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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 through an online survey. Participants completed the Why Try Stigma Scale (WTSS) and measures of self-stigma and depression. Structural equation modeling was used to test the WTSS factor structure and path models. Reducing the WTSS from 12 to 6 items led to good fit. The regressive model of self-stigma was validated. A good fit was demonstrated for a model in which harm leads to unworthiness, then incapability, and then depression. The regressive model worsens sense of worthiness, which in turn affects personal capability, resulting in increased depression.

Background and Objectives Although advocates and providers identify stigma as a major factor in confounding the recovery of people with SUDs, research on addiction stigma is lacking, especially when compared to the substantive literature examining the stigma of mental illness. Methods A review of key studies from the stigma literature that yielded empirically supported concepts and methods from the mental health arena was contrasted with the much smaller and mostly descriptive findings from the addiction field. Results Integration of this information led to Part I of this two part paper, development of a research paradigm seeking to understand phenomena of addiction stigma (eg, stereotypes, prejudice, and discrimination) and its different types (public, self, and label avoidance). Conclusions and Scientific Significance In Part II paper (American Journal of Addictions, Vol xx, pages xxx–xxx, this issue), we address how this literature informs a research program meant to develop and evaluate and stigma strategies (eg, education, contact, and protest). Both papers end with recommendations for next steps to jumpstart the addiction stigma portfolio. Here in Part I, we offer one possible list of key research issues for studies attempting to describe or explain addiction stigma. (Am J Addict 2016;XX:1–8)

Advocates and scientists have partnered to develop and evaluate programs meant to erase the egregious effects of the different forms of stigma. Enough evidence has been collected to yield lessons about approaches to stigma change. Some of the most insightful of these lessons emerge from unintended consequences of good intentioned approaches, and are the focus of this paper. They include the limited benefits of education especially when compared to contact, beating stigma is more than changing words, beware pity as a message, understand the competing agendas of stigma change, replace ideas of normalcy with solidarity, and avoid framing self‐stigma as the problem of people with mental illness and not of society. The paper ends with consideration of the back seat role that psychiatrists and other mental health providers should have in stigma change.

Previous research about coping with the stigma of mental illness mostly relied on cross-sectional or qualitative research designs. In the present study, the consequences of ten identity management strategies for mental illness stigma were observed in a longitudinal design. Cross-lagged analyses were used to describe the influence of the strategies on the frequency of stigma experiences and on mental health in a two-wave panel of people with mental illness (*N* = 367, 79% repeated response rate). Selective disclosure and information seeking emerged as adaptive identity management strategies, whereas overcompensation and withdrawal led to lower mental health. Results were mostly unaffected by demographic and psychiatric variables. The results support an empowerment model of stigma resilience that portrays stigmatized people as active constructors of their social world.

Schomerus G, Schwahn C, Holzinger A, Corrigan PW, Grabe HJ, Carta MG, Angermeyer MC. Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Objective: To explore whether the increase in knowledge about the biological correlates of mental disorders over the last decades has translated into improved public understanding of mental illness, increased readiness to seek mental health care and more tolerant attitudes towards mentally ill persons. Method: A systematic review of all studies on mental illness-related beliefs and attitudes in the general population published before 31 March 2011, examining the time trends of attitudes with a follow-up interval of at least 2 years and using national representative population samples. A subsample of methodologically homogeneous studies was further included in a meta-regression analysis of time trends. Results: Thirty-three reports on 16 studies on national time trends met our inclusion criteria, six of which were eligible for a meta-regression analysis. Two major trends emerged: there was a coherent trend to greater mental health literacy, in particular towards a biological model of mental illness, and greater acceptance of professional help for mental health problems. In contrast, however, no changes or even changes to the worse were observed regarding the attitudes towards people with mental illness. Conclusion: Increasing public understanding of the biological correlates of mental illness seems not to result in better social acceptance of persons with mental illness.

Objective: Mental illness stigma is common, but it is unclear why it affects some individuals more than others. We tested the hypothesis that the way persons with mental illness perceive their ingroup (people with mental illness) in terms of group value, group identification and entitativity (perception of the ingroup as a coherent unit) shapes their reaction to stigma. Method: Ingroup perceptions, perceived legitimacy of discrimination and reactions to stigma (educating or helping others, social performance, secrecy, social distance, hopelessness) were assessed among 85 people with mental illness using questionnaires and a standardized role-play test. Results: Controlling for depression and perceived discrimination, high group value and low perceived legitimacy of discrimination predicted positive reactions to stigma. High group identification and entitativity predicted positive reactions only in the context of high group value or low perceived legitimacy of discrimination. Conclusion: Group value and perceived legitimacy of discrimination may be useful targets to help people with mental illness to better cope with stigma.

Many individuals with mental illnesses are troubled by self-stigma and the subsequent processes that accompany this stigma: low self-esteem and self-efficacy. "Why try" is the overarching phenomenon of interest here, encompassing self-stigma, mediating processes, and their effect on goal-related behavior. In this paper, the literature that explains "why try" is reviewed, with special focus on social psychological models. Self-stigma comprises three steps: awareness of the stereotype, agreement with it, and applying it to one's self. As a result of these processes, people suffer reduced self-esteem and self-efficacy. People are dissuaded from pursuing the kind of opportunities that are fundamental to achieving life goals because of diminished self-esteem and self-efficacy. People may also avoid accessing and using evidence-based practices that help achieve these goals. The effects of self-stigma and the "why try" effect can be diminished by services that promote consumer empowerment.

A way to promote eliminating stigma surrounding mental illnesses is targeting the phenomenon in children. This study's purpose is to validate models of mental illness stigma on children in Grades 6–8. Children completed the revised Attribution Questionnaire in a pretest of a larger study on a mental health education program. Data from this study permitted testing of roles of demographics in these social cognitive models. Subsequent analyses using manifest model structural equations were mixed, but mostly showed adequate fit for multiple versions of the models. These results suggest that models of blame and dangerousness are relevant to the way 10 to 13-year-olds stigmatize mental illness. Demographics were not found to fit these models satisfactorily. Implications of these findings for stigma-change agenda are discussed.

Summary The purpose of this study was to examine the factor structure of the transformational leader-ship model in human service teams. As the nature of this work environment mandates certainmanagement-by-exception practices, patterns of correlations between perceptions of activeand passive management-by-exception behaviors and transformational, transactional, andlaissez-faire leadership were of interest. 236 leaders and 620 subordinates from 54 mentalhealth teams completed the Multifactor Leadership Questionnaire, form 8Y. Results suggestthat active and passive management-by-exception factors are independent constructs.Copyright # 2003 John Wiley & Sons, Ltd. The transformational leadership model as described by Bass (1985) has developed a substantialresearch base supporting its validity across a variety of organizational types as well as cultures (Bass,1998). However, this research has led to several ongoing controversies regarding the underlying factorstructure of the model. One such controversy is whether or not the two management-by-exception fac-tors (active vs. passive) represent distinct constructs. These factors, which describe leader behaviorsthat are problem-driven, are the focus of the present research project. To place these factors in propercontext, however, we first consider the broader model of which they are a part.

Work and housing opportunities of persons with psychosis, substance abuse disorder, and other mental illnesses are significantly hampered by societal stigma. Earlier research by Weiner and colleagues (1988) examined stigmatizing attitudes associated with general health disabilities in terms of attributions about the controllability and stability of these disabilities. The relevance of this model for describing attributions about four psychiatric disorders is examined in this study. One hundred and fifty two adults rated four psychiatric groups (cocaine addiction, depression, psychosis, and mental retardation) and two physical health groups (cancer and AIDS) on six items corresponding with controllability and stability attributions. Findings from a factor analysis supported the distinction between controllability and stability factors. Results also suggested that mental health disabilities were rated more negatively on these factors than physical disabilities. Participants clearly discriminated among mental health disabilities, with cocaine addiction rated most negative in terms of controllability and mental retardation rated most negative in terms of stability. Attribution analyses provide useful information for changing the community's reactions to persons with mental illness. © 2000 John Wiley & Sons, Inc.

A combination of educational and organizational strategies help rehabilitation teams develop programs that effectively address the needs of their consumers.

The graduate training of psychologists should prepare them for central roles in state hospitals, especially roles involving direct patient care and supervision of colleagues. To what extent do actual job practices match graduate preparation? To find out, 55 psychologists from 12 state hospitals in the Midwest were surveyed regarding their educational backgrounds and time currently spent in various job activities. Results indicated that paperwork consumes more time than any other activity, followed by therapeutic services, psychological assessment, supervision, and case management. Almost 50% of the sample was trained under a cognitive-behavioral orientation; however, more than 60% of survey participants now practice according to eclectic models. These results imply that psychologists in these settings may not be utilized to their full potential because of a variety of organizational constraints.

Interactive staff training (IST) uses principles of organizational psychology to help line-level staff members design and implement social learning programs for severely mentally ill inpatients. IST is a training package that includes assessment of staff perceptions regarding programatic needs, selection of appropriate social learning strategies to meet these needs, appointment of a program committee from within the ward to champion development of the social learning strategy, and participative decision making about aspects of the social learning strategy. Staff on an extended care ward at a state hospital participated in IST for 15 months as part of a pilot study of its effects. Ongoing examination of ward programing showed that IST significantly increased staff and patient participation in rehabilitation programing and decreased the rate of physical restraints and aggression-related. Changes in staff attitudes about rehabilitation programing were noted on a subsample of IST participants. Implications for more controlled research into IST are discussed.

Summary Previous research has shown that burnout in staff members at psychiatric hospitals is significantly associated with state anxiety and collegial support. The directionality of these relationships may be inferred using a cross-lagged panel design. To do this, 35 staff members representing various clinical disciplines completed measures of burnout, support, and anxiety twice, eight months apart. Burnout comprised three factors: emotional exhaustion, depersonalization, and personal accomplishment. Findings from one cross-lagged panel suggested that emotional exhaustion causes state anxiety. The second panel showed that lack of collegial support caused depersonalization. Understanding causes and effects of burnout for inpatient psychiatric staff may lead to training and resource development that will improve the quality of their work environment.

Despite the success that behavior therapy has demonstrated in treating severely mentally ill adults, widespread impact of behavioral treatments on this population has been limited because the staff of many inpatient settings do not routinely utilize these strategies. Surveying staff regarding their perception of programatic and organizational needs is proposed as a valuable first step for selecting behavioral strategies to be introduced in these settings. Goldfried and D'Zurilla (1969) developed a behavioral assessment survey that is especially useful for identifying staff needs vis-a-vis behavioral rehabilitation. Using these strategies, survey questions addressed five problem areas: Administrative, Staff, Patient, Resource, and Programatic. Results using this survey with 40 clinicians on the extended care unit of a state hospital showed that staff members had greatest concern with the Patient Problem Area (i.e., aversive patient behaviors that are not sufficiently addressed by treatment plans). Further analyses showed staff members were interested in addressing Patient concerns using incentive procedures. The needs assessment in this study not only provided useful information that might be generalized to other treatment settings, but also showcased a reliable survey approach that program developers might implement prior to designing training curricula for behaviorally naive staff in inpatient settings.

The stigma of mental disorders and psychological treatment afflicts rural clients more than most. This article provides practitioners with guidance in selecting and utilizing effective treatments for self-stigma in rural settings. We review both public stigma and self-stigma. Public stigma explains society's negative impact on individuals, while self-stigma describes an individual's internalization of public stigma. We review treatment principles and empirical research on psychotherapy for self-stigma rural settings. We finish with a case illustration of cognitive therapy with a rural client suffering from self-stigma.

Growing up in a household with alcoholic or mentally ill parents is more likely to produce lower self-esteem, greater dysphoria, and more anxiety in adulthood. To test this hypothesis, 139 undergraduate and graduate students completed measures of anxiety, depression, social avoidance, self-esteem, and social support. Results showed that adult children of alcoholics, adult children of mentally ill, and adult children of substance-abusing mentally ill had lower self-esteem and were more socially anxious than normal controls. Adult children of mentally ill parents were more depressed and showed greater trait anxiety than did adult children of alcoholics and controls. The impact of parental pathology is diminished when the adult child has a large and/or satisfactory social support network.

Several behavioral rehabilitation strategies have been empirically validated in the treatment of schizophrenia and are now the psychosocial treatments of choice for chronic mental disorders. The stress-vulnerability model and an empirically based decision tree offer clinicians' guidance in prescribing strategies that are particularly relevant for each patient. Hence, behavioral family therapy may be indicated for patients who experience disease exacerbation that results from stressful family interactions. Patients with insufficient social and coping skills may benefit from skills training. Supported employment and job-finding clubs may be indicated for patients with deficits in work skills. The form and programmatic matrix of these strategies differ, depending upon their locus in inpatient and outpatient settings.