Stigma resistance at the personal, peer, and public levels: A new conceptual model.

Stigma resistance is consistently linked with key recovery outcomes, yet theoretical work is limited. This study explored stigma resistance from the perspective of individuals with serious mental illness (SMI). Twenty-four individuals with SMI who were either peer-service providers (those with lived experience providing services; N = 14) or consumers of mental health services (N = 10) engaged in semistructured interviews regarding experiences with stigma, self-stigma, and stigma resistance, including key elements of this process and examples of situations in which they resisted stigma. Stigma resistance is an ongoing, active process that involves using one’s experiences, knowledge, and sets of skills at the (1) personal, (2) peer, and (3) public levels. Stigma resistance at the personal level involves (a) not believing stigma or catching and challenging stigmatizing thoughts, (b) empowering oneself by learning about mental health and recovery, (c) maintaining one’s recovery and proving stigma wrong, and (d) developing a meaningful identity apart from mental illness. Stigma resistance at the peer level involves using one’s experiences to help others fight stigma and at the public level, resistance involved (a) education, (b) challenging stigma, (c) disclosing one’s lived experience, and (d) advocacy work. Findings present a more nuanced conceptualization of resisting stigma, grounded in the experiences of people with SMI. Stigma resistance is an ongoing, active process of using one’s experiences, skills, and knowledge to develop a positive identity. Interventions should consider focusing on personal stigma resistance early on and increasing the incorporation of peers into services

The delaying effect of stigma on mental health help‐seeking in Sri Lanka

Background: Mental health stigma has been associated with delays in seeking treatment. Aims: To describe perceived stigma experienced by patients and carers in Sri Lanka and to determine the effects of stigma on help‐seeking delay. Methods: Survey of outpatients and family carers (n = 118 dyads) attending two psychiatric hospitals in Sri Lanka, using the Disclosure and Discrimination subscales of the Stigma Scale. Results: Stigma was positively related to help‐seeking delay for carers but not patients. Public stigma experienced by carers accounted for 23% of the variance in help‐seeking delay. Conclusion: Reducing stigma may reduce help‐seeking delays during the course of treatment

PERSEPSI MASYARAKAT TERHADAP LOKASI PASAR BARU BOBOU KELURAHAN FAOBATA KECAMATAN BAJAWA KABUPATEN NGADA

This study aims to determine how the community's perception of the Pasar Baru Bobou location. This research is a qualitative descriptive study, which explains or describes the results of the research based on the data obtained from the research results. The population in this study are people in 7 sub-districts, and traders who sell in the market. The sampling technique used purposive sampling method, namely the community and traders as market users. The population in this study amounted to 179 people consisting of 140 people and 39 traders. The data collection technique uses a questionnaire or questionnaire which contains statements and summarized in tables and graphs and explains them according to the results of the interview. The results of this study indicate that the relocation of the Bajawa Inpres Market to Pasar Baru Bobou resulted in many community complaints. In general, the results of research in 7 urban villages describe the community as agreeing with the market relocation. However, the community complained about the cost of transportation to the Bobou market. They said that the transportation costs were very expensive, up 100-200% from usual. Meanwhile, for traders, they complained about the availability of water in the market. Therefore, the recommendation given to the government regarding public complaints is that the government needs to provide free vehicles for the community, at least free vehicles in the city as transportation to the market if government funds allow. Meanwhile, for traders, the government must pay more attention to the availability of water in the market

TB STIGMA – MEASUREMENT GUIDANCE

TB is the most deadly infectious disease in the world, and stigma continues to play a significant role in worsening the epidemic. Stigma and discrimination not only stop people from seeking care but also make it more difficult for those on treatment to continue, both of which make the disease more difficult to treat in the long-term and mean those infected are more likely to transmit the disease to those around them. TB Stigma – Measurement Guidance is a manual to help generate enough information about stigma issues to design and monitor and evaluate efforts to reduce TB stigma. It can help in planning TB stigma baseline measurements and monitoring trends to capture the outcomes of TB stigma reduction efforts. This manual is designed for health workers, professional or management staff, people who advocate for those with TB, and all who need to understand and respond to TB stigma

Gendered aspects of perceived and internalized HIV-related stigma in China.

Although studies have demonstrated that females experience more HIV-related stigma than males do, questions remain regarding the different dimensions of the stigma (i.e., perceived versus internalized) in China. The present study investigated gender differences in perceived and internalized HIV-related stigma, taking into account the potential influence of education. The study was conducted between October 2011 and March 2013. A total of 522 people living with HIV (PLH) were recruited from Anhui Province, China. The PLH participated in a survey using the Computer Assisted Personal Interview (CAPI) method. The gender differences in perceived and internalized HIV-related stigma were calculated with and without stratifying by education level. Female participants had significantly less education than the male participants. No significant difference was observed between females and males with respect to perceived stigma. However, females reported significantly higher internalized stigma than males did (p < .001). When socio-demographic characteristics were controlled, the gender difference in internalized stigma remained significant among educated participants (p = .038). The findings suggested that gender differences in HIV-related stigma were primarily found for internalized stigma. Heightened intervention efforts are encouraged to reduce internalized HIV-related stigma, particularly among female PLH in China and other regions with similar gender dynamics

The power to resist: the relationship between power, stigma, and negative symptoms in schizophrenia.

Stigmatizing beliefs about mental illness can be a daily struggle for people with schizophrenia. While investigations into the impact of internalizing stigma on negative symptoms have yielded mixed results, resistance to stigmatizing beliefs has received little attention. In this study, we examined the linkage between internalized stigma, stigma resistance, negative symptoms, and social power, or perceived ability to influence others during social interactions among people with schizophrenia. Further, we sought to determine whether resistance to stigma would be bolstered by social power, with greater power in relationships with other possibly buffering against motivation/pleasure negative symptoms. Fifty-one people with schizophrenia or schizoaffective disorder completed measures of social power, internalized stigma, and stigma resistance. Negative symptoms were assessed using the Clinical Assessment Interview for Negative Symptoms (CAINS). Greater social power was associated with less internalized stigma and negative symptoms as well as more stigma resistance. Further, the relationship between social power and negative symptoms was partially mediated by stigma resistance. These findings provide evidence for the role of stigma resistance as a viable target for psychosocial interventions aimed at improving motivation and social power in people with schizophrenia

Continuum Belief, Categorical Belief, and Depression Stigma: Correlational Evidence and Outcomes of an Online Intervention

Continuum belief interventions that erode boundaries between “normal” individuals and individuals with psychiatric problems may help to reduce psychiatric stigma, but a number of questions persist. The magnitude of belief change attributable to the intervention is unclear. Moreover, most studies have executed continuum interventions to reduce stigma of schizophrenia, and all studies have examined intervention effects on only public stigma. This study utilized a large sample (n = 654) to examine effects of a continuum intervention on depression stigma—public stigma in the full sample and self-stigma among participants with a self-reported history of depression. Participants were randomly assigned to one of three intervention groups: (a) the control group, which read material that merely described depression, (b) the continuum group, which read material that attested to a continuum view of depression, or (c) the categorical group, which read material that attested to a categorical view of depression. Correlational analyses demonstrated that preintervention categorical belief positively predicted, and preintervention continuum belief negatively predicted, depression stigma. Moreover, preintervention categorical belief positively predicted, and preintervention continuum belief negatively predicted, self-stigma among participants with a self-reported history of depression. There was scant evidence that the intervention affected public stigma among participants without a history of depression and no evidence that it affected self-stigma among participants with a history of depression. These findings illuminate a number of key priorities for future research on continuum belief intervention and its prospects for stigma reduction

A comparison of substance use stigma and health stigma in a population of veterans with co-occurring mental health and substance use disorders

OBJECTIVE: This pilot study examined whether substance use or mental illness was more stigmatizing among individuals with co-occurring mental health and substance abuse problems. METHODS: This study included 48 individuals with co-occurring substance use and mental health problems enrolled in a Substance Abuse and Mental Health Services funded treatment program. Subjects received a baseline assessment that included addiction, mental health, and stigma measures. RESULTS: The sample consisted primarily of White males with an average age of 38 years. Substance abuse was found to be more stigmatizing than mental illness, F(1, 47) = 14.213, p < .001, and stigma varied across four different levels of stigma (Aware, Agree, Apply, and Harm), F(2.099, 98.675) = 117.883, p < .001. The interaction between type and level of stigma was also significant, F(2.41, 113.284) = 20.250, p < .001, indicating that differences in reported stigma between types varied across levels of stigma. Post hoc tests found a significant difference between all levels of stigma except for the comparison between Apply and Harm. Reported stigma was significantly higher for substance abuse than mental illness at the Aware and Agree levels. In addition, pairwise comparisons found significant differences between all levels of stigma with the exception of the comparison between Apply and Harm, indicating a pattern whereby reported stigma generally decreased from the first level (Aware stage) to subsequent levels. CONCLUSIONS: These results have important implications for treatment, suggesting the need to incorporate anti-stigma interventions for individuals with co-occurring disorders with a greater focus on substance abuse

Disentangling the stigma of HIV/AIDS from the stigmas of drugs use, commercial sex and commercial blood donation – A factorial survey of medical students in China

Background: HIV/AIDS related stigma interferes with the provision of appropriate care and support for people living with HIV/AIDS. Currently, programs to address the stigma approach it as if it occurs in isolation, separate from the co-stigmas related to the various modes of disease transmission including injection drug use (IDU) and commercial sex (CS). In order to develop better programs to address HIV/AIDS related stigma, the inter-relationship (or 'layering') between HIV/AIDS stigma and the co-stigmas needs to be better understood. This paper describes an experimental study for disentangling the layering of HIV/AIDS related stigmas. Methods: The study used a factorial survey design. 352 medical students from Guangzhou were presented with four random vignettes each describing a hypothetical male. The vignettes were identical except for the presence of a disease diagnosis (AIDS, leukaemia, or no disease) and a cocharacteristic (IDU, CS, commercial blood donation (CBD), blood transfusion or no cocharacteristic). After reading each vignette, participants completed a measure of social distance that assessed the level of stigmatising attitudes. Results: Bivariate and multivariable analyses revealed statistically significant levels of stigma associated with AIDS, IDU, CS and CBD. The layering of stigma was explored using a recently developed technique. Strong interactions between the stigmas of AIDS and the co-characteristics were also found. AIDS was significantly less stigmatising than IDU or CS. Critically, the stigma of AIDS in combination with either the stigmas of IDU or CS was significantly less than the stigma of IDU alone or CS alone. Conclusion: The findings pose several surprising challenges to conventional beliefs about HIV/ AIDS related stigma and stigma interventions that have focused exclusively on the disease stigma. Contrary to the belief that having a co-stigma would add to the intensity of stigma attached to people with HIV/AIDS, the findings indicate the presence of an illness might have a moderating effect on the stigma of certain co-characteristics like IDU. The strong interdependence between the stigmas of HIV/AIDS and the co-stigmas of IDU and CS suggest that reducing the co-stigmas should be an integral part of HIV/AIDS stigma intervention within this context

Development of a scale to measure stigma related to podoconiosis in Southern Ethiopia

Background: Health-related stigma adds to the physical and economic burdens experienced by people suffering from neglected tropical diseases (NTDs). Previous research into the NTD podoconiosis showed significant stigma towards those with the disease, yet no formal instrument exists by which to assess stigma or interventions to reduce stigma. We aimed to develop, pilot and validate scales to measure the extent of stigma towards podoconiosis among patients and in podoconiosis-endemic communities. Methods: Indicators of stigma were drawn from existing qualitative podoconiosis research and a literature review on measuring leprosy stigma. These were then formulated into items for questioning and evaluated through a Delphi process in which irrelevant items were discounted. The final items formed four scales measuring two distinct forms of stigma (felt stigma and enacted stigma) for those with podoconiosis and those without the disease. The scales were formatted as two questionnaires, one for podoconiosis patients and one for unaffected community members. 150 podoconiosis patients and 500 unaffected community members from Wolaita zone, Southern Ethiopia were selected through multistage random sampling to complete the questionnaires which were interview-administered. The scales were evaluated through reliability assessment, content and construct validity analysis of the items, factor analysis and internal consistency analysis. Results: All scales had Cronbach’s alpha over 0.7, indicating good consistency. The content and construct validity of the scales were satisfactory with modest correlation between items. There was significant correlation between the felt and enacted stigma scales among patients (Spearman’s r = 0.892; p < 0.001) and within the community (Spearman’s r = 0.794; p < 0.001). Conclusion: We report the development and testing of the first standardised measures of podoconiosis stigma. Although further research is needed to validate the scales in other contexts, we anticipate they will be useful in situational analysis and in designing, monitoring and evaluating interventions. The scales will enable an evidencebased approach to mitigating stigma which will enable implementation of more effective disease control and help break the cycle of poverty and NTDs