Examining the association between perceived stigma, its correlates, and restrictions in participation among persons with disabilities in Nepal: a cross-sectional study.

BACKGROUND: Disability stigma in low- and middle-income countries is one of the most persistent and complex barriers limiting persons with disabilities (PwDs) from enjoying their rights and opportunities. Perceived stigma among PwDs and its impact on participation restriction is rarely assessed in Nepal. OBJECTIVE: This study aimed to measure the extent of perceived stigma by PwDs, identify its relationships with specific demographic factors, and assess the impact on social participation. METHODS: A cross-sectional survey was conducted between May and July 2022 among PwDs in Nepal, with a sample of 371. The Explanatory Model Interview Catalog (EMIC) stigma scale and P-scale suitable for people affected by stigmatized conditions were used, and the generated scores were analyzed. One-way ANOVA was performed to determine group differences for sociodemographic variables, and linear regression and correlational analysis were used to identify their association and measure the strength and direction of the relationship. RESULTS: The mean stigma score was 16.9 (SD 13.8). 42% of respondents scored higher than the mean. The scores differed significantly by disability type, caste and ethnicity, education, occupation, and household wealth. Over 56% reported participation restriction, and 38% had severe/extreme restriction. Approximately 65% of participants with intellectual disabilities, 53% with multiple disabilities, and 48.5% of persons with severe or profound disabilities experienced severe or extreme restrictions. Perceived stigma had a positive correlation with Disability type (r = 0.17, P < 0.01) and negative correlations with Severity of disability (r= -0.15, P < 0.05), and Household wealth (r= -0.15, P < 0.01). Education was inversely associated with both stigma (r= -0.24, P < 0.01), and participation restriction (ß= -9.34, P < 0.01). However, there was no association between stigma and participation restriction (ß= -0.10, P > 0.05). CONCLUSION: All participants exhibited stigma in general; however, the severity varied based on disability type, level of education, and sociocultural circumstances. A large proportion of participants reported facing a high degree of restrictions in participation; however, no association was detected between perceived stigma and participation restriction. A significant negative linear correlation was observed between education and participation restriction. Stigma reduction programs focusing on education and empowerment would be especially important for overcoming internalized stigma and increasing the participation of PwDs.

Impact of follow-up by peer support workers on mental health service users' global functioning and self-stigmatisation.

OBJECTIVES: The introduction of the first French professional peer support workers training program. (« Médiateurs de santé pairs en santé mentale ¼) led to a series of evaluations. After a number of qualitative studies demonstrating benefits of peer support for all stakeholders, our objective was to evaluate its direct effects for users by focusing on repeated quantitative measures: global functioning and self-stigma scores. The hypothesis was that peer support would improve the former and decrease the latter. METHOD: The procedure was based on a one-year follow-up of two groups of mental health service users. Both groups received usual care, either with or without additional peer support. All of them were asked to respond to three questionnaires at the beginning of the study and 6 and 12 months later: a sociodemographic and clinical questionnaire, a global functioning scale and a self-stigmatization scale. Samples included 85/64/35 participants at the three stages for the PHM group, and 205/157/105 for the control group. RESULTS: Peer support improved global functioning. Nevertheless, it had no impact on self-stigmatization scores which remained rather low throughout the observational period. CONCLUSIONS: Despite difficulties concerning follow-up of service users during the course of the study and the reluctance to integrate a new profession based on experiential knowledge, it appears that the hope of recovery can improve global functioning of people with mental disorders. The reasons for low self-stigmatization and its stability over time remain to be explored.

Self-stigmatization of high-school students seeking professional psychological help: the chain-mediating effect of perceived social support and optimism.

Background: Research has shown that stigmatization of professional psychological help-seeking is an important factor influencing attitudes toward seeking professional psychological help (ATSPPH). However, how perceived social support (PSS) and optimism have a mediating role is not clear. Objective: Examine the associations between ATSPPH, self-stigmatization of seeking help, PSS, and optimism in a cohort of Chinese high-school students (HSSs). Methods: An offline survey was conducted in three high schools in Chongqing (China) from 20 February to 20 May 2023. Participants were HSSs recruited through their teachers. A total of 2,159 HSSs completed a survey on demographic information as well as the Self-Stigmatization of Seeking Help (SSOSH) score, ATSPPH, Perceived Social Support Scale (PASS), and Life Orientation Test (LOT). Mediation analyses were conducted using the "Process" macro in SPSS 26.0 to estimate the direct and indirect effects of self-stigmatization of seeking psychological help on ATSPPH. Results: Self-stigmatization of seeking psychological help was significantly and negatively related to ATSPPH among HSSs. Self-stigmatization of psychological help-seeking influenced ATSPPH through three pathways: (a) separate mediating effect of PSS (effect = -0.029); (b) separate mediating effect of optimism (effect = -0.069); (c) chain-mediating effect of PSS and optimism (effect = -0.017). These data suggested that self-stigmatization of psychological help-seeking could influence ATSPPH directly and indirectly through PSS and optimism. Conclusion: PSS and optimism mediated the relationship between self-stigmatization of seeking help and ATSPPH. Improving the ability of HSSs to perceive social support and cultivating optimism could help improve the self-stigmatization of help-seeking and promote a positive attitude toward professional help-seeking.

[Stigmatization and social anxiety in patients with skin diseases]. / Stigmatisierung und soziale Angst bei Patient:innen mit Hauterkrankungen.

Stigmatization of patients with skin diseases has only recently attracted more attention in research. However, both external stigmatization by society and self-stigmatization by the affected patients are widespread in patients with skin diseases. Many studies show that in this group of patients, the experience of both kinds of stigmatization is associated with psychosocial burden, such as social anxiety. This is often independent of the visibility of skin lesions. The psychosocial burden of affected individuals may lead to psychological comorbidities, such as depression or anxiety disorders, making it important to screen patients in dermatologic settings for the presence of these conditions. Interventions to reduce external and self-stigmatization have been developed, but more randomized controlled trials are needed to test the effects of such interventions.

Investigation in to psychometric properties of self stigma scale by seeking psychological help in adolescent students.

BACKGROUND: Stigmatization and help seeking are the one of the most important concepts of preventive interventions and mental health promotion in adolescent. METHODS: This study is in descriptive, correlational and methodological design. The sample of the study consisted of 250 volunteer students studying in a total of six schools. The Self Stigma Scale in Seeking Psychological Help was used as a data collection tool. Data were evaluated with content validity index based on expert opinion, exploratory and confirmatory factor analysis, Cronbach's Alpha coefficient. FINDINGS: Factor loadings explained 52% of the total variance in the two sub-dimensions. The KMO value was determined as 0.76 and the sample was found to be sufficient. The Cronbach's alpha coefficient of the entire scale was determined as.74. The alpha values of the sub-dimensions were determined as 0.76 and 0.74, respectively. In both exploratory and confirmatory factor analysis, all factor loads are >0.30. In confirmatory factor analysis, all fit indices were found to be >0.80 and the RMSEA value was determined as 0.067. CONCLUSIONS: The results of the study revealed that it is a valid and reliable measurement tool that can be used to evaluate the level of self-stigma in seeking psychological help in adolescents. PRACTICE IMPLICATIONS: It is recommended that scale will be a guide in protective and preventive studies for researchers and school nurses working with students.

Prevalence and predictive risk factors of self-stigmatization in patients with rare diseases: Based on health ecology model.

BACKGROUND AND AIMS: Given the cause of self-stigmatization of patients with rare diseases is complicated, and the self-stigmatization can be prevented by managing the related risk factors. This study aimed to report the prevalence as well as influencing factors associated with self-stigmatization in patients with rare diseases. METHODS: From January to April 2022, the respondent-driven sampling (RDS) method was used to select patients with rare diseases through the Chinese Organization for Rare Disorders as the subjects. Based on the theoretical model of health ecology, logistic regression analysis was used to explore the association between self-stigmatization level and sample characteristics of patients with rare diseases. RESULTS: A total of 530 patients were included, 50.2% of whom were male, and most of them are under 45 years old (86.5%). The prevalence of self-stigmatization in patients with rare diseases was 85.7%. Logistic regression analysis indicated that age (OR: 0.624, 95% CI: [0.399, 0.976]), mental health status (OR: 0.184, 95% CI: [0.076, 0.445]), family relations (OR: 0.180, 95% CI: [0.074, 0.434]), full time work (OR: 2.835, 95% CI: [1.024, 7.849]) and medical insurance (OR: 0.296, 95% CI: [0.105, 0.835]) were risk factors for self-stigmatization of patients with rare diseases. CONCLUSIONS: Chinese patients with rare diseases have a high level of self-stigmatization, and the potential risk factors are multi-level and multi-dimensional.

Self-Stigmatization of Healthcare Workers in Intensive Care, Acute, and Emergency Medicine.

This quantitative study examines whether employees in the fields of intensive care or acute and emergency medicine experience psychological distress because of their daily work. In addition, it was examined if self-stigmatization tendencies can significantly influence the willingness to seek help, and therefore psychological problems are not being treated adequately. These problems lead to various difficulties in professional and private contexts and ultimately endanger patient safety. From May to June 2021, an online questionnaire survey was conducted. This questionnaire combined two validated measuring instruments (PHQ-D and SSDS). To ensure high participation, the departments of anesthesia and/or intensive care medicine in 68 German hospitals were contacted, of which 5 responded positively. A total of 244 people participated in the questionnaire survey. On average, depressive symptoms were of mild severity. At the same time, self-stigmatization regarding depressive symptoms was high. These results highlight the practical need to prepare staff who work in the field of intensive care or acute and emergency medicine at the early onset for potentially traumatic and emotionally demanding events during their university education or studies. Adequate, evaluated, and continuously available support services from the psychosocial field should become an integral part of every staff care structure.

Internalized stigma in mental health staff with lived experience of mental crises-Does the professional role protect against self-stigmatization?

Objective: The stigma of mental illness is widespread in the general population and also among healthcare and psychiatric professionals. Yet, research on the self-stigma of the latter is still limited. The purpose of this article was to assess self-stigma and its correlates in mental health professionals with lived experiences of mental crisis and treatment. Methods: In a cross-sectional exploratory research project, 182 mental health professionals with lived experiences of mental crisis and treatment from 18 psychiatric hospital departments in the German federal states of Berlin and Brandenburg were surveyed on their lived experiences, self-stigma, perceived stigma in the workplace, subjective vulnerability to crises, and meaningfulness of lived experiences. To investigate the relationships between the variables, manifest and latent correlation analyses were calculated. Results: Results showed low levels of self-stigma and perceived public stigma in the workplace. Self-stigma was significantly and positively associated with workplace stigma and subjective vulnerability to crisis, but not with identification with lived experiences. Conclusion: The relationship between self-stigma, workplace stigma, and vulnerability should be investigated in terms of mutual causality in order to derive possible strategies of reducing self-stigma along with its detrimental effects. Possible reasons for the low levels of self-stigma are discussed in the light of limitations, including processes of self-selection, with highly self-stigmatizing individuals being possibly discouraged from participating. Strategies to enhance sampling quality are briefly discussed.

Simply too much: the extent to which weight bias internalization results in a higher risk of eating disorders and psychosocial problems.

PURPOSE: Weight bias internalization (WBI) is associated with negative health consequences such as eating disorders and psychosocial problems in children. To date, it is unknown to what extent WBI considerably raises the risk of negative outcomes. METHODS: Analyses are based on cross-sectional data of 1,061 children (9-13 years, M = 11, SD = 0.9; 52.1% female) who filled in the WBI scale (WBIS-C). First, ROC analyses were run to identify critical cut-off values of WBI (WBIS-C score) that identify those who are at higher risk for psychosocial problems or eating disorder symptoms (as reported by parents). Second, it was examined whether WBI is more sensitive than the relative weight status in that respect. Third, to confirm that the cut-off value is also accompanied by higher psychological strain, high- and low-risk groups were compared in terms of their self-reported depressive symptoms, anxious symptoms, body dissatisfaction, and self-esteem. RESULTS: WBIS-C scores ≥ 1.55 were associated with a higher risk of disturbed eating behavior; for psychosocial problems, no cut-off score reached adequate sensitivity and specificity. Compared to relative weight status, WBI was better suited to detect disturbed eating behavior. Children with a WBIS-C score ≥ 1.55 also reported higher scores for both depressive and anxious symptoms, higher body dissatisfaction, and lower self-esteem. CONCLUSION: The WBIS-C is suitable for identifying risk groups, and even low levels of WBI are accompanied by adverse mental health. Therefore, WBI is, beyond weight status, an important risk factor that should be considered in prevention and intervention. LEVEL OF EVIDENCE: Level III, cross-sectional analyses based on data taken from a well-designed, prospective cohort study.

Patients responses to diagnoses of mental disorders: Development and validation of a reliable self-report measure.

OBJECTIVES: Psychiatric patients are regularly informed about diagnoses. Treatment guidelines assume that informing patients fosters functional coping processes, but few research exists on how patients respond. Thus, the objective was to develop a standardized self-report measure to assess patients reactions to diagnoses. METHODS: Fifty nine items were generated based on a qualitative study. The process of item selection and determination of the factor structure were performed on a sample of 252 patients: Results of an explorative factor analysis with a randomly split sub-sample 1 were cross-validated by confirmatory factor analysis on sub-sample 2. The revised 26-item instrument was revaluated using data from an independent sample of 1.271 patients with different diagnoses. RESULTS: Three functional and three dysfunctional processing styles emerged from the analyses and provided good model fit in the revaluation study (TLI = 0.935; CFI = 0.943; RMSEA = 0.051; SRMR = 0.048). Variance-analytical calculations and post hoc analyses revealed significant differences among diagnoses with regard to coping styles, such as schizophrenia was associated with self-stigmatization and anorexia nervosa showed pronounced over-identification. Overall, various diagnosis-dependent specifics were found. CONCLUSIONS: As patients reactions to diagnoses vary substantially, their formation, impact on treatment and overall cause should be investigated in further studies.

Intrapersonal predictors of weight bias internalization among elementary school children: a prospective analysis.

BACKGROUND: Weight-related stigmatization is a widespread problem. Particularly the internalization of weight-related stereotypes and prejudices (weight bias internalization, WBI) is related to mental and physical health impairments. To date, little is known about the risk factors of WBI. Previous studies are mainly cross-sectional and based on adult samples. As childhood is a sensitive period for the development of a healthy self-concept, we examined predictors of WBI in children. METHODS: The final sample included 1,463 schoolchildren (6-11 years, 51.7% female) who took part in a prospective study consisting of three measurement waves. The first two waves delivered data on objective weight status and self-reported weight-related teasing, body dissatisfaction, relevance of one's own figure, self-esteem and depressive symptoms; WBI was measured during the third wave. To examine predictors of WBI, we ran hierarchical regression analyses and exploratory mediation analyses. RESULTS: Lower parental education level, higher child weight status, female gender, experience of teasing, higher body dissatisfaction, higher figure-relevance, and higher depression scores were found to be predictive for higher WBI scores. Body dissatisfaction (only for girls) and the relevance of one's own figure (both genders) mediated the association between self-esteem and WBI; no weight-related differences were observed. CONCLUSIONS: Our study offers longitudinal evidence for variables that enable the identification of children who are at risk for WBI. Thus, the findings deliver starting points for interventions aimed at the prevention of adverse health developments that come along with WBI.

Subjective Recovery in Patients with Schizophrenia and Related Factors.

Subjective recovery is a personally perceived recovery involving other factors beyond clinical recovery. This study aims at investigating the factors related to subjective recovery in patients with schizophrenia living in Turkey. This study assessed 120 clinically stable outpatients with schizophrenia or schizoaffective disorder using the clinical and psychosocial scales. Gender, type of the diagnosis of disease, and age of the illness onset were found to be correlated with the subjective recovery. Subjective recovery was significantly correlated with CGI-S (r = - 0.25), total PANSS score (r = - 0.29), global assessment of functioning (r = 0.27), social functioning (r = 0.43), internalized stigma (r = - 0.38), self-esteem (r = 0.56), depression (r = - 0.59), and hopelessness (r = - 0.55). Hopelessness and self-esteem were found to be predictive of the subjective recovery explaining 52% of the variance. It can be argued that efforts to promote hope and self-esteem contribute to the subjective recovery.

Self-Stigmatization in children receiving mental health treatment in Lahore, Pakistan.

INTRODUCTION: Self-stigma has a negative impact on the lives of children with mental health illnesses. It is a massive obstacle in the way of seeking professional help and poses a challenge to clinician's efforts to timely intervene and provide treatment. AIM: The aim of our study was to measure the stigma associated with mental illness in children with a variety of psychiatric diagnoses. METHODS: Following Institutional Review Board approval, an interviewer-based questionnaire was administered to children (aged 8-12 years), receiving treatment in Child Psychiatry Department at a tertiary care hospital in Lahore. The questionnaire comprised of Demographic Information Form and Paediatric Self-Stigmatization Scale (PaedS). In addition, parent / caregiver also completed a modified sub scale of the PaedS measuring the children's rejection by others due to their mental health difficulties. RESULTS: 110 children with various psychiatric problems, were interviewed with a mean age of 10 years + 1.7. Widespread presence of self-stigmatization was found in these children with particularly high scores for the scales of Societal Devaluation (2.6 + 0.54), Secrecy (2.85 + 0.59) and Self stigma (2.7 + 0.70). Almost two third of parents also answered in affirmative to statements about their children rejection by others due to their mental health difficulties. Children with emotional/ behavioral difficulties had statistically significant scores on secrecy and personal rejection subscales (P value<.05). CONCLUSIONS: Significant self-stigmatization amongst the children diagnosed with mental health illnesses in Lahore, Pakistan emphasize negative societal attitudes, which need to be addressed effectively in a timely manner.

Stigma and Self-Stigma in Addiction.

Addictions are commonly accompanied by a sense of shame or self-stigmatization. Self-stigmatization results from public stigmatization in a process leading to the internalization of the social opprobrium attaching to the negative stereotypes associated with addiction. We offer an account of how this process works in terms of a range of looping effects, and this leads to our main claim that for a significant range of cases public stigma figures in the social construction of addiction. This rests on a social constructivist account in which those affected by public stigmatization internalize its norms. Stigma figures as part-constituent of the dynamic process in which addiction is formed. Our thesis is partly theoretical, partly empirical, as we source our claims about the process of internalization from interviews with people in treatment for substance use problems.

Measuring stigma in children receiving mental health treatment: Validation of the Paediatric Self-Stigmatization Scale (PaedS).

BACKGROUND: Research on the impact of stigma associated with mental illness in children is scarce. Considering the known negative effects of stigma associated with mental illness in adults, it is crucial to explore the stigma experienced by children who access mental health treatment. However, no scale measuring self-stigmatization in younger children is available to date. This study aimed to develop and validate such a scale, the Paediatric Self-Stigmatization Scale (PaedS). METHODS: A total of 156 children (119 receiving outpatient and 37 receiving inpatient treatment), aged 8-12 years, completed the PaedS, the Self-Perception Profile for Children and the Pediatric Quality of Life Inventory (PedsQL - Child Report, ages 8-12). In addition, parents completed the PedsQL (Parent Report for Children, ages 8-12), the Strengths and Difficulties Questionnaire (SDQ) and a modified subscale of the PaedS measuring the children's rejection by others due to their mental health difficulties. RESULTS: A confirmatory factor analysis showed that a four-factor structure, comprising Societal Devaluation, Personal Rejection, Self-Stigma and Secrecy scales, had excellent fit to the data (CFI=0.95; TLI=0.95; RMSEA=0.05). Child-reported PaedS scores were positively correlated with parental-reported PaedS scores and negatively with PedsQL, the SDQ, and 5 out of 6 subscales of the Self-Perception Profile for Children, suggesting adequate convergent validity (all P-values<0.05). CONCLUSIONS: The PaedS is a valid instrument, which is hoped to advance the understanding of self-stigmatization in children with mental health difficulties and contribute to its prevention.