The link between anticipated and internalized stigma and depression: A systematic review.

Stigmatized groups may experience psychological distress. Yet, some studies show no significant relation between stigma and mental health outcomes. This systematic review investigates the link between anticipated and internalized stigma, and one mental health outcome, depression. We aimed to (1) determine whether anticipated and internalized stigma predict levels of depression, and (2) review the quality of evidence for this link. We searched PsycInfo, PubMed and EMBASE databases. Eighty-three studies (N = 34,705) met our inclusion criteria, across five stigma categories: Sexual and gender minorities; HIV/AIDS; Illness or disability-related (non-HIV); Weight, and Other. We reviewed evidence within each category and study design and developed a narrative synthesis. Sixty studies (72.3%) supported the proposed link, which varied across categories from 53.6% to 100%. Using the NIH quality assessment tool, most studies were of fair quality. Most cross-sectional studies (76.7%) straightforwardly supported the positive relation between internalized and/or anticipated stigma and depression, while only 40% of longitudinal studies did. Implications for the study of stigma and mental health outcomes are discussed.

Health literacy among self-help leprosy group members reduces stereotype endorsement and stigma-related harm in rural Nepal.

There is increasing appreciation that group memberships can have both beneficial and damaging impacts on health. In collaboration with Nepal Leprosy Trust (NLT), this longitudinal study explores a group-based approach to stigma reduction among people affected by leprosy in rural Nepal (N = 71)-a hard to reach and underrepresented non-WEIRD population. Informed by the 'social cure' literature, and the progressive model of self-stigma, we use a longitudinal design. We found that a sense of belonging to a self-help group can facilitate education in terms of health literacy, and over time these two factors also have impacts on participants stigma. Specifically, self-help group belonging predicted improvements in health literacy, leading to reduced endorsement of negative stereotypes and thus less stigma-related harm among people affected by leprosy. The study offers promising evidence that group-based interventions, which support health education, can reduce the harmful impact of stigma in very challenging contexts.

Stigma is associated with illness self-concept in individuals with concealable chronic illnesses.

OBJECTIVES: Previous research suggests that chronic illnesses can elicit stigma, even when those illnesses are concealable. Such stigmatization is assumed to lead to a stigmatized identity. Additionally, chronic illness affects one's self-concept, as one reconstructs a sense of self with illness incorporated. However, no research has examined the interplay between stigma and self-concept in those with concealable chronic illnesses. Therefore, we investigated the extent to which experienced, anticipated, and internalized stigma are associated with illness self-concept in individuals living with concealable chronic illnesses. Furthermore, we explored if the aforementioned aspects of stigma are associated with enrichment in the self-concept in the same cohort. DESIGN: An online correlational survey of people with concealable chronic illness (N = 446). METHODS: Participants completed self-report measures of chronic illness-specific measures of stigma and illness self-concept, both negative and positive. RESULTS: Results indicated that there is a positive relationship between experienced, anticipated, and internalized stigma and illness self-concept, indicating that stigma is associated with increased preoccupation and perceived impact of one's illness on the self. Although there is also a negative relationship between anticipated and internalized stigma and enrichment, only internalized stigma is associated with enrichment over and above the effects of control variables such as personal control. CONCLUSIONS: Our findings bridge the existing literature on illness self-concept and stigma for chronic illness groups, with a specific focus on those with concealable chronic illnesses. More varied approaches to coping with illness should be encouraged, including encouraging enrichment aspects to potentially act as a buffer between the effects of stigma and illness self-concept.

Identity processes and eating disorder symptoms during university adjustment: a cross-sectional study.

BACKGROUND: Young people with eating disorders (EDs) and ED symptoms are at risk during university adjustment, suggesting a need to protect their health. The social identity approach proposes that people's social connections - and the identity-related behaviour they derive from them - are important for promoting positive health outcomes. However, there is a limited understanding as to how meaningful everyday connections, supported by affiliative identities, may act to reduce ED symptoms during a life transition. METHODS: Two hundred eighty-one first year university students with an ED or ED symptoms completed an online survey during the first month of university. Participants completed self-reported measures of affiliative identity, social support, injunctive norms and ED symptoms. Path analysis was used to test a hypothesised mediated model, whereby affiliative identity has a significant indirect relation with ED symptoms via social support and injunctive norms. RESULTS: Results support the hypothesised model. We show that affiliative identity predicts lower self-reported ED symptoms, because of its relation with social support and injunctive norms. CONCLUSIONS: The findings imply that affiliative identities have a positive impact on ED symptoms during university adjustment, because the social support derived from affiliative identity is associated with how people perceive norms around disordered eating. Our discussion emphasises the possibility of identity processes being a social cure for those at risk of ED symptoms.

Stigma of eating disorders and recovery-related outcomes: A systematic review.

OBJECTIVE: People with eating disorders (EDs) tend to engage in behaviours that are ordinarily perceived as normal in society, such as restrictive dieting. However, when people are diagnosed with an ED, they may often feel stigmatized, which is likely to act as a barrier to recovery. To date, there is a limited understanding of how stigma of EDs impacts recovery-related outcomes. METHOD: A systematic search was performed using PsychINFO and PubMed. Multiple combined searches of terms relating to stigma, EDs, and recovery-related outcomes were conducted. PRISMA guidelines were followed throughout the selection process and resulted in nine studies meeting specific inclusion criteria. The extracted data are examined in a critical narrative synthesis. RESULTS: Our review suggested that across different samples and measures, stigmatization of EDs is negatively related to a range of factors important for recovery. These include psychological, social and physical health outcomes, ED psychopathology and treatment-seeking behaviours. CONCLUSIONS: Based on the quality assessment, it was concluded that future research would benefit from the use of research designs that can demonstrate causality and generalize findings across community samples. Therefore, in order to improve recovery-related outcomes, treatment plans must consider the type of ED stigma experienced and its relation with specific recovery-related outcomes.

Exposure to Domestic Violence and Abuse: Evidence of Distinct Physical and Psychological Dimensions.

Recent literature on exposure to domestic violence (DV) highlights the need for increased understanding of the dynamics of domestic violence and abuse (DVA). The current aims were to explore whether two separate dimensions, physical and psychological DVA, were evident in adult children's reports of their exposure to DVA in their family of origin, and whether these dimensions affected psychological well-being and perceived satisfaction with emotional support (hereafter referred to as social support satisfaction). Young adults (N = 465, aged 17-25, 70% female) reported their experiences of DVA as perpetrated by their parents/caregivers, as well as psychological well-being and social support satisfaction, in an online survey. Using confirmatory factor analysis (CFA), we verified the presence of a two-factor model (physical and psychological DVA). Hierarchical linear regression analysis demonstrated the differing impact of these two factors: Specifically, although exposure to psychological DVA (domestic abuse [DA]) was related to reduced psychological well-being, there was no significant effect of exposure to physical DVA (DV). However, mediation analysis suggested the presence of a suppression effect; there was a magnification of the negative relationship between exposure to psychological DA and social support satisfaction when exposure to physical DV was accounted for. Although findings are preliminary, they provide strong evidence to support theoretical arguments regarding the need for future research to conceptualize exposure to DVA in terms of both physical and psychological dimensions. Our findings also highlight that to improve service response and provide effective interventions, it is essential to include exposure to psychological DA in risk assessments of such young adults.

When and How Video Games Can Be Good: A Review of the Positive Effects of Video Games on Well-Being.

Video games are a source of entertainment for a wide population and have varied effects on well-being. The purpose of this article is to comprehensively examine game-play research to identify the factors that contribute to these disparate well-being outcomes and to highlight the potential positive effects. On the basis of existing literature, we argue that the effects of gaming on well-being are moderated by other variables, such as motivations for gaming and video-game characteristics. Specifically, the inclusion of social activity can benefit prosocial behaviors and affect the relationship between violent video games and aggression that some studies have demonstrated. Moreover, the research on the relationship between violent video games and aggression depends greatly on individual and sociocontextual variables outside of game play. The inclusion of physical activity in games can provide an improvement in physical health with high levels of enjoyment, potentially increasing adherence rates. Overall, following our review, we determined that the effects of gaming on well-being are moderated by and depend on the motivation for gaming, outside variables, the presence of violence, social interaction, and physical activity. Thus, we argue that there is potential for an "optimal gaming profile" that can be used in the future for both academic- and industry-related research.

Stigma predicts health-related quality of life impairment, psychological distress, and somatic symptoms in acne sufferers.

Acne vulgaris has been associated with deficits in psychological well-being and health-related quality of life. Few studies have investigated how stigma contributes to our understanding of the well-being of acne sufferers, although it is clear that acne is stigmatized and stigmatization is associated with impaired well-being. The current study aimed to investigate the ability of perceived stigma to predict health-related quality of life, psychological distress, and somatic symptoms over and above established predictors. University students and staff suffering from acne completed self-report measures online. Hierarchical multiple regression analyses showed that perceived stigma significantly contributed to the prediction of all three well-being measures, over and above the effects of gender, acne severity, acne location, and use of medication. Indeed, perceived stigma made the largest unique contribution to predicting well-being. Our findings suggest that interventions that attempt to counter stigma could also improve the overall well-being of people affected by acne.

Restricted reproductive rights and risky sexual behaviour: How political disenfranchisement relates to women's sense of control, well-being and sexual health.

Few studies have investigated the role of disenfranchisement and denial of agency in women's sexual health. To address this, a cross-sectional study of disenfranchisement, control (general and reproductive control) and health was conducted in Ireland, where abortion is severely restricted. Multiple mediation models ( N = 513 women) indicated that general but not reproductive control mediates the association between disenfranchisement and psychological well-being. Additionally, serial mediation shows disenfranchisement is associated with lower sense of control, which is linked to poorer well-being and risky sexual behaviour. Disenfranchisement arising from socio-political contexts may have important implications for women's sexual health.

Family identification: a beneficial process for young adults who grow up in homes affected by parental intimate partner violence.

Exposure to parental intimate partner violence (parental IPV) is a complex trauma. Research within social psychology establishes that identification with social groups impacts positively on how we appraise, respond to and recover from traumatic events. IPV is also a highly stigmatized social phenomenon and social isolation is a major factor for families affected by IPV, yet strong identification with the family group may act as a beneficial psychological resource to young people who grew up in homes affected by IPV. The current study, an online survey of 355 students (M age = 20, 70% female), investigated if a psychosocial process, specifically identification with the family, may influence the relationship between the predictor, exposure to parental IPV, and outcomes, global self-esteem and state anxiety. Mediation analysis suggests that identification with the family has a positive influence on the relationship between exposure to parental IPV and psychological outcomes; exposure to parental IPV results in reduced family identification, but when family identification is strong it results in both reduced anxiety and increased self-esteem for young people. The findings highlight the importance of having a strong sense of belonging to the extended family for young people who were exposed to parental IPV, thus has implications for prevention, intervention, and social policy.

The impact of anticipated stigma on psychological and physical health problems in the unemployed group.

Previous research has demonstrated that the unemployed suffer increased psychological and physical health problems compared to their employed counterparts. Further, unemployment leads to an unwanted new social identity that is stigmatizing, and stigma is known to be a stressor causing psychological and physical health problems. However, it is not yet known whether being stigmatized as an unemployed group member is associated with psychological and physical health in this group. The current study tested the impact of anticipated stigma (AS) on psychological distress (PD) and physical health problems, operationalized as somatic symptoms (SSs), in a volunteer sample of unemployed people. Results revealed that AS had a direct effect on both PD and SSs, such that greater AS significantly predicted higher levels of both. Moreover, the direct effect on SSs became non-significant when PD was taken into account. Thus, to the extent that unemployed participants anticipated experiencing greater stigma, they also reported increased PD, and this PD predicted increased SSs. Our findings complement and extend the existing literature on the relationships between stigmatized identities, PD and physical health problems, particularly in relation to the unemployed group. This group is important to consider both theoretically, given the unwanted and transient nature of the identity compared to other stigmatized identities, but also practically, as the findings indicate a need to orient to the perceived valence of the unemployed identity and its effects on psychological and physical health.