Stigma is considered an important barrier to seeking mental health services. Two types of stigma exist: public stigma and self-stigma. Theoretically, it has been argued that public stigma leads to ...the development of self-stigma. However, the empirical support for this assertion is limited to cross-sectional data. Therefore, the goal of this research was to examine the relationship between public stigma and self-stigma over time. Perceptions of public and self-stigma were measured at Time 1 (T1) and then again 3 months later at Time 2 (T2). Using structural equation modeling, we conducted a cross-lag analysis of public stigma and self-stigma among a sample of 448 college students. Consistent with assertions that public stigma leads to the development of self-stigma, we found that public stigma at T1 predicted self-stigma at T2, whereas the converse was not true. These findings suggest that if self-stigma develops from public stigma, interventions could be developed to interrupt this process at the individual level and reduce or eliminate self-stigma despite perceptions of public stigma.
Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This ...correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge-both approaches and methods-regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development's Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described.The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.
Advocates and scientists have partnered to develop and evaluate programs meant to erase the egregious effects of the different forms of stigma. Enough evidence has been collected to yield lessons ...about approaches to stigma change. Some of the most insightful of these lessons emerge from unintended consequences of good intentioned approaches, and are the focus of this paper. They include the limited benefits of education especially when compared to contact, beating stigma is more than changing words, beware pity as a message, understand the competing agendas of stigma change, replace ideas of normalcy with solidarity, and avoid framing self‐stigma as the problem of people with mental illness and not of society. The paper ends with consideration of the back seat role that psychiatrists and other mental health providers should have in stigma change.
Summary
In recent years, there has been considerable research on the relation between weight stigma and mental health, but no quantitative synthesis of the empirical evidence is available to date. ...This meta‐analysis (105 studies, 59 172 participants, and 497 effect sizes) fills this gap by quantifying the association between weight stigma and mental health. Age, gender, and factors presumed to exert a protective role (i.e., adaptive coping strategies and perceived social support) were tested as potential moderators. The three‐level meta‐analytic model estimated under a random effects assumption revealed a medium to large negative association between weight stigma and mental health (r = −0.35). The overall association remained significant when controlling for publication year, education, and body weight. There was substantial heterogeneity in effect sizes between studies (I2 = 43%) and within studies (I2 = 56%). Surprisingly, all moderator hypotheses had to be rejected. Body weight was a significant moderator, indicating a stronger association between weight stigma and diminished mental health with increasing body mass index. Future research might focus on explaining the heterogeneity of findings and on testing causality as well as potential underlying mechanisms.
Stigma is a well-documented barrier to health seeking behavior, engagement in care and adherence to treatment across a range of health conditions globally. In order to halt the stigmatization process ...and mitigate the harmful consequences of health-related stigma (i.e. stigma associated with health conditions), it is critical to have an explicit theoretical framework to guide intervention development, measurement, research, and policy. Existing stigma frameworks typically focus on one health condition in isolation and often concentrate on the psychological pathways occurring among individuals. This tendency has encouraged a siloed approach to research on health-related stigmas, focusing on individuals, impeding both comparisons across stigmatized conditions and research on innovations to reduce health-related stigma and improve health outcomes. We propose the Health Stigma and Discrimination Framework, which is a global, crosscutting framework based on theory, research, and practice, and demonstrate its application to a range of health conditions, including leprosy, epilepsy, mental health, cancer, HIV, and obesity/overweight. We also discuss how stigma related to race, gender, sexual orientation, class, and occupation intersects with health-related stigmas, and examine how the framework can be used to enhance research, programming, and policy efforts. Research and interventions inspired by a common framework will enable the field to identify similarities and differences in stigma processes across diseases and will amplify our collective ability to respond effectively and at-scale to a major driver of poor health outcomes globally.
The present study conducted a meta-analysis and systematic review on studies evaluating the effectiveness of stigma reduction programs in improving knowledge and reducing negative attitudes towards ...people living with HIV (PLHIV).
Meta-analysis (k = 42 studies) found significant and small effect sizes in the improvement of the participants' knowledge of HIV/AIDS from interventions with (Cohen's d = 0.48, 95% CI 0.30, 0.66) and without control groups (Cohen's d = 0.42, 95% CI 0.28, 0.57). Significant and small effect sizes were found in the improvement of the participants' attitudes toward PLHIV from interventions with (Cohen's d = 0.39, 95% CI 0.23, 0.55) and without control groups (Cohen's d = 0.25, 95% CI 0.11, 0.39). Significant and small effect sizes were sustained at the follow-up assessments. Subgroup analysis showed that number of intervention sessions, intervention settings, and sample type significantly moderated the effect sizes in the meta-analysis. Findings from the systematic review of 35 studies indicated that most of the included studies showed positive results in reducing negative attitudes toward PLHIV and improving HIV-related knowledge. Most of the included studies tended to have low methodological quality.
The present meta-analysis and systematic review indicated that the studies generally found small improvement in HIV-related knowledge and reduction in negative attitudes towards PLHIV among the stigma reduction programs being evaluated. High-quality stigma reduction programs with multidimensional stigma indicators and psychometrically sound outcome measures are highly warranted.
•Studies show small effects in improving HIV knowledge.•They also have small effects reducing negative attitudes toward PLHIV.•Stigma reduction programs are more effective among professional samples.•Programs with multiple sessions are more effective.•Programs conducted in community settings are more effective.
While researchers have been increasingly interested in the notion of category stigma, they have largely focused on stigmatized industry categories. Because products serve as a key interface between ...producers and consumers, we suggest that product categories should play a prominent role in the stigmatization process. Product category stigma occurs when a product category is seen as violating the expectations of its audience members. We argue that when an organization offers a product from a stigmatized category, it is subject to lower evaluations and higher penalties from the stigmatizing audience, regardless of its true underlying quality. Further, when an organization is perceived as increasing its engagement in a stigmatized category, the lower evaluations transfer to the organization’s other products. Finally, we argue that an organization’s reputation for quality actually amplifies this stigma penalty. We find support for our hypotheses in a sample of online reviews for the U.S. craft brewing industry.
One prominent social-cognitive model of internalized stigma by Corrigan and his colleagues (2012; 2002) proposes that individuals are exposed to societal stereotypes about mental illness, at least ...tacitly agree with them, and may apply them to oneself, engendering harmful self-beliefs. There is limited empirical support for this model in serious mental illness. Moreover, it is not clearly established how internalized stigma and its associated factors impact recovery in this population. The current study uses structural equation modeling (SEM) to assess the social-cognitive model's goodness of fit in a sample of Veterans with serious mental illness (Veteran sample, n = 248), and then validates the model in a second and independent sample of individuals receiving community-based psychiatric rehabilitation services (community sample, n = 267). Participants completed the Self-Stigma of Mental Illness Scale (SSMIS; Corrigan et al., 2006) and measures of self-esteem, self-efficacy, and recovery attitudes. Consistent with Corrigan and colleagues' formulation of internalized stigma, SEM analyses showed a significant indirect pathway from stereotype awareness, to stereotype agreement, to application to self, to self-esteem decrement, to poorer recovery attitudes. Additionally, there was a significant direct effect from stereotype awareness to self-esteem. This study shows that individuals with serious mental illness experience psychological harm from stigma in two ways: (1) through perceived public prejudice and bias, and (2) through internalizing these negative messages. In particular, stigma harms individuals' self-esteem, which then reduces their recovery attitudes.
•The internalization of stigma can be modeled with a single pathway in serious mental illness.•Perceived stigma (stereotype awareness) has a direct influence on self-esteem decrement.•Anti-stigma interventions should be implemented early on in the course of treatment.
Many health conditions perceived to be contagious, dangerous or incurable, or resulting in clearly visible signs, share a common attribute - an association with stigma and discrimination. While the ...etiology of stigma may differ between conditions and, sometimes, cultural settings, the manifestations and psychosocial consequences of stigma and discrimination are remarkably similar. However, the vast majority of studies measuring stigma or addressing stigma through interventions employ a disease-specific approach.
The current paper opposes this siloed approach and advocates a generic concept of 'health-related stigma' in both stigma measurement and stigma interventions. Employing a conceptual model adapted from Weiss, the current paper demonstrates the commonalities among several major stigmatized conditions by examining how several stigma measurement instruments, such as the Social Distance Scale, Explanatory Model Interview Catalogue, Internalized Stigma of Mental Illness, and Berger stigma scale, and stigma reduction interventions, such as information-based approaches, contact with affected persons, (peer) counselling, and skills building and empowerment, were used successfully across a variety of conditions to measure or address stigma. The results demonstrate that 'health-related stigma' is a viable concept with clearly identifiable characteristics that are similar across a variety of stigmatized health conditions in very diverse cultures.
A more generic approach to the study of health-related stigma opens up important practical opportunities - cross-cutting measurement and intervention tools are resource saving and easier to use for personnel working with multiple conditions, allow for comparison between conditions, and recognize the intersectionality of many types of stigma. Further research is needed to build additional evidence demonstrating the advantages and effectiveness of cross-condition approaches to stigma measurement and interventions.
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