in Integrated Care

The authors describe research on the self‐stigma of mental illness and help seeking, mental health literacy, and health outcomes in an integrated care medical center. Results revealed that self‐stigma of mental illness and self‐stigma of seeking help had an inverse relationship with mental health literacy. No statistically significant relationships were found between health outcomes, either type of self‐stigma, and mental health literacy. The authors discuss these and other findings and offer research and counseling implications.     

Knowing so much,yet knowing so little: a scoping review of interventions that address the stigma of mental illness in the Canadian context

Stigma can have detrimental effects on the health and wellbeing of individuals living with a mental illness. This scoping review describes the nature, range, and extent of intervention research aimed at reducing public and self-stigma of mental illness in the Canadian context. The review was guided by Arksey and O’Malley’s framework. A search of databases and relevant websites identified 35 primary studies. Most studies used quantitative research methods and included predominantly youth or middle-aged adults, women, and white Canadian-born people. Guided by different conceptualizations of stigma, direct or indirect contact, education, and advocacy-focused interventions, aimed to provide information, and/or develop skills to address self and public stigma. Most studies evaluated interventions’ effectiveness short-term. Of the few studies that followed-up participants long-term, some were able to reduce stigmatizing attitudes post-intervention, however, these targeted only specific groups such as students or health care professionals. Lack of diversity among the samples, and limited evidence of long-term effectiveness of interventions, were some of the studies’ limitations. What is currently known about interventions aimed at reducing the stigma of mental illness in the Canadian context is not informed by research among vulnerable groups, such as people living with a mental illness, older adults, immigrants, and people of diverse ethnic backgrounds. Interventions that are informed by clear conceptualizations of stigma and rigorously evaluated in a range of ethno-cultural groups would create a knowledge base that is useful for policy-makers, community leaders, and agencies serving various ethnic communities in Canada.     

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.     

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.     

The stigma of seeking help for mental health issues: mediating roles of support and coping and the moderating role of symptom profile

A key factor to the prevalence of mental illness might be the disinclination to seek help, perhaps owing to the stigma of mental illness. In two studies, the contribution of severity of depressive symptoms, social support, and unsupport, coping strategies, and salience of psychological versus biological features of depression in relation to perceived self‐ and other‐stigma of help‐seeking for mental health issues were examined. Participants were first year students experiencing a transitional stressor, namely entry to university. Together, the findings point to the contribution of social support and unsupportive interactions, and coping methods to the prediction of perceived stigma of seeking help, but that the framing of mental illness can limit or strengthen these relations.     

Stigma of mental illness,religious change,and explanatory models of mental illness among Jewish patients at a mental-health clinic in North Jerusalem

During 3 months in 2004, 38 recent referrals to a Community Mental Health Clinic in North Jerusalem, a substantially Ultra-Orthodox Jewish neighborhood, were evaluated by the Explanatory Model Interview Catalogue. This questionnaire, which includes a 13-item scale measuring stigma towards mental illness, was adapted and translated into Hebrew. Patients with a more religious upbringing expressed a greater sense of stigma towards mental illness; however, patients who now had a more religious affiliation did not. The 14 patients who had experienced a religious change toward a more religious affiliation reported a lower level of stigma than the 24 non-returnees. Even when controlling for religious upbringing, the partial correlation between stigma score and religious change was significant. Stigma was lower among younger but not older returnees. Findings from this study support the hypothesis that a stigma of mental illness may be a deterrent to the use of a public mental-health clinic for religious Jews in Israel. Ultra-Orthodox Jewish patients (especially non-Hasidic) used a nonreligious explanatory model (perception and understanding) of mental illness more often than a religious explanatory model. This last finding could reflect a shift in the Ultra-Orthodox Jewish communities from a religious to a more medical and psychological explanatory model.     

Competence and warmth stereotypes prompt mental illness stigma through emotions

Public stigma toward mental illness subgroups (11 mental illness subgroups and 2 subgroups perceived to have mental illness) was examined. Competence and warmth stereotypes were used to predict emotional reactions posited to mediate behavioral inclinations ranging from passive to active harm or facilitation. Fear mediated the relationship between low competence and warmth stereotypes and passive harm. Anger, and to a lesser extent fear, mediated the relationship between low warmth and active harm. Pity mediated the relationship between warmth and active facilitation. Neither envy nor admiration linked stereotypes to behavioral reactions. Results suggest that emotions share motivational direction with behavior, to approach or to avoid, rather than simply sharing valence. Implications for research on stigma toward mental illness subgroups are discussed.     

心理疾病污名内隐测评的类别标签初探

采用单一类型内隐联想测验,考察以往研究中常用的概括化心理疾病词和具体心理疾病词作为心理疾病内隐污名间接测量概念词或类别标签的有效性。结果发现,相较于与积极词配对的任务,两类概念词与消极词（心理疾病态度词）配对的任务反应时更快,正确率更高。研究表明概括化概念和具体疾病与反映人们对心理疾病患者真实态度的消极词存在更紧密的自动联结,是人们头脑中表征心理疾病的概念词或类别标签,可作为内隐测量中的心理疾病概念词用于污名评估。     

Differences in attributions of mental illness and social distance for portrayals of four mental disorders

For individuals with mental illness, others' perceptions of mental illness often limit integration into communities. Perceptions of mental illness manifest as social stigma in the form of social distance and may depend on individuals' attributions of the origins of mental illness. 180 university students completed a survey on attribution of mental illness and social distance across several disorders (psychiatric and physical). Participants indicated greater social distance for severe mental illness (i.e., schizophrenia) than less severe mental illness and physical illness. More desire for social distance may be related to unfamiliarity with severe mental illness rather than less severe mental and physical illnesses. Greater understanding of how individuals perceive mental illness can inform efforts to educate the public.     

Narrative enhancement and cognitive therapy: a new group-based treatment for internalized stigma among persons with severe mental illness

Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally led treatment to address this issue. In this article, we discuss our development of a new group-based approach to the treatment of internalized stigma which we have termed "narrative enhancement and cognitive therapy (NECT)". We describe the treatment approach and offer an illustration of it by way of a case vignette.     

Stigma-Busting,Compeer, and the Psychology Student: A Pilot Study on the Impact of Contact with a Person Who Has a Mental Illness

Stigma has been identified both by people with mental illnesses and by empirical research to be a major barrier to service use and recovery. In addition, research has suggested that the most effective strategy for reducing stigma is personal contact with a person who has a mental illness and who is contributing to the life of the community. This article reports the qualitative findings from a study of the use of the Compeer model to address stigma in undergraduate psychology students. Findings suggest that befriending a person with a mental illness, even when done as a requirement for a college course, can be a useful experience in exposing and challenging stigmatizing perceptions and expectations and in offering people insights into the humanity and life experiences of a person with mental illness. Limitations and implications of this study for future stigma-busting efforts are discussed.