Mieke Verhaeghe

Stigmatization and Self-Esteem of Persons in Recovery From Mental Illness: the Role of Peer Support

Background: Persons with mental health problems often experience stigmatization, which can have detrimental consequences for their objective and subjective quality of life. Previous research seeking for elements buffering this negative association focused on coping strategies and revealed that none of the most often used strategies is successful. Aims: This article studies whether peer support among clients can moderate this negative link, and to what extent. Following the buffering hypothesis on stress and social support, it was expected that the association between stigmatization and self-esteem would be less among persons experiencing greater peer support. Methods: This research problem was studied by means of ordinary least squares regression analysis using quantitative data from structured questionnaires completed by 595 clients of rehabilitation centres. Results and Conclusions: The results confirm that stigmatization is negatively related to self-esteem, while peer support is positively linked with it. Furthermore, they show that peer support moderates the negative association between stigmatization and self-esteem, but not in the expected way. These findings suggest that peer support can only have positive outcomes among clients with few stigma experiences, and that stigmatization itself could impede the formation and beneficial consequences of constructive peer relationships among persons receiving professional mental healthcare.

The association between network social capital and self-rated health: pouring old wine in new bottles?

This study examines whether there is an association between network social capital and self-rated health after controlling for social support. Moreover, we distinguish between network social capital that emerges from strong ties and weak ties. We used a cross-sectional representative sample of 815 adults from the Belgian population. Social capital is measured with the position generator and perceived social support with the MOS Social Support-scale. Results suggest that network social capital is associated with self-rated health after adjustment for social support. Because different social classes have access to different sets of resources, resources of friends and family from the intermediate and higher service classes are beneficial for self-rated health, whereas resources of friends and family from the working class appear to be rather detrimental for self-rated health. From a health-promoting perspective, these findings indicate that policy makers should deal with the root causes of socioeconomic disadvantages in society.

Pain acceptance and personal control in pain relief in two maternity care models: a cross-national comparison of Belgium and the Netherlands

BackgroundA cross-national comparison of Belgian and Dutch childbearing women allows us to gain insight into the relative importance of pain acceptance and personal control in pain relief in 2 maternity care models. Although Belgium and the Netherlands are neighbouring countries sharing the same language, political system and geography, they are characterised by a different organisation of health care, particularly in maternity care. In Belgium the medical risks of childbirth are emphasised but neutralised by a strong belief in the merits of the medical model. Labour pain is perceived as a needless inconvenience easily resolved by means of pain medication. In the Netherlands the midwifery model of care defines childbirth as a normal physiological process and family event. Labour pain is perceived as an ally in the birth process.MethodsWomen were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004-2005. Two questionnaires were filled out by 611 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth either at home or in a hospital. However, only women having a hospital birth without obstetric intervention (N = 327) were included in this analysis. A logistic regression analysis has been performed.ResultsLabour pain acceptance and personal control in pain relief render pain medication use during labour less likely, especially if they occur together. Apart from this general result, we also find large country differences. Dutch women with a normal hospital birth are six times less likely to use pain medication during labour, compared to their Belgian counterparts. This country difference cannot be explained by labour pain acceptance, since - in contrast to our working hypothesis - Dutch and Belgian women giving birth in a hospital setting are characterised by a similar labour pain acceptance. Our findings suggest that personal control in pain relief can partially explain the country differences in coping with labour pain. For Dutch women we find that the use of pain medication is lowest if women experience control over the reception of pain medication and have a positive attitude towards labour pain. In Belgium however, not personal control over the use of pain relief predicts the use of pain medication, but negative attitudes towards labour.ConclusionsApart from individual level determinants, such as length of labour or pain acceptance, our findings suggest that the maternity care context is of major importance in the study of the management of labour pain. The pain medication use in Belgian hospital maternity care is high and is very sensitive to negative attitudes towards labour pain. In the Netherlands, on the contrary, pain medication use is already low. This can partially be explained by a low degree of personal control in pain relief, especially when co-occurring with positive pain attitudes.

Associative stigma among mental health professionals: implications for professional and service user well-being.

In contrast with growing attention given to the stigma experiences of mental health service users, the stigma literature has paid almost no attention to mental health professionals. This study focuses on experiences of associative stigma among these professionals. We investigate the link between associative stigma and three dimensions of burnout as well as job satisfaction among mental health professionals, and the link of associative stigma with self-stigma and client satisfaction among service users. Survey data from 543 professionals and 707 service users from diverse mental health services are analyzed using multilevel techniques. The results reveal that among mental health professionals associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction. In addition, in units in which professionals report more associative stigma, service users experience more self-stigma and less client satisfaction. The results reveal that associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction among mental health professionals.

Stigma and trust among mental health service users

This article investigates whether and how the stigma experiences of mental health service users relate to trust in the professionals caring for them, and how both stigma and trust relate to service user satisfaction. The study uses survey data gathered from mental health service users (N = 650 service users from 36 organizations) and applies multilevel regression analyses. The results show that service users with more stigma experiences report less trust and are, partially for that reason, less satisfied with the services. Furthermore, service users with more severe symptoms and those with a psychotic disorder seem the most vulnerable ones for the processes occurring.

Associative Stigma among Mental Health Professionals

In contrast with growing attention given to the stigma experiences of mental health service users, the stigma literature has paid almost no attention to mental health professionals. This study focuses on experiences of associative stigma among these professionals. We investigate the link between associative stigma and three dimensions of burnout as well as job satisfaction among mental health professionals, and the link of associative stigma with self-stigma and client satisfaction among service users. Survey data from 543 professionals and 707 service users from diverse mental health services are analyzed using multilevel techniques. The results reveal that among mental health professionals associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction. In addition, in units in which professionals report more associative stigma, service users experience more self-stigma and less client satisfaction. The results reveal that associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction among mental health professionals.

Stigmatization in Different Mental Health Services: A Comparison of Psychiatric and General Hospitals

The earliest studies about stigmatization of persons receiving professional mental health care date from the time when psychiatric hospitals constituted the predominant facilities. The landscape of care has changed enormously since. Current research reveals that stigmatization still exists and has detrimental outcomes, not only for clients of psychiatric hospitals, but also for clients of so-called alternative settings. Studies that explicitly compare stigma experiences between different organizations are very scarce, however. This article compares clients from psychiatric and general hospitals according to three dimensions of stigmatization, using data from structured questionnaires (n = 555). The results reveal that when background characteristics are taken into account clients of psychiatric wards of general hospitals report less stigma expectations and social rejection experiences in comparison with their counterparts in psychiatric hospitals. Concerning self-rejection, no differences are found. These results suggest that more attention should be paid to specific characteristics of mental health services themselves in discussions about stigmatization and destigmatization of mental health care.

Childbirth expectations and experiences in Belgian and Dutch models of maternity care

Belgian and the Dutch societies show many similarities but differ with regard to the organisation of maternity care. The Dutch way of giving birth is well‐known for its high percentage of home births and its low medical intervention rate. In contrast, home births in Belgium are uncommon and the medical model is taken for granted. We expect that diverging models of maternity care give rise to different patterns of expectations and experiences. This quantitative comparative study took place in Belgian and Dutch hospitals and independent midwifery practices. Two questionnaires were completed by 611 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth, at home or in a hospital. Expectations about childbirth and the experience of childbirth have been assessed with the Wijma delivery expectancy/experience questionnaire enabling repeated measurement. A linear mixed model, with three fixed factors (time, country and place of birth), shows that expectations and experiences diverge. Dutch women have more negative expectations and experiences compared to Belgian women. Women who had a home birth had only slightly more optimistic expectations compared to women who had a hospital birth, but they rated their experiences as more positive.

Ward features affecting stigma experiences in contemporary psychiatric hospitals: a multilevel study

BackgroundVarious studies have revealed the existence and negative consequences of stigmatization of persons receiving professional mental health care. Less attention is generally paid to factors affecting these stigma experiences. The influence of the immediate treatment context, especially, is largely neglected.ObjectiveIn this article, a multilevel design is used to explore the link between characteristics of the treatment context and stigma experiences, controlling for client characteristics.MethodData of 366 clients from 42 wards in psychiatric hospitals are used to investigate the relationship of individualized treatment, group atmosphere and ward size to self-rejection.ResultsThe results reveal significant differences in self-rejection between the wards. Furthermore, they show that individualized treatment in a ward is related to less self-rejection, but only if it does not worsen the group atmosphere. A positive group atmosphere seems to reduce self-rejection. Finally, clients of larger wards report more self-rejection.ConclusionThe connection between ward characteristics and stigma experiences has important research and policy implications. It brings together the domains of stigma research and mental health services research, which have mostly been developed on a separate basis. In terms of policy, this kind of study could highlight factors in the immediate treatment that could be changed to reduce stigma experiences for clients of mental health services.

Organizational and Individual Level Determinants of Stigmatization in Mental Health Services

Despite the large amount of research on the existence and the negative consequences of stigmatization of clients of mental health services, little is known about the differences between services. Using data from 520 clients of 47 rehabilitation centers in a multilevel design, we studied organizational and individual characteristics explaining variation in social rejection and self-rejection. The results reveal that only a very small percentage of variance in stigmatization is explained by organizational features, such as size, composition of the client population and the kind of supplied activities. Client level characteristics affecting stigmatization are current mental health status, former mental hospitalization, and participation in psychotherapeutic activities.