Stigma by association among alcohol and other drug and harm reduction workers: Implications for workplace outcomes.

INTRODUCTION: The negative attitudes people hold towards those who use alcohol or other drugs (AOD) can also affect the people who work with this community, leading to lowered productivity and wellbeing. The impact of this stigma by association in the AOD and harm reduction sector is particularly significant because workers may have lived experience of AOD use and identify strongly with their client group. This study aimed to examine how stigma by association among health workers in the AOD/harm reduction sector relates to workplace outcomes. A secondary aim was to explore how lived experience influences experiences of stigma by association. METHODS: The research used a cross-sectional survey design and data collection occurred in 2023. Australian AOD/harm reduction workers (n = 228) completed an online survey assessing stigma by association as well as various workplace outcomes measures. RESULTS: Participants who reported experiencing more stigma by association experienced poorer workplace wellbeing, higher burnout and greater intentions to leave the AOD/harm reduction field. Experiences of stigma by association were unrelated to job satisfaction. Additional analyses revealed that participants with lived experience reported higher levels of job satisfaction and lowered intentions to leave the sector, but findings of stigma by association and its impacts on workplace outcomes did not differ from those without lived experience. DISCUSSION AND CONCLUSIONS: Identifying staff experiences of stigma by association and developing support and advocacy mechanisms to address this is likely to be key to reducing these experiences and ultimately to increasing positive workplace outcomes for AOD and harm reduction staff.

Pancultural nostalgia in action: Prevalence, triggers, and psychological functions of nostalgia across cultures.

Nostalgia is a social, self-relevant, and bittersweet (although mostly positive) emotion that arises when reflecting on fond past memories and serves key psychological functions. The majority of evidence concerning the prevalence, triggers, and functions of nostalgia has been amassed in samples from a handful of largely Western cultures. If nostalgia is a fundamental psychological resource, it should perform similar functions across cultures, although its operational dynamics may be shaped by culture. This study (N = 2,606) examined dispositional nostalgia, self-reported triggers of nostalgia, and functions of experimentally induced nostalgia in young adults across 28 countries and a special administrative region of China (i.e., Hong Kong). Results indicated that nostalgia is frequently experienced across cultures, albeit better valued in more-developed countries (i.e., higher national wealth and life-expectancy). Nostalgia is triggered by psychological threats (especially in warmer countries), sensory stimuli (especially in more-developed countries), and social gatherings (especially in less-developed countries). The positive or negative affect prompted by experimentally induced nostalgia varied by country, but was mild overall. More importantly, recalling a nostalgic (vs. ordinary) memory increased social connectedness, self-continuity, and meaning in life across cultures. In less-developed countries, recalling an ordinary memory also conferred some of these functions, reducing the effect size of nostalgia. Finally, recalling a nostalgic (vs. ordinary) memory augmented state satisfaction with life in countries with lower quality of living (i.e., lower life-expectancy and life-satisfaction). Overall, findings confirm the relevance of nostalgia across a wide range of cultures and indicate cultural nuances in its functioning. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The cognitive tenacity of self-directed ageism.

Ageism refers to prejudice or discrimination based on a person's age. When ageism is directed at older people, it is unique in two ways: it is socially condoned in a manner that other types of prejudice are not, and the animus is eventually self-directed. Of central interest here is why ageism becomes self-directed in late adulthood, despite its potentially harmful personal costs. We present a cognitive model in which negative ageist beliefs become increasingly accessible and difficult to eliminate owing to broader developmental shifts in mentation. Given that these effects are contingent on our social environment, systemic changes in societal conceptions of age and aging are needed if we are to reduce vulnerability to self-directed ageism.

Interactions across the ages: How concerns about warmth and competence impact age-based stereotype threat in the workplace.

Although the disengagement consequences of age-based stereotype threat in the workplace are well-documented, it is less clear what causes employees to experience age-based stereotype threat. Based on socioemotional selectivity theory, the present study examines whether and why daily cross-age interactions in the workplace lead to stereotype threat. Using a diary study design over 2 weeks, 192 employees (86 employees aged 30 and younger; 106 employees aged 50 and older), completed 3570 reports on daily interactions with coworkers. Results showed that both younger and older employees experienced stereotype threat when they engaged in cross-age interactions compared to interactions with people of a similar age. The characteristics of cross-age interactions that led employees to experience stereotype threat differed by age, however. Consistent with socioemotional selectivity theory, cross-age interactions were problematic for younger employees to the degree that they triggered concerns about competence, whereas concerns about warmth led to stereotype threat among older employees. Daily stereotype threat was associated with reduced feelings of workplace belonging for both younger and older employees but, contrary to expectations, stereotype threat was not related to energy and stress. These findings suggest that cross-age interactions can lead to stereotype threat for both younger and older employees, particularly when younger employees worry they are perceived as incompetent or older employees worry they are perceived as less warm. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The antecedents and consequences of stereotype threat in Parkinson's disease.

OBJECTIVE: The aim of this study was to examine what factors make people with Parkinson's disease more susceptible to stereotype threat (i.e., the concern of being evaluated in line with negative group-based stereotypes) and the clinical consequences of this. METHOD: Forty-nine people with Parkinson's disease completed a measure of stereotype threat, as well as measures that indexed potential antecedents and clinical consequences of stereotype threat. RESULTS: Younger age and greater communication difficulties emerged as significant predictors of stereotype threat. Higher stereotype threat was also associated with increased emotional distress. CONCLUSIONS: These findings are an important first step in understanding stereotype threat in Parkinson's disease and may help to guide the development of intervention and educational efforts aimed at countering its effects.

"Let's get physical" - or social: The role of physical activity versus social group memberships in predicting depression and anxiety over time.

BACKGROUND: Physical activity is often promoted as a way to prevent and combat anxiety and depression in adolescents. However, very little research has sought to establish whether the benefits of exercise arise from the excercise itself or from the social context in which it takes place. We explore the hypothesis that it is not physical activity on its own, but rather adolescents' engagement in group life (as part of a sports group or otherwise), that accounts for positive mental health effects associated with physical activity. METHODS AND RESULTS: We conducted a longitudinal study that tracked 558 high-school boys and found that anxiety and depression over time was not predicted by (a) T1 physical fitness as determined by 7 speed and agility tests, or (b) engaging in multiple sports as co-curricular activies at T1. In contrast, multiple group memberships - irrespective of the activity - predicted reduced depression and anxiety over time, particularly when these were groups that adolescents identified with and experienced as compatible with each other. LIMITATIONS: Limitations relate to (a) physical fitness only being measured at T1, (b) the absence of a measure of frequency and duration of physical activity, and (c) the homogeneity of the sample. CONCLUSIONS: We conclude that group memberships and the social identities that adolescents derive from these groups (including, but not restricted to, those involving sport) function as a psychological resource to reduce anxiety and depression over time.

Lived Experience as a Protective Factor for Mental Health Workers.

OBJECTIVE: When clients do not seem to be improving, mental health workers have more negative job attitudes, experience higher levels of client-related burnout, and are more interested in leaving the field. Nonetheless, it is unclear whether all mental health workers are equally susceptible to burnout caused by feelings that their clients are not improving. Specifically, people with lived experience of mental illness are intimately familiar with their own recovery challenges and thus may be less susceptible to this source of burnout. METHODS: To test this possibility, mental health providers (N=179) from a nongovernmental community mental health organization in Australia completed a survey assessing their perceptions of client improvement from treatment, their feelings of client-related burnout, and a range of organizational outcomes (job satisfaction, job engagement, workplace well-being, and intentions to resign). RESULTS: Moderated mediation analyses revealed that although mental health providers who felt that their clients were not improving experienced client-related burnout, lived experience served as a buffer. Staff with lived experience were less susceptible to burnout associated with perceptions that their clients were not improving from treatment. Mental health providers with lived experience also reported more positive job attitudes compared with providers without lived experience. CONCLUSIONS: Given the high rates of burnout in the mental health profession, future research should examine why lived experience appears to buffer staff from burnout when they believe that their clients are not improving. This knowledge could aid in the development of interventions to boost resilience, engagement, and longevity in the field.

Weight-based stereotype threat in the workplace: consequences for employees with overweight or obesity.

BACKGROUND/OBJECTIVES: Employees with overweight or obesity are often stereotyped as lazy, unmotivated, and less competent than employees with normal weight. As a consequence, employees with overweight or obesity are susceptible to stereotype threat, or the concern about confirming, or being reduced to, a stereotype about their group. This survey study examined whether employees with overweight or obesity experience stereotype threat in the workplace, whether it is associated with their perceived ability to meet their work demands (i.e., work ability), and whether high levels of knowledge about one's self (i.e., authentic self-awareness) can offset a potential negative association. SUBJECTS/METHODS: Using a correlational study design, survey data were collected from N = 758 full-time employees at three measurement points across 3 months. Employees' average body mass index (BMI) was 26.36 kg/m² (SD = 5.45); 34% of participants were employees with overweight (BMI between 25 and <30), and 18% of participants were employees with obesity (BMI > 30). RESULTS: Employees with higher weight and higher BMI reported more weight-based stereotype threat (rs between 0.17 and 0.19, p < 0.001). Employees who experienced higher levels of weight-based stereotype threat reported lower work ability, while controlling for weight, height, and subjective weight (ß = -0.27, p < 0.001). Authentic self-awareness moderated the relationship between weight-based stereotype threat and work ability (ß = 0.14, p < 0.001), such that the relationship between stereotype threat and work ability was negative among employees with low authentic self-awareness (ß = -0.25, p < 0.001), and non-significant among employees with high authentic self-awareness (ß = 0.08, p = 0.315). CONCLUSIONS: The findings of this study contribute to the literature by showing that weight-based stereotype threat is negatively associated with employees' perceived ability to meet their work demands, particularly among those employees with low authentic self-awareness.

No evidence that implicit identification with mental illness predicts recovery.

OBJECTIVES: Recovery from mental illness is multiply-determined, but one factor that has been proposed to influence recovery is the degree to which the person identifies as someone with a mental illness. This study examines the relationship between implicit identification with being mentally unwell and recovery among clients of a community mental health service. A multi-faceted view of recovery was adopted. METHODS: A longitudinal design was used to assess implicit identification with mental illness and its relationship to recovery, including symptom severity, well-being, life satisfaction, and optimism, which were supplemented with ratings by both support workers and the research assistants who conducted the study. Participants were 216 community mental health care clients, with 150 retested at Time 2, and 100 retested at Time 3. RESULTS: Implicit identification with mental illness was correlated with recovery at Time 1 and Time 3, though this relationship did not emerge at Time 2. Cross-lag regression analyses failed to reveal evidence that implicit identification with mental illness predicts subsequent recovery. CONCLUSIONS: The current research suggests that implicit identification with mental illness can be considered a marker of ongoing recovery, but is not predictive of subsequent recovery. Hence, these data suggest that implicit identification with mental illness is unlikely to play an independent role in the recovery process. PRACTITIONER POINTS: Research regarding the mental health consequences of implicit identification focuses on symptomatology. Recovery is more than a reduction in symptoms, however, and thus, a broader conceptualization of recovery was examined. Implicit identification with being mentally unwell was associated with poorer recovery broadly operationalized, but did not predict subsequent recovery.

Improving the Quality of Bowel Preparation: Rewarding Patients for Success or Intensive Patient Education?

INTRODUCTION AND OBJECTIVES: The quality of the bowel preparation is a critical parameter for the outcome of colonoscopies. It is well established that the bowel preparation modality (e.g., split or larger volume preparation) significantly improves the quality of the bowel preparation. Patient compliance is another important factor impacting on the quality of bowel preparations that receives relatively little research attention. We aimed to explore if intensified education or a lottery ticket as reward for good bowel preparation could improve outcomes. METHODS: After informed consent, all patients received a standardized printed information booklet. In a randomized fashion, patients were offered (a) a lottery scratchy ticket with an opportunity to win $25,000 as "reward" for good bowel preparation, (b) an education session delivered over the phone by a trained nurse, or (c) no additional measure. RESULTS: Overall, the quality of the bowel preparation was rated good or very good in 69.1% (95% CI 61.7-75.7%) of patients. Reward intervention did not influence the quality of bowel preparation (OR 0.42, 95% CI 0.09-1.91, p = 0.260); however, bowel preparation quality decreased in patients randomized to receive the additional education (OR 0.28, 95% CI 0.08-0.96, p = 0.042). Neither intervention significantly impacted on polyp detection rates. CONCLUSIONS: Contrasting general beliefs, additional interventions (e.g., incentives or phone consultation) did not improve the quality of the bowel preparation. The unexpected result shows that utilizing extra resources must be balanced against real-world outcomes and may not always provide the expected result.

Identification with drug use among young adults who are at risk of transitioning to more serious use.

Understanding the drug use trajectories for at risk young adults can help reduce harms associated with serious drug use. This longitudinal study tracked young people to assess whether implicit and explicit identification with substance use predicts changes in use over time and whether patterns of use impacts identification with drugs. Two hundred and twenty-eight participants were initially recruited from homeless shelters, youth centers, drug health services, and parks where young people who use drugs are known to frequent. Over a 20-month period, 78 of these original participants were successfully recontacted and surveyed again. The survey assessed implicit and explicit identification with drug use, along with known risk factors, to determine if identification predicts changes in drug use over time as assessed by frequency, recency, and multiple drug use. Results revealed that implicit and explicit identification with drug use were stronger among participants who used more frequently, more recently, and used multiple drugs, although this finding only emerged cross-sectionally and not longitudinally. Overall, these results suggest that patterns of drug use are associated with the identity of the individual and that identification with drug use is a marker of drug-using behavior, but identification with drug use does not appear to be predictive of future behavior nor an outcome of prior drug use.

An empirical study of how emotion dysregulation and social cognition relate to occupational burnout in dentistry.

Introduction Dentists are frequently exposed to occupational stressors, including emotionally tense interactions with patients who are experiencing pain, anxiety and fear. Unsurprisingly, dentists are also a group that experience particularly high levels of occupational burnout. The present study provides the first empirical test of whether occupational burnout is higher, and general wellbeing is lower, for dental practitioners and students who have greater difficulties managing their own emotions (emotion dysregulation) and detecting and interpreting social cues from others (social cognitive difficulties).Materials and methods Ninety-six dental practitioners and 54 dental students completed validated measures of emotion regulation, social cognitive function, occupational burnout and wellbeing.Results Consistent with broader literature, rates of burnout were significantly higher in both dental practitioners and students, relative to normative standards. Importantly, the results also identified significant associations between rates of burnout with both emotion dysregulation, as well as one of the measures of social cognitive function: the empathic disposition to experience discomfort in response to the distress of others (personal distress). Ratings of emotion dysregulation and personal distress were also significantly higher for dental students relative to practitioners.Conclusion These data highlight the importance of being able to effectively manage difficult emotions in the dental practice.

Perceived inability to help is associated with client-related burnout and negative work outcomes among community mental health workers.

Community mental health is a vital service, but it faces ongoing challenges from its high staff-turnover rates. The current study provides a preliminary test of a novel explanation for employee disengagement in community mental health. It is proposed that providing assistance to clients, while simultaneously feeling that only limited progress is being made, is associated with client-related burnout among community mental health providers, leading to negative work outcomes. Employees (N = 349) from three non-governmental community mental health organisations in Australia completed a survey assessing their perceptions of client improvement from treatment, client-related burnout and a range of organisational outcomes. Analyses revealed that perceptions that clients are not improving was associated with burnout, which in turn is related to lower job satisfaction, decreased job engagement, poorer workplace well-being, and increased turnover intentions. These findings suggest that interventions that highlight positive changes among clients could reinforce the important service provided by community mental health employees and may minimise burnout and negative work outcomes.

For Better or Worse: Facebook Use and Wellbeing Among Community Mental Health Care Clients.

Online social networking is ubiquitous, but research regarding its relationship to wellbeing has yielded contradictory results. This study examined the relationship between Facebook use and wellbeing among community mental health service clients. Twenty-six clients from a community mental health service provided access to their Facebook page. Seven aspects of 3674 Facebook posts were coded, and cross-lagged multilevel models were estimated over three periods to establish the relationship between Facebook use and wellbeing over time. Some aspects of Facebook use were related to wellbeing within the same period, although this pattern of relationships did not emerge longitudinally. Although Facebook has the potential to forge social connections for those who are socially isolated, Facebook use was neither helpful nor harmful over time among people with mental health problems. Given the prevalence of social networking, a clearer understanding of its impact on wellbeing is critical for mental health providers.

Age-based stereotype threat and work outcomes: Stress appraisals and rumination as mediators.

Both older and younger employees experience age-based stereotype threat in the workplace, but only older employees appear to be vulnerable to disengagement as a consequence. The present study examines 2 mechanisms that might explain this age difference: (a) stress appraisals of challenge and hindrance and (b) rumination. Using a weekly diary study design over 5 weeks, 280 employees across the life span (aged between 18 and 66 years), completed 1,288 weekly surveys. Work outcomes examined were job satisfaction, job engagement, affective organizational commitment, workplace well-being, and intentions to quit. Results showed that while both older and younger employees experienced age-based stereotype threat, it was uniquely problematic for older employees. Furthermore, challenge appraisals mediated the relationships between age-based stereotype threat and job engagement, commitment, and intentions to quit among older, but not younger, employees. Rumination mediated the relationships between age-based stereotype threat and job satisfaction, commitment, well-being, and intentions to quit among older, but not younger, employees. These findings suggest that stereotype threat might be detrimental to work outcomes because older employees are less likely to appraise stereotype threat as a challenge, and more likely to ruminate when they experience stereotype threat. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Attitudes of people working in mental health non-governmental organisations in Australia: A comparison with other mental health professionals.

Research suggests that stigma impacts help-seeking behaviour and health outcomes for people affected by mental illness. This study compared the attitudes of Australian non-governmental organisation support workers towards people with mental illness with those of other health professionals. Three hundred and seventy four support workers were randomly allocated to answer questions about one of the six vignettes. Results indicated that non-governmental organisation support workers held more positive attitudes towards people with mental illness than those of general practitioners, psychiatrists and psychologists measured in prior research. These results suggest that non-governmental organisations may be a more positive and comfortable entry and referral point for mental health clients.

Health workers' support for hepatitis C treatment uptake among clients with a history of injecting.

Hepatitis C virus is stigmatised because of its association with injecting drug use. Although treatment is available, uptake remains low, especially among people who inject drugs. Ninety health workers completed a survey assessing attitudes towards people who inject drugs and support for treatment for three client scenarios: one who stopped injecting, one on methadone, and one continuing to inject. Support for hepatitis C virus treatment was significantly higher, where the client was not injecting. Participants who showed more negative attitudes towards people who inject drugs were less supportive of clients entering hepatitis C virus treatment, illustrating the influence of health workers' attitudes in determining treatment options offered to clients.

Implicit and explicit internalized stigma: Relationship with risky behaviors, psychosocial functioning and healthcare access among people who inject drugs.

INTRODUCTION: People who inject drugs (PWID) are stigmatized by society. Over time people may begin to internalize the stigma about their group. This research examines how implicit and explicit internalized stigma among PWID relates to health care and treatment access, psychosocial functioning, and engagement in risky behaviors. METHODS: PWID were recruited from a needle and syringe program (NSP) located in Sydney, Australia. Participants completed a survey examining explicit and implicit internalized stigma, risky behaviors (e.g., sharing injecting equipment, unprotected sex), health care and treatment access (e.g., comfort attending NSPs), and psychosocial functioning (e.g., mental health). Detailed demographic variables were also collected. RESULTS: A total of 115 clients completed the measures. To the degree that participants had internalized the stigma about their group (measured explicitly), they felt less comfortable attending NSPs, had greater severity of dependence, and experienced more depressive symptoms. The implicit measure of internalized stigma was related to treatment engagement and needle sharing, although the direction of these effects was unexpected. CONCLUSIONS: This research highlights the importance of ongoing research into the implications of internalized stigma for PWID. Assessing both explicit and implicit internalized stigma appears to be beneficial as these are related to different health and behavioral outcomes.

Stereotype threat and social function in opioid substitution therapy patients.

OBJECTIVES: People with a history of substance abuse are subject to widespread stigmatization. It seems likely that this societal disapproval will result in feelings of stereotype threat, or the belief that one is the target of demeaning stereotypes. If so, stereotype threat has the potential to contribute to functional difficulties including poor social outcomes. METHODS: Eighty drug users on opioid substitution therapy and 84 demographically matched controls completed measures of mental health and social function. The opioid substitution therapy group were additionally asked to complete a measure that focused on their feelings of stereotype threat in relation to their drug use history. Bivariate correlations and hierarchical regression analyses were conducted to establish the magnitude and specificity of the relationship between stereotype threat and social functioning. RESULTS: Relative to controls, the opioid substitution therapy group reported higher levels of negative affect and schizotypy, and poorer social functioning, with all three of these indices significantly correlated with their feelings of stereotype threat. The results also showed that stereotype threat contributed significant unique variance to social functioning in the opioid substitution therapy group, even after taking into account other background, clinical, and mental health variables. CONCLUSIONS: Social functioning is an important aspect of recovery, yet these data indicate that people with a history of drug abuse who believe they are the target of stereotypical attitudes have poorer social functioning. This relationship holds after controlling for the impact of other variables on social functioning, including mental health. The theoretical and practical implications of these findings are discussed. PRACTITIONER POINTS: Concerns about being stereotyped can shape the social experiences of opioid substitution therapy patients. Opioid substitution therapy patients who feel negatively stereotyped experience greater social function deficits, and this relationship emerges after controlling for important clinical and mental health variables. Understanding the relationship between feeling stereotyped and social function may assist practitioners in their treatment. The study is cross-sectional, and thus, experimental or longitudinal research is required to determine the causal direction between stereotype threat and social function.

Internalized Stigma Among People Who Inject Drugs.

BACKGROUND: Perceived experiences of stigma have been found to be associated with poorer psychosocial outcomes and engagement in risk practices among people who inject drugs. Yet the extent to which people internalize or accept the stigma surrounding their injecting drug use, and whether this is associated with risky injecting practices, is not well known. OBJECTIVES: The aim of this study was to assess the extent of internalized stigma among a sample of people who inject drugs in Australia and identify socio-demographic, injecting risk, and mental health correlates. METHODS: People who inject drugs were recruited from a needle and syringe program located in Sydney, Australia to complete a brief survey. The survey included measures of internalized stigma, severity of drug dependence, self-esteem, depression, and shared use of injecting equipment. RESULTS: The sample comprised 102 people who inject drugs. Internalized stigma was higher among participants who reported being depressed in the past month, and was also associated with greater severity of drug dependence and diminished self-esteem. There was no relationship between internalized stigma and shared use of needles or other injecting equipment in the past month. Conclusions/Importance: Findings underscore the need for further investigation of internalized stigma among people who inject drugs. In particular, future research should assess the impact of implicit (i.e., subconscious) internalized stigma on mental health.