Self-stigma in alcohol dependence scale: development and validity of the short form.

BACKGROUND: Self-stigma is associated with low self-esteem, high shame and reduced drinking-refusal self-efficacy in people with alcohol use disorder (AUD). The Self-Stigma in Alcohol-Dependence Scale-Short Form (SSAD-SF) was designed to enable a brief, but valid assessment of AUD self-stigma. METHODS: We reduced the 64-item SSAD, originally derived from 16 stereotypes towards people with AUD, by removing the most offensive items based on perspectives of people with lived experience. The newly created scale was then assessed and validated in a cross-sectional study involving 156 people reporting alcohol issues in various treatment settings. RESULTS: The 20-item SSAD-SF includes five stereotypes, with good internal consistency for each subscale and the overall scale. It reflects the four-stage progressive model of self-stigmatization with decreasing scores over the stages awareness of stereotypes, agreement with stereotypes, self-application of stereotypes, and harmful consequences for self-esteem, and highest correlations between adjacent stages. The subscales apply and harm were associated with internalized stigma, shame, reduced self-esteem, and lower drinking-refusal self-efficacy, as supported by multivariate regression models. DISCUSSION: The SSAD-SF is a valid instrument for measuring the process of self-stigmatization in people with AUD. Self-stigma is a consistent predictor of reduced self-esteem, higher shame and lower drinking-refusal self-efficacy in people with AUD. We discuss merits of the progressive model for understanding and addressing self-stigma in AUD.

Weight Self-Efficacy and Recovery Among African-Americans With Serious Mental Illness and High Body Weight.

ABSTRACT: Many African-Americans with serious mental illness fail to engage in evidence-based programs that positively affect weight management. We examined how having a weight-related physical illness correlated with self-efficacy, recovery, and quality of life by contrasting illnesses with symptoms that are obviously perceived ( e.g. , sleep apnea and pain related to weight) versus those that are not ( e.g. , hypertension). African-Americans with serious mental illness who were overweight (body mass index ≥25) completed the Weight Efficacy Lifestyle Questionnaire, Recovery Assessment Scale, and Quality of Life Scale in this study assessing the impact of a program on weight and health. Silent weight-related physical disorders were not found to correlate with quality of life, recovery, or weight self-efficacy. Differences in recovery were found in people with versus without sleep apnea and weight-related pain. Findings suggest future directions for affirming approaches to promote engagement among African-Americans with serious mental illness in weight management programs.

Does the peer-led Honest, Open, Proud program reduce stigma's impact for everyone? An individual participant data meta-regression analysis.

PURPOSE: Many people with mental illness experience self-stigma and stigma-related stress and struggle with decisions whether to disclose their condition to others. The peer-led Honest, Open, Proud (HOP) group program supports them in their disclosure decisions. In randomized controlled trials, HOP has shown positive effects on self-stigma and stigma stress on average. This study examined individual predictors of HOP outcomes and tested the hypothesis that stigma stress reduction at the end of HOP mediates positive HOP effects at follow-up. METHODS: Six RCTs were included with data at baseline, post (after the HOP program) and at 3- or 4-week follow-up. Baseline variables were entered in meta-regression models to predict change in self-stigma, stigma stress, depressive symptoms and quality of life among HOP participants. Mediation models examined change in stigma stress (post) as a mediator of HOP effects on self-stigma, depressive symptoms, and quality of life at follow-up. RESULTS: More shame at baseline, and for some outcomes reduced empowerment, predicted reduced HOP effects on stigma stress, self-stigma, depressive symptoms, and quality of life. Younger age was related to greater improvements in stigma stress after the HOP program. Stigma stress reductions at the end of HOP mediated positive effects on self-stigma, depressive symptoms and quality of life at follow-up. CONCLUSION: Participants who are initially less burdened by shame may benefit more from HOP. Stigma stress reduction could be a key mechanism of change that mediates effects on more distal outcomes. Implications for the further development of HOP are discussed.

Honest, Open, Proud (HOP) for people with mental illness in Hong Kong: a randomized controlled trial.

BACKGROUND: Self-stigma among people with mental illness is negatively associated with personal and clinical recovery. Due to the concealable nature of mental illness, people with mental illness experience constant struggles between concealment and disclosure. Disclosure of mental health challenges can potentially minimize negative impacts of self-stigma and enhance self-esteem and sense of empowerment. Honest, Open, Proud (HOP) is a peer-led intervention that promotes autonomous and dignified decisions about disclosure. PURPOSE: This study examined the effectiveness of HOP on concealment motivation, empowerment, self-stigma, stigma stress, and recovery among people with lived experience of mental illness in Hong Kong. METHODOLOGY: A total of 162 participants with a mean age of 45.38 were recruited and randomized into intervention group and waitlist control group. Participants in the intervention group were invited to attend a 6-session HOP group intervention. RESULTS: Significant improvement in optimism score from the empowerment scale was found in the intervention group compared to the waitlist control group and the effect was sustained at 1-month follow-up. However, significant changes were not found in other outcome variables. CONCLUSION: Only improvement in optimism was observed in the current study. Future study needs to examine the effects of HOP with further modification to maximize the benefit for people with lived experience of mental illness in the local context.

How do Americans perceive the stigma of leprosy?

The stigma of leprosy will have reduced effects if people cannot reliably perceive it. Two factors impact these perceptions: familiarity and entitativity. One hundred and forty-five participants tested this assertion using an online platform to complete measures of stigma about leprosy as well as measures of familiarity and entitativity. The group of 145 completed the same measures of stigma, entitativity, and familiarity 1 week later. Standard deviations of time 1 and time 2 measures of stigma were used as indices of consistent (reliable) perceptions at the individual level. Results showed partial support for familiarity being positively associated with reliable responding. Moreover, high entitativity scores were associated with greater stigma perceptions at time 1 and time 2. Ongoing research on these indicators may be important in crafting future anti-stigma programs for leprosy.

The stigma of alcohol-related liver disease and its impact on healthcare.

People with alcohol-related liver disease (ALD) experience stigma and discrimination. This review summarises the evidence on stigma in healthcare and its implications for people with ALD, drawing from the literature on the stigma associated with mental illness and, specifically, alcohol use disorder (AUD). Public stigma, self-stigma and structural stigma all contribute to failure to seek help or delays in seeking help, inferior healthcare, and negative health outcomes, which increase the overall burden of ALD. Stigma can be experienced, but also anticipated and avoided, with both scenarios negatively impacting on ALD healthcare. Blaming people with ALD for their condition is central to the stigma of ALD. Stigma affects ALD healthcare at all stages, from prevention, early detection and intervention, to allocation of scarce resources in liver transplantation. People with lived experience need to be empowered to lead action against the stigmatisation of patients with ALD. Promulgating a dynamic model of individual and social responsibility for AUD, a continuum model of harmful alcohol use, and establishing training on ALD-related stigma for healthcare professionals are strategies to address stigma. Integrating addiction and ALD services, providing stigma-free prevention, and overcoming the frequent separation of addiction services from general healthcare are necessary. Beyond healthcare, addressing social inequality, the social dimensions of ALD risk and outcomes, and ensuring equal access to services is necessary to improve outcomes for all people with ALD. More research is needed on the stigma of ALD in low- and middle-income countries and in countries with restrictive drinking norms. Interventions to reduce the stigma of ALD and facilitate early help-seeking need to be developed and evaluated.

Attitudes towards disclosing a mental illness: impact on quality of life and recovery.

PURPOSE: The decision whether to disclose a mental illness has individual and social consequences. Secrecy may protect from stigma and discrimination while disclosure can increase social support and facilitate help-seeking. Therefore, disclosure decisions are a key reaction to stigma. The first aim of this study was to test a newly developed scale to measure disclosure attitudes, the Attitudes to Disclosure Questionnaire (AtDQ). The second aim was to examine the impact of attitudes towards disclosing a mental illness on quality of life and recovery. METHODS: Among 100 participants with mental illness, disclosure attitudes, quality of life, recovery, benefits of disclosure, secrecy, social withdrawal, self-stigma, and depressive symptoms were assessed at weeks 0, 3 and 6. Psychometric properties of the AtDQ were analysed. Longitudinal associations between disclosure attitudes at baseline and quality of life and recovery after 6 weeks were examined in linear regressions. RESULTS: The analyses of the AtDQ indicated one-factor solutions, high acceptability, high internal consistency, and good retest reliability for the total scale and the subscales as well as high construct validity of the total scale. Results provided initial support for sensitivity to change. More positive disclosure attitudes in general and in particular regarding to family at baseline predicted better quality of life and recovery after 6 weeks. CONCLUSION: The current study provides initial support for the AtDQ as a useful measure of disclosure attitudes. Disclosing a mental illness, especially with respect to family, may improve quality of life and recovery of people with mental illness.

The Impact of Contact and Fame on Changing the Public Stigma of Mental Illness.

Many famous people have disclosed their mental illness to erase the harmful effects of stigma. This study examines the relative impact of disclosure stories from people who are or are not celebrities. We expected noncelebrities would be viewed as more similar and likeable and therefore have greater effects on stigma change. Research participants from an MTurk panel viewed self-disclosure stories from celebrity, Mariah Carey, or noncelebrity, Malia Fontecchio. Participants completed the Difference and Disdain Scale prior to reviewing the vignettes and immediately after each one. Participants also completed scales representing perceptions of fame, dissimilarity, and likeability of the person in each story. Results supported hypotheses: Mariah Carey was perceived as more famous, more dissimilar, and less likeable than Malia Fontecchio. Reading the Malia Fontecchio story led to greater improvement in disdain stigma than the Mariah Carey story. Implications for the varied role of celebrity status in stigma change are discussed.

Perceptions of difference and disdain on the self-stigma of mental illness.

BACKGROUND: People with mental illness are viewed as different and disdained by the general population leading to public stigma. When public stigma becomes internalized, it results in self-stigma. Content-less measures of stigma have shown to benefit studying public stigma, but research on self-stigma is limited. AIMS: This study sought to validate the use of content-less measures (Difference and Disdain) to assess self-stigma of mental illness. METHODS: Participants with lived experience (N = 291) completed a survey including measures of Difference and Disdain for self-stigma and outcomes assessing depression, self-esteem, recovery and the "Why Try" effect. Factor structure of Difference and Disdain across stages of self-stigma and their effects on harmful outcomes were analyzed. RESULTS: Factor structure was not supported. Reliability analysis suggested a two-stage conceptualization of self-stigma for Difference and Disdain characterized by early (i.e. aware, agree) and late stages (i.e. apply, harm). Disdain was found to independently contribute to significant harmful outcomes, especially in the late stages. CONCLUSIONS: Disdain seems to be the driver of the egregious effects of self-stigma for people with mental illness. Anti-stigma efforts should focus on stereotypes of Disdain in the future.

Debate: Stigma implications for diagnosing personality disorders in adolescents.

Diagnosing personality disorders (PDs) in adolescence is a complex and often controversial decision. While early diagnosis provides a pathway to treatment, stigmatizing labels might unintentionally increase prejudice and discrimination for youth and their families, resulting in harm and treatment avoidance. In this paper, we outline stigma-related considerations for diagnosing PDs in adolescence, including types of stigma (public stigma, self-stigma, associative stigma) and moderators of stigma (continuum beliefs, biogenetic attributions, PD sub-diagnosis). Research indicates that PDs are among the most stigmatizing diagnoses in adults, particularly among healthcare providers. Experiences with stigma may differentially impact adolescents, who are undergoing rapid changes in identity development and profound influences from educational systems, peers, and social media. Youth who receive mental health services (especially those embedded in schools) worry about whether and how to talk about a diagnosis. However, adolescents with significant behavioral symptoms are often seen as different from their peers even prior to a formal diagnosis. Systematic efforts are needed to anticipate and mitigate stigma-related impacts on adolescents who might be diagnosed with PDs.

Difference and Disdain as Indicators of the Public Stigma of Mental Illness.

ABSTRACT: Viewing a stigmatized group as different from everyone else is believed to be a contentless stigma that leads to disdain. This study tests whether three emotions-intergroup anxiety, anger, and empathy-mediate the path between difference and disdain. Six hundred thirty-eight research participants from MTurk provided valid responses to an online survey via Qualtrics. The survey used standardized measures of difference, disdain, intergroup anxiety, anger, and empathy. The hypothesized path model was tested using structural equation modeling (SEM). Fit indicators from SEM and corresponding betas supported a two-mediator model. Specifically, difference was found to be significantly associated with disdain. The path between the two was positively mediated by anger and negatively mediated by empathy. Difference and disdain may become important constructs in predicting and assessing stigma change. Perspective-taking that enhances empathy may prove especially useful for decreasing difference and disdain perceptions about people with mental illness.

Vicarious Stigma and Self-Stigma Experienced by Parents of Children with Mental Health and/or Neurodevelopmental Disorders.

The stigma of young children with mental health and/or neurodevelopmental disorders is experienced by their parents in at least two ways: self-stigma and vicarious stigma. Secrecy may diminish stigma through impression management or strategic disclosure. The present study explores the relationship between vicarious stigma, self-stigma, secrecy coping, depression, and quality of life. Additionally, we examine the structure of a novel measure of vicarious stigma. Fifty parents of children with mental health and/or neurodevelopmental disorders completed measures. Self-stigma and sadness due to vicarious stigma were significantly associated with greater depression and diminished quality of life. Higher secrecy coping was also associated with higher depression and lower quality of life, supporting the benefits of disclosure. This research meaningfully adds to our understanding of stigma in general, and as experienced by parents of children with mental health and/or neurodevelopmental disorders. Implications for ongoing stigma change development and evaluation are discussed.

Difference as an indicator of the self-stigma of mental illness.

BACKGROUND: People with mental illness are viewed as different from the general population resulting in public stigma. When public stigma becomes internalized, it leads to self-stigma. The most distal stage of self-stigma is harm which can lead to negative self-concepts that inhibit recovery. AIM: This study examines how perceptions of "differentness" reflect self-stigma. We developed the Differentness Self-Stigma Scale (DSSS) to assess four regressive stages of self-stigma - awareness, agreement, application, and harm - and aimed to see whether DSSS scores predict self-stigma more effectively than the Self-Stigma of Mental Illness Scale (SSMIS). METHOD: Participants with lived experience (N = 291) completed a survey including the DSSS, SSMIS and outcomes assessing depression, self-esteem, recovery and the "why try" effect. RESULTS: DSSS scores differed significantly from the SSMIS in the agreement and harm stages of self-stigma. Higher self-stigma scores on the DSSS harm subscale predicted lower self-esteem and higher depression scores. However, the DSSS did not demonstrate a regressive pattern between all four stages of self-stigma like the SSMIS. CONCLUSION: The increase of DSSS scores at the application stage may be explained by perceived public stigma (i.e. how the public understands differentness). Future research should unpack the effects of perceived difference on self-stigma for the DSSS.

Factors predicting help seeking for mental illness among college students.

BACKGROUND: Evidence supports the contribution of various stigma-related constructs to help-seeking. These constructs have yet to be tested in a single model among college students, a group highly affected by mental illness. AIMS: Using data from 153 college students, this study examines factors contributing to help seeking for mental illness. METHOD: Using path analysis, the current study evaluated a model of the relationship between level of familiarity, personal stigma, desired social distance, label avoidance, attitudes towards treatment seeking and intentions to seek treatment. RESULTS: Findings support a model of help-seeking describing the relationship between familiarity with mental illness, personal stigma, social distance, label avoidance, attitudes and intentions to seek treatment. CONCLUSIONS: Findings suggest label avoidance, attitudes towards treatment seeking and intentions to seek treatment might be augmented through interventions aimed at increasing college students' levels of familiarity, or intimate contact, with individuals with mental illness. Additional implications for practice and further research are addressed.

Challenges to welcoming people with mental illnesses into faith communities.

Faith communities are important to the psychiatric care of people with mental illness. I distinguish the effects of two principles of becoming welcoming communities: compassion, in which the community accommodates members with mental illnesses so they are fully included, and dignity, which rests on the essential worth of everyone.

Supporting mental health disclosure decisions: the Honest, Open, Proud programme.

The stigma associated with mental health problems leaves many feeling they have to 'hide' their difficulties. Supporting them in making disclosure decisions can potentially improve well-being, reduce self-stigma and support recovery processes. In this editorial we discuss the case for interventions designed for this purpose and present one prominent programme: Honest, Open, Proud.

The influence of the age of dementia onset on college students' stigmatic attributions towards a person with dementia.

BACKGROUND: Research in the area of public stigma and Alzheimer's disease (AD) is limited to examining stigmatic beliefs towards persons aged 65 and over (i.e., persons with late-onset dementia). The aim of the present study was to compare college students' stigmatic attributions towards an older and a younger person with AD, using an attributional model of stigma. METHOD: A cross-sectional study was conducted with 375 college students (mean age = 25.5, 58.9% female, 64.3% Jewish) who answered a computerized, self-administered, structured questionnaire after being presented with one of two randomly distributed vignettes varying in the age of the person with AD - 80 or 50 years of age. Cognitive, emotional and behavioral attributions of stigma were assessed using an adapted version of the Attribution Questionnaire. Other variables examined included background information, experiences and concerns about developing AD. T-tests and Ordinary Least Square (OLS) hierarchical regressions were used to analyze results. RESULTS: Similar to previous studies, students' levels of dementia stigma were low to moderate. Negative attributions were consistently and significantly higher (ß = .17 to .33, p < .01), and positive attributions were significantly lower (ß = -.26, p < .01) when the target person was younger rather than older. CONCLUSION: The differences in stigmatic beliefs towards a younger and older person with AD point to the theoretical and practical importance of clearly stating the age of the target person in stigma studies as well as in programs aimed at reducing public stigma towards persons with AD.

Recovery, peer support and confrontation in services for people with mental illness and/or substance use disorder.

Mental illness recovery has been described as an outcome (symptom free) or process (symptom management) where peer supporters are essential. Whereas, substance use disorder recovery endorses outcome alone: achieving recovery once abstinent. Peer supporters with an abstinence agenda use confrontation for those in denial. Herein, we unpack this distinction.Declaration of interestsNone.

Reactions to Solidarity Versus Normalcy Messages for Antistigma Campaigns.

This study considers two of many messages that are used in antistigma campaigns: normalcy, that mental illness is like most kinds of illness-"You are just like me," and solidarity, that one's mental illness is accepted-"I stand with you." This study examined how research participants rated message merit: understandable, effective, and compelling. We particularly examined how views on message merit varied by whether participants reported previous mental health experience. Three hundred seventy-three participants rated the merit of the two messages provided in random order. They also reported previous experience with mental health services. Overall, participants viewed solidarity messages with greater merit than normalcy. Participants with self-reported mental illness viewed the solidarity message even better than participants without mental illness; this pattern varied by specific mental health experience. Findings suggest a greater understanding of stigma reduction methods from those who are more likely to have experienced stigma.

Disclosure and Quality of Life Among Unemployed Individuals With Mental Health Problems: A Longitudinal Study.

Unemployment and mental disorders are associated with impaired quality of life. Because of the stigma associated with mental illness, unemployed individuals with mental health problems face the difficult decision whether to disclose their condition to others. Disclosure has both risks and benefits, and it is unclear how it affects quality of life. We therefore examined disclosure attitudes at baseline as predictors of quality of life after 6 months and also assessed social support, depressive symptoms, self-stigma, and perceived discrimination among 301 unemployed individuals with mental health problems. Better quality of life at follow-up was predicted by better attitudes toward disclosure among family and friends, shorter length of unemployment, less symptoms, and, at a trend level, less self-stigma at baseline. Thus disclosure in one's private environment may improve quality of life among unemployed individuals with mental health problems.