A Multilevel Approach for Reducing Mental Health and Substance Use Disparities Affecting Bisexual Individuals

Despite bisexual individuals being at increased risk for mental health and substance use problems, clinicians’ ability to provide affirmative and competent care to bisexual clients is limited by their lack of bisexual-specific training. To address this common gap in training, this article provides a brief review of bisexual health disparities and the factors that influence them. Then, we describe a multi-level approach for improving the health and well-being of bisexual individuals. This approach addresses factors that influence health at the micro-level (e.g., strategies that clinicians can use to help bisexual clients cope with stigma-related stressors), mezzo-level (e.g., adaptations to clinical environments and training programs that promote bisexual-affirmative care), and macro-level (e.g., advocating for political change and implementing strategies to reduce prejudice against bisexual individuals at the population-level). Specifically, we describe how clinicians can adapt evidence-based interventions to tailor them to the needs of their bisexual clients. Additionally, we discuss the need for bisexual-affirmative clinical training and provide recommendations for how clinical training can be adapted to prepare clinicians to work effectively with bisexual clients. Finally, we describe how population-level interventions can be used to reduce prejudice against bisexual individuals in order to reduce bisexual health disparities. Given the striking health disparities affecting bisexual individuals, there is a critical need to develop, test, and disseminate interventions to improve the health of this population and to prepare clinicians to provide bisexual-affirmative care.     

国外心理疾病烙印影响研究概述

心理疾病污名足加诸在心理疾病患者身上的耻辱标记,世界卫生组织2001年指出"心理和行为障碍患者康复的最大阻碍就是社会对他们的污名和与之相连的歧视".作者对国外污名领域的研究进行了回顾,论述了心理疾病污名的概念、有关其影响机制的理论和实证研究.从公众污名和自我污名两方面论述了污名对心理疾病患者的影响以及消除污名的方法.     

Sacrifice and Stigma: Managing Religious Risk

This article develops a theoretical explanation for the incidence of sacrifice and stigma or “strictness” that—unlike the extant literature—explicitly incorporates a supernatural motive for religiosity. This innovation permits a precise delineation of religious risks and leads to the critical insight that “strictness” is an instrument of mutually beneficial risk mitigation. The theory yields alternative explanations for all empirical regularities on the incidence of strictness that the club model explains, including the seemingly anomalous labor market behavior of Ultra‐Orthodox Jews in Israel, the high lethality of extremist religious sects, and the positive correlation between strictness and social service provision. Among the attributes that distinguish the risk mitigation approach from the club model are: its explanation of observed income dispersion within strictness categories that is substantially greater than that implied by the club model; its prediction that the positive correlation between strictness and exclusivity is a causal relationship in which exclusivity is causally prior to strictness; and its demonstration that variation in the risk mitigation benefits members derive from strictness is at least as important as variation in the opportunity costs of strictness in explaining variation in the levels of strictness employed across denominations and sects.     

Recasting Stigma as a Dialogical Concept: A Case Study of Rural‐to‐Urban Migrants in China

The present study explores stigma against rural‐to‐urban migrants in China, drawing on a dialogical approach. It investigates the processes of stigmatization from two sides: that of the stigmatizer and that of the stigmatized. Open‐ended individual interviews were conducted with 138 participants (60 urban residents and 78 rural‐to‐urban migrants) in Tianjin, China. Findings from this study indicate that migrants were stigmatized by urban residents as having an unattractive physical appearance, potential perils of disease or crime, and discredited places of origin. Such stigma was embedded in China's unique hukou system and generated from a social categorization of superior and inferior groups. Migrants reported a number of coping strategies to counter such stigma: blaming fate, stigma reversal and upward mobility. However, migrants did not view themselves contemptuously and expressed positive feelings about their lives as migrants. They regarded internal migration as a way of pursuing happiness. Overall, urban residents stigmatized migrants legitimated by the hukou system, while migrants were surprisingly resilient against stigma, and did not internalize it, due to their economics‐driven internal migration. This study underscores that stigma in a given society is dialogically interdependent with its socio‐cultural context and that the perspectives of both the stigmatizer and the stigmatized need to be taken into consideration. Copyright © 2013 John Wiley & Sons, Ltd.     

Influence of character strengths on mental health stigma

We examined traits of open-mindedness, kindness, hope, and social intelligence in the context of mental health stigma. Stigma – a process that objectifies and dehumanizes a person who has mental illness – diminishes people’s ability to control their behavior as coping with stigma requires self-regulation. Exploring mental health stigma through the lens of character strengths allows for understanding individual differences and kinds of characteristics that help decrease the ramifications associated with stigma of mental health. Several tasks explored the effects of character strengths on implicit and explicit mental health stigma: implicit association task, measures of willingness to interact with those with a mental health disorder, and a social distance task of self, friend, and person with a disorder. Character strengths of social intelligence and kindness were indicative of less stigma of mental health. More open-minded individuals tended to not hold individuals diagnosed with a mental health disorder personally responsible for acquiring that disorder.     

Whiteness and Disability: Double Marginalization

Whiteness involves a set of privileges that are lost or removed when a person becomes, or is perceived to be, disabled. For European American women, disability impacts femininity, the part of identity that differentiates them from European American men who hold maximal power and privilege in U.S. society. Disability represents a health issue, a barrier to social participation, and vulnerability to individual and societal abuse. Development of a healthy disability identity allows European American women to negotiate the multicultural situation of being White, women, and disabled.     

People with physical disability in Serbia: Relationship between internalized stigma,experienced and anticipated discrimination,and empowerment

The aim of present study was to explore relationships between experienced and anticipated discrimination, internalized stigma, and empowerment among people with physical disabilities in Serbia. The convenience sample consisted of persons with different types of physical disabilities. The following scales were administrated: The Discrimination and Stigma Scale, the Internalized Stigma of Mental Illness Scale, and the Boston University Empowerment Scale. An analysis showed that internalized stigma was correlated with experienced and anticipated discrimination and empowerment, while no correlation was found between empowerment and discrimination. People with physical disabilities who experienced and anticipated discrimination are at higher risk of reporting internalized stigma.     

Veil as Stigma: Exploring the Role of Representations in Muslim Women's Management of Threatened Social Identity

This study extends research on the relations between social representations and social identities through an exploration of how Muslim women manage the stigma of veiling. Based on analysis of individual and group interviews among Muslim women in Denmark and the UK, the study highlights the dialectical nature of social identity as constructed through and against others' representations of social groups and the norms of valuing they impose. It shows how, for the women here, the reinforcement of a shared sense of Muslim identity goes together with re‐evaluation of aspects of that identity, principally in response to representations of the veil that deny Muslim women agency and cast them as oppressed. It shows how norms of gender and agency are in this process variously resisted and affirmed, resulting in the reframing of gendered religious values. Theoretically, the study argues that an account of the role of representations in the construction of identity challenges the inter‐group framework of existing approaches to threatened social identity and sheds light on intersectional dynamics of identity. Copyright © 2016 John Wiley & Sons, Ltd.     

How does self stigma differ across people with psychiatric diagnoses and rheumatoid arthritis,and how does it impact on self-esteem and empowerment?

Self stigmatising attitudes have been found in people who have psychiatric diagnoses, however, research assessing self stigma in physical illnesses is rare. It is known that receiving a diagnosis of rheumatoid arthritis (RA) can affect a person’s identity and self esteem. This study aimed to compare levels of self stigma, self esteem and empowerment between people diagnosed with psychiatric illnesses and people diagnosed with RA to establish whether self stigma, and specifically endorsement of negative stereotypes, is associated with self esteem and empowerment across these two groups. A total of 202 participants (psychiatric group n = 102; RA group n = 100) were interviewed using the Internalised Stigma of Mental Illness scale (ISMI), or the Internalized Stigma of Mental Illness scale- Rheumatoid Arthritis (ISMI-RA), the Index of Self Esteem (ISE) and the Mental Health Confidence Scale (MHCS). Overall, the psychiatric group had higher self stigma scores (2.5 vs. 2.2, p < .01), lower self esteem (48.7 vs. 36.8, p < .001) and lower empowerment scores (3.8 vs. 4.3, p < .001) than the RA group. However, sizable proportions of both groups had high self stigma scores. ISMI/ISMI-RA was associated with the ISE and the MHCS. The stereotype endorsement subscale of the ISMI/ISMI-RA was not related to self esteem or empowerment in either group. Interventions that aim to decrease self stigma and increase self esteem could focus on alienation.