Embarrassment as a public vs. private emotion and symbolic coping behaviour.

In dealing with embarrassment, individuals engage in symbolic coping behaviours (e.g., hiding one's face by wearing sunglasses). Research investigated these behaviours when embarrassment is experienced as a public emotion (e.g., others present). Contrary, there is emerging evidence showing that embarrassment can be experienced as a private emotion (e.g., no others present) as well. This is why the present research seeks to enhance previous work on symbolic coping behaviours and investigates to what extent symbolic coping behaviours differ when embarrassment is experienced in public and private. First, the present study finds that individuals experience embarrassment as a private as well as a public emotion. Second, both types of embarrassment relate to symbolic coping behaviours. Third, while both types of embarrassment experience a preference for face-hiding products there are differences in symbolic coping behaviours. Fourth, the study transfers extant research to a different cultural context.

Scar Perception in School-aged Children After Major Surgery in Infancy.

BACKGROUND: The long-term effects of childhood surgery scars on health status, quality of life (QoL), self-esteem, and body image remain uncertain. This study explores these effects in school-aged children. METHODS: We conducted a retrospective cohort study involving 454 children (58% boys; 8-17 years) who had undergone surgical correction of anatomical anomalies or neonatal ECMO. Data included patient-reported scar perception and scar-related embarrassment, along with psychological assessment via questionnaires. RESULTS: About 34% of children rated their scars as 'nice-looking', 49% as 'indifferent', and 12% as 'rather ugly'. Most children (91%) never experienced scar-related embarrassment, while frequent embarrassment was reported by 3%. Surgical scar correction was desired by 6% of the 8-year-olds and 19% of the 17-year-olds. Scar perception did not significantly affect health status or QoL. However, negative scar perception was associated with lower self-esteem in girls and a more negative body image in boys. Girls were more likely to report negative scar perception (OR: 1.54, 95%-CI: 1.06-2.24) and scar-related embarrassment (OR: 4.29, 95%-CI: 1.77-10.44). CONCLUSION: Children who underwent surgery in the neonatal period and subsequently grew up with scars resulting thereof, mostly perceive them either indifferently or positively, with minimal effect on health status and QoL. Nonetheless, some children, particularly girls, experienced negative perceptions of their scars, although scar-related embarrassment was rare. We recommend integrating scar assessment into routine follow-up at ages 12 and 17, and offering appropriate and timely guidance and support to children at risk for negative effects of scars. LEVEL OF EVIDENCE: III.

The blushing brain: neural substrates of cheek temperature increase in response to self-observation.

Darwin proposed that blushing-the reddening of the face owing to heightened self-awareness-is 'the most human of all expressions'. Yet, relatively little is known about the underlying mechanisms of blushing. Theories diverge on whether it is a rapid, spontaneous emotional response that does not involve reflection upon the self or whether it results from higher-order socio-cognitive processes. Investigating the neural substrates of blushing can shed light on the mental processes underlying blushing and the mechanisms involved in self-awareness. To reveal neural activity associated with blushing, 16-20 year-old participants (n = 40) watched pre-recorded videos of themselves (versus other people as a control condition) singing karaoke in a magnetic resonance imaging scanner. We measured participants' cheek temperature increase-an indicator of blushing-and their brain activity. The results showed that blushing is higher when watching oneself versus others sing. Those who blushed more while watching themselves sing had, on average, higher activation in the cerebellum (lobule V) and the left paracentral lobe and exhibited more time-locked processing of the videos in early visual cortices. These findings show that blushing is associated with the activation of brain areas involved in emotional arousal, suggesting that it may occur independently of higher-order socio-cognitive processes. Our results provide new avenues for future research on self-awareness in infants and non-human animals.

The Impact of Dupilumab on Work Productivity and Emotional Health in CRSwNP: A Multicentric Study in Northeast Italy.

Chronic rhinosinusitis with nasal polyps (CRSwNP) in the severe forms is associated with a poor quality of life. Dupilumab has been suggested as an add-on treatment option for severe CRSwNP. Severe CRSwNP patients treated with Dupilumab in different rhinological units were considered for this study via their evaluation at the baseline at first and the consequential follow-up at 6-, 12-, and 24 months from the first administration. At baseline (T0) and at each follow-up, patients underwent NPS, Sinonasal Outcome Test (SNOT)-22, Visual Analogue Scale (VAS) for smell, and Sniffin' sticks identification test (SSIT). The SNOT-22 domains for function and emotion were also analysed separately. Two hundred and seventeen patients with at least 6 months of follow-up were included. All parameters have improved during treatment (p < 0.0001). Noticeably, both the function and emotion SNOT-22 domains have improved within 6 months of treatment and have continued to progress during every interval within 12 months from the baseline, positively influencing patients' emotivity and augmenting their social and economic performances. Dupilumab improves the QoL of CRSwNP patients with good effects on the reported productivity and emotional health. Clinicians should pay attention to these two aspects when dealing with patients affected by severe CRSwNP.

Facing the Emotional Barriers to Colorectal Cancer Screening. The Roles of Reappraisal and Situation Selection.

BACKGROUND: Disgust, embarrassment, and fear can hinder the attendance of colorectal cancer (CRC) screening. However, individuals can respond to these emotions differently. The present study tested whether reappraising a negative stimulus versus avoiding a negative stimulus is associated with age; whether these two emotion regulation strategies (reappraisal and situation selection) moderate the effects of disgust, embarrassment and fear on CRC screening intention; and the efficacy of a message based on participants' preferred emotion regulation strategy. METHODS: We recruited 483 Italian participants (aged 40-84 years) through snowball sampling. Participants were randomly assigned to one of four conditions differing for a message promoting CRC screening with an affective lever, a cognitive lever, both levers or none. Key variables included emotion regulation strategies, emotional barriers and intention to get screened. RESULTS: The preference for reappraisal over situation selection increased with age. Reappraisal neutralized the effect of disgust on CRC screening intention. The combined message with both affective and cognitive levers increased CRC screening intention (b = 0.27, ß = 0.11, SE = 0.13 p = .049), whereas reading the message based only on the affective (b = 0.16, ß = 0.06, SE = 0.14 p = .258) or the cognitive (b = 0.22, ß = 0.09, SE = 0.14 p = .107) lever was not effective. CONCLUSIONS: Communication campaigns should support the activation of a reappraisal strategy of emotion control, and messages promoting CRC screening should highlight both the instrumental (i.e., early detection) and affective (i.e., peace of mind) benefits of attendance.

Testing the Factor Structure and Construct Validity of the German Version of Gray et al.'s (2003) Sexual Fantasy Questionnaire.

Gray et al.'s (2003) Sexual Fantasy Questionnaire (SFQ) is becoming an increasingly used self-report measure of sexual fantasy use. The current study analyzed the factorial structure and construct validity of the behavioral items of the SFQ using a nomological network of other sexuality-related measures in a large German-speaking sample (N = 846). Participants' (27.7% females) mean age was 30.8 years (SD = 11.0). Exploratory factor analysis revealed a 65-item scale comprising five-factors, which were termed: normophilic sexual fantasies, sexualized aggression, sexualized submission, submissive courtship, and bodily functions. This German version of the SFQ was found to have high construct validity indicated by its association with other related constructs. Based on these results, we argue that the SFQ is a valid self-report measure that can be used in both research and clinical practice (foremost the factors sexualized aggression and sexualized submission). Suggestions for future research are discussed in light of the results and the study's limitations.

National survey of barriers to colorectal cancer screening in Jordan.

Background: Colorectal cancer is among the leading malignancies globally and in Jordan. It causes significant morbidity and mortality. It can be detected early, but uptake of colorectal cancer screening in Jordan is substantially low. Aim: To determine the underlying barriers to the uptake of colorectal cancer screening in Jordan. Methods: A cross-sectional study was conducted in the northern, central and southern regions of Jordan using selfadministered questionnaire that evaluated the barriers and attitudes towards colorectal cancer screening among adults aged 45 years and above living in Jordan. The data was analyzed using SPSS version 25.0. Results: Of the 1477 participants enrolled in the study, 29.1% reported the lack of information about screening as a major barrier to uptake, followed by the fear of any potential complications due to the test (10%), embarrassment associated with colonoscopy (7.8%), and fear of the result (7.4%). Only 9% of the study participants had taken the colonoscopy test for colorectal cancer screening. Conclusion: Lack of information about colorectal cancer screening, misconceptions and embarrassment drive the low uptake of colorectal cancer screening in Jordan. There is a need for nationwide education and awareness on colorectal cancer screening to address the barriers reported in this study and increase screening uptake.

Effects of Embarrassment on Self-Serving Bias and Behavioral Response in the Context of Service Failure.

Previous research has focused on examining embarrassment in sensitive product purchase situations. Although embarrassment is a widespread emotion in consumption situations, few studies have explored its impact on service encounters, especially in the service failure context. This study examines how customers react to different service failures that cause embarrassment and explores whether self-serving bias exists when customers perceive higher embarrassment in service failure. This study uses a 2 (source of failure) × 2 (level of embarrassment) scenario experimental method to examine the effect of two sources of failure on consumer locus attributions, negative emotions, and negative behaviors, considering the moderating effects of the level of embarrassment. Data were collected from 218 student subjects in Taiwan. The results show that embarrassment is important in service failure contexts. Specifically, when consumers perceive higher embarrassment, they attribute more responsibility to the service provider. These attributions, in turn, influence customers' emotions and behavioral responses. These findings have several important theoretical and practical implications in terms of embarrassing service failures.

Managing menstruation during natural disasters: menstruation hygiene management during "super floods" in Sindh province of Pakistan.

Menstruation is part of women's normal life, which requires basic hygienic practices. Managing hygiene can be affected by several factors and situations such as natural disasters. Focusing on 'super flooding' in Pakistan's Sindh Province, we pay attention to how this 'natural disaster' has affected hygienic practices of menstrual cycle of women. The study meticulously examines the dynamics of menstrual hygiene management, encompassing the nuanced encounters with feelings of shame and embarrassment among girls and women situated in flood camps, schools, and community shelters. It also intends to highlight women's challenge and embarrassment to participate in the distribution process of essential resources such as pads. The insights garnered from this study hold potential relevance for various stakeholders, including policymakers, healthcare practitioners, and researchers, offering a nuanced comprehension of the intersection of menstrual hygiene, climate change, and well-being of women.

French validation of the Quality of life in Essential Tremor Questionnaire (QUEST) and the Essential Tremor Embarrassment Assessment (ETEA).

Two scales have been developed and validated in English to evaluate the impact of tremor on daily life, namely Quality of life in Essential Tremor Questionnaire (QUEST) and Essential Tremor Embarrassment Assessment (ETEA). The psychometric properties of the French version of these two scales were assessed for 117 patients with head tremor. Both scales showed excellent acceptability, very good internal consistency (Cronbach's alpha coefficient>0.8) and reproducibility (Lin concordance coefficient>0.8), satisfactory external validity and satisfactory sensitivity to change. In conclusion, the French versions of QUEST and ETEA are comprehensive, valid and reliable instruments for assessing patients with head tremor.

Patients' views and experiences of delayed diagnosis of inflammatory bowel disease: a qualitative study.

BACKGROUND: Diagnosing inflammatory bowel disease (IBD) can be challenging. Patients have been found to experience significant diagnostic delay, which can lead to poorer clinical outcomes. The reasons for this delay are not fully understood, and exploring patients' perspectives can offer important insights. AIM: To explore the views and experiences of patients who self-report a delay in IBD diagnosis. DESIGN & SETTING: Qualitative methodology using semi-structured interviews. Participants were recruited via social media and a national IBD charity. METHOD: Interviews were conducted by telephone between December 2018 and February 2019. Data were analysed using thematic analysis and drawing on the constant comparison method. RESULTS: Sixteen interviews were carried out. Ten participants were female and six were male; participants were aged 20-65 years. Four main themes were identified: patient factors contributing to delay; primary care factors contributing to delay; systemic factors contributing to delay; and perceived consequences of delayed diagnosis. Participants reported initially not seeking help due to embarrassment or normalising their symptoms. Having consulted, participants reported further delay in receiving a diagnosis due to their perception that GPs had either mislabelled symptoms, expressed uncertainty, or not taken symptoms seriously. Systemic factors, including lack of access to test results and communication issues across primary and secondary care, were also cited as contributing to delayed diagnosis. Several participants felt that their delayed diagnosis led to poorer clinical outcomes. CONCLUSION: These findings can support patients and GPs in their conversations about symptoms that may indicate IBD, and potentially contribute to reducing diagnostic delay, as well as informing future primary care interventions.

Assessing Fear, Embarrassment, and Disgust in Colonoscopy: The Development of Measurement Instruments and Psychometric Evidence.

BACKGROUND: Avoidance of colonoscopy is often associated with fear, embarrassment, and disgust aroused in screening procedures. However, each emotion can be linked to different challenges faced by patients. More research is needed to evaluate and address the causes of these respective emotions. AIM: The purpose of this study was to develop and assess the scales of three negative emotions (i.e., fear, embarrassment, and disgust) caused by specific issues in colonoscopy screening. METHOD: The measurement items were developed based on multiple common barriers in colonoscopy screening procedures. An online sample of 232 adults aged 45-75 was recruited from Amazon Mechanical Turk to test the scales. Explorative and confirmatory factor analyses were conducted to validate the measurement models. RESULTS: Psychometric evidence demonstrated the factor structures of three negative emotions. Each emotional factor was caused by unique combinations of barriers in the preparation, screening, and recovery stages of colonoscopy. Most of the emotional factors were associated with attitudes and screening intention. CONCLUSION: This study showed different dimensions of negative emotions and their underlying causes in colonoscopy. These findings will help assess specific causes of negative emotions in colonoscopy and develop effective interventions to improve screening uptake.

The Neural Signatures of Shame, Embarrassment, and Guilt: A Voxel-Based Meta-Analysis on Functional Neuroimaging Studies.

Self-conscious emotions, such as shame and guilt, play a fundamental role in regulating moral behaviour and in promoting the welfare of society. Despite their relevance, the neural bases of these emotions are uncertain. In the present meta-analysis, we performed a systematic literature review in order to single out functional neuroimaging studies on healthy individuals specifically investigating the neural substrates of shame, embarrassment, and guilt. Seventeen studies investigating the neural correlates of shame/embarrassment and seventeen studies investigating guilt brain representation met our inclusion criteria. The analyses revealed that both guilt and shame/embarrassment were associated with the activation of the left anterior insula, involved in emotional awareness processing and arousal. Guilt-specific areas were located within the left temporo-parietal junction, which is thought to be involved in social cognitive processes. Moreover, specific activations for shame/embarrassment involved areas related to social pain (dorsal anterior cingulate and thalamus) and behavioural inhibition (premotor cortex) networks. This pattern of results might reflect the distinct action tendencies associated with the two emotions.

Social distance of bystanders affects people's embarrassment via changing fear of negative evaluation and feelings of attachment security.

BACKGROUND: Embarrassment is a self-conscious emotion with important social functions, but it is not well understood. The perception of bystanders is considered a precondition for embarrassment, which makes it unique from other self-conscious emotions. Studies have shown that socially close bystanders can reduce individuals' embarrassment. However, whether and how the embarrassment of individuals varies with the changes in social distance between them and their bystanders remained unclear, which indicates the key characteristics of embarrassment. METHODS: The current research consists of two studies. Study 1 tested whether participants' embarrassment systematically varied with social distance by setting up three levels of social distance: close friends (i.e., short), casual friends (i.e., medium), and strangers (i.e., long), based on 159 participants. With two full mediation models, study 2 investigated whether and how the fear of negative evaluation and state attachment security mediated the influence of social distance on embarrassment based on 155 participants. CONCLUSIONS: The current findings revealed that the social distance between bystanders and protagonists systematically influenced the embarrassment of protagonists and this effect occurred via two parallel pathways, i.e., by increasing the fear of negative evaluation and by reducing state attachment security. The findings not only showed the unique role of bystander characteristics on embarrassment, but also two cognitive processes behind this unique self-conscious emotion: fearing negative evaluation and seeking attachment for security.

Body Image Perception and the Effect of Different Educational Programs on Embarrassment in Patients Undergoing Colonoscopy.

PURPOSE: Colonoscopy is recognized as a safe and effective tool for detecting colorectal cancer. However, patients may experience discomfort and embarrassment arising from their body image, with the prejudice that health care professionals will have negative thoughts about their bodies. This study was carried out to determine the effect of the perception of body image and education given with different educational programs on the feeling of embarrassment in patients who were scheduled to undergo colonoscopy. DESIGN: Quasi-experimental study with pre-test, post-test. METHODS: The population of this quasi -experimental study with pre-test, post-test, and experimental groups consisted of 184 patients who underwent colonoscopy for the first time at the endoscopy department of a university hospital. FINDINGS: No statistically significant difference in the mean Colonoscopy Embarrassment Scale (CES) pre-test scores was found between the groups (P > .05). The mean CES post-test scores of the video group were lower than those of the other groups, with a statistically significant difference (P < .05). Comparing the intragroup CES pre-test and post-test mean scores, the mean CES post-test scores were found to be lower in all three groups, with a statistically significant difference between the groups (P < .05). Although a statistically weak negative correlation was found between the body image mean scores and the pre-test CES mean scores of the booklet and video groups, no correlation was observed in the control group. CONCLUSIONS: The body image perception was found to affect the sense of embarrassment in patients undergoing colonoscopy, and the mean embarrassment scores decreased with planned training programs.

Performing normality in working life among heavy substance users.

Aim: Work is an important part of most people's everyday lives and well-being. Substance use by employees is associated with several negative consequences, such as absence from work and poor work performance. The study examines the strategies through which people who have problems with substance use produce a "normal" self and avoid becoming stigmatised in the workplace. Methods: The study uses data from in-depth unstructured life story interviews, which were conducted over phone with 13 people. The participants had developed various problematic heavy substance use habits. The interviews were analysed by applying interactional analysis and by using Goffman's concepts of "normality", "embarrassment", "face-work", "stigma" and "performance". Results: The analysis identified multiple strategies the participants used to produce normality and to avoid embarrassment and stigmatisation at work. These include skilful use of drugs in order not to show withdrawal symptoms, various ways of hiding their heavy substance use, frequent change of jobs, the maintenance of a clean and professional look, and attributing the absence from work to mental or physical illness. Moreover, the participants strategically avoided social contacts in which embarrassing situations could arise. When this was not possible, they manipulated their corporeal looks by hiding such kinds of bodily marks that would connote abnormality. Conclusion: The analysis points out that maintaining normality at work does not only refer to the efforts of trying to hide the effects of the drugs on behaviours and the body. It also reveals that the participants used substances to be able to perform energetically their work tasks, and in this way present themselves as normal workers. This ambivalence in performing normality makes the work life of people who use substances challenging.

Do your troubles today seem further away than yesterday? On sleep's role in mitigating the blushing response to a reactivated embarrassing episode.

The "sleep to forget and sleep to remember hypothesis" proposes that sleep weakens the emotional tone of an experience while preserving or even enhancing its content. Prior experimental research however shows contradictory findings on how emotional reactivity changes after a period of sleep, likely explained by methodological variations. By addressing these inconsistencies, we investigated the mitigating effect of overnight sleep on emotional reactivity triggered by memory reactivation. Using a karaoke paradigm, we recorded participants' singing of two songs, followed by exposing them to one of the recordings (rec1) to induce an embarrassing episode. After a 12-hr period of either day-time wakefulness (N = 20) or including nighttime sleep (N = 20), we assessed emotional reactivity to the previously exposed recording (rec1) and the newly exposed recording (rec2). Emotional reactivity was assessed with a physiological measure of facial blushing as the main outcome and subjective ratings of embarrassment and valence. Sleep and wake were monitored with diaries and actigraphy. The embarrassing episode was successfully induced as indicated by objective and subjective measures. After controlling for an order effect in stimulus presentation, we found a reduction in blushing response to the reactivated recording (rec1) from pre- to post-sleep compared to wakefulness. However, emotional reactivity to the reactivated recording (rec1) and the new recording (rec2) did not differ after sleep and wakefulness. This study shows that facial blushing was reduced following overnight sleep, while subjective ratings were unaffected. Whether the beneficial effect of sleep is due to changes in memory representation or rather emotion regulation remains elusive.

Perceção dos enfermeiros especialistas em enfermagem de reabilitação quanto à referenciação de doentes / Perception of specialist nurses in rehabilitation nursing regarding patient referral

RESUMO: Com o envelhecimento da população há um aumento das situações de dependência, levando a uma maior procura de respostas no âmbito da saúde e de apoios sociais. Cabe aos profissionais de saúde o eficiente comprometimento na articulação e integração de cuidados, adequados às reais necessidades da população, usando os recursos de forma eficaz. OBJETIVO: Conhecer as vivências e o significado atribuído pelos Enfermeiros Especialistas em Enfermagem de Reabilitação de um Agrupamento de Centros de Saúde do Norte de Portugal, relativamente à referenciação de doentes. METODOLOGIA: Trata-se de um estudo qualitativo, com orientação metodológica da análise fenomenológica de Giorgi. Utilizou-se uma pesquisa exploratória descritiva, com recurso a uma entrevista. A amostra é não probabilística intencional, composta por 13 Enfermeiros Especialistas em Enfermagem de Reabilitação que trabalham nas Equipas de Cuidados Continuados Integrados de um Agrupamento de Centros de Saúde do Norte. RESULTADOS: Das falas dos enfermeiros especialistas emergiram quatro temas: Missão; Constrangimentos; Necessidade de Cuidados Especializados e Sugestões de Melhoria. Os Enfermeiros Especialistas em Enfermagem de Reabilitação, demonstram conhecimento da missão da Equipa de Cuidados Continuados Integrados como resposta no âmbito dos cuidados de saúde no seu contexto social. Estes profissionais, não reconhecem a necessidade de cuidados especializados a todos os doentes que são referenciados para a equipa. Na referenciação de doentes, são apontados alguns constrangimentos como: a falta de trabalho em equipa, a falta de informação, as referenciações inadequadas e o potencial de reabilitação. Como sugestões de melhoria, indicam: a revisão dos critérios de referenciação, a multidisciplinaridade das equipas, o aumento do número de vagas em Equipas de Cuidados Continuados Integrados, bem como o estabelecimento de prioridades na admissão dos doentes referenciados, a necessidade de reavaliação enquanto aguardam vaga e por último a formação/informação das equipas. CONCLUSÃO: Com a auscultação da perceção dos enfermeiros especialistas, evidenciou-se a subutilização deste recurso. Emergiu deste estudo a necessidade de implementação de melhorias, esperando assim, obter a superior competência nas referenciações de doentes para as Equipas de Cuidados Continuados Integrados, utilizado os recursos de forma eficiente e eficaz.

SUMMARY: With the aging of the population, there is an increase in situations of dependence, leading to a greater demand for health responses and social support. It is up to health professionals to efficiently compromise in the articulation and integration of care, appropriate to the real needs of the population, using resources effectively. OBJECTIVE: To know the experiences and meaning attributed by the EEER of a Grouping of Health Centers in northern Portugal, regarding the referral of patients. METHODOLOGY: This is a qualitative study, under methodological orientation of Giorgi's phenomenological analysis. Descriptive exploratory research was used, using an interview. The sample is non-probabilistic intentional, composed of 13 Nurses Specialists in Rehabilitation Nursing who work in the Integrated Continuing Care Teams of a Grouping of Northern Health Centers. RESULTS: Four themes emerged from the statements of the specialist nurses: Mission; Constraints; Need for Specialized Care and Improvement Suggestions. The Specialist Nurses in Rehabilitation Nursing demonstrate knowledge of the mission of the Integrated Continuing Care Team as a response in the field of health care in its social context. These professionals do not recognize the need for specialized care for all patients who are referred to the team. In the referral of patients, some constraints are pointed out such as: lack of teamwork, lack of information, inadequate referrals and rehabilitation potential. As suggestions for improvement, they indicate: the review of the reference criteria, the multidisciplinarity of the teams, the increase in the number of vacancies in Integrated Continuing Care Teams, as well as the establishment of priorities in the admission of the referred patients, the need for reassessment while waiting for a vacancy and finally the training/information of the teams. CONCLUSION: With the auscultation of the perception of specialist nurses, the underuse of this resource was evidenced. From this study emerged the need to implement improvements, thus hoping to obtain the superior competence in user referrals for integrated continuous care teams, using resources efficiently and effectively.

Robots do not judge: service robots can alleviate embarrassment in service encounters.

Although robots are increasingly used in service provision, research cautions that consumers are reluctant to accept service robots. Five lab, field, and online studies reveal an important boundary condition to earlier work and demonstrate that consumers perceive robots less negatively when human social presence is the source of discomfort. We show that consumers feel less judged by a robot (vs. a human) when having to engage in an embarrassing service encounter, such as when acquiring medication to treat a sexually transmitted disease or being confronted with one's own mistakes by a frontline employee. As a consequence, consumers prefer being served by a robot instead of a human when having to acquire an embarrassing product, and a robot helps consumers to overcome their reluctance to accept the service provider's offering when the situation becomes embarrassing. However, robot anthropomorphism moderates the effect as consumers ascribe a higher automated social presence to a highly human-like robot (vs. machine-like robot), making consumers feel more socially judged. Supplementary Information: The online version contains supplementary material available at 10.1007/s11747-022-00862-x.

Antipsychotic-Related Stigma and the Impact on Treatment Choices: A Systematic Review and Framework Synthesis.

BACKGROUND: Antipsychotics are a class of medications primarily used to treat individuals with psychotic disorders. They have also been indicated for patients with other psychiatric conditions, such as post-traumatic stress disorder and major depressive disorder. Non-adherence is prominent amongst individuals prescribed antipsychotics, with medication-related self-stigma and social stigma identified as major factors. No previous reviews have focused on stigma associated specifically with antipsychotic medication. This systematic literature review aimed to synthesise evidence on the prevalence of stigmatising attitudes and behaviours related to antipsychotic treatment and understand their impact on antipsychotic treatment initiation and continuation. METHODS: Two independent reviewers screened studies from databases, congress proceedings, ClinicalTrials.gov, and PsychU.org; relevant studies reported quantitative or qualitative data on antipsychotic-related stigma in adults with psychotic disorders, mood disorders, borderline personality disorder or anxiety disorders, or healthcare providers or caregivers of these patients, and any impact on treatment. Framework synthesis facilitated extraction and synthesis of relevant information; quantitative and qualitative data were coded and indexed against a pre-specified thematic framework by two independent reviewers. RESULTS: Forty-five articles reporting on 40 unique studies were included; 22 reported quantitative data, 16 reported qualitative data, and two reported quantitative and qualitative data relating to antipsychotic-related stigma. Framework synthesis identified four themes: 1) impact of antipsychotic treatment on a) social stigma or b) self-stigma; 2) impact of side effects of antipsychotic treatment on a) social stigma or b) self-stigma; 3) impact of route of administration of antipsychotic treatment on stigma; 4) impact of stigma on the use of antipsychotics. CONCLUSION: This systematic literature review found that antipsychotic-related social and self-stigma is a factor in non-adherence to antipsychotics. Further research should examine stigma in a wider range of patients and the extent to which clinicians' treatment decisions are impacted by the potential stigma associated with antipsychotic medications.