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Introduction
My focus is on the social conditions that effect the lives of people with serious mental illness, especially the impact of stigma and cultural disparities
Skills and Expertise
Additional affiliations
January 2012 - present
January 2011 - present
January 2011 - present
Publications
Publications (625)
Background
Stigma of mental health conditions hinders recovery and well-being. The Honest, Open, Proud (HOP) program shows promise in reducing stigma but there is uncertainty about the feasibility of a randomized trial to evaluate a peer-delivered, individual adaptation of HOP for psychosis (Let's Talk).
Methods
A multi-site, Prospective Randomize...
Background
Self-stigma is associated with low self-esteem, high shame and reduced drinking-refusal self-efficacy in people with alcohol use disorder (AUD). The Self-Stigma in Alcohol-Dependence Scale-Short Form (SSAD-SF) was designed to enable a brief, but valid assessment of AUD self-stigma.
Methods
We reduced the 64-item SSAD, originally derived...
Purpose:
Research from Western societies indicates pervasive public stigma against people with alcohol use disorders (AUDs). However, there is a lack of knowledge about the interactions between different components of stigma and their contribution to discriminatory behaviour towards individuals with AUDs within the Chinese cultural context. The aim...
Objective: Compared to Western cultures, self-determination needs are expressed and pursued differently in Asian cultures, where interdependence and achieving greater good for the group are prioritized. To accommodate these needs, we propose the use of family-centered decision making (FCDM) to complement the shared decision-making (SDM) practice, f...
Objective: Traumatic experiences are prevalent among people with serious mental illness and can significantly worsen outcomes. This study aimed to identify an urban cluster of trauma types, compare continuous distress ratings versus categorical experience of trauma for predicting outcomes such as depression and quality of life, and investigate the...
The self-stigma of mental illness can undermine self-esteem leading to greater depression. This study examines the impact of varied models of self-stigma on Chinese with serious mental illness. First, we validate a progressive model of self-stigma. Then, we examine the mediating effects of self-esteem on stigma harm and depression. Finally, we exam...
Stigma toward mental health and substance use problems (MHSUP) represents a global public health challenge that undermines the quality of mental health care. This study looked at whether an anti-stigma intervention would result in a significant decrease in stigmatizing and discriminatory attitudes among Community Health Center (CHC) staff toward in...
Background
Self-stigma among people with mental illness is negatively associated with personal and clinical recovery. Due to the concealable nature of mental illness, people with mental illness experience constant struggles between concealment and disclosure. Disclosure of mental health challenges can potentially minimize negative impacts of self-s...
Many African-Americans with serious mental illness fail to engage in evidence-based programs that positively affect weight management. We examined how having a weight-related physical illness correlated with self-efficacy, recovery, and quality of life by contrasting illnesses with symptoms that are obviously perceived (e.g., sleep apnea and pain r...
Consequences of self-stigma exhibit a four-step regressive model from being aware of public stigma, to agreeing with it, to applying it to oneself, to resulting harm on the self. We hypothesize the relationship between self-stigma and psychosocial functioning is mediated by three constructs: the why try effect, stigma stress coping resources, and p...
Purpose
Many people with mental illness experience self-stigma and stigma-related stress and struggle with decisions whether to disclose their condition to others. The peer-led Honest, Open, Proud (HOP) group program supports them in their disclosure decisions. In randomized controlled trials, HOP has shown positive effects on self-stigma and stigm...
Background
Chile is implementing a Community Mental Health Model with a strong role of primary health care (PHC). PHC has great potential to early detection and provision of accessible and coordinated services to people who present mental illness and/or substance use issues (MISUI). However, stigma toward people with MISUI among PHC professionals i...
Formal peer-support services are provided by people with shared lived experience of serious mental illness and recovery to help others with psychiatric disabilities address their priorities in, among other things, transitioning from hospitals, dealing with physical health, and illness management/recovery. This article summarizes a systematic review...
The current study explored the understandings and experiences of Asian international students (AISs) in terms of mental health, disclosure and help-seeking within higher education (HE) in Scotland, UK. A qualitative study using individual semi-structured interviews with AISs (n=20) was used and an inductive thematic approach to analysis was conduct...
Engaging young people as peer researchers in mental health research
Involving children and young people as collaborators in youth mental health research is becoming more widely valued and recognised as essential to ensuring that research is relevant and responsive to their needs. Young people are often eager and capable of being involved in all stages of the research process (Mawn et al, 2015) yet little informatio...
People with mental illness are challenged by self-stigma, leading to a sense of behavioral futility and reduced goal seeking. Honest, Open, Proud (HOP) program is a peer service program that utilizes strategic disclosure to combat self-stigma. HOP was developed and predominantly examined in western culture, leaving unknown its effectiveness in East...
The stigma of behavioral health conditions can be explained in terms of stereotypes, prejudices, and discrimination. Stereotypes and prejudices often lead to discriminatory behaviors that limit access to rightful opportunities. Four types of stigma (self-stigma, public stigma, label avoidance and structural stigma) contribute to lower self-esteem,...
Stigma toward people with mental illness and substance use problems is a significant global concern, and prevents people with these conditions from accessing treatment, particularly in primary health care (PHC) settings. Stigma is a cultural phenomenon that is influenced by particular contexts and can differ by country and region. The majority of s...
Stigma and discrimination of people with substance use disorders (SUD) contribute massively to the harm done by their condition: stigma has negative effects on service engagement, life opportunities, and personal shame, both for those who struggle with substance abuse and their families. Overcoming the stigma of substance use disorders is essential...
Stigma and discrimination of people with substance use disorders (SUD) contribute massively to the harm done by their condition: stigma has negative effects on service engagement, life opportunities, and personal shame, both for those who struggle with substance abuse and their families. Overcoming the stigma of substance use disorders is essential...
Stigma and discrimination of people with substance use disorders (SUD) contribute massively to the harm done by their condition: stigma has negative effects on service engagement, life opportunities, and personal shame, both for those who struggle with substance abuse and their families. Overcoming the stigma of substance use disorders is essential...
Stigma and discrimination of people with substance use disorders (SUD) contribute massively to the harm done by their condition: stigma has negative effects on service engagement, life opportunities, and personal shame, both for those who struggle with substance abuse and their families. Overcoming the stigma of substance use disorders is essential...
The main objective of the present study was the translation of The Attribution Questionnaire (AQ-27) into Persian language (AQ-27-P), and analysis of psychometric properties for use in Persian-speaking population and to evaluate the responsibility and dangerousness models of mental illness stigma. 600 adults were selected through the quota sampling...
People with serious mental illness die up to 20 years younger than others in the same age group, with people of color showing even earlier death. The social disadvantages experienced by this group-for example, poverty, criminal legal involvement, and immigration-are further determinants of this disparity. Peer health navigators (PHNs) are people wi...
Many famous people have disclosed their mental illness to erase the harmful effects of stigma. This study examines the relative impact of disclosure stories from people who are or are not celebrities. We expected noncelebrities would be viewed as more similar and likeable and therefore have greater effects on stigma change. Research participants fr...
People with alcohol related liver disease (ALD) experience stigma and discrimination. This review summarizes the evidence on ALD stigma in healthcare and its implications for people with ALD, drawing from the literature on mental illness stigma and specifically the stigma of alcohol use disorder (AUD). Public stigma, self-stigma and structural stig...
The stigma of leprosy will have reduced effects if people cannot reliably perceive it. Two factors impact these perceptions: familiarity and entitativity. One hundred and forty-five participants tested this assertion using an online platform to complete measures of stigma about leprosy as well as measures of familiarity and entitativity. The group...
Diagnosing personality disorders (PDs) in adolescence is a complex and often controversial decision. While early diagnosis provides a pathway to treatment, stigmatizing labels might unintentionally increase prejudice and discrimination for youth and their families, resulting in harm and treatment avoidance. In this paper, we outline stigma‐related...
Purpose
The decision whether to disclose a mental illness has individual and social consequences. Secrecy may protect from stigma and discrimination while disclosure can increase social support and facilitate help-seeking. Therefore, disclosure decisions are a key reaction to stigma. The first aim of this study was to test a newly developed scale t...
Background: The lived experience of people with mood disorders may be leveraged to inform priorities for research, define key treatment outcomes, and support decision-making in clinical care. The aim of this mixed-methods project was to provide insight into how people with depression and bipolar disorder experience the impact of symptoms, their tre...
Strategies to diminish stigma’s harm are driven by three agendas. (1) A services agenda, which seeks to decrease stigma so people better engage in care, (2) a rights agenda, which seeks to stem the injustice of stigma so people are able to meet life goals and aspirations, and (3) a self-worth agenda, which strives to replace shame with self-affirmi...
The stigma of young children with mental health and/or neurodevelopmental disorders is experienced by their parents in at least two ways: self-stigma and vicarious stigma. Secrecy may diminish stigma through impression management or strategic disclosure. The present study explores the relationship between vicarious stigma, self-stigma, secrecy copi...
International students often face psychosocial, academic, financial and adaptation challenges within the Higher Education (HE) environment that may impact on their mental health. The current study explored the understandings and experiences of Asian international students (AISs) in terms of mental health, disclosure, help-seeking and adaptation spe...
Purpose
This study aims to examine the reliability and validity of the Arabic version of the attribution questionnaire (AQ).
Design/methodology/approach
The AQ is designed to assess attitudes, affects and behavioral intentions related to a hypothetical person diagnosed with schizophrenia. The original English version was translated into Literary A...
Background:
Recovery is an essential construct in healthcare treatment for patients diagnosed with severe mental illnesses (SMI). Of all the psychometric instruments available for measuring recovery, the 41-item Recovery Assessment Scale (RAS) is the most widely used. Several brief versions have been proposed, including the 24-item version. In thi...
Background: Self-stigma (the internalisation of negative stereotypes) is known to reduce help-seeking behaviours and treatment adherence in people who have a mental illness, resulting in worsening health outcomes. Moreover, self-stigma diminishes self-esteem and self-efficacy, and leads to higher levels of depression. Half of all lifetime cases of...
Community-based participatory research (CBPR) is an approach that involves community members in research, not as research participants, but as partners. However, few studies have examined CBPR projects conducted among African Americans with serious and persistent mental illness (SPMI). This article focuses specifically on the Inspiring Change (IC)...
Persons with Alzheimer’s disease (AD) may experience stigma related to having a neurodegenerative disease. This study combined attribution theory and constructs of aging bias (ageism, aging anxiety, anxiety about developing AD) to describe the stigma of AD. Two hundred and fifty-eight Amazon MTurk workers read a vignette describing an older adult,...
Viewing a stigmatized group as different from everyone else is believed to be a contentless stigma that leads to disdain. This study tests whether three emotions-intergroup anxiety, anger, and empathy-mediate the path between difference and disdain. Six hundred thirty-eight research participants from MTurk provided valid responses to an online surv...
This meta-analytic study synthesized findings from 108 independent data sets across 22 cultures to investigate whether the stigma internalization model (the internalization of experienced stigma and perceived stigma to self-stigma) is associated with well-being and recovery of people with mental illness. We also examined the moderating role of coll...
Introduction: This study sought to examine self-stigma at the intersection of two identities: mental illness and gender.
Methods: Using an MTurk panel, 100 self-identified men and women with and without mental illness (total N = 400) completed the Difference and Disdain Self-Stigma Scale.
Results: Significant effects were found for mental illness (...
Background
This study aimed to culturally translate the Attribution Questionnaire (AQ) to the Swedish language and examine the reliability and validity of the new Swedish version to measure stigma towards disability pension applicants in the Swedish context among psychiatrists and general practitioners.
Methods
The AQ was translated from the origi...
Background
The purpose of this study is to increase understanding of physicians’ attitudes towards disability pension applicants, and the impact of diagnosis. We hypothesize that physicians are more likely to think that patients with physical illnesses should get a disability pension than those with mental illness or alcohol dependence. Disability...
Purpose
As many as half of all college students meet DSM-5 criteria for a mental illness; less than 5% report the ability to successfully navigate and complete their degrees. This is in part due to the lack of knowledge of reasonable accommodations for psychiatric disabilities.
Method
In the current study, we conducted qualitative interviews with...
The stigma connected to some health conditions can interfere with care and impact an individual's overall health. In this entry we discuss types of stigma (e.g., public, internalized, associative) and various mechanisms whereby stigma influences health. Individuals with stigmatized health conditions such as mental illness, HIV, and drug addiction m...
Self-determination is a critical element of shared decision making among people recovering from mental illness. However, shared decision making between the patient and caregiver may not align with the accepted values of East Asian communities. Family-centered decision making may be considered a more adaptive approach for use among East Asian servic...
Background
People with mental illness are viewed as different and disdained by the general population leading to public stigma. When public stigma becomes internalized, it results in self-stigma. Content-less measures of stigma have shown to benefit studying public stigma, but research on self-stigma is limited.
Aims
This study sought to validate...
Purpose
This study aimed to evaluate the effectiveness of cognitive behavior therapy (CBT) on reducing self-stigma in Chinese people with depression.
Methods
By adopting a randomized controlled trial design, 62 participants with clinical depression were randomly assigned to a 10-session CBT or treatment as usual. Standardized assessment tools were...
Objectives
Self-stigma in parents of children with a mental health disorder is a painful experience, yet the process by which it is formed is poorly understood. A model of this process would improve our understanding and inform intervention development. The two existing models of self-stigma have not been tested with parents of children with a ment...
Purpose
While serious mental illness (SMI) and substance use disorders (SUD) are common, less research has focused on causal beliefs across conditions. This is an important question when trying to understand the experience of dual diagnosis. The purpose of this paper is to examine how three factors representing causal beliefs (biogenetic, psychosoc...
Hoarding disorder (HD) has been newly classified as a distinct mental disorder and is a considerable public health concern. Treatment ambivalence is a problem in this clinical population, and stigma of HD may be one potential factor contributing to an unwillingness to seek treatment. Stigma of HD is understudied, despite the media often perpetuatin...
Faith communities are important to the psychiatric care of people with mental illness. I distinguish the effects of two principles of becoming welcoming communities: compassion, in which the community accommodates members with mental illnesses so they are fully included, and dignity, which rests on the essential worth of everyone.
Background: Evidence supports the contribution of various stigma-related constructs to help-seeking. These constructs have yet to be tested in a single model among college students, a group highly affected by mental illness.
Aims: Using data from 153 college students, this study examines factors contributing to help seeking for mental illness.
Meth...
Background:
Research in the area of public stigma and Alzheimer's disease (AD) is limited to examining stigmatic beliefs towards persons aged 65 and over (i.e., persons with late-onset dementia). The aim of the present study was to compare college students' stigmatic attributions towards an older and a younger person with AD, using an attributiona...
Objective:
Currently there is no universally agreed upon language for those seeking psychiatric treatment, and labels commonly include patient, client, consumer, and service user. Although there is some research regarding preferences for label (Dickens & Picchioni, 2012), little is known about how people perceive an individual differently based on...
Purpose: Despite the importance of the stigma construct for the rehabilitation of people with severe mental illness, there are still no scales that offer a measurement for public stigma in Spanish with good psychometric properties. The aim of this paper is to refine and improve an existing scale to measure public stigma towards people with severe m...
The stigma associated with mental health problems leaves many feeling they have to ‘hide’ their difficulties. Supporting them in making disclosure decisions can potentially improve well-being, reduce self-stigma and support recovery processes. In this editorial we discuss the case for interventions designed for this purpose and present one prominen...
This study considers two of many messages that are used in antistigma campaigns: normalcy, that mental illness is like most kinds of illness-"You are just like me," and solidarity, that one's mental illness is accepted-"I stand with you." This study examined how research participants rated message merit: understandable, effective, and compelling. W...
Objective:
Peer coaches are an important element in supported education programs. Peers are students with lived experience in recovery. As coaches, they provide on-campus support to assist students with psychiatric disabilities.
Method:
A community-based participatory research (CBPR) team interviewed 44 participants including students with psych...
Stigmatizing attitudes among primary care (PC) providers potentially contribute to poor health outcomes for individuals with serious mental illness (SMI). In this pilot study, our primary aim is to test the feasibility, and preliminary implementation of two interventions (contact and education) to help change provider attitudes and behavior. Partic...
Objectives
Stigma toward people with mental health problems (MHP) in primary health care (PHC) settings is an important public health challenge. Research on stigma toward MHP is relatively scarce in Chile and Latin America, as are instruments to measure stigma that are validated for use there. The present study aims to validate the Opening Minds Sc...
Full copy of the Parents' Self-Stigma Scale
Although many college students face mental health challenges, the rate of mental health service utilization among students is low. Stigma complicates the experience of mental health problems, and interferes with students’ likelihood of pursuing needed services. This randomized controlled trial examines the effectiveness of a peer-led group-based in...
Objective: Peer services have been identified as a key agent in promoting recovery (both as an outcome and as a process) for people with co-occurring disorders. We attempt to make sense of this connection here by examining public perceptions of recovery and peer services separately for serious mental illness (SMI) and substance use disorder. Two di...
Objective:
Recovery from severe mental illnesses (SMI) has been described as an outcome (end state where persons are symptom free) or as a process (despite symptoms, people can pursue life goals). Less clear is whether recovery as a process has credibility in the substance use disorders (SUD) community. We examined how public perceptions and expec...
Purpose
Nurses and nursing students often hold stigmatizing attitudes toward patients with mental illness, contributing to poor health outcomes. To address this, direct contact with persons with lived experience in mental illness (i.e. consumers) has been integrated into training curricula. This has shown decreased negative attitudes and increased...
African Americans are burdened by high rates of obesity that contribute to chronic disease and early mortality. To tailor a weight loss intervention to meet the needs of African Americans with serious mental illness, a community-based participatory research (CBPR) team comprised primarily of African Americans with serious mental illness guided qual...
Background: People with mental illness are viewed as different from the general population resulting in public stigma. When public stigma becomes internalized, it leads to self-stigma. The most distal stage of self-stigma is harm which can lead to negative self-concepts that inhibit recovery.
Aim: This study examines how perceptions of “differentne...
Unemployment and mental disorders are associated with impaired quality of life. Because of the stigma associated with mental illness, unemployed individuals with mental health problems face the difficult decision whether to disclose their condition to others. Disclosure has both risks and benefits, and it is unclear how it affects quality of life....
Mental illness recovery has been described as an outcome (symptom free) or process (symptom management) where peer supporters are essential. Whereas, substance use disorder recovery endorses outcome alone: achieving recovery once abstinent. Peer supporters with an abstinence agenda use confrontation for those in denial. Herein, we unpack this disti...
Frequent calls for changing diagnostic labels to decrease stigma may result in unintended consequences. Condemning incorrect language by policing word choice oversimplifies the depth of work involved to increase opportunities for people with mental illness. This Open Forum reviews three unintended consequences of using scolding language.
For parents of children with a mental health disorder, self-stigma can negatively impact their self-esteem and empowerment. Although measures of self-stigma exist, these have not been created in consultation with parents of children with a mental health disorder. Thus, the aim of this study was to construct a new scale based on parents' experiences...
This paper reviews studies on familiarity of mental illness to determine the relationships that familiarity has with public stigma. We propose a U-shaped relationship between familiarity and stigma that includes the expected inverse distribution (greater familiarity leads to less public stigma) and a provocative, positive relationship (familiarity...
The “why try” effect, a consequence of self‐stigma, is a sense of behavioral futility that may worsen depression. This study examines the regressive model of self‐stigma, the factor structure of a why try measure, and the pathway through which self‐stigma leads to depression. Data from 291 people self‐identifying with mental illness were collected...
Purpose
The purpose of this paper is to look specifically at the intersection between behavioral health and immigration stigma.
Design/methodology/approach
In April of 2017, 256 US participants answered an online solicitation on MTurk to answer questions regarding perceptions of others. Participants were randomized to one of four vignettes which...
The author attended a conference whose goal was to understand how stigma harms people with fetal alcohol spectrum disorder (FASD) and their families. However, presentations were largely distant from the literature, seemingly unaware of the growing body of empirical research on stigma and stigma change related to health conditions in general. Dr. Ma...
Background: The painful experience of mourning after suicide can be further complicated by the stigma surrounding suicide survival. We investigated how grief and depression influence the perception of stigma towards survivors in a sample of help-seeking persons bereaved through suicide. Methods: Cross-sectional design. Information on sociodemograph...
Objective:
While suicide attempt survivors report feelings of shame and stigmatization, no published scale measures self-stigma experienced by attempt survivors. This article describes the creation and validation the Self-Stigma of Suicide Attempt Scale (SSSAS).
Methods:
The SSSAS was validated in an online sample (n = 292) of suicide attempt su...
The current opioid crisis in the U.S. is unprecedented and calling for a nationwide reorganization of the public health prevention program. Stigma is a persistent barrier to this agenda, unfortunately with a limited body of research on substance use disorder (SUD) available to inform it. We review the broader research literature on the stigma of be...