Jennifer E. Boyd

Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis

An expansive body of research has investigated the experiences and adverse consequences of internalized stigma for people with mental illness. This article provides a systematic review and meta-analysis of the extant research regarding the empirical relationship between internalized stigma and a range of sociodemographic, psychosocial, and psychiatric variables for people who live with mental illness. An exhaustive review of the research literature was performed on all articles published in English that assessed a statistical relationship between internalized stigma and at least one other variable for adults who live with mental illness. In total, 127 articles met the inclusion criteria for systematic review, of which, data from 45 articles were extracted for meta-analyses. None of the sociodemographic variables that were included in the study were consistently or strongly correlated with levels of internalized stigma. The review uncovered a striking and robust negative relationship between internalized stigma and a range of psychosocial variables (e.g., hope, self-esteem, and empowerment). Regarding psychiatric variables, internalized stigma was positively associated with psychiatric symptom severity and negatively associated with treatment adherence. The review draws attention to the lack of longitudinal research in this area of study which has inhibited the clinical relevance of findings related to internalized stigma. The study also highlights the need for greater attention on disentangling the true nature of the relationship between internalized stigma and other psychosocial variables.

Internalized Stigma of Mental Illness (ISMI) Scale: A multinational review

The Internalized Stigma of Mental Illness (ISMI) scale is a 29-item questionnaire measuring self-stigma among persons with psychiatric disorders. It was developed with substantial consumer input and has been widely used, but its psychometric qualities have not been comprehensively evaluated across multiple versions. Here we review the 55 known versions, and provide the 47 available versions, including: Arabic, Armenian, Bengali, Bulgarian, Chinese (Mainland, Taiwan, Hong Kong), Croatian, Dutch, English (USA, South Africa), Estonian, Farsi, Finnish, French, German, Greek, Hebrew, Hindi, Japanese, Khmer, Korean, Lithuanian, Lugandan, Maltese, Polish, Portuguese (Portugal, Brazil), Romanian, Russian, Samoan, Slovenian, Spanish (Spain), Swahili, Swedish, Tongan, Turkish, Urdu, and Yoruba, and qualitative English and Swahili versions, as well as versions for depression, schizophrenia, substance abuse, eating disorders, epilepsy, inflammatory bowel disease, leprosy, smoking, parents and caregivers of people with mental illness, and ethnicity. The various versions show reliability and validity across a wide range of languages, cultures, and writing systems. The most commonly reported findings of studies using the ISMI are that internalized stigma correlates with higher depression, lower self esteem, and higher symptom severity. Initial studies of ways to reduce internalized stigma are promising and warrant further investigation.

Psychology and culture during long-duration space missions ☆

The International Academy of Astronautics Study Group on Psychology and Culture in LongDuration Space Missions first convened in May 2003, at the 14 Humans in Space Symposium in Banff, Canada. After this initial meeting to define the group’s task, members divided into subcommittees and worked on drafts of sections of the document over email. The group reconvened in person several times to coordinate the structure of the paper. These sessions occurred at scientific meetings where many of the members were present. The study group formally convened in 2003 at the International Astronautical Congress (IAC) in Bremen and at the Institute for Biomedical Problems 40 Anniversary Symposium in Moscow. In 2004 it convened at the IAC in Vancouver and at the Annual Meeting of the Aerospace Medical Association (AsMA) in Anchorage. In 2005 it convened at the Humans In Space Symposium in Graz, at the IAC in Fukuoka, and at the AsMA Meeting in Kansas City. In 2006 the group worked over e-mail and will convene at the IAC in Valencia after the paper is finished in order to debrief and set out plans for future work. The objective of this report is twofold: a) to describe the current knowledge of cultural, psychological, psychiatric, cognitive, and interpersonal issues that are relevant to the behavior and performance of astronaut crews and ground support personnel; and b) to make recommendations for future human space missions, including both transit and planetary surface operations on the Moon, Mars, and beyond. The focus will be on long-duration missions lasting at least six weeks, when important psychological and interpersonal factors begin to take their toll on crewmembers. This information is designed to provide guidelines for astronaut selection and training, in-flight monitoring and support, and post-flight recovery and re-adaptation. After a consideration of Cultural Issues, which impact on the entire report, four main sections follow: Personality, Coping, and Adaptation; Behavioral Health and Psychiatry; Cognition and Complex Performance Skills; and Interpersonal and Organizational Issues. For each of these sections, there is a review of general issues; implications for mission operations in terms of crew selection, training, monitoring and support, and re-adaptation to Earth; and operational and research recommendations involving future missions to Earth orbit, the lunar surface, or to Mars and beyond.

The relationship of multiple aspects of stigma and personal contact with someone hospitalized for mental illness, in a nationally representative sample

The stigma of mental illness has been shown to be affected by personal contact with mental illness and by a belief in the genetic heritability of mental illness. We use data from a nationally representative survey to test whether the relationship of stigma with contact remains after taking into account the effects of genetic beliefs and other background characteristics. Contact was defined as a history of psychiatric hospitalization among respondents themselves, their family members, or their friends. Respondents answered questions about a vignette character with a mental illness. We found that respondents with contact felt less anger and blame toward the character, thought that the character had a more serious problem, and would want less social distance from the character, including both casual and intimate aspects of social distance. Respondents with contact were not significantly different from the general population in the degree to which they expressed sympathy, thought the problem would last a lifetime, or wanted to restrict reproduction. Thus, contact is associated with having a less ostracizing, critical attitude toward a stranger with mental illness. The results underscore the importance of this experienced group as a resource in fighting stigma in society. Since many people who have had a psychiatric hospitalization have not told their friends or family members about it, this lower-stigma group could be enlarged.

Psychometric Properties of the Chinese Version of the Perceived Stress Scale in Policewomen

Background The 10-item Perceived Stress Scale (PSS-10) is one of most widely used instruments to measure a global level of perceived stress in a range of clinical and research settings. This study was conducted to examine the psychometric properties of the Simplified Chinese version of the PSS-10 in policewomen. Methodology A total of 240 policewomen were recruited in this study. The Simplified Chinese versions of the PSS-10, the Beck Depression Inventory Revised (BDI-II), and the Beck Anxiety Inventory (BAI) were administered to all participants, and 36 of the participants were re-tested two weeks after the initial testing. Principal Findings The overall Cronbachs alpha was 0.86, and the test–retest reliability coefficient was 0.68. Exploratory Factor Analysis (EFA) yielded 2 factors with eigenvalues of 4.76 and 1.48, accounting for 62.41% of variance. Factor 1 consisted of 6 items representing “negative feelings”; whereas Factor 2 consisted of 4 items representing “positive feelings”. The item loadings ranged from 0.72 to 0.83. The Confirmatory factor analysis (CFA) indicated a very good fit of this two-factor model to this sample. The PSS-10 significantly correlated with both BDI-II and BAI, indicating an acceptable concurrent validity. Conclusions The Simplified Chinese version of the PSS-10 demonstrated adequate psychometric properties for evaluating stress levels. The results support its use among the Chinese population.

Brief version of the Internalized Stigma of Mental Illness (ISMI) scale: psychometric properties and relationship to depression, self esteem, recovery orientation, empowerment, and perceived devaluation and discrimination.

OBJECTIVE The internalized stigma of mental illness impedes recovery and is associated with increased depression, reduced self-esteem, reduced recovery orientation, reduced empowerment, and increased perceived devaluation and discrimination. The Internalized Stigma of Mental Illness (ISMI) scale is a 29-item self-report questionnaire developed with consumer input that includes the following subscales: Alienation, Discrimination Experience, Social Withdrawal, Stereotype Endorsement, and Stigma Resistance. Here we present a 10-item version of the ISMI containing the two strongest items from each subscale. METHOD Participants were all outpatient veterans with serious mental illness. Following the rigorous scale-reduction methods set forth by Stanton and colleagues (2002), we selected the 10 items, tested the psychometrics of the shortened scale in the original validation sample (N = 127), and cross-checked the results in a second dataset (N = 760). RESULTS As expected, the ISMI-10 retained the essential properties of the ISMI-29, including adequate internal consistency reliability and external validity in relation to depression, self-esteem, recovery orientation, perceived devaluation and discrimination, and empowerment. The ISMI-10 scores are normally distributed and have similar descriptive statistics to the ISMI-29. The reliability and depression findings were replicated in a cross-validation sample. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE We conclude that the ISMI-10 has strong psychometric properties and is a practical, reliable, and valid alternative to the original ISMI-29. Future work should test the ISMI-10 in more diverse samples. This shorter version should reduce respondent burden in program evaluation projects that seek to determine whether participation in psychosocial rehabilitation programming reduces internalized stigma.

Cultural differences in crewmembers and mission control personnel during two space station programs.

INTRODUCTION Cultural differences among crewmembers and mission control personnel can affect long-duration space missions. We examine three cultural contrasts: national (American vs. Russian); occupational (crewmembers vs. mission control personnel); and organizational [Mir space station vs. International Space Station (ISS)]. METHODS The Mir sample included 5 American astronauts, 8 Russian cosmonauts, and 42 American and 16 Russian mission control personnel. The ISS sample included 8 astronauts, 9 cosmonauts, and 108 American and 20 Russian mission control personnel. Subjects responded to mood and group climate questions on a weekly basis. The ISS sample also completed a culture and language questionnaire. RESULTS Crewmembers had higher scores on cultural sophistication than mission control personnel, especially American mission control. Cultural sophistication was not related to mood or social climate. Russian subjects reported greater language flexibility than Americans. Crewmembers reported better mood states than mission control, but both were in the healthy range. There were several Russian-American differences in social climate, with the most robust being higher work pressure among Americans. Russian-American social climate differences were also found in analyses of crew only. Analyses showed Mir-ISS differences in social climate among crew but not in the full sample. DISCUSSION We found evidence for national, occupational, and organizational cultural differences. The findings from the Mir space station were essentially replicated on the ISS. Alterations to the ISS to make it a more user-friendly environment have still not resolved the issue of high levels of work pressure among the American crew.

Prediction of Changes in Self-Stigma Among Veterans Participating in Partial Psychiatric Hospitalization: The Role of Disability Status and Military Cohort

OBJECTIVE Interventions addressing internalized stigma are a new area of research, and it is important to identify the types of clientele who derive benefit from existing interventions. METHOD Information was provided by 235 veterans attending a partial psychiatric hospitalization program, regarding their levels of internalized stigma on admission and discharge from a 3-week program that included interventions targeting internalized stigma. RESULTS Upon discharge, veterans receiving disability benefits demonstrated less reduction in internalized stigma than those not receiving disability benefits. Time of service moderated the relationship between disability status and change in internalized stigma, such that veterans serving in the more recent Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) cohort who received disability benefits had a more difficult time resolving internalized stigma. Further analyses suggested that OEF/OIF/OND cohort veterans receiving disability benefits have more difficulty developing effective stigma resistance, and more difficulty resolving stigma-related alienation, than other veterans. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Based on this research, particular attention should be devoted to internalized stigma among OEF/OIF/OND veterans.

The Internalized Stigma of Mental Illness: Cross-Cultural Adaptation and Psychometric Properties of the Portuguese Version of the ISMI Scale

Abstract This study examined the psychometric properties of the Portuguese version of the ISMI scale in a sample of 253 adult psychiatric outpatients. The exploratory factor analysis replicated the five factor structure of the scale. The results revealed good internal consistency. Criterion-related validity supported the variability in response to stigma across clinical diagnoses. Thus, the Portuguese version of the ISMI scale can be considered appropriate to measure and differentiate between stigmatization experiences. Also, in order to design more focused approaches aimed to reduce the negative effects of internalized stigma, its use in institutional and in community-based mental health services is recommended.

Patterns in Crew-Initiated Photography of Earth from the ISS: Is Earth Observation a Salutogenic Experience?

To provide for crewmember well-being on future exploration missions, understanding coping strategies that International Space Station (ISS) crewmembers adopt to mitigate the inherent stress of long-duration confinement is important. A recent retrospective survey of flown astronauts found that the most commonly reported psychologically enriching aspects of spaceflight had to do with their perceptions of Earth. ISS crewmembers photograph Earth both volitionally and in response to requests from Crew Earth Observations (CEO) scientists. Automatically recorded data from the camera can be used to test hypotheses about factors correlated with self-initiated crewmember photography. The present study used these objective in-flight data to investigate the nature of voluntary photographic activity. We examined the distribution of photographs with respect to time, crew, and subject matter. We determined whether the frequency fluctuated in conjunction with major mission events such as vehicle dockings and extravehicular activities (EVAs, or spacewalks), relative to the norm for the relevant crew. We also examined the influence of geographic and temporal patterns on frequency of Earth photography activities. We tested the hypotheses that there would be peak photography intensity over locations of personal interest, as well as on weekends.