Stigma and Health

News media messages about people with opioid use disorders (OUDs) can circulate stigma by discussing the peril, or harm, those individuals cause to others. A recent study suggests that stigma peril can harm public attitudes and behavioral intentions toward people with OUDs (Ledford et al., 2022), but little is known about the direct outcomes of stigma peril or the mediating pathways through which opioid stigma peril influences stigma outcomes. Centered on the model of stigma communication (Smith, 2007; Smith et al., 2019), this study utilized a 2 (stigma peril: high, low) × 3 (opioid type: prescription opioid, heroin, fentanyl) between-subjects, online factorial experiment to investigate the effects of stigma peril on social distance, behavioral regulation, opioid-related policy support, and stigma message sharing through two primary mediation pathways: stigma beliefs and negative emotions. The study also examined the moderating role of personal experience with OUDs. Results among 364 U.S., English-speaking Amazon Mechanical Turk workers found evidence that opioid stigma peril directly harmed opioid-related policy support and indirectly predicted all four study outcomes through either stigma beliefs, negative emotions, or both mediators. Follow-up conditional indirect effects analysis revealed that anger and frustration served a mediating role only for people who had a close friend or family member with an OUD. Results of this study advance theoretical understandings of the stigma message effects process and suggest that health journalists, practitioners, and policymakers should avoid peril-based messaging. Additional theoretical and practical implications are discussed.

Drawing from intersectionality and minority stress theory, we examined the main and interaction effects of racial/ethnic discrimination, intraminority, and sexual minority stress on changes in disordered eating over the course of a month. Participants were 186 U.S. sexual minority men (SMM). Most participants (n = 139) reported a marginalized racial/ethnic identity (i.e., SMM of Color). Participants completed self-report measures at baseline and at 1 month follow-up. SMM of Color reported greater purging and muscle building than non-Latine White SMM. Our primary analyses revealed that the interaction effects between racial/ethnic discrimination and sexual minority stressors predicted increases in excessive exercise, binge eating, purging, and muscle building, such that at high levels of sexual minority stress, racial/ethnic discrimination predicted increases in disordered eating. However, for excessive exercise, at low levels of internalized stigma, experiences of racial/ethnic discrimination predicted increases in excessive exercise. Results from this study provide several targetable stress processes that may be used to guide the prevention and treatment of disordered eating in men with multiple marginalized identities. Our findings reinforce the necessity for culturally responsive/affirming care that recognizes the impacts of multiple identities and their respective experiences in the development and maintenance of disordered eating.

In this meta-analysis, we explored the association between individualistic versus collectivist cultures and levels of social distance from people with serious mental illness (SMI). Utilizing the social distance scale to measure societal attitudes, we systematically reviewed and analyzed data from 71 samples (extracted from 48 studies), revealing that collectivist cultures exhibited higher levels of social distance from people with SMI than did individualistic cultures. A possible explanation for these findings is that collectivist cultures, emphasizing social cohesion and conformity, view SMI as a threat to societal harmony, whereas individualistic cultures, which prioritize autonomy and self-expression, tend to be more accepting of SMI. These findings underscore the importance of considering cultural context in stigma reduction efforts and indicate the need for tailored interventions to reduce stigma and subsequently enhance the quality of life for individuals with SMI.

Affordance management theory explains the stigmatization of people based on the stereotypical threats or opportunities they pose to universal human goals. Previous research on affordance management theory suggests that the cause of stigma toward people with schizophrenia is the stereotype that they are a threat to the fundamental goal of physical safety. The purpose of this study was to replicate past findings using a large, representative sample. This study included a reanalysis of the mental health modules from the 2006 (N = 770) and 2018 (N = 480) General Social Survey. Participants considered vignettes describing a person with schizophrenia or depression and then rated their perceived risk of violence, desire for social distance, and treatment recommendations. Results supported affordance management theory by showing increased perceptions of violence in schizophrenia compared with depression. In addition, schizophrenia prompted an increased desire for social distance in high-contact social situations and increased endorsement of segregation in mental hospitals. Overall, this study was a meaningful step forward in the application of affordance management theory to mental illness stigma and demonstrated that the theory can offer new insights into existing data.

Moral values play an important role in understanding stigma toward people with opioid use disorder (OUD) and attitudes toward related treatment modalities, given the moralized nature of substance use disorders in the United States. This study explored how moral values, attributions about OUD, and demographic factors influence stigma and attitudes toward methadone clinics. Using structural equation modeling (SEM), this study analyzed data from a 2 × 2 between-subjects factorial survey design (n = 248). Participants, recruited via the online survey platform Prolific, were demographically diverse but predominantly White. Measures included the Moral Foundations Questionnaire and scales assessing attributions, stigma, and attitudes toward a hypothetical methadone clinic. Endorsement of care and fairness values was generally associated with reduced stigma and favorable attitudes toward the methadone clinic, both directly and mediated by making less attributions of OUD to irreligiosity and character flaws. In contrast, values of purity, loyalty, and authority were generally linked to heightened stigma indirectly through more attributions of OUD to irreligiosity and character flaws. Methadone clinic proximity effects revealed stronger negative attitudes among middle- to upper class participants when the clinic was described as closer to home compared to lower class participants. Recognizing the influence of moral values and demographic characteristics in advocacy and education efforts, potentially reframing perceptions of OUD and its treatments.

Antistigma campaigns and interventions have been responsible for myriad positive outcomes across domains (e.g., HIV/AIDS, addiction, mental health); there have also been frequent calls to maximize success by considering adverse unintended effects. Aligning with such calls, this special issue of Stigma and Health focuses on the adverse unintended effects that can result from well-meaning antistigma efforts. This introductory article to the special issue first describes how adverse unintended effects stemming from prosocial action have long been a concern across many fields. Next, we highlight examples of adverse unintended effects and calls for action specific to antistigma campaigns and intervention messages. We then briefly describe the nine articles comprising this special issue. Articles focus on numerous conditions (e.g., substance abuse, anorexia nervosa, depression, Alzheimer’s disease) and a range of outcomes (e.g., increased stigma, feelings of being negatively stereotyped). Quantitative, qualitative, and conceptual approaches toward uncovering and understanding adverse unintended effects are represented. In totality, the articles highlight the possibility of adverse unintended effects and the need to consider this possibility in development and evaluation efforts. A greater focus on adverse unintended effects can help maximize the success of well-intended antistigma campaigns and interventions.

Depression and type 2 diabetes are chronic conditions which are often stigmatized and when left untreated have negative impacts on health outcomes. This study examined the relationship between demographics, diabetes, depression, and three dimensions of stigma (personal stigma, community stigma, and stigma concerning future success); 190 adults were field recruited in Mexico City by a Spanish-speaking research team to participate in a health survey using an experimental vignette methodology. Seemingly unrelated regression was used to estimate the three dimensions of stigma. Findings indicate that the gender of the vignette subject differentially impacted stigma toward those with depression and/or diabetes. Community-level stigma was higher toward women experiencing symptoms of depression than toward men. Personal-level stigma and stigma concerning one’s future success were also higher toward women with co-occurring depression and diabetes than for men. Men who had both diabetes and depression experienced less personal social distance stigma and less stigma related to future success than those who experienced only depression. These findings indicate that both genders of the vignette subject and if he/she also has symptoms of type 2 diabetes influence the levels of stigma expressed toward individuals with depression in Mexico City. Suggestions for future research, along with implications for health care practice, including health literacy and stigma reduction efforts are presented.

Borderline personality disorder (BPD) is a psychological condition associated with significant impairments in psychosocial functioning. Sexual minority individuals, such as those identifying as lesbian, gay, and bisexual, are at elevated risk for BPD. Experiences of invalidation are strongly associated with BPD and commonly reported by sexual minorities. However, little research has examined how different forms of invalidation, including sexual minority stigma, confer risk for BPD, particularly in diverse and resource-limited contexts. We examined associations between experiences of parental invalidation, sexual orientation microaggression, internalized homophobia, and BPD symptoms among 130 lesbian, gay, and bisexual adults in Malaysia, where sexual minority identities remain highly stigmatized. In addition, we investigated whether self-compassion serves a protective role. Participants were recruited from the community and completed online questionnaires assessing the above constructs. Results from hierarchical linear regressions indicated that experiences of parental invalidation and sexual orientation microaggression (but not internalized homophobia) were associated with more severe BPD symptoms. Self-compassion did not moderate these associations but was independently associated with less severe BPD symptoms, above and beyond experiences of invalidation. Our findings provide further evidence for the key role of environmental invalidation in conferring risk for BPD among sexual minorities and suggest potentially important implications for understanding and treating BPD.

Mental health stigma poses a significant burden on affected individuals, particularly adolescents, who are especially vulnerable to its consequences. However, the processes and predictors of adolescent mental health stigma remain underexplored. Guided by the Etiology and Effects of Stigma model, this study examines a broad range of factors that shape mental health stigma in this population. Data were drawn from the Red Noses Culturally Sensitive Stigma Survey, a cross-sectional study involving 4,752 final-grade students across 38 secondary schools in Flanders, Belgium. Stigmatizing attitudes and social distance were assessed using a vignette describing a peer with depressive symptoms. Stepwise multilevel linear regression models revealed key differences in stigma based on social background and elucidated the nuanced roles of familiarity and causal attributions. Notably, a dissonance emerged between stigmatizing attitudes and social distance, suggesting that endorsing stereotypes does not necessarily translate into discriminatory behavior. Furthermore, our findings diverge from previous research on the Etiology and Effects of Stigma model in adults, indicating that while contact-based and attributional factors significantly influence stigma, they do not fully explain variations across social backgrounds. These findings underscore the complex and multifaceted nature of adolescent mental health stigma and highlight the limitations of interventions that focus solely on altering attributions to mitigate stigma.

Nonsuicidal self-injury (NSSI) is highly stigmatized and increasingly prevalent among young adults. Perceived public NSSI stigma may hamper help-seeking, decrease social support, and impede the development of effective public health interventions to address NSSI. Research has been limited, however, by the lack of validated measures of perceived public NSSI stigma, which may be less prone to social desirability biases than other self-report measures of stigma. Thus, we adapted an existing measure of suicide attempt stigma (Scocco et al., 2012) to develop a measure of perceived public NSSI stigma (Stigma of Nonsuicidal Self-Injury [STONSI] scale). In two samples of young adult university students (one not screened and one prescreened for elevated depressive symptoms), we found support for a two-factor structure of the STONSI (one factor with reverse-coded items and one factor with non-reverse-coded items), which is used to create an average of all items, consistent with that identified for the suicide attempt stigma measure from which it was adapted. The STONSI exhibited strong internal consistency as well as within-person stability over a 6-week follow-up period. STONSI scores did not differ by lifetime history of NSSI; however, perceived public NSSI stigma was associated with indicators of NSSI severity. Future work is needed to test the validity and reliability of the STONSI in diverse samples with respect to age, clinical setting, and cultural context. If results are replicated, the STONSI may be a valuable tool for future research on NSSI stigma, its correlates, and the development of NSSI stigma interventions.

Both experiences of weight stigma (EWS) and the internalization of weight bias (IWB) have been linked to negative health outcomes. The relationship between weight stigma (EWS and IWB) and gastrointestinal (GI) symptoms, however, has not yet been explored. The aim of the present study was to assess the associations between weight stigma (EWS and IWB) and general GI symptoms and irritable bowel syndrome (IBS). Participants (N = 406) were recruited through a Qualtrics research panel, approximating the body mass index distribution across adults in the United States. Five general GI symptom clusters (i.e., epigastric pain, diarrhea and discomfort, reflux, nausea and vomiting, constipation) were assessed, along with total GI symptom burden and symptoms consistent with IBS. In hierarchical regression analyses, EWS and IWB showed significant positive associations with each GI symptom cluster (epigastric pain, diarrhea and discomfort, reflux, nausea and vomiting, constipation) and total symptom burden. Binary logistic regression was also conducted to assess the association between IWB, EWS, and IBS. Both IWB and EWS were significantly associated with IBS in separate regressions. Results suggest that both EWS and IWB may be linked to experiences of GI symptoms, including IBS. Future research should explore the existence of these relationships, determine the stability of the associations, and identify any causal pathways.

Self-stigma is pervasive among adults with mental health, drug use, and carceral histories. Yet, existing instruments are limited because they are lengthy and capture a single type of self-stigma, imposing significant respondent burden and resulting in incomplete assessment. This study describes the development and psychometric evaluation of a brief instrument of criminal justice (CJ), opioid use disorder (OUD), and mental health disorder (MHD) combined self-stigma. Participants (N = 213) were justice-involved adults with OUD and MHD who completed a survey from August 2023 to January 2024 on sociodemographic characteristics; three validated measures of self-stigma; psychological distress; active concealment of CJ, OUD, and MHD; and health-related quality of life (QOL). Analyses included exploratory factor analysis, confirmatory factor analysis, and structural equation modeling. Four exploratory factor analysis models were compared. Fit indices, factor loadings, and the meaning of factor indicators were examined. MHD self-stigma was associated with greater psychological distress (p < .001), more active concealment (p < .001), and poorer mental health QOL (p = .001). CJ self-stigma was associated with more active concealment (p = .007) but also better mental health QOL (p < .001). While correlated with MHD and CJ self-stigma, OUD self-stigma was not related to the health outcomes (p > .05 for all outcomes). OUD, MHD, and CJ self-stigma are correlated yet distinct and can be measured with a single, brief 12-item instrument. Preliminary construct validity was supported through associations with poorer health, but further evaluation of the validity and reliability of the brief instrument is needed.

People with depression, a commonly stigmatized disease, often experience discrimination that can negatively impact their academic achievement, access to housing, and health outcomes. Mediated intergroup contact (MIC) suggests that positive media representations of mental illness can attenuate the stigmatizing attitudes held by the general public and promote behaviors that may close the disparate gaps in health outcomes. However, much of the research on MIC focuses on how high-status social groups (e.g., neurotypical groups) perceive and react to stigmatized social groups (e.g., neurodivergent groups). Therefore, this study examined how exposure to one of three narratives about depression (vs. a nonhealth-related narrative control) impacted individuals diagnosed with depression (n = 414) and individuals never diagnosed with depression (n = 350). Findings suggest that those never diagnosed with depression reported more theoretically consistent results regarding intergroup attitudes and behavioral intentions to participate in intergroup interactions and vote on health policies, while those diagnosed with depression had more mixed results. The expected similarities and unexpected differences between the groups may inform theoretical implications regarding MIC generally and practical suggestions regarding the use of entertainment media as an intervention to promote intergroup and intragroup relationships and avoid self-stigma among those diagnosed with a stigmatized disease.

Antistigma campaigns and intervention messages have the potential to reduce the harmful stigmatization of various conditions (e.g., HIV/AIDS, mental illness). However, antistigma messages also have the capacity to cause adverse unintended effects. Scholars have long noted this possibility—which is not unique to antistigma efforts—but consideration of adverse unintended outcomes in antistigma campaigns and interventions still lacks necessary attention. We provide a typology of adverse unintended effects to help categorize and catalyze research in this area, aiming to draw additional focus to the issue and aid scholars and practitioners who seek to minimize the likelihood of adverse unintended effects. Our typology categorizes unintended message effects that can negatively influence the general population and those with stigmatized conditions. We provide three broad categories of adverse unintended effects on the general population and three broad categories focused on those with a stigmatized condition, each containing multiple subcategories. Steps for using this typology to minimize adverse unintended effects are provided. We also describe what we hope will become a new normal for antistigma efforts, including equal attention to favorable and adverse outcomes. Critically, our typology is not intended to argue against antistigma messaging, nor is it a condemnation of those who take on the admirable challenge of using messages to improve the plight of those with stigmatized conditions. Instead, we hope the typology assists in minimizing adverse unintended effects so that favorable outcomes can be maximized.

Out-of-date HIV knowledge among health care workers (HCWs) can hinder the quality of care for people with HIV (PWH) and contribute to stigmatizing attitudes and behaviors. However, the role of HIV knowledge on stigma and mechanisms underlying HCWs’ attitudes and behaviors remain understudied. This study examined empathy and social distance as mediators in the relationship between HIV knowledge and stigma toward PWH among HCWs. Cross-sectional data from 219 HCWs were collected at two clinics in the Dominican Republic. Serial mediation analyses examined the indirect effects of HIV knowledge on stigmas (i.e., worry related to contracting HIV, taking additional infection precautions, and moralizing opinions about PWH’s behaviors) through empathy and social distance, adjusting for age and sexual orientation. Mean age was 42.16 years (SD = 11.97). Most participants identified as female (79.9%), heterosexual 68.9%, and multiracial (71.7%). The serial mediation models revealed significant indirect effects, suggesting that insufficient HIV knowledge was associated with less empathy toward PWH (B = 1.92, β = .33, SE = .37, p < .001). Lower empathy, in turn, was associated with greater desire for social distance (B = .15, β = .18, SE = .06, p = .009). Greater social distance was subsequently linked to increased worry related to contracting HIV (B = .13, β = .21, SE = .04, p = .001), taking additional infection precautions (B = .06, β = .14, SE = .03, p = .035), and more moralizing opinions about PWH (B = .11, β = .13, SE = .05, p = .027). Interventions that improve HIV knowledge and foster empathy, thereby possibly reducing the desire for social distance from PWH among HCWs, should be explored to test their potential to mitigate HIV stigma and enhance care outcomes for PWH.

Valid measures are essential to identify barriers to therapy-seeking in Brazil. Thus, the aim of this study was to adapt and examine the psychometric properties of the Self-Stigma of Seeking Help Scale (SSOSH), Perceptions of Stigmatization by Others for Seeking Help, Mental Help-Seeking Attitudes Scale (MHSAS), and Mental Help-Seeking Intention Scale. Data were collected from a community sample (n = 307) and a hard-to-reach group of civilian police officers (n = 94), and invariance analyses were conducted to assess whether the measures had similar psychometric properties across the two groups. The SSOSH and MHSAS achieved scalar invariance, while the Perceptions of Stigmatization by Others for Seeking Help and Mental Help-Seeking Intention Scale achieved metric invariance. Follow-up analyses indicated that the police officers reported higher SSOSH scores than the community members, though there were no group differences on the MHSAS. This study is the first to conduct a comprehensive invariance examination of these specific scales.

Sluggish cognitive tempo (SCT), a syndrome of inattention characterized by daydreaming, spaciness, confusion, and slow thinking and behavior, is strongly correlated with childhood trauma and symptoms resembling trauma-related dissociative disorders. Without trauma recognition, those with SCT may face label-based stigma that could negatively impact their psychosocial well-being and access to trauma-informed care. However, research regarding the impact of diagnostic labels and perceived etiology on perceptions of individuals presenting with SCT symptoms is lacking. In a 3 × 3 vignette-based study featuring a story of a protagonist with dissociative, hypoactive symptoms (N = 372 mostly female, White university undergraduate students), we investigated stigma of the label SCT (vs. a less pejorative proposed label, cognitive disengagement hypoactivity syndrome [CDHS], and no label) and its perceived etiology (childhood trauma, biogenetic, or unknown). Our key findings were that recovery optimism, or the belief that someone is capable of recovery, is higher when a childhood trauma history is recognized as the etiology compared to a biogenetic or unknown etiology, regardless of diagnostic label. Also, blame was higher toward childhood trauma and unknown etiologies but lower toward a biogenetic etiology. Finally, the SCT label predicted significantly lower recovery optimism based on the name alone, but CDHS did not. There were no significant differences between groups in the other stigma variables (perceived competence, likability, and status). Implications of these novel findings are discussed in terms of clinical recommendations and trauma survivor advocacy.

Transgender and gender nonconforming (TGNC) individuals have been described as suffering from societal stigma across a variety of health dimensions, including food vulnerability and worse nutritional outcomes. Identifying personal predictors of stigma toward TGNC individuals among registered dieticians (RDNs) and dietetics students may help address these neglected needs. A total of 172 participants were surveyed (128 completed surveys, response rate 74.41%). Psychometric questionnaires (personality traits by Big Five Inventory, inclination toward intuitive eating by Intuitive Eating Scale, attitudes toward individuals with larger bodies and TGNC people according to the Attitude Towards Obese People and Attitude Towards Transgender People, respectively) and sociodemographic characteristics were recorded. Females comprised 86% of the sample. RDNs composed 58% of the sample, and the remaining 42% were dietetics students. Statistical analyses included analysis of covariance and partial correlations by Spearman’s ρ coefficients, both corrected for age. No significant difference was observed between RDNs and dietetics students in relation to attitudes toward TGNC individuals (F = .886, p = .350). Openness to experience (partial ρ = .374, p = .003), intuitive eating (body food choice congruence: partial ρ = .306, p = .015; unconditional permission to eat: partial ρ = .255, p = .044), and attitudes toward individuals with larger bodies (partial ρ = .408, p < .001) were positively correlated with better attitudes toward TGNC people. The present study suggests that promoting gender-inclusive and weight-positive content within dietetic education, while also increasing representation of diverse body weights and shapes, could address neglected needs across gender-diverse individuals.

Latino and Black sexual minority men (SMM) are at elevated risk of cigarette use compared to their heterosexual and White SMM counterparts. Internalized homophobia may affect substance use disparities. However, the research linking internalized homophobia and substance use has been inconsistent. The purpose of the present study was to clarify the association between internalized homophobia and daily cigarette use by testing the roles of internalized racism and ethnic identity acceptance as potential moderators of this link. This study collected data from 165 Black and/or Latino SMMs across the United States (Mage = 23.72, SD = 3.85) as part of a larger study. Data were collected from December 2020 to February 2021 via Qualtrics Panels. Zero-inflated Poisson regression was conducted to examine the association between internalized homophobia and daily cigarette use and whether internalized racism and/or ethnic identity acceptance would moderate the association between internalized homophobia and daily cigarette use. Internalized homophobia was negatively associated with daily cigarette use; however, this association was significantly moderated by internalized racism and ethnic identity acceptance. Simple slope analyses revealed that low levels of internalized racism and high levels of ethnic identity acceptance attenuated the positive association between internalized homophobia and daily cigarette use. At low levels of ethnic identity acceptance, the positive association between internalized homophobia and daily cigarette use was strengthened. This research aids in contextualizing the association between internalized homophobia and daily cigarette use among Latino and Black SMM. Implications for smoking treatment and prevention programs are discussed.

Health workers hold stigmatizing attitudes toward people with mental distress, and contact-based interventions have been developed to address these attitudes. However, measures used to evaluate interventions have mixed validity support, including measures developed with service user involvement. The present study intended to provide a psychometric examination of one such measure, the 15-item Opening Minds Scale for Health Care Providers (Kassam et al., 2012; Modgill et al., 2014). With 286 health worker participants from a paid academic survey platform, including 19 retest samples, the focus was on addressing methodological limitations of previous psychometric evaluations. Current data demonstrated mixed fit to the known correlated three-factor structure (standardized root-mean-square residual [SRMR] = .057, root-mean-square error of approximation [RMSEA] = .054, comparative fit index = .754, Tucker–Lewis fit index = .897) and poor fit with the unidimensional model (SRMR = .080, RMSEA = .084, comparative fit index = .418, Tucker–Lewis fit index = .755). Data fitting to the bifactor solution (a structure comprising a general factor and three lower order factors) was attempted but did not converge. Scores had strong internal consistency (ωt = .73–.86), very weak test–retest reliability (r = −.46 to .21), and weak to moderate albeit statistically significant support for the interrelationship between the factors (rs = .32–.55). There is some evidence to consider the 15-item Opening Minds Scale for Health Care Providers as a viable measure of stigmatizing attitudes. However, further robust and transparent evaluations are still needed to surface better validity support.

People with disabilities (PWDs) experience public stigma, which can be internalized as self-stigma. While some individuals succumb to this internalization, others exhibit greater resistance. This study seeks to understand the factors contributing to these differing responses. We hypothesized that PWDs may develop a greater sense of belonging to their disability community as a response to facing public stigma, which can lead to feelings of pride in their disability. This pride can mitigate the internalization of public stigma into self-stigma and further alleviate associated negative psychosocial outcomes. We conducted a cross-sectional survey for PWDs (n = 220), assessing their enacted stigma (i.e., exposure to public stigma), self-stigma, belongingness in the disability community, and disability pride, alongside psychosocial outcomes like self-esteem and depression and anxiety symptoms. Through a series of structural equation modeling analyses, we built increasingly complex models. Model 1 demonstrated that a sense of belonging mediates the relationship between enacted stigma and disability pride. Model 2 introduced a serial mediation, with both belonging and disability pride mediating the link between enacted stigma and self-stigma. Models 3 and 4 further showed that disability pride is linked to increased self-esteem and reduced depression, thus buffering the effects of self-stigma. Our results indicate that cultivating a sense of belonging and disability pride plays a significant role in reducing self-stigma and its adverse effects. These findings also suggest potential strategies for researchers, professionals, and policymakers to support engagement in one’s community and develop pride as mechanisms to enhance the psychosocial well-being of individuals with disabilities.

Mental health stigma is common in the Middle East, particularly the stigma related to psychosis; however, there is limited research in understanding stigma from the individual, family/carer, and public perspective and limited evidence outlining the availability and acceptability of antistigma interventions for this population. The aim was to undertake a systematic review and narrative synthesis examining experiences of the stigma of psychosis from the perspective of Middle Eastern populations (the individual, family/carers, and the public) and examining the effectiveness of available antistigma interventions. Four databases (Medline, APA PsycInfo, Embase, and Web of Science) were searched for eligible studies. Studies were included if (a) participants were Middle Eastern ethnicity adults and (b) they examined experiences of stigma of individuals with psychosis, families/carers, stigmatizing public attitudes, or the utility of psychosis stigma interventions or campaigns. A narrative synthesis was undertaken to analyze results. A total of 18 studies were included in the review. Eight studies addressed the personal stigma experiences from the perspective of the person with psychosis or family member/carer and concluded with themes of rejection, oppression, isolation, lack of awareness, negative labels, and burden. Six addressed the population attitudes to psychosis in the Middle East which reported preferences of distance, lower chances of employability, negative labels, and rejection of close relationships. Four studies evaluated antistigma interventions for psychosis in the Middle East and found that antistigma intervention studies demonstrated that the interventions were feasible and acceptable. Evidence from two trials suggests that antistigma interventions can help reduce internalized stigma for people with psychosis from Middle Eastern populations. Stigmatizing beliefs and attitudes toward psychosis were identified among different Middle Eastern populations; however, the influence of cultural variations should be explored in future research. There are also insufficient data to recommend any specific intervention to reduce stigma related to psychosis in Middle Eastern populations, and further research is needed.

Microaggressions are pervasive in everyday life for individuals who hold marginalized identities, such as persons with disability. Although disability comprises the largest minority group in the world, limited research examines microaggressions among persons with disability. The purpose of this study was to examine the experience of microaggressions among women with physical disability. Recruited from social media groups, women with physical disability (N = 108) completed an electronic survey including the Ableist Microaggressions Scale and a demographics questionnaire, which included disability-specific questions (e.g., age of onset). All participants reported some level of microaggressions. The study also found that specific experiences, including number of surgeries, age of onset, and number of health concerns were associated with the number and type of reported microaggressions. Findings from this study further our understanding of microaggressions encountered by women with disability, a group underrepresented within the research. Further implications are discussed.

Self-stigma is associated with negative mental health and treatment outcomes. Interventions that target self-stigma among individuals with mental health difficulties are needed. The aim of the present study was to develop and test the feasibility, acceptability, and preliminary effect of a single-session, acceptance-based behavioral therapy (ABBT) workshop for self-stigma (The Mindful Way Through Self-Stigma) among adults waiting to receive treatment at outpatient mental health clinics. Participants (N = 39) participated in a virtual, 2-hr, ABBT-based group workshop designed to target self-stigma. Participants completed self-report questionnaires assessing levels of self-stigma and hypothesized mechanisms of change (experiential avoidance, mindfulness, and values-based actions) at baseline, 1-week, and 1-month follow-up. Participants also completed self-report measures of satisfaction and provided feedback via qualitative interviews after the workshop. Overall, feedback indicated that participants found the program to be acceptable and helpful. Findings from repeated measures analyses of variance showed that self-stigma and experiential avoidance significantly decreased, and mindful acceptance significantly increased, over the course of the study. Changes in self-stigma were associated with changes in experiential avoidance and mindful acceptance. To our knowledge, this is the first study to examine a brief, group-based, telehealth-delivered ABBT-based intervention that is designed to target self-stigma across a range of diagnostic presentations. The present study extends the literature on the promise of ABBT-based interventions for self-stigma and addresses a need for shorter self-stigma interventions that can be easily disseminated at scale and integrated into existing mental health care systems.

The Hispanic/Latinx community has shown stigma toward psychological illness. However, minimal research has examined stigma toward attention-deficit/hyperactivity disorder (ADHD) in this population. This study experimentally examined stigma toward ADHD compared to depressive symptoms or no symptoms. Participants included 192 U.S. Hispanic/Latinx adults who were randomized into reading one of three vignettes: an individual with ADHD symptoms, an individual with depressive symptoms, or an individual without any psychological symptoms (control). Subsequently, participants completed a public stigma measure toward the individual in the vignette and rated the individual’s need for treatment. The ADHD group and the depression group had significantly higher public stigma and treatment need than the control group. The depression group had significantly higher public stigma and treatment need than the ADHD group. Our findings suggest that interventions that reduce stigma for ADHD and depression are needed in the Hispanic/Latinx community.