Recovery and trauma among urban African Americans with serious mental illness.

OBJECTIVE: Traumatic experiences are prevalent among people with serious mental illness and can significantly worsen outcomes. This study aimed to identify an urban cluster of trauma types, compare continuous distress ratings versus categorical experience of trauma for predicting outcomes such as depression and quality of life, and investigate the mediating role of recovery orientation in the impact of trauma exposure on outcomes. METHOD: Data came from an intervention study on African Americans with serious mental illness living in a large urban area; 212 participants completed baseline self-report measures of past trauma experiences, related distress levels, recovery, depression, and quality of life. Data were assessed using correlations and regressive path modeling. RESULTS: Overall, 56.6% of participants reported experiences with trauma. Analyses suggested an urban cluster of trauma types that was self-reported by over 25% of participants. Distress due to trauma strongly correlated with greater depression as well as reduced quality of life and recovery. Interestingly, the categorical presence of trauma history (yes/no) had no significant relationship with any outcomes. Path analyses revealed that recovery mediated the impact of trauma distress on depression and quality of life, specifically implicating the recovery subfactor of hope. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Results suggested that cognitive reframing focused on positive appraisals of overall recovery, and the hope subfactor can have a positive influence on trauma outcomes. The study supported the role of recovery in posttraumatic growth and suggests that hope can be used to help patients process trauma healthily. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A systematic review of community-based participatory research studies involving individuals with mental illness.

OBJECTIVE: This systematic review examined community-based participatory research (CBPR) studies in which people with mental illness (PWMI) directly contributed to research projects. The purpose was to describe study characteristics, team structure and logistics, and level of involvement of in the research process. METHOD: We searched the PsycINFO database from January 2000 to July 2020, identifying 1,395 records and analyzing the 31 that met inclusion criteria. Articles were eligible if they were (a) published in English in a peer-reviewed journal; (b) explicitly stated that at least one adult with mental illness assisted with the study as a CBPR team member; and (c) included a research outcome. RESULTS: Most studies collected qualitative data. Project length, team composition, and frequency of meetings were not specified in about one third of the articles. Twenty-nine studies reported involvement of people with mental illness in research activities such as recruitment, data collection, transcription, and analysis. Nearly half did not specify if they received any training. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Individuals with mental illness were heavily involved in planning and conducting research, demonstrating the feasibility of meaningful involvement. Future research should consider how people with lived experience can assist with quantitative methods, and articles should clearly and explicitly describe characteristics of the partnership (e.g., team composition, frequency of meetings, compensation). The protocol is published in Open Science registry at https://osf.io/mshfb. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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

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

How do Americans perceive the stigma of leprosy?

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

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

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

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

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

Strengths and challenges of peer coaches for supported education in colleges and universities.

OBJECTIVE: Peer coaches are an important element in supported education programs. Peers are students with lived experience in recovery. As coaches, they provide on-campus support to assist students with psychiatric disabilities. METHOD: A community-based participatory research (CBPR) team interviewed 44 participants including students with psychiatric disabilities, faculty, and staff about their perceptions of peer coaches. Thematic analysis was used to analyze interview transcripts. RESULTS: Possible strengths included helping navigate services, addressing sense of being alone, and managing school demands. Challenges included finding suited peers, addressing burnout, providing training and supervision, and matching coaches with students. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A list of ingredients for peer coaches within a supported education program was generated. Future research should determine the modifier of these key ingredients. Our findings informed the development of a peer coaching program which is now going through feasibility, fidelity, and impact evaluation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

How does familiarity impact the stigma of mental illness?

This paper reviews studies on familiarity of mental illness to determine the relationships that familiarity has with public stigma. We propose a U-shaped relationship between familiarity and stigma that includes the expected inverse distribution (greater familiarity leads to less public stigma) and a provocative, positive relationship (familiarity in some groups leads to worse public stigma). Note that despite many studies in this arena, the U-shaped curve is not definitively supported by existing research. We believe its value, however, lies as a heuristic for hypotheses development to better understand the relationship between familiarity and public stigma. After reviewing research, we focus on two roles that comprise the surprising positive relationship: nuclear family members and mental health service providers like clinical psychologists. We then review research that suggests burden and associative stigma might account for the positive relationship between these groups and stigma. We end by using these findings to propose directions for future research, including on the development and evaluation of anti-stigma approaches.

Perspectives on diet and physical activity among urban African Americans with serious mental illness.

African Americans are burdened by high rates of obesity that contribute to chronic disease and early mortality. To tailor a weight loss intervention to meet the needs of African Americans with serious mental illness, a community-based participatory research (CBPR) team comprised primarily of African Americans with serious mental illness guided qualitative research to understand factors that affect weight and interventions that may diminish obesity. Data from five focus groups (n = 55) were analyzed to better understand this group's needs. Participants voiced individual, social, and structural barriers to maintaining and achieving a healthy weight and provided perspectives on potential solutions.

Self-stigma and the mediating impact of the "why try" effect on depression.

The "why try" effect, a consequence of self-stigma, is a sense of behavioral futility that may worsen depression. This study examines the regressive model of self-stigma, the factor structure of a why try measure, and the pathway through which self-stigma leads to depression. Data from 291 people self-identifying with mental illness were collected through an online survey. Participants completed the Why Try Stigma Scale (WTSS) and measures of self-stigma and depression. Structural equation modeling was used to test the WTSS factor structure and path models. Reducing the WTSS from 12 to 6 items led to good fit. The regressive model of self-stigma was validated. A good fit was demonstrated for a model in which harm leads to unworthiness, then incapability, and then depression. The regressive model worsens sense of worthiness, which in turn affects personal capability, resulting in increased depression.

Comparing Chinese and European American mental health decision making.

BACKGROUND: Shared decision making (SDM) tends to reflect more Western values of individualism and empowerment, values that may be foreign to East Asian healthcare preferences for collectivism and family involvement: family centered decision making (FCDM). AIMS: To show that Chinese will be more likely to believe FCDM would be more pleasing for them if they were the patient. Conversely, European Americans will respond more favorably to SDM. To examine effects of Western acculturation on FCDM compared to SDM. METHOD: In this study, preferences for FCDM versus SDM and doctor-led decision making (DrDM) were examined in a vignette study completed online by European Americans (n = 298) and Chinese (n = 327). Research participants read a vignette about Lily (a depression patient) presenting with symptoms of depression. After reading the vignette, participants completed items representing two sets of outcomes: three perceptions of impact on Lily and how participants might respond for themselves in a similar decision making situation. RESULTS: Chinese rated FCDM greater than European and Chinese Americans. Chinese Americans mostly responded similar to European Americans and not Chinese. CONCLUSION: European Americans prefer SDM more for mental health services. Chinese value FCDM more than European Americans. Preferences of Chinese living in America seem to parallel European Americans.

Stigma and the public health agenda for the opioid crisis in America.

The current opioid crisis in the U.S. is unprecedented and calling for a nationwide reorganization of the public health prevention program. Stigma is a persistent barrier to this agenda, unfortunately with a limited body of research on substance use disorder (SUD) available to inform it. We review the broader research literature on the stigma of behavioral health (i.e., mental illness and SUD) to identify strategies to address the opioid crisis and harmful stigma. A major difference between mental illness and SUD stigma is that the latter is legally and socially sanctioned. In making sense of the behavioral strategies for stigma change, we consider three agendas for stigma prevention (prevention, rights, and self-worth). We suggest that incorporating the rights and the self-worth agendas with an in vivo focused contact model, might be most effective for an integrative strategy aimed at targeting opioid stigma. Involving people in recovery as key drivers of this agenda and evaluating the detrimental impact of using stigma as a health tool (social sanction), will bring new horizons to solving this deadly epidemic.

Changing public stigma with continuum beliefs.

BACKGROUND: Given the egregious effect of public stigma on the lives of people with mental illness, researchers have sought to unpack and identify effective components of anti-stigma programs. AIM: We expect to show that continuum messages have more positive effect on stigma and affirming attitudes (beliefs that people with mental illness recover and should be personally empowered) than categorical perspectives. The effect of continuum beliefs will interact with contact strategies. METHOD: A total of 598 research participants were randomly assigned to online presentations representing one of the six conditions: three messages (continuum, categorical, or neutral control) by two processes (education or contact). Participants completed measures of continuum beliefs (as a manipulation check), stigma and affirming attitudes after viewing the condition. RESULTS: Continuum messages had significantly better effect on views that people with mental illness are "different," a finding that interacted with contact. Continuum messages also had better effects on recovery beliefs, once again an effect that interacted significantly with contact. CONCLUSIONS: Implications of these findings for improving anti-stigma programs are discussed.

The Stigma of Personality Disorders.

This article reviews the recent literature on the stigma of personality disorders, including an overview of general mental illness stigma and an examination of the personality-specific stigma. Overall, public knowledge of personality disorders is low, and people with personality disorders may be perceived as purposefully misbehaving rather than experiencing an illness. Health provider stigma seems particularly pernicious for those with borderline personality disorder. Most stigma research on personality disorders has been completed outside the USA, and few stigma-change interventions specific to personality disorder have been scientifically tested. Limited evidence suggests that health provider training can improve stigmatizing attitudes and that interventions combining positive messages of recovery potential with biological etiology will be most impactful to reduce stigma. Anti-stigma interventions designed specifically for health providers, family members, criminal justice personnel, and law enforcement seem particularly beneficial, given these sources of stigma.