Demographic covariates and vocational rehabilitation services as predictors of employment outcomes of people with physical disabilities: a hierarchical logistic regression analysis.

PURPOSE: Stable employment is essential for the health, psychosocial, and financial well-being of people with physical disabilities (PwPD). Unfortunately, the low employment rate for PwPD in the U.S. exposes them to adverse effects of unemployment, including depression, anxiety, low self-esteem, and physical pain. Helping PwPD find gainful employment will improve their general health and well-being. However, few empirical studies examine factors affecting the employment outcomes of PwPD. This study aims to examine the relationship between demographic covariates, vocational rehabilitation (VR) services, and employment outcomes of PwPD. MATERIALS AND METHODS: This secondary data analysis study includes 17,598 PwPD from the U.S. Department of Education's Rehabilitation Services Administration's Case Service Report (RSA-911) dataset. Our analysical approach was hierarchical logistic regression analysis. RESULTS: For VR services, workplace support, technology support, job placement assistance, and VR counseling significantly contribute to predicting employment outcomes for PwPD. Even after entering VR services, the demographic variables (age, race, education, referral sources, low-income, long-term unemployment, and disability significancy) were still significant predictors of employment. CONCLUSIONS: Findings from this study can be used by state VR counselors and other disability service providers to plan and select effective employment-related interventions to improve the employment outcomes of PwPD.

The alarmingly low employment rate among PwPD significantly impacts their psychological, financial, social, and overall health well-being in the U.S.Vocational rehabilitation services, including workplace support, technology assistance, VR counseling, and job placement support, are pivotal in facilitating employment for PwPD.PwPD who received workplace support exhibited nearly six times higher odds of attaining employment compared to those without such assistance.PwPD who received technology support experienced four times higher odds of achieving employment in contrast to those without technology assistance.

Dynamic altruistic cooperation within breast tumors.

BACKGROUND: Social behaviors such as altruism, where one self-sacrifices for collective benefits, critically influence an organism's survival and responses to the environment. Such behaviors are widely exemplified in nature but have been underexplored in cancer cells which are conventionally seen as selfish competitive players. This multidisciplinary study explores altruism and its mechanism in breast cancer cells and its contribution to chemoresistance. METHODS: MicroRNA profiling was performed on circulating tumor cells collected from the blood of treated breast cancer patients. Cancer cell lines ectopically expressing candidate miRNA were used in co-culture experiments and treated with docetaxel. Ecological parameters like relative survival and relative fitness were assessed using flow cytometry. Functional studies and characterization performed in vitro and in vivo include proliferation, iTRAQ-mass spectrometry, RNA sequencing, inhibition by small molecules and antibodies, siRNA knockdown, CRISPR/dCas9 inhibition and fluorescence imaging of promoter reporter-expressing cells. Mathematical modeling based on evolutionary game theory was performed to simulate spatial organization of cancer cells. RESULTS: Opposing cancer processes underlie altruism: an oncogenic process involving secretion of IGFBP2 and CCL28 by the altruists to induce survival benefits in neighboring cells under taxane exposure, and a self-sacrificial tumor suppressive process impeding proliferation of altruists via cell cycle arrest. Both processes are regulated concurrently in the altruists by miR-125b, via differential NF-κB signaling specifically through IKKß. Altruistic cells persist in the tumor despite their self-sacrifice, as they can regenerate epigenetically from non-altruists via a KLF2/PCAF-mediated mechanism. The altruists maintain a sparse spatial organization by inhibiting surrounding cells from adopting the altruistic fate via a lateral inhibition mechanism involving a GAB1-PI3K-AKT-miR-125b signaling circuit. CONCLUSIONS: Our data reveal molecular mechanisms underlying manifestation, persistence and spatial spread of cancer cell altruism. A minor population behave altruistically at a cost to itself producing a collective benefit for the tumor, suggesting tumors to be dynamic social systems governed by the same rules of cooperation in social organisms. Understanding cancer cell altruism may lead to more holistic models of tumor evolution and drug response, as well as therapeutic paradigms that account for social interactions. Cancer cells constitute tractable experimental models for fields beyond oncology, like evolutionary ecology and game theory.

Implementation and assessment of a novel drug interaction tool (TLC-act) in an entry-to-practice doctor of pharmacy program.

BACKGROUND AND PURPOSE: Drug-drug interaction (DDI) assessment is an important role that pharmacists have in practice. Students often struggle with this complex clinical reasoning skill. TLC-Act is a tool that was created to mirror the steps and clinical checkpoints that pharmacists complete when assessing DDIs. Through integration of TLC-Act in the pharmacy curriculum, students will be better prepared for assessing and evaluating DDIs when in practice. EDUCATIONAL ACTIVITY AND SETTING: For the 2021-2022 academic year, an asynchronous educational activity to teach students how to use TLC-Act was created and implemented. Five videos that encompassed multiple facets of TLC-Act including an introduction to the tool and how to use it, an example application of the tool to a patient case, and the clinical utility of using TLC-Act in the hospital and community settings. Students were instructed to view all five videos and then complete a patient case that focused on the DDI between ciprofloxacin and metformin. FINDINGS: A pre- and post-activity survey was disseminated to 640 students across the first three years of the program to gather students' perspectives on the educational activity. Overall, survey response rates were 32% for the pre- and 23% for the post-activity surveys. SUMMARY: The TLC-Act educational activity improved students' skills with managing DDIs.

Subjective well-being of adults with multiple sclerosis during COVID-19: Evaluating stress-appraisal-coping and person-environment factors.

BACKGROUND: People with multiple sclerosis (MS) have been coping with high levels of stress during the ongoing coronavirus pandemic, affecting their employment, physical, and mental health, and overall life satisfaction. OBJECTIVE: This study evaluated constructs of the stress-appraisal-coping theory and positive person-environment factors as predictors of subjective well-being for adults with MS. METHOD: Participants included 477 adults with MS recruited through the National Multiple Sclerosis Society. Hierarchical regression analysis was used to determine the incremental variance in subjective well-being accounted for by demographic covariates, functional disability, perceived stress, stress appraisal, coping styles, and positive person-environment contextual factors. RESULTS: Positive stress appraisal and coping flexibility were significantly associated with subjective well-being at the bivariate correlation level and at the step they were entered into the regression model. Marital status, household income, functional disability, perceived stress, hope, core self-evaluations, and social support were significant predictors in the final model, accounting for 60% of the variance in subjective well-being scores (R² = .60, f² = 1.48; large effect size). CONCLUSIONS: Findings from this study support a stress management and well-being model based on constructs of Lazarus and Folkman's stress-appraisal-coping theory and positive person-environment contextual factors, which can inform the development of theory-driven and empirically supported stress management and well-being interventions for people with MS during the ongoing global health crisis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PHArmacy Students as Educators (PHASE): Implementation and evaluation of an educator's curriculum for pharmacy students.

BACKGROUND AND PURPOSE: Designed to address the Association of Faculties of Pharmacy of Canada's competency "teach pharmacy team members, the public, and other health care professionals," the PHArmacy Students as Educators (PHASE) program was developed by the institute's entry-to-practice doctor of pharmacy program. The program's objective was to support students in developing the necessary skills to fulfill their role as pharmacist-educators. EDUCATIONAL ACTIVITY AND SETTING: We performed a two-year pilot (2017-2019) of the PHASE program which consists of a large-group didactic session followed by an academic half-day (AHD) session. Evaluation was conducted using Likert-scale and qualitative student survey data collected pre- and post-sessions to determine: (1) how the PHASE program supported students as future educators, and (2) students' perceptions and experiences related to teaching and learning. FINDINGS: All students in the 2020 and 2021 graduating cohorts were included in the study following consent. We determined that while respondents agreed to the statement, "A role of a pharmacist includes being an educator" (93.7% and 98.2% for 2020 and 2021 cohorts) at baseline, the proportion of strongly agree responses increased following the didactic session (P < .005). Of note, average Likert-score for respondents' confidence in educating increased following the AHD session (P < .001). Qualitative analysis identified an increase in students' self-rated ability for determining learners' needs, developing and conducting educational sessions, and confidence related to educating others. SUMMARY: Overall, the PHASE program showed positive impact during the first two years of implementation and lessons learned from the pilot are discussed.

Environmental scan of the patient voice in Canadian E2P PharmD programs.

INTRODUCTION: There has been an increasing interest in embedding patients' voices in the education of healthcare professionals. The purpose of this study was to conduct an environmental scan of entry to practice doctor of pharmacy (E2P PharmD) programs in Canada to determine to what extent pharmacy educators in Canada incorporate real patient voices in course delivery. METHODS: A web-based survey was distributed to an estimated total number of 750 pharmacy educators at eight Canadian English-speaking E2P PharmD programs. Respondents answered questions related to their experience incorporating patients' voices into their teaching, the value of patients' voices, and their perceived barriers. Aggregate data were analyzed using descriptive statistics. RESULTS: Fifty-three pharmacy educators (7%) responded. Most respondents (93%) agreed that patients' voices are indispensable in pharmacy education, while only 32% reported that they had involved real patient voices in their courses in the past three years. Patient speech or presentation was reported as the most used method to involve real patient voices in their courses (39%), followed by question-and-answer sessions (17%). The top barriers perceived by pharmacy educators for involving real patients were insufficient teaching time (33%) and difficulty in recruiting patients (27%). CONCLUSIONS: Patients' voices were used by one-third of the E2P PharmD educators who participated, though over 90% recognized its value. Where deployed, patients were invited to speak on a variety of topics relevant to their personal experiences. More research is needed to determine what benefits can result from patient voices and how to improve its sustainability.

Sleep problems in children with autism spectrum disorder in Hong Kong: a cross-sectional study.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a growing prevalence of sleep problems associated with significant behavioral problems and more severe autism clinical presentation. Little is known about the relationships between autism traits and sleep problems in Hong Kong. Therefore, this study aimed to examine whether children with autism have increased sleep problems than non-autistic children in Hong Kong. The secondary objective was to examine the factors associated with sleep problems in an autism clinical sample. Methods: This cross-sectional study recruited 135 children with autism and 102 with the same age range of non-autistic children, aged between 6 and 12 years. Both groups were screened and compared on their sleep behaviors using the Children's Sleep Habits Questionnaire (CSHQ). Results: Children with autism had significantly more sleep problems than non-autistic children [t (226.73) = 6.20, p < 0.001]. Bed -sharing [beta = 0.25, t (165) = 2.75, p = 0.07] and maternal age at birth [beta = 0.15, t (165) = 2.05, p = 0.043] were significant factors associated with CSHQ score on the top of autism traits. Stepwise linear regression modeling identified that only separation anxiety disorder (beta = 4.83, t = 2.40, p = 0.019) best-predicted CSHQ. Conclusion: In summary, autistic children suffered from significantly more sleep problems and co-occurring separation anxiety disorder brings greater sleep problems as compared to non-autistic children. Clinicians should be more aware of sleep problems to provide more effective treatments to children with autism.

Positive Organizational Psychology Factors as Serial Multiple Mediators of the Relationship between Organization Support and Job Satisfaction Among Peer Support Specialists.

BACKGROUND: Research has demonstrated the effectiveness of peer support specialists in helping people with severe mental illness increase community tenure, decrease hospitalization, boost treatment satisfaction, improve social functioning, and increase quality of life. OBJECTIVE: The purpose of the present study was to evaluate positive organizational psychology constructs as serial multiple mediators of the relationships between perceived organizational support and job satisfaction among peer support specialists. METHODS: One hundred and twenty-one peer support specialists from the Texas statewide peer certification training programs and the National Association of Peer Supporters participated in the present study. These peer support specialists completed an online survey composed of self-report measures related to perceived organizational support, positive organizational psychology factors, and job satisfaction. A serial multiple mediation (SMMA) analysis was conducted to evaluate autonomous motivation to work, work engagement, and organizational commitment as mediators of the relationship between perceived organizational support and job satisfaction. RESULTS: The SMMA model accounted for 49% of the variation in job satisfaction scores (R2 =. 49, f2 = 0.96 [> 0.35], a large effect size). Autonomous motivation to work, work engagement, and organizational commitment were significantly associated with job satisfaction after controlling for the effect of perceived organizational support. CONCLUSIONS: Perceived organizational support increased autonomous motivation to work, work engagement, organizational commitment, and job satisfaction. Peer support specialists are integral members of the interdisciplinary mental health treatment team. Leaders of community-based mental health and rehabilitation agencies who are committed to hire and retain peer support specialists must provide strong organizational support and develop interventions to increase peer support specialists' autonomous motivation to work, work engagement, and organizational commitment as a job retention and career development strategy.

Demographic Covariates, Vocational Rehabilitation Services, and Employment Outcomes of Working-Age Adults with Anxiety Disorders: A Multivariate Logistic Regression Analysis.

PURPOSE: This study aimed to investigate the relationships between demographic covariates, vocational rehabilitation (VR) services, and employment outcomes of individuals with anxiety disorders. The specific research question for the current study investigate demographic variables and vocational rehabilitation services as predictors of competitive employment outcomes. METHODS: Data for the present study were extracted from the most recent United States Rehabilitation Service Administration 2018 Case Service Report (RSA-911) data. A purposeful selection, multivariate logistic regression analysis was conducted to examine the case service report data of 9266 individuals with anxiety disorders who received vocational rehabilitation services based on their demographic variables and receipt of VR services. RESULTS: The results indicated that African Americans and Latinx, people who have completed high school or more, people who do not receive disability-related benefits, and those who received more vocational rehabilitation services were more likely to be gainfully employed. In addition, receipt of financial support for life crises and occupational credentials (i.e., other services and maintenance services) and vocational rehabilitation counseling and guidance services were significant predictors of employment outcomes. Conversely, receipt of supported employment and transition services were negatively associated with employment outcome. CONCLUSIONS: In the present study, we identified VR services that can improve and risk factors that can impede employment outcomes of people with anxiety disorders. We also identified medical, psychosocial, and vocational interventions that can lessen the effect of anxiety disorders on physical and mental health functioning.

A gene expression-based model predicts outcome in children with intermediate-risk classical Hodgkin lymphoma.

Classical Hodgkin lymphoma (cHL) is a common malignancy in children and adolescents. Although cHL is highly curable, treatment with chemotherapy and radiation often come at the cost of long-term toxicity and morbidity. Effective risk-stratification tools are needed to tailor therapy. Here, we used gene expression profiling (GEP) to investigate tumor microenvironment (TME) biology, to determine molecular correlates of treatment failure, and to develop an outcome model prognostic for pediatric cHL. A total of 246 formalin-fixed, paraffin-embedded tissue biopsies from patients enrolled in the Children's Oncology Group trial AHOD0031 were used for GEP and compared with adult cHL data. Eosinophil, B-cell, and mast cell signatures were enriched in children, whereas macrophage and stromal signatures were more prominent in adults. Concordantly, a previously published model for overall survival prediction in adult cHL did not validate in pediatric cHL. Therefore, we developed a 9-cellular component model reflecting TME composition to predict event-free survival (EFS). In an independent validation cohort, we observed a significant difference in weighted 5-year EFS between high-risk and low-risk groups (75.2% vs 90.3%; log-rank P = .0138) independent of interim response, stage, fever, and albumin. We demonstrate unique disease biology in children and adolescents that can be harnessed for risk-stratification at diagnosis. This trial was registered at www.clinicaltrials.gov as #NCT00025259.

Checkpoint protein expression in the tumor microenvironment defines the outcome of classical Hodgkin lymphoma patients.

Emerging evidence indicates a major impact for the tumor microenvironment (TME) and immune escape in the pathogenesis and clinical course of classical Hodgkin lymphoma (cHL). We used gene expression profiling (n = 88), CIBERSORT, and multiplex immunohistochemistry (n = 131) to characterize the immunoprofile of cHL TME and correlated the findings with survival. Gene expression analysis divided tumors into subgroups with T cell-inflamed and -noninflamed TME. Several macrophage-related genes were upregulated in samples with the non-T cell-inflamed TME, and based on the immune cell proportions, the samples clustered according to the content of T cells and macrophages. A cluster with high proportions of checkpoint protein (programmed cell death protein 1, PD-1 ligands, indoleamine 2,3 dioxygenase 1, lymphocyte-activation gene 3, and T-cell immunoglobulin and mucin domain containing protein 3) positive immune cells translated to unfavorable overall survival (OS) (5-year OS 76% vs 96%; P = .010) and remained an independent prognostic factor for OS in multivariable analysis (HR, 4.34; 95% CI, 1.05-17.91; P = .043). cHL samples with high proportions of checkpoint proteins overexpressed genes coding for cytolytic factors, proposing paradoxically that they were immunologically active. This checkpoint molecule gene signature translated to inferior survival in a validation cohort of 290 diagnostic cHL samples (P < .001) and in an expansion cohort of 84 cHL relapse samples (P = .048). Our findings demonstrate the impact of T cell- and macrophage-mediated checkpoint system on the survival of patients with cHL.

Pharmacy Students' Experiences of Self-regulated Learning through Simulated Virtual Patients.

Objective: Virtual patient (VP) cases are a valuable learning tool for students, used to apply classroom knowledge and develop clinical skills. It is unknown whether exposure to multiple VP cases helps students develop self-regulated learning (SRL). We sought to learn more about how students engaged in SRL as they made goals for approaching patient care during repeated exposure to cases. Methods: Second-year students (N=211) were invited to participate in an online survey. Students were surveyed before and/or after completing three VP cases. Each survey consisted of two open-ended questions. Prior to each case, students were asked "How will you change the sequence of your approach to completing the VP assessment today, if at all?" and after each case, "What more do you have to learn in order to approach similar real-life patient assessments?" A thematic analysis was conducted on open-ended survey responses. Results: One hundred and seventy pre-case and 242 post-case responses were received. The most common themes identified in pre-case surveys were a need for a more systematic approach and specific strategies for executing the patient care process. Some students had no plans for approaching VP cases. The most common themes identified in post-case surveys were knowledge gaps of medical conditions, therapeutics, and lab tests. Conclusion: VPs provided students the opportunity to self-identify gaps in knowledge and plan to strengthen their clinical reasoning skills. More research is needed to understand the relationship between VP cases, instructional guidance for supporting SRL and the realities of the intended benefits to students' learning and practice.

Development and validation of the social motivation scale in people with disabilities.

OBJECTIVE: Social effectiveness is key to success in the labor market. For decades, social motivation has been empirically studied as both a presumed cause and consequence of social effectiveness. Yet, few direct measures of social motivation exist, and even fewer have been validated with a disability population. This study provides the measurement structure and psychometric properties of a newly created measure of social motivation tested with a general disability population. RESEARCH DESIGN: Participants included 1,013 US adults with disabilities. Exploratory factor analysis (EFA) and Confirmatory Factor Analysis (CFA) were implemented to validate the measure. RESULTS: Results of the EFA suggest that a reduced 26-item inventory exhibits a 5-factor structure in a general population of people with disabilities. These results were confirmed with the CFA. Concurrent validity analysis revealed that most factors were significantly associated with relevant psychosocial variables in the expected directions. CONCLUSIONS: The Social Motivation Inventory provides a useful tool for enhancing understanding of social motivation in rehabilitation psychology and rehabilitation counseling research and practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychometric validation of the Job Satisfaction of Persons with Disabilities Scale in a sample of peer support specialists.

OBJECTIVE: The primary purpose of the study was to evaluate the psychometric properties of the Job Satisfaction of Persons with Disabilities Scale in a sample of peer support specialists. METHOD: A total of 121 employed peer support specialists with lived experience of a serious mental health condition were recruited for this study from statewide peer certification training programs and the International Association of Peer Supporters. Respondents completed an online survey on job satisfaction and related constructs. A principal components analysis was used to explore and identify the instrument subscales. RESULTS: The findings identified 2 factors: (a) the 9-item job satisfaction with intangible benefits factor and (b) the 5-item job satisfaction with tangible benefits factor. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The Job Satisfaction of Persons with Disabilities Scale demonstrates good-to-excellent psychometrics. The use of this scale among peer support specialists within training and supervision practices in psychiatric rehabilitation settings is warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Company Characteristics, Disability Inclusion Practices, and Employment of People with Disabilities in the Post COVID-19 Job Economy: A Cross Sectional Survey Study.

Purpose In the post coronavirus disease 2019 (COVID-19) recession economy, rehabilitation counselors, transition specialists, and other disability service providers must redouble their efforts to connect with employers to create employment opportunities for people with physical and mental impairments. The purpose of the present study was to investigate company characteristics and effective disability inclusion practices that are related to employment of people with disabilities. Methods Four hundred sixty-six employers completed a demographic questionnaire and the Disability Inclusion Profiler. Results Results indicated company characteristics and disability practices were positively related to employment of people with disabilities. Conclusions Findings of the present study can be used by transition specialists, rehabilitation counselors, and other disability service providers to engage and connect with employers to increase employment opportunity for people with disabilities in the post COVID-19 economy. Future research and practice implications are provided.

Personal, health and function, and career maintenance factors as determinants of quality of life among employed people with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is an intrusive disease that significantly affects labor force participation. OBJECTIVE: This study examined the extent to which factors at the personal, health and function, and environmental/career maintenance levels contribute to the predictability power for quality of life among employed people with MS. METHOD: Participants consisted of 523 members of nine National Multiple Sclerosis Society chapters representing 21 states and Washington, DC. These individuals were employed at the time of the survey, and they were primarily middle age (average age of 48 years) and Caucasian (74%). RESULTS: The final hierarchical multiple regression model explained 54 percent of the variability in participants' quality of life scores, although none of the hypothesized personal/demographic predictors were significant. Participants who perceived better overall health and lower levels of stress, who experienced less severe cognitive and mobility-related MS symptoms, and who expressed stronger job-person matches and higher levels of job satisfaction reported higher quality of life scores than did other participants. CONCLUSIONS: The findings underscore the complexity involved in predicting perceived quality of life among employed people with MS. Implications of these findings for future research and clinical practice are discussed.

Validation of the RHL30 digital gene expression assay as a prognostic biomarker for relapsed Hodgkin lymphoma.

Despite continuing improvements in the management of classical Hodgkin lymphoma (cHL), relapse remains associated with a risk of lymphoma-related mortality. The biological composition of relapse tumour biopsies shows interpatient variability, which can be leveraged to design prognostic biomarkers. Here, we validated the RHL30 assay, a previously reported gene expression model in an independent cohort of 41 patients with relapsed cHL. Patients classified as high-risk by the RHL30 assay had inferior failure-free survival (FFS) after autologous stem cell transplantation (2-year FFS 41% vs. 92%, P = 0·035). The RHL30 model is a robust biomarker that risk-stratifies patients considered for autologous stem cell transplantation.

Psychiatric Symptoms, Psychosocial Factors, and Life Satisfaction Among Persons With Serious Mental Illness: A Path Analysis.

This study explores the effects of biopsychosocial factors on life satisfaction among persons with serious mental illness. Participants in this study included a convenience sample of 194 adults recruited from Texas and Wisconsin. A path analysis was conducted with psychiatric symptoms as an exogenous variable, and illness insight, social self-efficacy, social support, community integration, and life satisfaction as endogenous variables. Beginning with a hypothesized model, a best model was obtained after removing the paths that were not significant and adding recommended paths supported by theory. In the final model, psychiatric symptoms, social self-efficacy, social support, and community integration were directly associated with life satisfaction. Illness insight did not directly affect life satisfaction but had indirect effects. Psychiatric symptoms may be the most important and direct predictor of life satisfaction; illness insight, social self-efficacy, social support, and community integration buffer the direct of effect of psychiatric symptoms on life satisfaction.

A factor analytic evaluation of the Self-Stigma Scale-Short (SSS-S) among psychosocial clubhouse members in the United States.

The main purpose of this study was to examine the factor structure, the internal consistency, and other aspects of validity of the English version of the Self-Stigma Scale-Short (SSS-S). In the present study, the SSS-S was assessed in a sample of 194 adults with psychiatric disabilities from four Psychosocial Clubhouses in the Southern and Midwestern United States. Exploratory factor analysis (EFA; n = 98) supported a one-factor structure of the SSS-S, which accounted for 59% of the variance. Confirmatory factor analysis (CFA; n = 96) demonstrated that the factor structure of the SSS-S was satisfactory. The scale was also reliable, with a Cronbach's alpha of 0.93 and 0.91 for the EFA and CFA samples, respectively. The SSS-S showed adequate convergent and criterion-related validity, as indicated by statistically significant positive correlations between internalized stigma with perceived societal stigma, symptom severity, and functional impairment, as well as negative correlations between internalized stigma with perceived social self-efficacy, social support, and resiliency. Overall, these findings support the English version of the SSS-S as a valid and reliable tool for determining the internalized stigma of adults with psychiatric disabilities in clinical settings and similar research.