Maya A. Al-Khouja

Mental illness stigma and disclosure in college students

Abstract Objective: The aim of this study was to investigate the relationship between mental illness identity, shame, secrecy, public stigma, and disclosure amongst college students. Participants included 1393 college students from five postsecondary institutions. Methods: Structural equation modeling was used to examine two path models predicting disclosure and desire to join a program aiding with disclosure. Results: Variables found to be significant in predicting disclosure included mental illness identity and public stigma. In turn, desire for disclosure predicted desire to join a program aiding in disclosure. Gender and race/ethnic differences were observed, with men and Whites more likely to want to disclose a mental illness or join a program aiding with disclosure compared with women and non-Whites, respectively. Conclusions: These findings suggest that some college students may find programs aiding in disclosure useful in assisting them to achieve their desire to be “out” with their mental illness.

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.

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.

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.

Examining the Impact of Public Service Announcements on Help Seeking and Stigma: Results of a Randomized Controlled Trial.

Abstract Health communication campaigns often seek to diminish stigma and promote care seeking, with public service announcements (PSAs) frequently prominent in these campaigns. One example is the Australian-based beyondblue campaign. As an alternative approach, campaigns may seek to reduce stigma by promoting stories of recovery. Participants completed measures of stigmatizing and empowering attitudes at pre-, post-, and 72-hour follow-up after being randomized to a PSA recovery-oriented video, treatable disease-oriented video (beyondblue), or control. When exposed to the recovery-oriented PSA, participants showed significant reduction in stigmatizing attitudes from pre- to posttest than beyondblue or the control group with the emergence of nonsignificant trends identified at follow-up. Findings suggest a recovery-oriented video leads to better change on measures of stigma and affirming attitudes than beyondblue. Despite the aforementioned findings, results failed to show either the recovery or beyondblue videos had a significant impact on intent to seek treatment.

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.

The Stigma of Pigmentary Disorders

One of the major barriers to individuals with pigmentary disorders in achieving their life goals is the stigma of their disorder. This paper provides a review of the existing research regarding stigma reduction, focusing on public stigma, and looking at approaches used within the mental health and other stigmatized communities. A main focus of pigmentary disorder advocates is to eliminate this stigma to remove the barrier it has on success and self-efficacy. Approaching this task from a perspective well-informed by previous research is important to both ensure that stigma reduction resources are spent wisely, and that anti-stigma approaches are effective.

Three agendas for changing the public stigma of mental illness.

Objective: Antistigma programs may be guided by 3 differing agendas: services (promote treatment engagement), rights (help people achieve rightful goals), and self-worth (facilitate self-worth and efficacy). This study examined the construct validity of this perspective by examining the factor structure of importance ratings of the 3 agendas. The study examined how importance might be viewed differently by the population as a whole versus a subsample of people who reported previous experience with mental health services and hence could be directly harmed by stigma. Methods: 373 individuals recruited using Mechanical Turk completed importance ratings for each of the 3 agendas. Measures of public stigma were completed to examine concurrent validity of importance ratings. Those who reported taking medications for a psychiatric disorder were divided into a separate group and completed a measure of self-stigma. Results: Outcomes seemed to confirm the factor structure of the 3 agendas model thereby offering partial support for the framework. Group analyses showed the services agenda was viewed as more important than rights or self-worth. People with mental health experience viewed the services agenda as more important than the other 2. However, dividing the mental health group into low and high self-stigma revealed that those with low self-stigma rated the rights agenda as more important. Conclusions and Implication for Practice: Participants with lower self-stigma identify the harm brought by stigma and thus endorse rights and self-worth more than those with higher self-stigma. Implications of these findings are discussed to assist to prioritize agendas for public health campaigns.

Insight into the stigma of suicide loss survivors: factor analyses of family stereotypes, prejudices, and discriminations

Families of individuals who die by suicide report public stigma that threatens their well-being. This study used a community-based participatory (CBPR) approach to describe a factor structure for the family stigma of suicide. Candidate items (n = 82) from a previous qualitative study were presented in an online survey format. Members of the public (n = 232) indicated how much they thought items represented public views and behaviors towards family members who lost a loved one to suicide. Factor analyses revealed two factors for stereotypes (dysfunctional, blameworthy), one factor for prejudice (fear and distrust), and three factors for discrimination (exclusion, secrecy, and avoidance).