Winnie W. S. Mak

Comparative stigma of HIV/AIDS, SARS, and Tuberculosis in Hong Kong

Abstract This study compares public stigma towards three types of infectious diseases— human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), severe acute respiratory syndrome (SARS), and tuberculosis (TB)—tests an attribution model of stigma, and explores the relationships between stigma and public attitudes towards government policies in Hong Kong. Using a population-based telephone survey, 3011 Hong Kong Chinese adults were randomly assigned to one of the three disease conditions and were interviewed about their attitudes and beliefs towards the assigned disease. Findings showed that public stigma was the highest towards HIV/AIDS, followed by TB and SARS. Using multi-sample model structural equation modeling, we found that the attributions of controllability, personal responsibility, and blame were applicable in explaining stigma across three disease types. Knowledge about the disease had no significant effect on stigma. Participants with less stigmatizing views had significantly more favorable attitudes towards government policies related to the diseases. The study is an important attempt in understanding the attributional mechanisms of stigma towards infectious diseases. Implications for stigma reduction and promotion of public awareness and disease prevention are discussed.

Seeking Professional Help: Etiology Beliefs About Mental Illness Across Cultures

In the present study, the authors examined the contributions of cultural beliefs about the etiology of mental illness to the seeking of help from mental health professionals among college students in 4 cultural groups, European Americans, Chinese Americans, Hong Kong Chinese, and Mainland Chinese. Group differences were found in help-seeking history and likelihood, with European and Chinese Americans being more likely to seek help than Hong Kong and Mainland Chinese. Multiple-group path analysis showed that lay beliefs about causes of mental illness and prior help-seeking history significantly predicted help-seeking likelihood, which was related positively to environmental/hereditary causes but negatively to social-personal causes. Our findings demonstrate the importance of understanding help-seeking patterns within specific cultural contexts and the effects of Western influences on shaping help-seeking propensities. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Internalization of stigma for parents of children with autism spectrum disorder in Hong Kong

An attribution model was tested to explain the internalization of stigma among parents of children with Autism Spectrum Disorder (ASD). In the model, the internalization paths from courtesy stigma to affiliate stigma and the impact of three types of social support on affiliate stigma and psychological well-being were examined. The study was conducted in Hong Kong, China; one hundred and eighty-eight parents of children with ASD were recruited to complete the questionnaire. The model showed excellent fit to the data. Path analysis suggested three possible paths of internalizing courtesy stigma, including the direct path to affiliate stigma, through perceived controllability, or through perceived responsibility and self-blame. Support from family, significant others, friends, or professionals was found to be related to affiliate stigma and psychological well-being differentially. The internalization of stigma among parents of ASD children was severe. The path model sheds light on possible ways to reduce stigma in future services.

Resilience: Enhancing Well-Being through the Positive Cognitive Triad.

The present study tested whether the relationships among resilience, life satisfaction, and depression could be explained by positive views toward the self, the world, and the future (positive cognitive triad). Structural equation modeling and mediation analyses were conducted based on 1,419 college students in Hong Kong. The model of positive cognitive triad as mediator between resilience and well-being fit the data (comparative fit index = .94, Tucker-Lewis index = .93, root-mean-square error of approximation = .08). Findings showed resilience to be significantly related to positive cognitions about the self, the world, and the future. Individuals who had higher level of resilience held significantly more positive cognitions and reported significantly higher levels of life satisfaction and lower levels of depression. The utility of the positive cognitive triad as the mechanism through which resilience enhances well-being was supported. Applications in cultivating resilience and positive cognitions in counseling services are discussed.

Combining education and video-based contact to reduce stigma of mental illness: "The Same or Not the Same" anti-stigma program for secondary schools in Hong Kong

This study examined the effects of three versions of school-based stigma reduction programs against mental illness - education, education followed by video-based contact (education-video), and video-based contact followed by education (video-education). The participants, 255 students from three secondary schools in Hong Kong, completed measures of stigmatizing attitudes (Public Stigma Scale), social distance (Social Distance Scale), and knowledge about schizophrenia (Knowledge Test) at pre-test, post-test, and 1-month follow-up. Results suggested that adding video-based contact to education could significantly improve program effectiveness only when video-based contact was presented after but not prior to education. In comparison with the education condition, the education-video condition showed larger improvements in stigmatizing attitudes at post-test, in social distance at both post-test and follow-up, and in knowledge at follow-up. However, such differences were not observed when the education condition was compared with the video-education condition. Implications of these findings for future research are discussed.

The phenomenon of somatization among community Chinese Americans.

ObjectiveThe phenomenon of somatization was explored in relation to the experiences of acculturation, stress, support, and distress.MethodsA representative community sample of 1,747 Chinese Americans (aged 18–65 years), selected by a multi-stage household sampling design, in the Los Angeles County was interviewed to tap their psychiatric diagnoses, symptomatology, level of acculturation, stress, and support.ResultsAcross all indices, Chinese Americans’ level of somatic symptoms, impairment related to somatization, and percentage of meeting the Somatic Symptom Index 5/5 (SSI 5/5) criterion were comparable to those found in other populations. Length of residence in the U. S. and acculturation were not related to somatization. Regression analyses showed that anxiety, depression, gender, age, education, stressors, and support were significantly related to somatization, ps<0.05. Somatizers tended to perceive themselves with poor health and utilized both Western and indigenous Chinese medicine.ConclusionThe importance of demographics, psychological distress, and stress was emphasized in the explanation of somatization tendencies among immigrant Chinese Americans. Somatization might be a stress response with regard to increased distress severity and psychosocial stressors rather than a cultural response to express psychological problems in somatic terms.

Help-seeking for mental health problems among Chinese

The underutilization of professional care is a perennial problem among Chinese populations. To examine the social-cognitive factors that may affect help-seeking intentions, the present study applied and extended Ajzen’s theory of planned behavior (TPB) to understand the intention to seek help from mental health professionals among Chinese. The effect of mental health and perceived barriers to help-seeking were also examined. Nine hundred and forty-one Chinese were recruited using a randomized household design in Hong Kong. Results from structural equation modeling showed that attitude, subjective norm, perceived behavioral control, and perceived barriers significantly predicted help-seeking intention. Mental health showed no significant effect on help-seeking intention. In addition, subjective norm indirectly predicted intention to seek help from mental health professionals through influencing attitude and perceived behavioral control. Results from multi-group analyses revealed that all path coefficients were invariant across gender. Results supported the utilization of TPB in understanding help-seeking intentions and highlighted the importance of subjective norm among Chinese. Implications on the enhancement of mental health awareness and the promotion of mental health services through a social-cognitive approach were highlighted.

Self-stigma among concealable minorities in Hong Kong: conceptualization and unified measurement.

Self-stigma refers to the internalized stigma that individuals may have toward themselves as a result of their minority status. Not only can self-stigma dampen the mental health of individuals, it can deter them from seeking professional help lest disclosing their minority status lead to being shunned by service providers. No unified instrument has been developed to measure consistently self-stigma that could be applied to different concealable minority groups. The present study presented findings based on 4 studies on the development and validation of the Self-Stigma Scale, conducted in Hong Kong with community samples of mental health consumers, recent immigrants from Mainland China, and sexual minorities. Upon a series of validation procedures, a 9-item Self-Stigma Scale-Short Form was developed. Initial support on its reliability and construct validity (convergent and criterion validities) were found among 3 stigmatized groups. Utility of this unified measure was to establish an empirical basis upon which self-stigma of different concealable minority groups could be assessed under the same dimensions. Health-care professionals could make use of this short scale to assess potential self-stigmatization among concealable minorities, which may hamper their treatment process as well as their overall well-being.

Gender and Ethnic Diversity in NIMH-funded Clinical Trials: Review of a Decade of Published Research

A total of 379 NIMH-funded clinical trials published between 1995 and 2004 in five major mental health journals were assessed on their inclusion of women and racial/ethnic groups in their study recruitment. Findings showed that whereas most of the studies reported gender information and gender representation was balanced across studies, less than half of the studies provided complete racial/ethnic information. All racial/ethnic groups except Whites and African Americans were underrepresented, a pattern that has not improved significantly over the last decade. Less than half of the studies had potential for subgroup analyses by gender and race/ethnicity.

Psychological Distress and Subjective Burden of Caregivers of People with Mental Illness: The Role of Affiliate Stigma and Face Concern

The present study tested the mediating role of affiliate stigma on the relationships between face concern with psychological distress and subjective burden among caregivers of people with severe mental illnesses. One hundred and eight Chinese caregivers in Hong Kong were surveyed. Based on Baron and Kenny’s (J Pers Soc Psychol 51:1173–1182, 1986) approach, affiliate stigma was found to serve as a partial mediator between face concern and caregiver distress and a full mediator between face concern and subjective burden. Cultural linkage of stigma and caregiver outcomes was identified, suggesting that researchers and practitioners should use a culturally sensitive approach to understand caregivers’ experience and alleviate their stigma.