Discrimination and social identity processes predict impairment and dysfunction among heavy drinkers.

BACKGROUND: Previous research has linked discrimination to poorer health. Yet health risk behaviours such as heavy alcohol consumption are often targeted with stigmatising public health campaigns. The current study sought to establish the link between experiencing discrimination and health outcomes among heavy drinkers, with a focus on exploring the multiple social identity processes that might underpin this relationship. METHODS: A survey was conducted with 282 people who self-reported consuming alcohol above recommended guidelines. We measured discrimination experienced as a drinker, components of social identification as a drinker (centrality, satisfaction, solidarity, homogeneity, and self-stereotyping), and two health outcomes: psychological distress and severity of alcohol use disorder symptomatology. RESULTS: Discrimination was a moderate-large predictor of psychological distress and alcohol use disorder symptoms. Three social identity constructs were implicated in the link between discrimination and ill-health: identity centrality and homogeneity positively mediated this relationship while identity satisfaction was a negative mediator. The model explained a large proportion of the variance (39-47%) in health outcomes. DISCUSSION: Results are interpreted with an emphasis on the need to avoid stigmatising messaging and to prioritise social identity processes to prevent and treat substance use disorders. We further highlight the need for social identity researchers to consider the multidimensional nature of social identities, especially in the context of stigmatised groups.

The reciprocal relationship between social identity and adherence to group norms.

Previous research has focused on how social identification influences people's adherence to group norms, but has rarely considered how norm adherence might in turn influence how strongly people identify with the group. We proposed a reciprocal relationship between social identification and norm adherence that is shaped by the salience of the social identity in question. Drawing on data from a longitudinal field study of young people attending a mass gathering (N = 661, 1239 unique observations), we used cross-lagged panel modelling across five timepoints to test the reciprocal relationship between social identification with friends and anticipated adherence to perceived drinking norms among friends before (T0), during (T1-T3), and after (T4) the event. Greater social identification at T1 significantly predicted greater norm adherence at T2 which, in turn, predicted greater social identification at T3. These bidirectional effects were only significant during the mass gathering event, when the referent social identity was salient and thus relevant and meaningful in the social context. Findings indicate a complex interplay between social identity and norm adherence that is context dependent and evolves over time. Not only does social identity promote norm adherence but also adherence to those same norms can reinforce a sense of connection to the group.

How conceptualizing obesity as a disease affects beliefs about weight, and associated weight stigma and clinical decision-making in health care.

OBJECTIVES: This study empirically investigated how conceptualizing obesity as a disease (i.e., pathologizing obesity) affects beliefs about weight, and weight stigma and discrimination among health professionals. DESIGN: An experiment that manipulated the pathologization of obesity was completed by a multi-nation sample of health professionals from Australia, UK, and USA (N = 365). METHODS: Participants were randomly assigned to one of two conditions where they were asked to conceptualize obesity as a disease or not a disease; then presented with a hypothetical medical profile of a patient with obesity who was seeking care for migraines. We measured biogenetic causal beliefs about obesity, endorsement of weight as a heuristic for health, negative obesity stereotypes, and treatment decisions. RESULTS: Participants in the disease (vs. non-disease) condition endorsed biogenetic causal beliefs more strongly and made more migraine-related treatment recommendations. No effect of the manipulation was found for the remaining outcomes. Biogenetic causal beliefs about obesity were associated with less weight stigma. Endorsing weight as a heuristic for health was associated with greater weight stigma and differential treatment recommendations focused more on the patient's weight and less on their migraines. CONCLUSIONS: Pathologizing obesity may reinforce biogenetic explanations for obesity. Evidence demonstrates complex associations between weight-related beliefs and weight stigma and discrimination. Biogenetic causal beliefs were associated with less weight stigma, while endorsing weight as a heuristic for health was associated with greater weight stigma and differential treatment. Further research is needed to inform policies that can promote health without perpetuating weight-based rejection in health care.

A community-led intervention to build neighbourhood identification predicts better wellbeing following prolonged COVID-19 lockdowns.

Introduction: A growing body of research supports the importance of social cohesion for population wellbeing. However, the majority of this research has been correlational, and rarely have interventions been evaluated. Method: We conducted a two-timepoint study investigating the role of Neighbour Day, a grass-roots, community-led intervention that seeks to build social cohesion across the population. Among a sample of 843, 125 were Neighbour Day participants while the remainder were not. Results: We found that, compared to non-participants, Neighbour Day participants had significantly higher neighbourhood identification, experienced greater social cohesion, and had larger neighbourhood social networks. Between timepoints, the majority of the sample experienced prolonged lockdowns to prevent COVID-19 transmission, and so unsurprisingly, wellbeing declined and psychological distress increased. However, Neighbour Day participants were protected against these negative mental health effects of lockdown. These benefits of Neighbour Day participation were mediated via neighbourhood identification. Discussion: Overall, the findings speak to the promise of large-scale interventions to build social identity, particularly due to their capacity to build resilience and protect people's wellbeing during times of collective change or crisis.

Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health.

Groups 4 Health (G4H) is a group psychotherapy program that targets social group disconnection. An emerging evidence base supports its efficacy in reducing loneliness, depression, and social anxiety. However, to date there has been no formal analysis of its acceptability to clients and therapists, nor an investigation of its feasibility for wider implementation. This input from end users is crucial to ensure the program's wider suitability and to contribute to its improvement. This study drew data from three clinical trials, including 266 G4H clients and 68 G4H therapists. From the Phase III trial only, additional data were available from 90 clients in a dose-controlled cognitive-behavioral therapy (CBT) comparison group, and focus groups/interviews with 6 therapists and 13 clients. Client satisfaction was high, with all average ratings >7/10, significantly exceeding the CBT comparison group. Therapist satisfaction with each module was >5/7. Retention was >80%. Homework completion was high, with <10% of clients saying that they had not attempted the homework. Therapists and clients both emphasized the benefits arising from G4H, and the contribution of the group context itself as a vehicle to achieve positive outcomes.

COVID-safe behaviour before, during and after a youth mass gathering event: a longitudinal cohort study.

OBJECTIVE: As mass gathering events resume in the wake of the COVID-19 pandemic, there is a pressing need to understand (a) engagement in COVID-safe behaviour at these events and (b) how attending a mass gathering impacts subsequent behaviours. This study examined anticipated COVID-safe behaviour before, during, and after a youth mass gathering event. DESIGN: Longitudinal cohort study. SETTING: Self-report data were collected online at five timepoints from secondary-school graduates participating in celebrations linked to an annual week-long youth mass gathering event in Australia. PARTICIPANTS: Australian secondary-school graduates completed surveys before the event (N=397), on days 1 (N=183), 3 (N=158) and 5 (N=163) of the event, and 3 weeks after the event (N=140). Of those who completed the first survey, 72 indicated they would attend a primary mass gathering site where the largest mass gathering of graduates in Australia occurs in a typical (non-pandemic) year; 325 indicated they would be celebrating at other locations (ie, secondary sites). PRIMARY OUTCOME MEASURES: Anticipated COVID-safe behaviour: physical distancing from friends and strangers and additional protective behaviours (hand hygiene and mask wearing). RESULTS: At all timepoints, participants anticipated maintaining appropriate (>1.5 m) physical distance from strangers, but not from friends (<0.5 m). Attendees at the primary site reported less physical distancing from friends over time throughout the mass gathering, χ2(4)=16.89, p=0.002. Physical distancing from strangers, χ2(4)=26.93, p<0.001, and additional protective behaviours, χ2(4)=221.23, p<0.001, also declined across the mass gathering among both groups. These reductions in COVID-safe behaviour were significant and enduring, with all declines persisting at follow-up. CONCLUSION: It is critical that public health messaging and interventions emphasise the risks of disease transmission arising from other attendees who are known to us during mass gathering events, and that such messaging is sustained during and following the event to combat reductions in COVID-safe behaviour.

Perceived legitimacy of weight-based discrimination: Consequences for group identity, collective action, body satisfaction, and self-esteem.

The present research applied the social identity approach to examine how the perceived legitimacy of weight-based discrimination among ingroup members influences their experience of their higher-weight identity and their well-being, and the conditions under which this occurs. Specifically, we investigated whether portraying weight-based discrimination as legitimate, as opposed to illegitimate, influenced higher-weight individuals' group identification, intentions to engage in collective action on behalf of their group, and their body satisfaction and self-esteem. The moderating role of group boundary permeability and the mediating role of group identification were also examined. North American adults with a self-reported BMI of or above 30 (N = 327) were randomly assigned to one of two experimental conditions: weight-based discrimination that was portrayed as legitimate or illegitimate by other ingroup members. Results revealed that portraying weight-based discrimination as being perceived as legitimate (versus illegitimate) among ingroup members significantly reduced group identification, but only among those who perceived their group's boundaries to be more permeable. For this particular group, reduced identification predicted, in turn, lower collective action intentions, body satisfaction, and self-esteem. This study highlights the damaging effect of legitimized discrimination for ingroup identification and the downstream consequences for collective action and well-being.

Groups 4 Health versus cognitive-behavioural therapy for depression and loneliness in young people: randomised phase 3 non-inferiority trial with 12-month follow-up.

BACKGROUND: Depression treatments are typically less effective for young people than for adults. However, treatments rarely target loneliness, which is a key risk factor in the onset, maintenance and development of depression. AIMS: This study evaluated the efficacy of a novel loneliness intervention, Groups 4 Health (G4H), relative to the best-practice treatment of cognitive-behavioural therapy (CBT) in reducing loneliness and depression over a 12-month period (Australian New Zealand Clinical Trial Registry: ACTRN12618000440224). METHOD: The study was a phase 3 randomised non-inferiority trial comparing G4H with dose-controlled group CBT. Participants were 174 people aged 15-25 years experiencing loneliness and clinically significant symptoms of depression, who were not in receipt of adjunct treatment. Participants were recruited from mental health services in Southeast Queensland, Australia. Randomisation was conducted using computer software. Follow-up assessments and statistical analyses were masked to allocation. Both interventions consisted of five 75 min group-based psychotherapy sessions. The primary outcomes were depression and loneliness, with a non-inferiority margin of 2.20 for depression. RESULTS: The trial enrolled 174 participants between 24 April 2018 and 25 May 2019, with 84 in the G4H condition and 90 in the CBT condition. All randomised participants were included in the intention-to-treat analyses (n = 174). The pre-post effect sizes for depression were dG4H = -0.71 and dCBT = -0.91. For loneliness, they were dG4H = -1.07 and dCBT = -0.89. At 12-month follow-up, the absolute difference between groups on depression was 1.176 (95% CI -1.94 to 4.29) and on loneliness it was -0.679 (95% CI -1.43 to 0.07). No adverse effects were observed. CONCLUSIONS: G4H was non-inferior to CBT for depression and showed a slight advantage over CBT for loneliness that emerged after treatment completion.

Non-stigmatising alternatives to anti-obesity public health messages: Consequences for health behaviour and well-being.

This project investigated how alternative non-stigmatising public health messages influence people's health behaviours and well-being, relative to traditional stigmatising weight-loss messages. We conducted three experimental studies (total N = 1281) that compared traditional weight-loss messages to weight-neutral messages (Study 1), weight-inclusive messages (Study 2) and size acceptance messages (Study 3). Results revealed that public health messages have differential effects on health behaviours and well-being, depending on the audience's BMI or perceived weight. However, campaigns that challenge weight stigma and promote body positivity have positive effects on some psychological indicators of health and well-being for people of all body sizes.

Groups 4 Health protects against unanticipated threats to mental health: Evaluating two interventions during COVID-19 lockdown among young people with a history of depression and loneliness.

BACKGROUND: Decades of research indicate that when social connectedness is threatened, mental health is at risk. However, extant interventions to tackle loneliness have had only modest success, and none have been trialled under conditions of such threat. METHOD: 174 young people with depression and loneliness were randomised to one of two evidence-based treatments: cognitive behaviour therapy (CBT) or Groups 4 Health (G4H), an intervention designed to increase social group belonging. Depression, loneliness, and well-being outcomes were evaluated at one-year follow-up; COVID-19 lockdown restrictions were imposed partway through follow-up assessments. This provided a quasi-experimental test of the utility of each intervention in the presence (lockdown group) and absence (control group) of a threat to social connectedness. RESULTS: At one-year follow-up, participants in lockdown reported significantly poorer wellbeing than controls who completed follow-up before lockdown, t(152)=2.41, p=.017. Although both CBT and G4H led to symptom improvement, the benefits of G4H were more robust following an unanticipated threat to social connectedness for depression (χ2(16)=31.35, p=.001), loneliness (χ2(8)=21.622, p=.006), and wellbeing (χ2(8)=22.938, p=.003). LIMITATIONS: Because the COVID-19 lockdown was unanticipated, this analysis represents an opportunistic use of available data. As a result, we could not measure the specific impact of restrictions on participants, such as reduced income, degree of isolation, or health-related anxieties. CONCLUSIONS: G4H delivered one year prior to COVID-19 lockdown offered greater protection than CBT against relapse of loneliness and depression symptoms. Implications are discussed with a focus on how these benefits might be extended to other life stressors and transitions.

Predicting Substance Use at a Youth Mass Gathering Event: The Role of Norms and the Importance of Their Source.

OBJECTIVE: Mass gathering events often involve high levels of substance use, yet the psychological predictors of substance use in these contexts have received minimal attention. This study examined the relationship between social norms and mass gathering attendees' anticipated substance use. We (a) tested this relationship while controlling for established predictors of substance use, (b) assessed longitudinally the impact of intraindividual changes in perceived substance use norms on intraindividual changes in participants' anticipated substance use, and (c) compared the relative impact of two normative referents (friends and typical mass gathering attendees). METHOD: Data were collected in situ at Schoolies (Australia's largest youth mass gathering). On Days 1, 3, and 5 of the 7-day festival, participants (N = 427; ages 16-19, 66% female) reported normative perceptions of drinking and drug taking among friends and other attendees, and indicated their own anticipated drinking and drug taking. RESULTS: Friend norms were associated with anticipated drinking and drug taking at each corresponding time point, with particularly strong relationships observed for anticipated drinking. Changes in friend norms also predicted changes in anticipated drinking and drug taking. Conversely, the effects of norms for typical attendees were weak. CONCLUSIONS: People's substance use at mass gatherings is particularly influenced by perceptions of friends' substance use. Friend norm perceptions change over time and dynamically influence young people's anticipated substance use in these high-risk settings. Interventions to reduce substance use at mass gatherings may be enhanced by correcting misperceptions of the normative behaviors of friends.

When trust goes wrong: A social identity model of risk taking.

Risk taking is typically viewed through a lens of individual deficits (e.g., impulsivity) or normative influence (e.g., peer pressure). An unexplored possibility is that shared group membership, and the trust that flows from it, may play a role in reducing risk perceptions and promoting risky behavior. We propose and test a Social Identity Model of Risk Taking in eight studies (total N = 4,708) that use multiple methods including minimal group paradigms, correlational, longitudinal, and experimental designs to investigate the effect of shared social identity across diverse risk contexts. Studies 1 and 2 provided evidence for the basic premise of the model, showing that ingroup members were perceived as posing lower risk and inspired greater risk taking behavior than outgroup members. Study 3 found that social identification was a moderator, such that effect of shared group membership was strongest among high identifiers. Studies 4 and 5 among festival attendees showed correlational and longitudinal evidence for the model and further that risk-taking was mediated by trust, not disgust. Study 6 manipulated the mediator and found that untrustworthy faces were trusted more and perceived as less risky when they were ingroup compared with outgroup members. Studies 7 and 8 identified integrity as the subcomponent of trust that consistently promotes greater risk taking in the presence of ingroup members. The findings reveal that a potent source of risk discounting is the group memberships we share with others. Ironically, this means the people we trust the most may sometimes pose the greatest risk. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Countervailing Effects of Weight Stigma on Weight-Loss Motivation and Perceived Capacity for Weight Control.

We hypothesized that exposure to weight stigma simultaneously increases motivation to lose or avoid gaining weight to avoid future stigma and decreases perceived capacity to do so, by heightening concerns about experiencing stigma and negative affect. Study 1 showed that more frequently experiencing weight-based discrimination was associated with greater concerns about being a victim of weight stigma, which predicted increased motivation to lose weight but decreased perceived capacity for weight control. Study 2 showed that participants randomly assigned to view a weight-stigmatizing (vs. control) message showed increased concerns about being a target of weight stigma, which indirectly increased motivation to lose weight and decreased state self-control. These, in turn, predicted increased willingness to engage in unhealthy weight-loss behaviors and decreased perceived capacity for weight control, respectively. Study 3 showed that increased motivation to avoid stigma and increased negative affect mediate these effects of exposure to weight stigma.