Exploring mental health problems and support needs among pregnant and parenting teenagers in rural areas Of Limpopo, South Africa.

BACKGROUND: Globally, teenage pregnancy is among the most social problems, affecting 21 million adolescents aged 15-19. Due to the increased responsibility of prenatal and postnatal care for their infants without support, pregnant and parenting teenagers, tend to experience mental health problems. Factors contributing to these problems among pregnant and parenting teenagers in rural African settings have hardly received scholarly attention and, therefore, are less understood. The purpose of the study was to explore mental health and challenges among pregnant and parenting teenagers,. METHOD(S): The study adopted a qualitative descriptive, exploratory, and phenomenological design. Purposive sampling was used to select 22 pregnant and parenting teenagers 18 years or older. Data were collected in ten selected clinics within the Demographic Surveillance Systems (HDSS) of DIMAMO and analysed using qualitative content analysis. RESULTS: The findings reveal that pregnant and parenting teenagers in rural areas experience various mental challenges such as depression. These challenges are caused by social problems such as stigmatisation, lack of support from families and friends, as well as parenting demands that contribute to poor progress at school or dropouts. Pregnant teens expressed concerns about the lack of spousal support resulting from abandoning their partners. CONCLUSIONS: Stress and depression were self-reported as mental problems among participants with various psychosocial implications, such as school dropout and miscarriage. There are various contributing factors to the mental health problems identified among pregnant and parenting teenagers, including inadequate family and spousal support. Access to integrated reproductive, psychosocial, and mental health services could be essential for these pregnant and parenting teenagers, to improve their mental well-being and improve the support system.

French validation of the barriers to access to care evaluation (BACE-3) scale.

BACKGROUND: The aim of this study was to develop and evaluate a French version of the Barriers to Access to Care Evaluation (BACE-3) scale that is tailored to the socio-cultural and language setting of the study. METHODS: The translation of the BACE-3 into French and its validation were the two key components of this psychometric investigation. An online survey was created and circulated to French-speaking participants who volunteered to participate in the study. RESULTS: For all translated questions, the reliability analysis key results (Cronbach's alpha and McDonald's Omega) were both>0.95, which is an excellent reliability value. The BACE-3 items were shown to be positively related to one another, implying excellent validity. Results of exploratory and confirmatory factor analyses showed that all stigma-related items were loaded under the same factor. CONCLUSIONS: The BACE-3 has been validated in French, and its psychometric qualities have been thoroughly evaluated and found to be excellent.

Stigmatization towards electro convulsive therapy: Impact of practical teaching on medical and nursing students.

BACKGROUND: This study explored the impact of theoretical and practical teaching on electro convulsive therapy (ECT) on medical and nursing students' stigmatizing attitudes towards ECT and representations of it. METHOD: Fourth-year medical students and nursing students answered questions from the Questionnaire on Attitudes and Knowledge of ECT (QuAKE) and from the Mental Illness: Clinicians' Attitudes version 2 (MICA v2) scale. The questionnaires were completed before and after observing a 3-hour practical training session in the ECT unit. The endpoint was the impact of practical training as assessed by MICA and QuAKE scores. Multivariate analyses were used to explore the impact of practical training on MICA and QuAKE total scores. RESULTS: Stigmatizing attitudes and representations of both medical and nursing students towards ECT were reduced after practical training (ß=-4.43 [95% CI -6.15; -2.70] p=0.0001). The impact was greater in medical students (ß=-8.03; 95% CI [-10.71; -5.43], P=0.0001) than in nursing students (ß=-2.77; 95% CI [-4.98; to 0.44], P=0.02). Gender, psychiatric history in close persons, and having already followed a psychiatric/ECT course had no independent impact on stigmatizing attitudes towards ECT and representations of it. CONCLUSION: Practical training in ECT should be given to all health professionals to improve access to it.

[Supporting sex workers in dealing with risks and exposure to violence]. / Accompagner les travailleurs du sexe face aux risques et à l'exposition à la violence.

Médecins du Monde France is involved in supporting sex workers in reducing health risks, and has highlighted the fragility of this population with regard to current legislative measures concerning sex work. These multiple constraints have negative repercussions in terms of access to health rights, but also in terms of their work.

Spanish menstrual literacy and experiences of menstruation.

There is growing recognition of the important role menstrual health plays in achieving health, education, and gender equity. Yet, stigmatisation and taboo remain present and negative emotions like fear and shame dominate the narrative when speaking about periods. This paper analyses how formal and informal menstrual education is received in Spain, to understand the role of menstrual health literacy in the way menstruation is experienced, and to identify what information would be useful to integrate into formal menstrual education. An online survey with more than 4000 participants (aged between 14 and 80, both people who will/do/have previously menstruate/d and those who do not menstruate) was conducted. Data was gathered using the digital platform Typeform, descriptive and inferential statistical analyses were performed with SPSS software and qualitative data was thematically analysed using Nvivo. Many participants declared not having received sufficient information on menstruation prior to menarche, particularly about how to physically manage it. Furthermore, negative emotions like shame, worry, and fear were recurrently reported to describe menarche; this has not changed between generations. Interestingly, we saw an increase in stress and sadness with an increase in perceived knowledge of the reproductive role of menstruation. We did observe a reduction in negative emotions when people who menstruate perceived they had sufficient information on how to manage their first bleeding. It is recommended that menstrual education beyond reproductive biology, particularly including how to physically manage periods, is integrated into school curricula. Menstrual education of everyone - including those who do not menstruate-can improve how periods are experienced in Spain.

Unintended Consequences of "Breast Is Best" Messaging on Mothers: An Autoethnography.

Purpose: To describe the breastfeeding experiences of a dietitian and mother so as to expose dominant discourses reinforcing expert-driven imperatives to breastfeed.Methods: Professional experiences and personal challenges related to breastfeeding promotion are described, analyzed, and interpreted using autoethnography. The social ecological model (SEM) is used as a sensitizing concept to guide the organization, presentation, and analysis of experiences.Results: Data were organized into two discussion themes: breastfeeding promotion practices and "failure" to breastfeed. Dominant discourses reinforcing expert-driven imperatives to breastfeed are revealed, including health as a duty, intensive motherhood, and mother blame. Discourses promoting or reinforcing breastfeeding simultaneously judge and denormalize formula-feeding.Conclusions: Contemporary breastfeeding promotion messages and strategies are quiet coercions used to influence infant-feeding decisions and do not support the principles of evidence-based practice, person-centred care, and informed choice.

[Stigmatisation of patients with mental disorders by medical interns specialising in general practice: A national survey]. / Stigmatisation des patients atteints d'un trouble mental par les internes de médecine générale : une enquête nationale.

OBJECTIVES: The objective was to assess the level of stigmatisation of psychiatric patients by medical interns specialising in general practice (GP), and to assess the influencing factors of stigmatisation. METHODS: A national survey was carried out among interns in general practice (GP) contacted through their local associations from December 10, 2019 to March 9, 2020. An online questionnaire was diffused. The validated French version of the Mental Illness Clinicians' Attitudes (MICA) was used to measure stigmatising attitudes towards psychiatry and persons with psychiatric disorder by the interns. This 16-item scale is designed to measure attitudes of health care professionals towards people with mental illness with scores ranging from 16 to 96 (the most stigmatizing). Several covariates were collected: socio-demographics, personal experiences with mental health, and mental health trainings during medical studies. All questionnaires were strictly anonymized. Comparative analyses of the MICA score by group were performed using Student's tests. RESULTS: A total of 389 interns responded. The majority of respondents were female (n=277; 71%) and the mean age was 27years [standard deviation (SD)±2.39]. The mean MICA rate was 40.64 (SD±8.09) for a neutral score of 56, reflecting low overall stigmatizing attitudes. MICA scores were significantly lower among female interns (40.11 vs. 41.95; P=0.042), those who had benefited from personal psychological or psychiatric support (38.70 vs. 41.61; P=0.001), and those who had completed a psychiatric externship (39.47 vs. 42.16; P=0.001). CONCLUSIONS: GP interns had an attitude that is generally not very stigmatizing even if its improvement should still be sought. This is particularly verified among those who have completed a psychiatric internship during their externship. This suggested association should be supported by other studies. The stakes are high for the future management of patients since stigmatisation by a physician is strongly implied in the worse healthcare management of patients with psychiatric disorders, leading them to a shorter lifespan.

[Self-stigma and functioning in patients with bipolar disorder]. / Auto-stigmatisation et fonctionnement dans le trouble bipolaire.

Self-stigma of people with bipolar disorder is an underestimated problem, with serious consequences in terms of clinical severity and social and professional functioning. OBJECTIVES: This study aimed to evaluate self-stigma in patients with bipolar disorder, to identify socio-demographic and clinical factors associated with it and to analyze the links between self-stigma and functioning in this population. METHODS: We conducted a cross-sectional, descriptive and analytic study including 61 patients with bipolar disorder meeting criteria of remission. We used the internalized stigma of mental illness (ISMI) to investigate self-stigma, and the functioning assessment short test (FAST) to assess functioning. RESULTS: The mean age of patients was 43.4 years. The sex ratio was 2.4. Half of the patients were single or divorced (50 %). They had secondary or university education in 69 % of cases and were professionally inactive in 59 % of cases. The socioeconomic level was low or medium in 92 % of cases. A personal judicial record was found in 16 % of patients, a suicide attempt in 41 % of cases. Most patients in our series had bipolar I disorder (92 %). The mean age at onset of the disease was 23.5 years, with a mean duration of disease progression of 20 years. Patients were hospitalized an average of 5.9 times. Most patients (90 %) exhibited psychotic features during their mood relapses. The mean duration of the last remission was 27.9 months. Patients had regular follow-ups at our consultations in 87 % of cases. Among the patients included in the study, 8 % were on long-acting neuroleptics. The mean score on the internalized stigma of mental illness was 2.36±0.56. More than half of our patients (59 %) were self-stigmatized. Discrimination and alienation were found in 51 % of cases, followed by resistance to stigmatization (43 %) and assimilation of stereotypes (41 %). Regarding functioning, a global impairment was noted in more than two thirds of patients (71 %). An alteration in professional functioning was found in 82 % of cases and in cognitive functioning in 69 % of cases. Disruption of the financial sphere concerned 43 % of the patients, and the relational sphere 41 % of them. Autonomy was altered in 41 % of patients. Analysis of the relationships between self-stigma and characteristics of the study population revealed statistically significant associations between higher self-stigma scores and single or divorced status, low socio-economic level and judicial record. In terms of clinical parameters, the mean self-stigma score was significantly associated with a higher total number of thymic episodes and hospitalizations, a longer cumulative duration of hospitalizations and a shorter duration of the last remission. In addition, the mean self-stigma score was associated with significantly more impaired functioning. CONCLUSIONS: Our study underlines the need to work towards the implementation of management modalities aimed at combating the self-stigmatization of patients with bipolar disorder and mitigating its negative consequences during the course of the disease.

"I don't know if you have searched through the scriptures to find a reference on HIV/AIDS. I mean there isn't going to be one, right?": HIV stigma solutions from dialogues between faith leaders and health care workers.

In South African communities, both faith leaders and health care workers play a vital role in supporting the health of community members and people living with HIV in particular. This study describes HIV stigma when faith leaders and health care workers engaged in discourse. The study used a descriptive qualitative inquiry design. Data were gathered between 2015 and 2016 in the areas of Masiphumelele and Gugulethu in Cape Town, South Africa. Three themes emerged: (1) participants identified influences that can increase HIV stigma; (2) participants shared the challenges that they face to reduce HIV stigma; and (3) participants suggested solutions to reduce HIV stigma. Themes discussed include ground-level problems and practical solutions to address HIV stigma in faith communities. Collaboration between faith leaders and health care workers are vital resources in the fight against HIV stigma. Future research and interventions should aim to promote organised collaboration between faith communities and health care structures.

Stigmatizing attitudes and social perception towards mental illness among Moroccan medical students.

OBJECTIVES: This study aimed to explore medical students' attitudes, social perception, and knowledge towards mental illness and identify the associated factors. METHODS: A cross-sectional study was conducted in the Medical Faculty of Fez. A representative sample of 420 Moroccan students from the first to the seventh years was selected randomly during the academic year (2018/2019). They completed the Mental Illness Clinicians Attitudes scale (MICA) and a self-questionnaire exploring sociodemographic data, the university course, social perception and knowledge towards mental illness, and the potential consideration of psychiatry as a career. RESULTS: The average age of participants was 21.73 years (SD ±2.60), and 72.4% (n=304) of respondents were female (M/F gender ratio=0.39). The participants held stigmatizing attitudes and negative social perceptions towards mental illness, as indicated by the high score of the MICA scale (mean=57.24; SD ±9.95). Females (p=0.02) and married students (p=0.02) showed significantly more tolerant attitudes. The attitudes of students (p=0.37) who completed the psychiatry clerkship were slightly more favorable (p=0.15). There was no significant difference in attitudes according to the level of study (p=0.06). Students with a lower socioeconomic level tended to be less stigmatizing (p=0.08). The assessment of knowledge about mental illness among students objectified major gaps. A total of 17.9% (n=75) considered psychiatry as a career. CONCLUSION: The attitudes of medical students in this study were stigmatizing, and this should without delay motivate Moroccan research, educational and health authorities to investigate further scientific research in this area to address these attitudes and remedies.

Perceived stigma among Tunisian healthcare workers during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: Stigma was a major issue during the COVID-19 pandemic. It posed a serious threat to the lives of healthcare workers (HCWs) who were expected to experience higher levels of stigma and increased psychological distress. This is the first survey to investigate forms and correlates of perceived stigma in Tunisian HCWs during the COVID-19 pandemic. METHODS: A cross-sectional web-based survey was conducted between October 8th and November 10th 2020, among 250 Tunisian HCWs. Data were collected using an online questionnaire using the Google Forms® platform. We used a self-reported instrument measuring COVID-19-related stigma, and the Multidimensional Scale of Perceived Social Support (MSPSS) to measure the perceived adequacy of social support from three sources: family, friends, and significant other. RESULTS: The mean stigma score was 18.6±8. Participants sometimes to often experienced stigma in their relationships with friends (22%), neighbors (27.2%), parents (22,4%), and in social activities (30.8%). This stigma was perceived mainly through avoidance (68.4%), and rarely through verbal (6%) or physical aggression (1.2%). The mean MSPSS total score was 5.26±1.24. In multivariate analysis, depression history (P<0.001), long working experience (P<0.001), having presented ageusia/anosmia (P=0.007) and lower total social support scale (P<0.001) were significantly associated with higher perceived stigma score. CONCLUSION: Our findings showed that HCWs perceived stigma in professional, societal and familial domains. Social support from family, friends and others seemed to protect against perceived stigma. Proper health education targeting the public appears to be an effective method to prevent social harassment of both HCWs and COVID-19 survivors.

[Barriers to access to care evaluation scale (bace-3) psychometric properties of the french version in a naturalistic ambulatory psychiatric community setting]. / Les barrières à l'accès aux soins : validation de la BACE-3 française.

OBJECTIVES: To translate into French and validate the BACE-3 scale (Barriers to Care Evaluation) and describe the barriers to access to care in mental health settings. METHODS: The instrument was translated into French with its author's authorisation and her supervision. Three outpatient consultation centres and two day hospitals in the same geographical region were involved. We included patients aged between 18 and 6years under regular follow-up with psychiatrists and diagnosed with a psychotic disorder, a bipolar disorder, a mood disorder, a personality disorder, an anxiety disorder or a somatoform disorder, all according to ICD-10 criteria. To be included subjects further had to have sought some health care support in the last twelve months or be be regularly treated in a continuous way at the time of inclusion. RESULTS: One hundred twenty-one patients were successively included during a regular consultation. The exploratory factor analysis of the 30-item BACE-3 yielded to a method factor (items that could only be answered by patients with a family and/or at work were recoded) and two clinically meaningful factors were named, Stigmatisation and Cognitive Bias and Denial. We found that the first factor was nicely in line with the factors we had extracted from the Internalized Stigma Mental Illness (ISMI) scale in the same sample. This provided an external validation of the BACE but it was difficult to conclude any further given the limited size of our sample. CONCLUSIONS: Barriers to care need to be addressed by clinicians. Internal and external validity properties of the BACE-3 scale show it can be used in French-speaking populations of outpatients suffering from mental health problems.

Part of the solution yet part of the problem: factors of schizophrenia stigma in mental health professionals.

BACKGROUND: Stigma is highly prejudicial to persons with schizophrenia, their families, the society and the health care system. Mental health professionals (MHP) are considered to be one of the main sources of schizophrenia stigma. OBJECTIVES: The aim of the study was to identify individual and contextual factors associated with stigma in MHP in its three dimensions (stereotypes, prejudices, discrimination, Fiske, 1998). METHODS: An online survey was conducted with specific measures of MHP stigma (stereotypes, prejudices and discrimination). Four categories of potential associated factors were also measured: sociodemographic characteristics, contextual characteristics (e.g., Work setting), individual characteristics (e.g., Profession, Recovery-oriented practices) and theoretical beliefs (e.g., Biological beliefs, Perceived similarities, Continuum versus Categorical beliefs). RESULTS: Responses of 357 MHP were analysed. Factors that were the most strongly associated with MHP stigma were Perceived similarities, Categorical beliefs, Biological beliefs, Recovery-oriented practice and Work setting (independent practice). Conversely, Gender, Specific trainings in stigma or recovery and Cognitive aetiology beliefs showed no association with any of MHP stigma dimension. Remaining factors show associations with a weak effect size. CONCLUSIONS: The survey results suggest that MHP stigma is more influenced by individual factors such as theoretical beliefs and recovery-oriented practices than contextual factors. These original results provide perspectives for reducing stigma in mental health practices.Key pointsMental health professionals (MHP) considering they share similarities with persons with schizophrenia or believing that schizophrenia is not a discrete social category but rather the extreme on a continuum between 'normal' and 'pathologic' reported less stigmatisation.MHP holding higher professional utility beliefs and using recovery-oriented practice reported fewer stereotypes, prejudice and discrimination.Other factors such as age, academic level, contact frequency, familiarity and multidisciplinary practice show associations with a weak effect size.

Perceived stigmatisation and reliability of questionnaire in the survivors with burns wound: A systematic review and meta-analysis.

Perceived stigmatisation (PS) can cause different effects on burns survivors such as depression, low self-esteem, body image disturbance, and social anxiety. Current systematic review and meta-analysis aimed to determine the average PS among the burns survivor population and the average reliability of the PS questionnaire (PSQ). A comprehensive systematic search was conducted in various international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as "Stigmatisation", "Burns", "Reliability", and "Questionnaire" from the earliest to February 1, 2023. The COSMIN and the Joanna Briggs Institute (JBI) checklists were applied to evaluate the risk of bias. Data analysis was performed in STATA V.14 and JAMOVI v 2.3.24 software. The analysis consisted of two sections. Firstly, the overall weighted average of PS was calculated based on mean and standard deviation. Then, the reliability average of PSQ was calculated with the reliability generalisation method based on the alpha coefficient, questionnaire items, and sample size of each study. Finally, eight articles were included in the quantitative analysis. The results showed the weighted average of PS was 2.14 (ES: 2.14, 95%CI: 1.77-2.51, Z = 11.40, I2 :97.8%, P < 0.001). The average of PS in the factors of confused/staring behaviour, absence of friendly behaviour, and hostile behaviour was 2.36 (ES: 2.36, 95%CI: 2.05-2.67, Z = 14.86, I2 :92.7%, P < 0.001), 2.13 (ES: 2.13, 95%CI: 1.87-2.39, Z = 16.22, I2 :93.8%, P < 0.001) and 2.07 (ES: 2.07, 95%CI: 1.67-2.47, Z = 10.05, I2 :96.5%, P < 0.001), respectively. The analysis showed that the overall coefficient alpha of the PSQ was 0.88 (ES: 0.88, 95%CI: 0.851-0.910, Z = 58.7, I2 : 95.04%, P < 0.001). Also, the alpha coefficient of factors including confused/staring behaviour, absence of friendly behaviour, and hostile behaviour were 0.847 (ES: 0.847, 95%CI: 0.770-0.924, Z = 21.6, I2 :99.13%, P < 0.001), 0.860 (ES: 0.860, 95%CI: 0.808-0.912, Z = 32.4, I2 :98.02%, P < 0.001) and 0.899 (ES: 0.899, 95%CI: 0.829-0.968, Z = 21.33, I2 : 0.0%, P < 0.001), respectively. In sum, the current study showed that the average PS was 2.14 out of 5 points. Most survivors and parents reported confused/starring behaviour as a common perceived behaviour from different individuals. Also, the average reliability of PSQ was 0.88, and it had acceptable reliability. More studies are required to better judge the level of PS among different age groups. Also, the psychometric properties of PSQ in different cultures are an essential issue.

Stigmatisation and perceived social support as predictor of treatment of substance use disorder (SUD): A systematic review.

OBJECTIVE: To review literature on the impact of stigmatisation and perceived social support on the treatment of substance use disorder patients. METHODS: The systematic review was conducted from March 2020 to June 2021, and comprised literature search through key words on PubMed, Scopus, PsycINFO, Science Direct, Full Free PDF, and Google Scholar databases of studies about stigma, social support and treatment of substance use disorders published in English language between 2010 and 2021. RESULTS: Of the 52 studies found, 8(15.3%) qualified for detailed review. The outcome suggested that the impact of stigma had negative consequences on the treatment of substance use disorders, and negative comments from close relatives was a major cause of relapse. In contrast, perceived social support had a constructive impact on the treatment of substance use disorders. CONCLUSIONS: Further research is required to understand the phenomenon of stigmatisation in the Pakistani population through validated tools.

[Women's vulnerability to alcohol and its impact on health]. / Vulnérabilité des femmes face à l'alcool et impacts sur la santé.

At the same level of consumption as men, specific vulnerabilities often expose women to the more rapid onset of more serious illnesses (cardiovascular and liver diseases, cancers, brain and cognitive damage, sleep disorders, risk of accidents, etc.). This worrying fact is still little known by the general population. Special prevention measures are needed, such as dedicated campaigns for women, specific guidelines for lower-risk drinking, systematic early detection of risky drinking among women, and brief intervention in the event of problem drinking.

["Roma adolescents: a more varied reality than we think"]. / « Les adolescents roms : une réalité plus variée qu'on ne croit ¼.

The Roma are a population that has been recorded in Europe since the Middle Ages. Today, there are more than ten million of them on the European continent, especially in Eastern Europe. They form several groups of great linguistic, cultural and social diversity, who are generally stigmatized by the majority populations despite multiple forms of integration. Some of them live in very precarious conditions, sometimes in ghettoized neighborhoods, like the people cared for by the association Médecins du Monde in Bulgaria. Livia Otal, an anthropologist by training and coordinator of the Bulgaria mission of Médecins du Monde, presents the actions carried out with these populations, particularly adolescents.

Oral cavity squamous cell carcinomas in patients with no identified risk factors: Feeling like an outsider.

OBJECTIVES: Head and neck squamous cell carcinomas (HNSCCs) mainly affect smokers and drinkers. However, oral cavity squamous cell cancers (OCSCCs) are increasingly affecting patients with no identified risk factors (NIRFs). This study aimed at characterising their experience of the disease. METHODS: Qualitative study based on semi-structured interviews of 20 survivors of OCSCC with NIRF. Methods used in grounded theory approach were applied. RESULTS: Patients with NIRF had a similar experience to that of patients with risk factors regarding treatments. The absence of identified causes led to stigma and led the patients to distance themselves, both from the stereotypic HNSCC cancer patient and the identity as a cancer patient. Furthermore, having no identified risk factors seemed to reinforce the fear of recurrence. CONCLUSION: This study is the first to address key gaps in knowledge regarding patients with NIRF having survived OCSCC. Their experience is similar to that of patients with orphan diseases. Owing to confrontation with other patients and the repeated questions of caregivers about tobacco/alcohol consumption, these patients felt stigmatised during their treatment. OCSCC patients with NIRF may benefit from guidance and support on how to engage in prevention.

The cultural epidemiology of stigma among people with schizophrenia : Adaptation and cross-cultural validation of the Explanatory Model Interview Catalogue (EMIC), in Dialectal Arabic (Darija), Morocco.

INTRODUCTION: Stigma underlies the violation of certain social, economic, and cultural rights of patients with schizophrenia, including their access to treatment and care. Measurement of stigma remains as complex and multifaceted as the phenomenon itself. Several measurement tools are available to assess the prevalence, intensity and qualities of stigma. The aim of the study was to carry out a cross-cultural adaptation of the Explanatory Model Interview Catalogue (EMIC), in the Moroccan Arabic dialect commonly known as "Darija". PATIENTS AND METHOD: The study was conducted in three psychiatric departments of public hospitals in the Souss-Massa region, located in southern Morocco. For the diagnosis of schizophrenia, the study was based on the decisions of the psychiatrists practicing at the study sites. The cross-cultural adaptation in Moroccan Darija of the stigma scale developed by Michel Weiss in the EMIC was carried out according to the six-step scientific method developed by Dorcas et al. RESULTS: Cronbach's alpha (internal consistency) was 0.845. Convergent validity determined by Pearson's coefficient showed a significant inter-item correlation and the intra-class correlation coefficient (test-retest) was 0.975 (0.993; 0.991). The item added in relation to the COVID-19 situation presented psychometric values similar to the others. CONCLUSION: The Darija version is culturally acceptable and can be used to approach the phenomenon of stigmatization in Morocco.

Psychological flexibility as a moderator of the relationship between HIV-related stigma and resilience among HIV/AIDS patients.

HIV-related stigmatisation is common in many parts of the world and is experienced by all categories of people living with HIV and AIDS (PLWHA). Although the negative consequences of HIV-related stigmatisation on the resilience of PLWHA is well documented, little is known about the plausible role of certain personal characteristics in moderating the stigma-resilience relationship. In addition to investigating the direct association of HIV-related stigma (personalised stigma, disclosure concern, concern about public attitude and negative self-image) with resilience, the present study examined whether psychological flexibility (PF) moderates the HIV-related stigmaresilience relationship among PLWHA. Participants included 280 PLWHA (M = 39.48; SD = 9.03) selected from Sacred Heart Catholic Hospital (SHCH), Obudu, Cross River State, Nigeria. Participants completed relevant self-report measures. Results showed that patients reported moderately high levels of resilience (M = 59.13; SD = 13.98). Hierarchical multiple regression analysis showed that HIV-related stigma (personalised stigma, disclosure concern and concern about public attitudes) were not significantly associated with resilience (p = 0.230; p = 0.747; p = 0.528). HIV-related negative self-image and PF were independently and significantly associated with resilience (p = 0.024; p = 0.000). Results of moderation hypothesis revealed that PF did not moderate the relationship between HIV-related disclosure concern and resilience (p = 0.903), and between HIV-related concern about public attitudes and resilience (p = 0.905), but PF moderated the relationship of HIV-related personalised stigma and resilience (p = 0.023), and the relationship of HIV-related negative self-image and resilience (p = 0.004). Therefore, interventions to promote resilience abilities in PLWHA should consider facilitating patients' psychological flexibility skills as it is critical in decreasing the hazardous effect of HIV-related stigma on the patients.