Annie Schmidt

What is the impact of self-stigma? Loss of self-respect and the “why try” effect

Abstract Background: The “Why Try” phenomenon, a consequence of self-stigma, is a sense of futility that occurs when people believe they are unworthy or incapable of achieving personal goals because they apply the stereotypes of mental illness to themselves. Aims: This study examines a four-stage model of self-stigma (aware, agree, apply, and self-stigma harm) and examines the “why try” effect as a result. We do that by testing a measure of “why try.” Method: Two hypothetical path models were tested. In the first, applying stereotypes to oneself leads to diminished self-respect and a sense of “why try”. In the second, the effect of applying stereotypes on “why try” is mediated by diminished self-respect. Participants completed the “why try” measure along with measures of self-stigma, public stigma, recovery, and empowerment. Results: Results show application of stereotypes to oneself predicts diminished self-respect and “why try”. “Why try” was significantly associated with agreement with public stigma, depression, and diminished sense of personal recovery. Conclusions: Findings from this study reveal the complex impact of self-stigma demonstrating its emotional and behavioral consequences. Implications for impacting self-stigma are discussed.

The public stigma of mental illness means a difference between you and me.

Social desirability can influence reports of stigma change in that subscribing to stigmatizing attitudes might pose a threat to personal beliefs of open-mindedness, while endorsing difference might not be as troubling. A measure is needed that assesses stigma change but is less susceptible to desirability effects. This study examined the psychometrics of various assessments of perceived difference from a person with mental illness. A total of 460 participants were recruited online using Amazons Mechanical Turk. Four measures of difference, the Likert Scale of Difference, Semantic Differential: Similar-Different Scale, Semantic Differential: Mental Illness versus Other Illness scale, and Cause of Perceived Difference Scale were compared to measures of stereotypes, affirming attitudes, and care seeking. A vignette describing a person with mental illness anchored the Difference Scale and a measure of stereotype. Results showed that measures of difference yielded significantly higher endorsements than measures of stereotypes; the Semantic Differential Scale: Similar-Different was endorsed at a higher rate than other difference scales. Difference scores were positively related to stereotypes and inversely related to affirming attitudes. Difference was also found to influence empowerment separate from, and in addition to stereotype. These results suggest a new domain as an efficient and sensitive measure of stigma change.

Changing public stigma with continuum beliefs

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

Using Peer Navigators to Address the Integrated Health Care Needs of Homeless African Americans With Serious Mental Illness

OBJECTIVE The study examined the impact of a peer navigator program (PNP) developed by a community-based participatory research team and used with a group of African Americans with serious mental illness who were homeless. METHODS Sixty-seven research participants were randomly assigned to receive PNP or treatment as usual (control) for one year. Data on general health and mental health, recovery, and quality of life were collected at baseline and at four, eight, and 12 months. RESULTS Findings from group × trial analyses of variance of omnibus measures of the four constructs showed significant impact over the year for participants in PNP compared with those in the control group, with analyses showing small to moderate effect sizes: general health status (η2=.24), psychological experience of physical health (η2=.42), recovery (η2=.36), and quality of life (η2=.14). These differences emerged even though both groups showed significant reductions in homelessness and increases in insurance coverage. CONCLUSIONS Implications for improving in-the-field health care for this population are discussed. Whether these results occurred because navigators were peers per se needs to be examined in future research.

Peer Navigators to Promote Engagement of Homeless African Americans with Serious Mental Illness in Primary Care

Homeless African Americans with serious mental illness experience higher rates of morbidity and mortality than adults with severe mental illness alone. Peer navigators, individuals with similar lived experiences, may help these individuals navigate the healthcare system to improve healthcare utilization. This study examined whether the Peer Navigator Program (PNP) improved scheduling and achieving healthcare appointments compared to treatment as usual (TAU) over the course of 12 months, including three periods within that timeframe: engagement (first three months), impact (middle six months), and maintenance (final six months). Results indicated no change during the first three months of the study, a significantly greater improvement in scheduled and achieved appointments for PNP compared to TAU during the middle six months, and maintenance of appointment change improvements over the final three months of the study. This research suggests peer navigators may offer a promising solution to barriers in utilizing the healthcare system for people with severe mental illness, especially those who may be homeless or from minority racial groups.

Who Comes Out With Their Mental Illness and How Does It Help

Abstract Coming out with mental illness may be an effective strategy for reducing self-stigma. This study examined predictors and consequences of coming out. Participants (N = 106) with severe mental illness who reported being out (n = 79) or not out (n = 27) endorsed benefits of being out (BBOs) and reasons for staying in. Predictors from baseline measures were self-stigma, insight, and psychiatric diagnosis. Three outcome measures—basic psychological needs, care engagement, and depression—were also completed at baseline and 1-month follow-up. Among participants already out, BBOs and reasons for staying in were significantly and independently associated with self-stigma, insight, and lifetime affective diagnoses. In terms of consequences, BBOs were associated with cross-sectional and 1-month measures of engagement for those already out, but not for closeted participants. Among closeted participants, BBOs were associated with baseline and 1-month measures of basic psychological needs. Implications for strategies meant to promote disclosure in order to decrease self-stigma are considered.

Website Designs for Communicating About Chemicals in Cigarette Smoke

ABSTRACT The Family Smoking Prevention and Tobacco Control Act requires the US government to inform the public about the quantities of toxic chemicals in cigarette smoke. A website can accomplish this task efficiently, but the site’s user interface must be usable to benefit the general public. We conducted online experiments with national convenience samples of 1,451 US adult smokers and nonsmokers to examine the impact of four interface display elements: the chemicals, their associated health effects, quantity information, and a visual risk indicator. Outcomes were perceptions of user experience (perceived clarity and usability), motivation (willingness to use), and potential impact (elaboration about the harms of smoking). We found displaying health effects as text with icons, providing quantity information for chemicals (e.g., ranges), and showing a visual risk indicator all improved the user experience of a webpage about chemicals in cigarette smoke (all p < .05). Displaying a combination of familiar and unfamiliar chemicals, providing quantity information for chemicals, and showing a visual risk indicator all improved motivation to use the webpage (all p < .05). Displaying health effects or quantity information increased the potential impact of the webpage (all p < .05). Overall, interface designs displaying health effects of chemicals in cigarette smoke as text with icons and with a visual risk indicator had the greatest impact on the user experience, motivation, and potential impact of the website. Our findings provide guidance for accessible website designs that can inform consumers about the toxic chemicals in cigarette smoke.

Campus solidarity campaign: respect and support for students with mental illness

Purpose – The purpose of this paper is to describe the evaluation of a set of potential logos for a campaign aimed at promoting an environment of solidarity and support on college campuses for students with mental illness. Design/methodology/approach – Participants completed an online survey responding to statements about college students and mental illness by selecting the logo they thought best represented each statement. Findings – One-sample χ2 tests were conducted to assess difference in frequency of brand endorsement by statement. Research limitations/implications – Through use of the scientific method to evaluate three potential logos designed to represent this campaign, it is more likely that the campaign will have its intended impact, and avoid potential deleterious effects. Limitations of the study include the representativeness of the sample, and the fact that endorsement of statements may not translate to behavior, the ultimate outcome of interest. Future studies should include population rese...

Feedback from American participants of a Mental Health First Aid training course

Purpose – Mental Health First Aid (MHFA) is a course meant to train participants in how to identify and respond to signs of mental disorders and crises. The purpose of this paper is to conduct a qualitative study of MHFA participants to get a sense of some values and challenges associated with the training. Design/methodology/approach – Results from an online survey of 143 participants yielded 24 discrete themes. Survey responses were gathered into a single data set and coded by two independent raters. Findings – Themes were sorted into four categories: MHFA benefits, training limitations, challenges to MHFA, and resources that facilitate MHFA. Several benefits emerged, consistent with findings from Australian studies. Research limitations/implications – Findings represent a sample of people who completed the program in Chicago; research needs to determine how perceived benefits and limitations vary by geographic area. Originality/value – Findings echoed many of the benefits found in studies conducted outside the USA and can be used to further improve MHFA training as it expands in the US market.