Measuring health-related stigma--a literature review

Stigma related to chronic health conditions such as HIV/AIDS, leprosy, tuberculosis, mental illness and epilepsy is a global phenomenon with a severe impact on individuals and their families, and on the effectiveness of public health programmes. To compare stigma measurement in different disciplines, a literature review was conducted. References were obtained through a search of literature databases and through examining relevant bibliographies. Sixty-three papers were selected that addressed the issue of measurement of stigma or related constructs and that contained a sample of the instrument or items used. Five unpublished studies were also included in the review. The aspects of health-related stigma used for assessment can be grouped in five categories. First, the experience of actual discrimination and/or participation restrictions on the part of the person affected; second, attitudes towards the people affected; third, perceived or felt stigma; fourth, self or internalized stigma; and fifth, discriminatory and stigmatizing practices in (health) services, legislation, media and educational materials. Within each of these areas, different research methods have been used, including questionnaires, qualitative methods, indicators and scales. The characteristics of the instruments considered most promising are described and compared. The purpose of stigma assessment is to increase our understanding of stigma and its determinants and dynamics, to determine its extent or severity in a given setting or target group and to monitor changes in stigma over time. The conclusions from this review are that (a) the consequences of stigma are remarkably similar in different health conditions, cultures and public health programmes; (b) many instruments have been developed to assess the intensity and qualities of stigma, but often these have been condition-specific; and (c) development of generic instruments to assess health-related stigma may be possible. To achieve this aim, existing instruments should be further validated, developed or adapted for generic use, where possible.     

The Menstrual Mark: Menstruation as Social Stigma

In this theoretical paper, we argue that menstruation is a source of social stigma for women. The word stigma refers to any stain or mark that renders the individual’s body or character defective. This stigma is transmitted through powerful socialization agents in popular culture such as advertisements and educational materials. We demonstrate, in our review of the psychological literature concerning attitudes and experiences of predominantly American girls and women, that the stigmatized status of menstruation has important consequences for their health, sexuality, and well-being. We argue that the stigma of menstruation both reflects and contributes to women’s lower social status and conclude with suggestions for ways to resist the stigma.     

Social Stigma and its Consequences for the Socially Stigmatized

This paper presents an integrative review of current and classic theory and research on social stigma and its consequences for the socially stigmatized. Specific attention is paid to stigma‐related processes surrounding race/ethnicity, gender, and sexual orientation. The origins and perpetration of social stigma are discussed alongside perspectives on how stigmatized groups and individuals experience stigma‐related stress. Consideration is given to responses to stigma in the form of coping, social support, and meaning‐making processes. Both the potential negative and positive consequences of social stigma are highlighted in this review through the integration of predominant social psychological theory with emerging critical and feminist theories of positive marginality and resistance. The paper culminates in a theoretical process model designed to provoke future theory and research that share its integrative aims.     

Stigmatisation intériorisée et consommation de substances psychoactives : revue systématique de la littérature

IntroductionSubstance use is a very stigmatized condition all over the world. Moreover, lots of people who use drugs or alcohol tend to internalize these stigmas, which can lead to harmful consequences. Corrigan's progressive model of self-stigma suggest that individuals go through four stages to internalize the stigma (aware, agree, apply, harm) and then undergo a stage of resignation and lack of hope and energy called “why try”. Research seems to be increasingly interested in this phenomenon, so we wonder, where we stand in the comprehension of internalized stigma for substances users?ObjectiveThis work aims to systematically review ten-past years studies about self-stigma in substance addiction in order to assess the status of curr ent works in this area.MethodThis systematic review was led inspired by the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statements on the electronic databases PubMed, PsycInfo and PsycArticle. The inclusion criteria were: references published between 2010 and 2020, in French or English language which shows results about self-stigma for psychoactives substances users. A total of 39 studies met the eligibility criteria for inclusion in this review.ResultsSynthesizing findings across the studies revealed some important topics. First, the progressive model seems to be statistically valid among drug and/or alcohol users. Nevertheless, self-stigma of drugs and/or alcohol is not the only condition that entails users. A varieties of other factors (i.e. HIV, sex work) are to be considered in the understanding of stigmatization. In the studies, negative consequences due to self-stigma in substance use were observed such as depression or anxiety symptoms, lower self-esteem and negatives emotions as fear and shame.ConclusionAll these results are to be considered within their limits. In light of these findings, the knowledge acquired will allow professionals to develop new interventions to prevent and to reduce self-stigma of drug and/or alcohol users.     

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.     

The fight against stigma: an overview of stigma-reduction strategies and interventions

In many health conditions, people are severely affected by health-related stigma and discrimination. A literature review was conducted to identify stigma-reduction strategies and interventions in the field of HIV/AIDS, mental illness, leprosy, TB and epilepsy. The review identified several levels at which interventions and strategies are being implemented. These are the intrapersonal, interpersonal, organizational/institutional, community and governmental/structural level. Although a lot of work has been carried out on stigma and stigma reduction, far less work has been done on assessing the effectiveness of stigma-reduction strategies. The effective strategies identified mainly concentrated on the individual and the community level. In order to reduce health-related stigma and discrimination significantly, single-level and single-target group approaches are not enough. What is required is a patient-centred approach, which starts with interventions targeting the intrapersonal level, to empower affected persons to assist in the development and implementation of stigma-reduction programmes at other levels.     

Psychosocial and Behavioural Assessment of Chronic Pain: Recommendations for Clinicians and Researchers

Abstract

A variety of methods have been developed for the assessment of chronic benign pain. In research or in clinical practise, choosing an adequate measurement technique can be a laborious task. This article has two main purposes: to report on some basic features to consider when selecting assessment instruments, and to present a review of some psychosocial and behavioural measurement methods for the assessment of chronic benign pain. The selected methods have, with one exception, been evaluated on Swedish chronic pain populations and are used in international pain research. In conclusion, we recommend the use of psychometrically sound instruments, and that the purposes for use of a measure have to be thoroughly considered in advance. We also emphasize that in clinical practise, each separate measure must be interpreted in a wider context, where clinical findings and judgements are considered as a whole. In addition, none of the single reviewed assessment techniques can replace the communication between the patient and the clinician.     

Stigma, obesity, and the health of the nation's children

Preventing childhood obesity has become a top priority in efforts to improve our nation's public health. Although much research is needed to address this health crisis, it is important to approach childhood obesity with an understanding of the social stigma that obese youths face, which is pervasive and can have serious consequences for emotional and physical health. This report reviews existing research on weight stigma in children and adolescents, with attention to the nature and extent of weight bias toward obese youths and to the primary sources of stigma in their lives, including peers, educators, and parents. The authors also examine the literature on psychosocial and physical health consequences of childhood obesity to illustrate the role that weight stigma may play in mediating negative health outcomes. The authors then review stigma-reduction efforts that have been tested to improve attitudes toward obese children, and they highlight complex questions about the role of weight bias in childhood obesity prevention. With these literatures assembled, areas of research are outlined to guide efforts on weight stigma in youths, with an emphasis on the importance of studying the effect of weight stigma on physical health outcomes and identifying effective interventions to improve attitudes.     

Exploring a taxonomy for aggression against women: can it aid conceptual clarity?

The assessment of aggression against women is demanding primarily because assessment strategies do not share a common language to describe reliably the wide range of forms of aggression women experience. The lack of a common language impairs efforts to describe these experiences, understand causes and consequences of aggression against women, and develop effective intervention and prevention efforts. This review accomplishes two goals. First, it applies a theoretically and empirically based taxonomy to behaviors assessed by existing measurement instruments. Second, it evaluates whether the taxonomy provides a common language for the field. Strengths of the taxonomy include its ability to describe and categorize all forms of aggression found in existing quantitative measures. The taxonomy also classifies numerous examples of aggression discussed in the literature but notably absent from quantitative measures. Although we use existing quantitative measures as a starting place to evaluate the taxonomy, its use is not limited to quantitative methods. Implications for theory, research, and practice are discussed. Aggr. Behav. 35:462–476, 2009. © 2009 Wiley‐Liss, Inc.     

Constructing a Theory and Evidence-Based Approach to Promote and Evaluate Autonomy in Addiction

ABSTRACT

In this article we use theory and empirical evidence to synthesize a model for the analysis of autonomy in people with addictions. We review research on motivation and denial as accepted addiction constructs that need to be replaced with non-stigmatizing and autonomy-supportive language when seeking to ‘treat’ addicts. We present three main factors involved in relational autonomy in addiction (mentalizing, positive self-concept, and stigma), and illustrate our model by examining variations on these parameters in two case studies of heroin addicts. We conclude that a growth perspective is needed to assess functioning in populations believed to be ‘addicted’ and make suggestions for assessment.     

An Argument for Separate Analyses of Attitudes Toward Lesbian, Gay, Bisexual Men, Bisexual Women, MtF and FtM Transgender Individuals

While past research has certainly investigated a variety of correlates of U.S. attitudes toward lesbians, gays, bisexual men, bisexual women, male-to-female (MtF) and female-to-male (FtM) transgender (LGBT) individuals, there are no U.S. quantitative studies that could be located that examined attitudes toward each of these groups separately. This is especially important because efforts to combat prejudices are likely to be most successful if they are based in research that explores how attitudes are both similar and different across specified targets of prejudice. Toward that goal, this essay underscores the significance of examining U.S. attitudes toward LGBT individuals as separate constructs. Both the gender and sexual orientation of the target of prejudice and the gender and sexual orientation of the respondent are highlighted as important constructs that should be considered when investigating U.S. attitudes toward LGBT individuals. First, I review previous U.S. studies that have examined attitudes toward LGBT individuals. Second, I offer arguments for how the intersections of gender and sexual orientation may affect attitudes toward LGBT individuals. Third, I discuss future considerations in studies of attitudes toward LGBT individuals in the context of multiple intersectionalities. I suggest that U.S. initiatives to reduce sexual stigma, gender nonconformity stigma, and transgender stigma should be grounded in research that highlights prejudicial attitudes as they vary by the target of prejudice and the respondents’ characteristics.     

Borderline Personality Disorder in 3-D: Dimensions,Symptoms, and Measurement Challenges

Borderline personality disorder (BPD) is a pervasive pattern of psychopathology characterized by unstable affect, suicidal behaviors, and identity problems (Diagnostic and statistical manual of mental disorders. Washington, DC: Author; 2000). BPD is heterogeneous in nature, highly prevalent in clinical settings, and increasingly studied by clinical and social psychologists. This review highlights affective instability, impulsivity, and interpersonal hypersensitivity, the interaction of which we believe accounts for the symptoms of BPD, the BPD criteria most associated with these features, and the interrelationships among these underlying dimensions. We also discuss difficulties in measurement of these dimensions. Real-world assessment methods will assist in the measurement of time-dependent processes and identify causes, covariates, or consequences of these processes to determine how these features manifest themselves in real life.     

Understanding the Relationships Among HIV/AIDS-Related Stigma,Health Service Utilization,and HIV Prevalence and Incidence in Sub-Saharan Africa: A Multi-level Theoretical Perspective

HIV-positive individuals often face community-wide discrimination or public shame and humiliation as a result of their HIV-status. In Sub-Saharan Africa, high HIV incidence coupled with unique cultural contexts make HIV-positive individuals particularly likely to experience this kind of HIV/AIDS-related (HAR) stigma. To date, there is a relatively small amount of high-quality empirical literature specific to HAR stigma in this context, supporting the notion that a better understanding of this phenomenon is needed to inform potential interventions. This paper provides a thorough review of the literature specific to HAR stigma in Sub-Saharan Africa, finding (a) qualitative support for the existence of important relationships between HAR stigma and health service utilization and barriers; (b) a need for more quantitative study of stigma and its relationships both to health service utilization and to HIV outcomes directly; and (c) a disconnect between methodological techniques used in this context-specific literature and well-known theories about stigma as a general phenomenon. This paper then draws from its empirical literature review, as well as from well-known theoretical frameworks from multiple disciplines, to propose a theoretical framework for the ecological and multilevel relationships among HAR stigma, health service utilization, and HIV outcomes in this context.     

Psychological consequences of motor vehicle accidents: A systematic review

People involved in motor vehicle accidents (MVA) are at increased risk for psychological problems. Although the existing literature states that MVAs cause substantial negative mental health effects, summarizing and comparing these effects to understand their consequences could be more explored. This systematic literature review provides an overview of the literature surrounding the psychological consequences of MVAs to summarize and quantify their effects on mental health. The studies published in an English-language journal in the last 20 years (2001–2021) that present psychological consequences of MVAs were included. Web of Science, Scopus, and PubMed databases were used for the literature search. The systematic literature search found 23 eligible studies. After identifying all relevant studies on the topic, we synthesized the applied psychological assessment methods and the psychological consequences of MVAs. Current gaps in the reviewed papers and what future research are needed are also discussed. Results indicated that negative psychological consequences following an MVA are substantial, with all studies pointing to negative consequences in at least one psychopathology. Trauma-related MVA injuries are associated with elevated psychological distress, and MVA-related psychological consequences could have long-term effects if left untreated.     

非体面工作者职业污名的作用机制及其应对策略

“非体面工作”是指在身体上令人不悦、社会认知程度不高的工作, 或者与我们道德观念中更英雄主义的东西背道而驰的工作类型。通过回顾非体面工作从业者职业污名的相关文献, 对非体面工作和职业污名的概念内涵进行划分与辨析; 基于认知评价理论构建了职业污名威胁感知过程模型, 探讨了非体面工作从业者职业污名的前因、评估、应对策略以及可能产生的潜在后果; 提出了未来潜在研究方向：(1)从动态视角探索职业污名的来源; (2)结合个体和情境因素探索职业污名管理的作用路径和作用效果; (3)考虑多样文化背景。     

“I'm Not That Type of Person”: Managing the Stigma of Having an Abortion

Drawing on interviews with U.S. women, this article offers a social–psychological framework for understanding the stigma of having an abortion and identifies the individual stigma management strategies women use to mitigate negative intrapersonal and interpersonal consequences of abortion stigma. We also contribute to contemporary understandings of abortion stigma by theorizing how aspects of abortion stigma—such as its concealability and episodic expression—interfere with women's potential to collectively manage or dismantle abortion stigma. Finally, we discuss how our conceptual framework can be used to inform the development of a measure of the stigma experiences of women who have had an abortion, which can help improve health and well-being outcomes for women.     

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.     

Health-related stigma: rethinking concepts and interventions

As a feature of many chronic health problems, stigma contributes to a hidden burden of illness. Health-related stigma is typically characterized by social disqualification of individuals and populations who are identified with particular health problems. Another aspect is characterized by social disqualification targeting other features of a person's identity-such as ethnicity, sexual preferences or socio-economic status-which through limited access to services and other social disadvantages result in adverse effects on health. Health professionals therefore have substantial interests in recognizing and mitigating the impact of stigma as both a feature and a cause of many health problems. Rendering historical concepts of stigma as a discrediting physical attribute obsolete, two generations of Goffman-inspired sociological studies have redefined stigma as a socially discrediting situation of individuals. Based on that formulation and to specify health research interests, a working definition of health-related stigma is proposed. It emphasizes the particular features of target health problems and the role of particular social, cultural and economic settings in developing countries. As a practical matter, it relates to various strategies for intervention, which may focus on controlling or treating target health problems with informed health and social policies, countering the disposition of perpetrators to stigmatize, and supporting those who are stigmatized to limit their vulnerability and strengthen their resilience. Our suggestions for health studies of stigma highlight needs for disease- and culture-specific research that serves the interests of international health.     

Stigma and Client Satisfaction in Mental Health Services

Numerous studies have revealed that stigmatization of persons with mental health problems has a large array of negative consequences. One outcome that has been largely neglected is client satisfaction. In this empirical study, the link between 3 types of stigma experiences and client satisfaction is explored in a sample of clients (N = 741) of professional mental health services in Belgium. This relationship is compared with the link between stigma and general life satisfaction; and the role of the self‐concept in these relationships is explored. The results reveal that the association depends on the dimension of stigma under study. The findings stress the importance of studying multiple dimensions of stigma experiences, in addition to multiple outcomes.     

The concept of vitality. Review of the vitality-related research domain

Existing literature identified numerous positive consequences of vitality, including somatic health, mental well-being, and improved performance. Despite the immense scientifically proven beneficial importance of vitality, the concept has not been accurately conceptualized to ensure its uniform, comprehensive understanding and application. Through a detailed analysis of 93 qualified research studies on vitality, the present study provides a contemporary and concise scoping review of the vitality research domain, in particular how researchers addressed vitality, what aspects of vitality they explored, and how they designed their investigations on vitality. The vitality research domain appears to be composed of mainly quantitative inquiries in the field of psychology. The findings disclose vitality as a quantifiable subjective positive concept consisting of fluctuating physiological and psychological energy, which can be regulated and harnessed by a person possessing it. In addition to outlining features and measurements of vitality, the review generalized its empirically identified antecedents and consequences.