Lindsay Sheehan

The Stigma of Personality Disorders

This article reviews the recent literature on the stigma of personality disorders, including an overview of general mental illness stigma and an examination of the personality-specific stigma. Overall, public knowledge of personality disorders is low, and people with personality disorders may be perceived as purposefully misbehaving rather than experiencing an illness. Health provider stigma seems particularly pernicious for those with borderline personality disorder. Most stigma research on personality disorders has been completed outside the USA, and few stigma-change interventions specific to personality disorder have been scientifically tested. Limited evidence suggests that health provider training can improve stigmatizing attitudes and that interventions combining positive messages of recovery potential with biological etiology will be most impactful to reduce stigma. Anti-stigma interventions designed specifically for health providers, family members, criminal justice personnel, and law enforcement seem particularly beneficial, given these sources of stigma.

Stakeholder Perspectives on the Stigma of Suicide Attempt Survivors

Background: Past scholarly efforts to describe and measure the stigma surrounding suicide have largely viewed suicide stigma from the perspective of the general public. Aims: In the spirit of community-based participatory research (CBPR), the current study brought together a diverse stakeholder team to qualitatively investigate the suicide stigma as experienced by those most intimately affected by suicide. Method: Seven focus groups (n = 62) were conducted with suicide attempt survivors, family members of those who died by suicide, and suicide loss therapists. Results: Themes were derived for stereotypes (n = 30), prejudice (n = 3), and discrimination (n = 4). People who attempted suicide were seen as attention-seeking, selfish, incompetent, emotionally weak, and immoral. Participants described personal experiences of prejudice and discrimination, including those with health professionals. Conclusion: Participants experienced public stigma, self-stigma, and label avoidance. Analyses reveal that the stigma of suicide shares similarities with stereotypes of mental illness, but also includes some important differences. Attempt survivors may be subject to double stigma, which impedes recovery and access to care.

The Specificity of Public Stigma: A Comparison of Suicide and Depression-Related Stigma

Each year, approximately 1.3 million Americans survive a suicide attempt. While stigma has been reported by suicide attempt survivors, limited research has examined how suicide stigma may differ from the stigma of mental illness. U.S. adults (n = 440) completed an online survey in which they were randomly assigned to one of four vignettes. Vignettes depicted a target individual with either past depression, past suicide attempt, death by suicide, or no information on suicide or mental illness (control). Participants completed a general measure of stigma, a suicide-specific stigma measure, and were surveyed on the recovery potential of individuals with mental illness and suicide attempt. While the general stigma measure failed to distinguish between groups, significant differences on the suicide stigma scale (SSAS-44) emerged between participants assigned in the depression and suicide conditions, especially for stereotype and prejudice subscales. Across conditions, participants believed that recovery was more realistic for someone described as having a mental illness than it was for someone described as having attempted suicide. These findings suggest that individuals who have attempted suicide are subject to differential stigma content from those with depression. Implications are discussed for combating stigma for suicide attempt survivors.

Making Sense of the Public Stigma of Suicide

Background: Research suggests that stigma is a barrier to care for individuals who have attempted suicide. While extensive work has examined the stigma of mental illness, less research has focused on the public stigma of suicide. Existing measures of suicide stigma have lacked a conceptual foundation or have failed to include the perspectives of suicide stakeholders. Aims: This research draws on previous qualitative research with suicide stakeholders to create a measure of public suicide stigma. Method: This study used a community-based participatory research (CBPR) approach to define a factor structure for suicide stigma. The CBPR team used focus groups to generate items for each component of stigma (stereotypes, prejudice, and discrimination). Two online surveys (N = 372; N = 243) asked members of the public to rate candidate items for stereotypes, prejudice, and discrimination. Results: Analyses revealed three factors for stereotypes (weak, crazy, distressed), two factors for prejudice (fear/distrust, anger), and three for discrimination (avoidance, disdain, coercion). Limitations: Results should be confirmed in other samples and further evidence gathered on convergent, divergent, and discriminant validity. Conclusion: The resulting 44-item Suicide Stigma Assessment Scale (SSAS) can be further validated and used to measure efficacy of stigma change interventions.

Structures and Types of Stigma

Stigma is a complex phenomenon described by the intersection of structures and types. In this chapter, we describe components of these structures, which largely derive from social psychological research, and types, which reflect mechanisms of stigma and mental illness. This includes a discussion of stigma as experienced by family members and more implicit forms of stigma. These constructs sometimes vary by mental illness so this chapter summarizes research in this area as well (Box 3.1).

The Healthcare Needs of Latinos with Serious Mental Illness and the Potential of Peer Navigators

Latinos with serious mental illness get sick and die much younger than other adults. In this paper, we review findings of a community based participatory research project meant to identify important healthcare needs, barriers to these needs, solutions to the barriers, and the promise of peer navigators as a solution. Findings from focus groups reflected general concerns of people with mental illness (e.g., insurance, engagement, accessibility) and Latinos with serious mental illness (e.g., immigration, language, and family). Feedback and analyses especially focused on the potential of peer navigators. Implications of these findings for integrated care of Latinos with serious mental illness are discussed.

Behind Closed Doors: The Stigma of Suicide Loss Survivors

Many thousands of families lose a loved one to suicide each year. The stigma experienced by family survivors threatens to further burden families and impede the grieving process. This study used a community-based participatory research process to explore the family stigma of suicide from a social-cognitive perspective. We describe a secondary analysis of qualitative data focusing on stigma directed at bereaved families. Thematic analysis of focus group data (n = 62) resulted in themes describing stereotypes, prejudice, and discrimination. Bereaved families were viewed as contributing to their loved ones death through abuse, neglect, denial, or failure to provide adequate help. Bereaved families were seen as emotionally strong, victims of the suicide, or as contaminated by their association. Families encounter pressure to keep the suicide a secret and experience withdrawal of support systems. Results suggest needs for evidence-based programs to address both public and internalized stigma experienced by bereaved families.

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.

Practitioner perspectives on Individual Placement and Support (IPS) for individuals with serious mental illness

BACKGROUND: Although individual placement and support (IPS) is established as an evidence-based model of supported employment, opportunities for improvements abound. Front-line supported employment practitioners are uniquely positioned to provide feedback on implementation. OBJECTIVE: This study investigates IPS from a practitioner perspective to illuminate themes in practitioner endorsement, advantages, disadvantages, growth opportunities, ideal practitioner characteristics, sequence of services and methods for promoting self-determination. METHODS: Sixty-seven employment practitioners completed an open-ended survey about IPS implementation. Qualitative results were analyzed using Lofland and Lofland’s (1984) systematic filing system and Berg’s (2004) themes to combine similar items into categorical frameworks. RESULTS: Three conceptual frameworks are described: Program, Practitioner Characteristics and Practitioner Essential Tasks. Despite general endorsement of IPS, many complexities are discussed. Practitioners emphasized the importance of interpersonal skills in establishing rapport, promoting hope and encouraging self-determination. Highly organized, persistent practitioners who balance client and business needs are seen as most effective. CONCLUSIONS: We offer these frameworks for utilization by IPS practitioners, researchers and stakeholders for the purposes of program development and organizational decision-making.

Understanding the factor structure of the public stigma of substance use disorder

Abstract Few empirical research studies have examined the public stigma of substance use disorder (SUD) compared to mental illness (MI). Expanding on the results of a qualitative study on the stigma of SUD, this study quantitatively examined items thought to represent the three constructs of public stigma: stereotypes, prejudice and discrimination. Additionally, exploratory factor analyses generated factor structures to provide meaning to each construct. Results indicated that some factors were endorsed significantly higher than others: for stereotypes, recklessness and threat were significantly endorsed more than unreliability and inadequacy; for prejudice, dread was endorsed the most; and for discrimination, restriction was endorsed more than invalidation. Additional oneway ANOVAs revealed that women significantly endorsed restriction more than men. Although further research is needed to confirm a complete set of factors, these results may help to establish a model for the public stigma of people with SUD.