By the 1990s, sociology faced a frustrating paradox. Classic work on mental illness stigma and labeling theory reinforced that the "mark" of mental illness created prejudice and discrimination for ...individuals and family members. Yet that foundation, coupled with deinstitutionalization of mental health care, produced contradictory responses. Claims that stigma was dissipating were made, while others argued that intervention efforts were needed to reduce stigma. While signaling the critical role of theory-based research in establishing the pervasive effects of stigma, both claims directed resources away from social science research. Yet the contemporary scientific foundation underlying both claims was weak. A reply came in a resurgence of research directed toward mental illness stigma nationally and internationally, bringing together researchers from different disciplines for the first time. I report on the general population's attitudes, beliefs, and behavioral dispositions that targeted public stigma and implications for the next decade of research and intervention efforts.
Crises lay bare the social fault lines of society. In the United States, race, gender, age, and education have affected vulnerability to COVID-19 infection. Yet, consequences likely extend far beyond ...morbidity and mortality. Temporarily closing the economy sent shock waves through communities, raising the possibility that social inequities, preexisting and current, have weakened economic resiliency and reinforced disadvantage, especially among groups most devastated by the Great Recession. We address pandemic precarity, or risk for material and financial insecurity, in Indiana, where manufacturing loss is high, metro areas ranked among the hardest hit by the Great Recession nationally, and health indicators stand in the bottom quintile. Using longitudinal data (
= 994) from the Person to Person Health Interview Study, fielded in 2019-2020 and again during Indiana's initial stay-at-home order, we provide a representative, probability-based assessment of adverse economic outcomes of the pandemic. Survey-weighted multivariate regressions, controlling for preexisting inequality, find Black adults over 3 times as likely as Whites to report food insecurity, being laid off, or being unemployed. Residents without a college degree are twice as likely to report food insecurity (compared to some college), while those not completing high school (compared to bachelor's degree) are 4 times as likely to do so. Younger adults and women were also more likely to report economic hardships. Together, the results support contentions of a Matthew Effect, where pandemic precarity disproportionately affects historically disadvantaged groups, widening inequality. Strategically deployed relief efforts and longer-term policy reforms are needed to challenge the perennial and unequal impact of disasters.
Mental illness is a global public health crisis. Although rates of untreated cases stand as a primary problem, stigma is a significant obstacle. Yet, global differences in levels and roots of stigma ...remain poorly understood. Using the Stigma in Global Context–Mental Health Study (SGC-MHS) data, we analyzed data on two components of stigma—prejudice and discriminatory potential—attached to clinically diagnostic cases of depression and schizophrenia. We examined whether stigma was higher in the East than West. Furthermore, we hypothesized that the link between prejudice and discriminatory potential in the East was due, in part, to cultural differences in the attributions about mental illness. With SGC-MHS’ nationally representative vignette data from over 11,000 respondents in 11 relevant countries (four Eastern, seven Western), analyses replicated past research of higher levels of stigma and more moral attributions in Eastern countries, particularly for depression. Moreover, prejudice-related disclosure spillover concerns predicted discriminatory potential (social distance) in the East, but not the West; this was driven by a greater emphasis on moral attributions in the East. Finally, exploratory analyses found that Western respondents endorsed higher discrimination for minority (vs. majority) group members with mental illness. In Eastern countries, the same pattern emerged for schizophrenia, but the reverse occurred for depression—greater stigma for majority as compared with minority group members. Together, these findings suggest that cultural differences in the sources of prejudice and attributions about the etiology of mental illness contribute, at least in part, to global differences in the profile of stigma.
In response to health problems, individuals may strategically activate their social network ties to help manage crisis and uncertainty. While it is well-established that social relationships provide ...a crucial safety net, little is known about who is chosen to help during an episode of illness. Guided by the Network Episode Model, two aspects of consulting others in the face of mental illness are considered. First, we ask who activates ties, and what kinds of ties and networks they attempt to leverage for discussing health matters. Second, we ask about the utility of activating health-focused network ties. Specifically, we examine the consequences of network activation at time of entry into treatment for individuals' quality of life, social satisfaction, ability to perform social roles, and mental health functioning nearly one year later. Using interview data from the longitudinal Indianapolis Network Mental Health Study (INMHS, N = 171), we focus on a sample of new patients with serious mental illness and a group with less severe disorders who are experiencing their first contact with the mental health treatment system. Three findings stand out. First, our results reveal the nature of agency in illness response. Whether under a rational choice or habitus logic, individuals appear to evaluate support needs, identifying the best possible matches among a larger group of potential health discussants. These include members of the core network and those with prior mental health experiences. Second, selective activation processes have implications for recovery. Those who secure adequate network resources report better outcomes than those who injudiciously activate network ties. Individuals who activate weaker relationships and those who are unsupportive of medical care experience poorer functioning, limited success in fulfilling social roles, and lower social satisfaction and quality of life later on. Third, the evidence suggests that social networks matter above and beyond the influence of any particular individual or relationship. People whose networks can be characterized as having a pro-medical culture report better recovery outcomes.
•Provides information about who people turn to for health discussion during an episode of illness.•Examines effects of network activation at time of entry into treatment for recovery outcomes one year later.•Individuals identify the best possible matches to support needs among a larger group of potential health discussants.•Activation of strong ties and those supportive of medical care is associated with better outcomes.•People whose networks can be characterized as having a pro-medical culture report better outcomes.
The Stigma Complex Pescosolido, Bernice A; Martin, Jack K
Annual review of sociology,
01/2015, Letnik:
41, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Since the beginning of the twenty-first century, research on stigma has continued. Building on conceptual and empirical work, the recent period clarifies new types of stigmas, expansion of measures, ...identification of new directions, and increasingly complex levels. Standard beliefs have been challenged, the relationship between stigma research and public debates reconsidered, and new scientific foundations for policy and programs suggested. We begin with a summary of the most recent
Annual Review
articles on stigma, which reminded sociologists of conceptual tools, informed them of developments from academic neighbors, and claimed findings from the early period of "resurgence." Continued (even accelerated) progress has also revealed a central problem. Terms and measures are often used interchangeably, leading to confusion and decreasing accumulated knowledge. Drawing from this work but focusing on the past 14 years of stigma research (including mental illness, sexual orientation, HIV AIDS, and race ethnicity), we provide a theoretical architecture of concepts (e.g., prejudice, experienced received discrimination), drawn together through a stigma process (i.e., stigmatization), based on four theoretical premises. Many characteristics of the mark (e.g., discredited, concealable) and variants (i.e., stigma types and targets) become the focus of increasingly specific and multidimensional definitions. Drawing from complex and systems science, we propose a stigma complex, a system of interrelated, heterogeneous parts bringing together insights across disciplines to provide a more realistic and complicated sense of the challenge facing research and change efforts. The Framework Integrating Normative Influences on Stigma (FINIS) offers a multilevel approach that can be tailored to stigmatized statuses. Finally, we outline challenges for the next phase of stigma research, with the goal of continuing scientific activity that enhances our understanding of stigma and builds the scientific foundation for efforts to reduce intolerance.
Stigma, the prejudice and discrimination attached to mental illness, has been persistent, interfering with help-seeking, recovery, treatment resources, workforce development, and societal ...productivity in individuals with mental illness. However, studies assessing changes in public perceptions of mental illness have been limited.
To evaluate the nature, direction, and magnitude of population-based changes in US mental illness stigma over 22 years.
This survey study used data collected from the US National Stigma Studies, face-to-face interviews conducted as 1996, 2006, and 2018 General Social Survey modules of community-dwelling adults, based on nationally representative, multistage sampling techniques. Individuals aged 18 years or older, including Spanish-speaking respondents, living in noninstitutionalized settings were interviewed in 1996 (n = 1438), 2006 (n = 1520), and 2018 (n = 1171). The present study was conducted from July 2019 to January 2021.
Respondents reacted to 1 of 3 vignettes (schizophrenia, depression, alcohol dependence) meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria or a control case (daily troubles). Measures included beliefs about underlying causes (attributions), perceptions of likely violence (danger to others), and rejection (desire for social distance).
Of the 4129 individuals interviewed in the surveys, 2255 were women (54.6%); mean (SD) age was 44.6 (16.9) years. In the earlier period (1996-2006), respondents endorsing scientific attributions (eg, genetics) for schizophrenia (11.8%), depression (13.0%), and alcohol dependence (10.9%) increased. In the later period (2006-2018), the desire for social distance decreased for depression in work (18.1%), socializing (16.7%), friendship (9.7%), family marriage (14.3%), and group home (10.4%). Inconsistent, sometimes regressive change was observed, particularly regarding dangerousness for schizophrenia (1996-2018: 15.7% increase, P = .001) and bad character for alcohol dependence (1996-2018: 18.2% increase, P = .001). Subgroup differences, defined by race and ethnicity, sex, and educational level, were few and inconsistent. Change appeared to be consistent with age and generational shifts among 2 birth cohorts (1937-1946 and 1987-2000).
To date, this survey study found the first evidence of significant decreases in public stigma toward depression. The findings of this study suggest that individuals' age was a conservatizing factor whereas being in the pre-World War II or millennial birth cohorts was a progressive factor. However, stagnant stigma levels for other disorders and increasing public perceptions of likely violence among persons with schizophrenia call for rethinking stigma and retooling reduction strategies to increase service use, improve treatment resources, and advance population health.
Among deaths of despair, the individual and community correlates of US suicides have been consistently identified and are well known. However, the suicide rate has been stubbornly unyielding to ...reduction efforts, promoting calls for novel research directions. Linking levels of influence has been proposed in theory but blocked by data limitations in the United States. Guided by theories on the importance of connectedness and responding to unique data challenges of low base rates, geographical dispersion, and appropriate comparison groups, we attempt a harmonization of the National Violent Death Reporting System (NVDRS) and the American Community Survey (ACS) to match individual and county–level risks. We theorize crosslevel sociodemographic homogeneity between individuals and communities, which we refer to as “social similarity” or “sameness,” focusing on whether having like-others in the community moderates individual suicide risks. While analyses from this new Multilevel Suicide Data for the United States (MSD-US) replicate several individual and contextual findings, considering sameness changes usual understandings of risk in two critical ways. First, high individual risk for suicide among those who are younger, not US born, widowed or married, unemployed, or have physical disabilities is cut substantially with greater sameness. Second, this moderating pattern flips for Native Americans, Alaska Natives, Asians, and Hispanics, as well as among native-born and unmarried individuals, where low individual suicide risk increases significantlywith greater social similarity. Results mark the joint influence of social structure and culture, deliver unique insights on the complexity of connectedness in suicide, and offer considerations for policy and practice.
Public attitudes about drug addiction and mental illness were compared.
A Web-based national survey (N=709) was conducted to compare attitudes about stigma, discrimination, treatment effectiveness, ...and policy support in regard to drug addiction and mental illness.
Respondents held significantly more negative views toward persons with drug addiction. More respondents were unwilling to have a person with drug addiction marry into their family or work closely with them. Respondents were more willing to accept discriminatory practices against persons with drug addiction, more skeptical about the effectiveness of treatments, and more likely to oppose policies aimed at helping them.
Drug addiction is often treated as a subcategory of mental illness, and insurance plans group them together under the rubric of "behavioral health." Given starkly different public views about drug addiction and mental illness, advocates may need to adopt differing approaches to reducing stigma and advancing public policy.
Background and Aims
Our ability to combat the opioid epidemic depends, in part, on dismantling the stigma that surrounds drug use. However, this epidemic has been unique and, to date, we have not ...understood the nature of public prejudices associated with it. Here, we examine the nature and magnitude of public stigma toward prescription opioid use disorder (OUD) using the only nationally representative data available on this topic.
Design
General Social Survey (GSS), a cross‐sectional, nationally representative survey of public attitudes.
Setting
United States, 2018.
Participants/Cases
A total of 1169 US residents recruited using a probability sample.
Measurements
Respondents completed a vignette‐based survey experiment to assess public stigma toward people who develop OUD following prescription of opioid analgesics. This condition is compared with depression, schizophrenia, alcohol use disorder (AUD) and subclinical distress using multivariable logistic or linear regression.
Findings
Adjusting for covariates (e.g. race, age, gender), US residents were significantly more likely to label symptoms of OUD a physical illness 73%, confidence interval (CI) = 66–80%; P < 0.001 relative to all other conditions, and less likely to label OUD a mental illness (40%, CI = 32–48%; P < 0.001). OUD was significantly less likely to be attributed to bad character (37%, CI = 30–44%; P < 0.001) or poor upbringing (17%, CI = 12–23%; P < 0.001) compared with AUD. Nonetheless, perceptions of competence associated with OUD (e.g. ability to manage money; 41%, CI = 33–49%; P < 0.01) were lower than AUD, depression and subclinical distress. Moreover, willingness to socially exclude people with OUD was very high (e.g. 76% of respondents do not want to work with a person with OUD), paralleling findings on traditional targets of strong stigma (i.e. AUD and schizophrenia).
Conclusions
US residents do not typically hold people with prescription opioid use disorder responsible for their addiction, but they express high levels of willingness to subject them to social exclusion.
Clinicians, advocates, and policy makers have presented mental illnesses as medical diseases in efforts to overcome low service use, poor adherence rates, and stigma. The authors examined the impact ...of this approach with a 10-year comparison of public endorsement of treatment and prejudice.
The authors analyzed responses to vignettes in the mental health modules of the 1996 and 2006 General Social Survey describing individuals meeting DSM-IV criteria for schizophrenia, major depression, and alcohol dependence to explore whether more of the public 1) embraces neurobiological understandings of mental illness; 2) endorses treatment from providers, including psychiatrists; and 3) reports community acceptance or rejection of people with these disorders. Multivariate analyses examined whether acceptance of neurobiological causes increased treatment support and lessened stigma.
In 2006, 67% of the public attributed major depression to neurobiological causes, compared with 54% in 1996. High proportions of respondents endorsed treatment, with general increases in the proportion endorsing treatment from doctors and specific increases in the proportions endorsing psychiatrists for treatment of alcohol dependence (from 61% in 1996 to 79% in 2006) and major depression (from 75% in 1996 to 85% in 2006). Social distance and perceived danger associated with people with these disorders did not decrease significantly. Holding a neurobiological conception of these disorders increased the likelihood of support for treatment but was generally unrelated to stigma. Where associated, the effect was to increase, not decrease, community rejection.
More of the public embraces a neurobiological understanding of mental illness. This view translates into support for services but not into a decrease in stigma. Reconfiguring stigma reduction strategies may require providers and advocates to shift to an emphasis on competence and inclusion.