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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 from 16 stereotypes towards people with AUD, by removing the most offensive items based on perspectives of people with lived experience. The newly created scale was then assessed and validated in a cross-sectional study involving 156 people reporting alcohol issues in various treatment settings. Results: The 20-item SSAD-SF includes five stereotypes, with good internal consistency for each subscale and the overall scale. It reflects the four-stage progressive model of self-stigmatization with decreasing scores over the stages awareness of stereotypes, agreement with stereotypes, self-application of stereotypes, and harmful consequences for self-esteem, and highest correlations between adjacent stages. The subscales apply and harm were associated with internalized stigma, shame, reduced self-esteem, and lower drinking-refusal self-efficacy, as supported by multivariate regression models. Discussion: The SSAD-SF is a valid instrument for measuring the process of self-stigmatization in people with AUD. Self-stigma is a consistent predictor of reduced self-esteem, higher shame and lower drinking-refusal self-efficacy in people with AUD. We discuss merits of the progressive model for understanding and addressing self-stigma in AUD. [ABSTRACT FROM AUTHOR]

Background: Health-related stigma and its internalization among individuals with chronic health conditions contribute to impaired mental and physical health and quality of life. Research on health-related stigma has been siloed, with disease-specific measures that may not capture the experiences of individuals with multiple health conditions and that prevent comparisons across health conditions. The current study aimed to develop and test a transdiagnostic measure of internalized health-related stigma for use among adults with different physical health conditions. Methods: An existing measure of internalized mental health stigma was adapted to assess stigma due to chronic physical health conditions following COSMIN procedures, with input from advisory boards of community members living with a range of stigmatized health conditions (obesity, type 1 and type 2 diabetes, skin diseases, HIV, chronic pain, and cancers) and of health professionals who specialized in these conditions. The new Internalized Health-Related Stigma (I-HEARTS) Scale was tested in an online sample of 300 adults with these health conditions, recruited from ResearchMatch. Additional psychosocial measures of mental health and quality of life were administered, and participants provided information about their health conditions and demographic characteristics. Exploratory factor analysis and tests of reliability and validity were conducted to determine the psychometric properties of the I-HEARTS Scale, and k-means clustering and receiver of characteristic curve analysis were used to determine a clinically meaningful cutoff score indicating high levels of internalized stigma. Results: Factor analysis results yielded a 25-item scale with a 3-factor solution, with subscales of Perceived and Anticipated Stigma, Stereotype Application and Self-Devaluation, and Stigma Resistance. Psychometric properties for internal consistency, inter-item and item-total correlations, and test-retest reliability were strong. Certain demographics (e.g., younger age) and characteristics related to health conditions (e.g., greater symptom severity) were associated with higher levels of internalized stigma. I-HEARTS Scale scores correlated moderately to strongly with related but distinct psychosocial measures, and a cutoff score of 3.40 or higher on the 1–7 rating scale was determined to indicate clinically meaningful levels of internalized stigma. Conclusions: The I-HEARTS Scale is a reliable and valid measure for the assessment of internalized health-related stigma among adults with varied stigmatized chronic health conditions. Study pre-registration: https://osf.io/84c5d/?view_only=87238512f6d6475c87f8f64280a8a15f. [ABSTRACT FROM AUTHOR]

Abstract 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 from 16 stereotypes towards people with AUD, by removing the most offensive items based on perspectives of people with lived experience. The newly created scale was then assessed and validated in a cross-sectional study involving 156 people reporting alcohol issues in various treatment settings. Results The 20-item SSAD-SF includes five stereotypes, with good internal consistency for each subscale and the overall scale. It reflects the four-stage progressive model of self-stigmatization with decreasing scores over the stages awareness of stereotypes, agreement with stereotypes, self-application of stereotypes, and harmful consequences for self-esteem, and highest correlations between adjacent stages. The subscales apply and harm were associated with internalized stigma, shame, reduced self-esteem, and lower drinking-refusal self-efficacy, as supported by multivariate regression models. Discussion The SSAD-SF is a valid instrument for measuring the process of self-stigmatization in people with AUD. Self-stigma is a consistent predictor of reduced self-esteem, higher shame and lower drinking-refusal self-efficacy in people with AUD. We discuss merits of the progressive model for understanding and addressing self-stigma in AUD.

Abstract Background Health-related stigma and its internalization among individuals with chronic health conditions contribute to impaired mental and physical health and quality of life. Research on health-related stigma has been siloed, with disease-specific measures that may not capture the experiences of individuals with multiple health conditions and that prevent comparisons across health conditions. The current study aimed to develop and test a transdiagnostic measure of internalized health-related stigma for use among adults with different physical health conditions. Methods An existing measure of internalized mental health stigma was adapted to assess stigma due to chronic physical health conditions following COSMIN procedures, with input from advisory boards of community members living with a range of stigmatized health conditions (obesity, type 1 and type 2 diabetes, skin diseases, HIV, chronic pain, and cancers) and of health professionals who specialized in these conditions. The new Internalized Health-Related Stigma (I-HEARTS) Scale was tested in an online sample of 300 adults with these health conditions, recruited from ResearchMatch. Additional psychosocial measures of mental health and quality of life were administered, and participants provided information about their health conditions and demographic characteristics. Exploratory factor analysis and tests of reliability and validity were conducted to determine the psychometric properties of the I-HEARTS Scale, and k-means clustering and receiver of characteristic curve analysis were used to determine a clinically meaningful cutoff score indicating high levels of internalized stigma. Results Factor analysis results yielded a 25-item scale with a 3-factor solution, with subscales of Perceived and Anticipated Stigma, Stereotype Application and Self-Devaluation, and Stigma Resistance. Psychometric properties for internal consistency, inter-item and item-total correlations, and test-retest reliability were strong. Certain demographics (e.g., younger age) and characteristics related to health conditions (e.g., greater symptom severity) were associated with higher levels of internalized stigma. I-HEARTS Scale scores correlated moderately to strongly with related but distinct psychosocial measures, and a cutoff score of 3.40 or higher on the 1–7 rating scale was determined to indicate clinically meaningful levels of internalized stigma. Conclusions The I-HEARTS Scale is a reliable and valid measure for the assessment of internalized health-related stigma among adults with varied stigmatized chronic health conditions. Study pre-registration https://osf.io/84c5d/?view_only=87238512f6d6475c87f8f64280a8a15f .

BACKGROUND: Only a few studies have explored the relationship between psychosocial factors and medication adherence in Indian patients with noncommunicable diseases (NCDs). We aimed to examine the association of psychosocial variables with medication adherence in people with NCDs and comorbid common mental disorders (CMDs) from primary care in rural southern India. METHODS: We performed a secondary analysis using baseline data from a randomized controlled trial in 49 primary care health centers in rural southern India (HOPE study). Participants were adults (≥30 years) with NCDs that included hypertension, diabetes, and/or ischemic heart disease, and comorbid depression or anxiety disorders. Medication adherence was assessed by asking participants if they had missed any prescribed NCD medication in the past month. Data were collected between May 2015 and November 2018. The association between psychosocial and demographic variables and medication nonadherence were assessed via logistic regression analyses. RESULTS: Of the 2486 participants enrolled, almost one-fifth (18.06%) reported missing medication. Male sex (OR = 1.74, 95% CI 1.37-2.22) and higher internalized mental illness stigma (OR = 1.46, 95% CI 1.07-2.00) were associated with higher odds of missing medication. Older age (OR = 0.40, 95% CI 0.26-0.60, for participants aged 64-75 years vs 30-44 years), reporting more social support (OR = 0.65, 95% CI 0.49-0.86), and higher satisfaction with health (OR = 0.74, 95% CI 0.61-0.89) were associated with lower odds of missing medication. CONCLUSIONS: Greater internalized mental illness stigma and less social support are significantly associated with lower rates of medication adherence in patients with NCDs and comorbid CMDs in rural India.

Abstract Background Individuals with higher weight (overweight or obesity) may experience social stigma due to their weight. Weight stigma can be internalized with adverse health effects. Internalized weight stigma is relevant across different weight categories, but no validated weight-neutral measure of internalized weight bias currently exists in Norway. The current study aimed to examine the validity of a Norwegian translation of the Modified Weight Bias Internalization Scale. Methods A Norwegian translation of the Modified Weight Bias Internalization Scale (WBIS-M) was administered in an adult Norwegian sample (N = 315, of which 251 women) ranging from self-reported “very underweight” to “very overweight”. Results A confirmatory factor analysis was conducted on 11 of the original 11 items in the WBIS-M. Based on previous factor analyses with this scale, we expected a one-factor model. One of the items related to competence showed poor model fit, and concern was raised around possible item ambiguity partway through the study. Two versions of this item were therefore tested, neither of which yielded an acceptable fit. After exclusion of this item, the results showed high loadings for the remaining 10 items on one factor with a high internal consistency (α = 0.94). Convergent validity was approached by looking at the relationship between answers on the WBIS-M, self-perceived weight, and items on overall health and psychological/emotional state. Conclusion The 10-item Norwegian version of the WBIS-M shows sound psychometric properties and can be used to measure internalized weight bias in a weight-neutral fashion in a Norwegian-speaking population. Internalized weight bias was correlated with psychological/emotional state and overall health, with those reporting more internalized weight bias also reporting that they felt worse. This relationship was stronger for women than men in our sample and was partially dependent on weight. The women also showed higher internalized weight bias than the men. Future studies should include more male participants and explore alternative versions of the missing item related to competence.

Objective Internalized stigma, which refers to the internalization of negative attitudes and beliefs towards persons with mental illness, significantly impacts their self- perception and overall well-being. This research examines the correlations among internalized stigma, the severity of symptoms, and self-esteem in individuals diagnosed with major depressive disorder (MDD), specifically comparing those currently experiencing active depression with those who are in remission. Material and Method Participants were selected from a psychiatric out- patient unit based on their diagnosis of MDD. Participants provided sociodemographic information and completed assessments measuring the severity of depression, level of anxiety, self-esteem, and internalized stigma. Results Participants experiencing active depression exhibited elevated levels of depression severity, anxiety severity, and internalized stigma, while also reporting diminished self-esteem in comparison to those who were in a state of remission. Strong positive relationships were observed between the severity of depression and internalized stigma where self- esteem was negatively correlated with the stigma. The results of the regression analysis showed that there was a significant relationship between the severity of depression, self-esteem, and internalized stigma in the group of individuals with active MDD. Conclusion This study underscores the impact of depression severity and self-esteem on internalized stigma in individuals with MDD. The findings indicate the need to implement comprehensive treatment techniques that address psychological and social variables like self- esteem and internalized stigma in addition to symptom management. Future studies should investigate the long-term connections and assess the efficacy of interventions in reducing the obstacles caused by stigma in the process of recovering from depression. [ABSTRACT FROM AUTHOR]

Background: Individuals with higher weight (overweight or obesity) may experience social stigma due to their weight. Weight stigma can be internalized with adverse health effects. Internalized weight stigma is relevant across different weight categories, but no validated weight-neutral measure of internalized weight bias currently exists in Norway. The current study aimed to examine the validity of a Norwegian translation of the Modified Weight Bias Internalization Scale. Methods: A Norwegian translation of the Modified Weight Bias Internalization Scale (WBIS-M) was administered in an adult Norwegian sample (N = 315, of which 251 women) ranging from self-reported "very underweight" to "very overweight". Results: A confirmatory factor analysis was conducted on 11 of the original 11 items in the WBIS-M. Based on previous factor analyses with this scale, we expected a one-factor model. One of the items related to competence showed poor model fit, and concern was raised around possible item ambiguity partway through the study. Two versions of this item were therefore tested, neither of which yielded an acceptable fit. After exclusion of this item, the results showed high loadings for the remaining 10 items on one factor with a high internal consistency (α = 0.94). Convergent validity was approached by looking at the relationship between answers on the WBIS-M, self-perceived weight, and items on overall health and psychological/emotional state. Conclusion: The 10-item Norwegian version of the WBIS-M shows sound psychometric properties and can be used to measure internalized weight bias in a weight-neutral fashion in a Norwegian-speaking population. Internalized weight bias was correlated with psychological/emotional state and overall health, with those reporting more internalized weight bias also reporting that they felt worse. This relationship was stronger for women than men in our sample and was partially dependent on weight. The women also showed higher internalized weight bias than the men. Future studies should include more male participants and explore alternative versions of the missing item related to competence. Plain English summary: Individuals with higher weight may experience social stigma due to their weight. This can include encountering beliefs that people of higher weight lack willpower or are not as smart or valuable as others. Stigma related to weight can then be internalized, leading to weight bias internalization, which is when people start to believe in weight-related stigma about themselves. A Norwegian translation of the modified weight bias internalization scale (WBIS-M) was answered by a Norwegian sample. A confirmatory factor analysis was conducted to determine whether the scale had a single-factor structure. The results showed that 10 of the original 11 items fit well, but one item related to the experience of competence should be removed. Once this item was removed, the scale had good statistical properties, indicating that internalized weight bias can be measured by the 10 items of the Norwegian WBIS-M. Internalized weight bias was related to how well people were feeling psychologically and health-wise, with those reporting more internalized weight bias also reporting that they felt worse. This relationship was stronger for women than men in our sample. Future studies should include more male participants and explore further versions of the competence item. [ABSTRACT FROM AUTHOR]

Background: The experience of stigma can exert a profound impact on the mental health and well-being of individuals with bipolar disorder (BD). Our study explores which factors of internalized stigma are associated with suicidal ideation and how they differ between the two sexes in a clinical sample of BD patients. Methods: The study follows a cross-sectional study design, employing the Clinical Global Impression for Bipolar Patients (CGI-BP) to evaluate the overall severity of illness and the alteration in patients affected by bipolar disorder, the Internalized Stigma of Mental Illness (ISMI) assessing self-stigma among individuals experiencing mental disorders, and the Columbia Suicide Severity Rating Scale (C-SSRS) identifying and assessing individuals vulnerable to suicide. Descriptive analyses, analysis of variance (ANOVA), and logistic regression analysis were conducted, and 344 BD subjects were recruited. Results: Our ANOVA results revealed a significant association between sex and suicide across ISMI sub-items (p = 0.000). Logistic regression analysis comprised three phases: Discrimination was consistently significant across all phases (p < 0.001), while Alienation and Stereotype emerged as additional predictors of suicide in later phases of the analysis (p < 0.001). Conclusions: Our study contributes to the growing body of literature on internalized stigma, sex, and suicidality among individuals with bipolar disorder. Early intervention programs and prevention strategies are needed. [ABSTRACT FROM AUTHOR]

IntroductionThis article describes the development and initial validation of a measure of implicit internalized stigma among queer people, the Implicit Internalized Sexual Orientation Stigma Affect Misattribution Procedure (Internal-SOS-AMP), a computer-administered sequential priming procedure.MethodsThe creation of the Internal-SOS-AMP involved a mixed-methods approach, including a literature review, expert interviews, stimuli selection and pilot testing, data collection from a large sample, reliability testing, correlational analyses, and confirmatory factor analysis. Psychometric testing was conducted with a national sample of 500 queer adults who completed two waves of data collection. Confirmatory factor analysis was used to evaluate two models: a one-factor model with internalized stigma specified as one overall construct and a two-factor model with internalized stigma specified as two constructs based on binary conceptions of gender (stigma regarding queer women and stigma regarding queer men).ResultsResults showed that the two-factor model best fit the data. This indicates that although implicit attitudes toward queer men and women are highly correlated, implicit internalized stigma differentiated by two gender stimuli groups (men and women) more accurately reflects the data. There was evidence of convergent validity as Internal-SOS-AMP scores showed small positive associations with explicit internalized stigma. Regarding divergent validity, Internal-SOS-AMP scores were inversely related to affirmation of a queer identity. Reliability results for the Internal-SOS-AMP showed good internal consistency and acceptable test–retest reliability.DiscussionThe creation of the Internal-SOS-AMP used best practices for measurement development. Psychometric findings show strong evidence of content validity, convergent validity, divergent validity, and reliability of the Internal-SOS-AMP.

Background: Stigma relating to mental illness has mostly been studied in communities and families. Less research has been conducted in India to understand the current subjective experience of persons with mental illness in the tertiary care hospital setting in India. Aim and Objectives: This study aimed to assess the extent of internalized stigma among persons and to see the association between self-stigma, self-esteem, insight, and adherence. Methodology: The study used a cross-sectional design. The present study was conducted in the Outpatient Department of LGB Regional Institute of Mental Health, Tezpur, Assam. For the present study, 200 persons with schizophrenia were selected. Participants of this study were persons with a clinical diagnosis of schizophrenia according to the International Classification of Diseases-10 Diagnostic Criteria for Research. Sociodemographic and clinical data sheet, Brief Psychiatric Rating Scale, the Internalized Stigma of Mental Illness Scale, Morisky Adherence Scale, and Rosenberg Self-Esteem Scale were administered. The collected data were analyzed using descriptive and inferential statistics in Statistical Package for Social Science (SPSS) 21 version. Results: The findings show that 45% of the participants were having moderate internalized stigma and 21% of the participants were having severe internalized stigma. Self-Esteem Scale (B = −341, t = −2.940, P = 005), medication adherence (B = −701, t = −9.832, P = 000), and insight (B = −711, t = −6.496, P = 000) contributed significantly to the prediction of internalized stigma among persons with schizophrenia (F [3,63] =58.712, P = 000) accounting for 85.8% variance. Conclusion: The findings confirm that self-esteem, medication adherence, and insight contributed significantly to the prediction of internalized stigma among persons with schizophrenia.

Background: Patients with schizophrenia and bipolar affective disorder (BPAD) diagnosis often experience high levels of internalized stigma, where they internalize negative societal views about mental illness. This can profoundly impact their quality of life (QOL), help-seeking behavior, adherence to treatment, increased disability, and increase the economic burden. This study was taken up to determine and compare internalized stigma in remitted patients of schizophrenia and bipolar disorder and correlate the association between internalized stigma and QOL. Methodology: A cross-sectional comparative hospital-based study with a sample size of 100 (48 patients of schizophrenia and 52 patients of bipolar disorder in remission) was taken for the study as per the International Classification of Diseases-10 criteria. Basic demographic data were collected using a semi-structured questionnaire. Remission was assessed by the Clinical Global Impressions-Severity Scale. Stigma was assessed using the Internalized Stigma of Mental Illness Scale and quality of life (QOL) was assessed using the World Health Organization Quality of Life Brief version (WHOQOL BREF), insight grading as per Comprehensive Textbook of Psychiatry 10th Edition. The level of significance was set at 0.05 for all statistical analyses. Results: A total of 100 subjects participated in the study, of which 48 belong to the schizophrenia group and 52 belong to the BPAD group. Prevalence of internalized stigma among subjects with schizophrenia is 54% and BPAD is 50%. There was a statistically significant association between diagnosis and self-stigma. Self-stigma was found to be more among female gender (P = 0.001), single (0.014), and unemployed (P = 0.010). There was a statistically significant negative correlation between internalized stigma scores and QOL. Conclusion: The current study found a strong negative correlation between internal stigma and QOL, suggesting that internal stigma may have a negative impact on social relationships, community participation, and physical and psychological well-being of the individual. Considering this, psychiatrist should formulate strategies to address internal stigma along with clinical manifestations.

Background: Stigma relating to mental illness has mostly been studied in communities and families. Less research has been conducted in India to understand the current subjective experience of persons with mental illness in the tertiary care hospital setting in India. Aim and Objectives: This study aimed to assess the extent of internalized stigma among persons and to see the association between self-stigma, self-esteem, insight, and adherence. Methodology: The study used a cross-sectional design. The present study was conducted in the Outpatient Department of LGB Regional Institute of Mental Health, Tezpur, Assam. For the present study, 200 persons with schizophrenia were selected. Participants of this study were persons with a clinical diagnosis of schizophrenia according to the International Classification of Diseases-10 Diagnostic Criteria for Research. Sociodemographic and clinical data sheet, Brief Psychiatric Rating Scale, the Internalized Stigma of Mental Illness Scale, Morisky Adherence Scale, and Rosenberg Self-Esteem Scale were administered. The collected data were analyzed using descriptive and inferential statistics in Statistical Package for Social Science (SPSS) 21 version. Results: The findings show that 45% of the participants were having moderate internalized stigma and 21% of the participants were having severe internalized stigma. Self-Esteem Scale (B = -341, t = -2.940, P = 005), medication adherence (B = -701, t = -9.832, P = 000), and insight (B = -711, t = -6.496, P = 000) contributed significantly to the prediction of internalized stigma among persons with schizophrenia (F [3,63] =58.712, P = 000) accounting for 85.8% variance. Conclusion: The findings confirm that self-esteem, medication adherence, and insight contributed significantly to the prediction of internalized stigma among persons with schizophrenia. [ABSTRACT FROM AUTHOR]

Background: Internalized stigma among patients with tuberculosis (TB) significantly affects delayed diagnosis, increased disease transmission, and poor treatment outcomes. However, conclusive empirical evidence on psychosocial interventions to reduce internalized stigma among patients with TB in Thailand remains scarce. Objective: This study aimed to examine the impact of a peer support intervention on reducing internalized stigma among patients with TB in Thailand. Methods: A one-group within-subjects repeated-measure design was conducted in the Muang Maha Sarakham district, Thailand, from February 2023 to July 2023. The study included 26 participants who met specified criteria. Measurements were taken at baseline, three months, and six months following TB diagnosis and medication treatment. The peer support intervention comprised TB health education, psycho-educational sessions, self-management support, and home visits. The Internalized Stigma of Tuberculosis Scale Thai Version was used to measure internalized stigma. Statistical analyses included descriptive statistics and repeated measures ANOVA. Results: Mean scores of total internalized stigma and its sub-dimensions (alienation, stereotype endorsement, discrimination experience, social withdrawal, and stigma resistance) differed significantly across the three-time points (p

Suicide is a leading cause of death among youth on the psychosis spectrum. Internalized mental health stigma is one risk factor for suicide that may be particularly salient for youth with psychosis-risk syndromes and early psychosis. Among this population, Black youth may face exposure to racism-related stressors that may exacerbate the negative effects of internalized stigma. This study examined whether internalized stigma and race interact to predict suicidal thoughts and behaviors (STB) in a help-seeking sample of Black and White adolescents with psychosis-risk syndromes and early psychosis. Findings suggest that Black youth with early psychosis spectrum disorders may be particularly vulnerable to the negative effects of internalized stigma as they pertain to STB. Internalized stigma may therefore represent an important treatment target in suicide prevention efforts among this population.

This document is an editorial from the journal Frontiers in Psychiatry that discusses the ongoing issue of stigma towards individuals with mental illnesses. It emphasizes the importance of raising awareness and providing training to diverse groups in order to challenge existing stereotypes and reduce stigmas. The editorial provides a summary of 22 articles included in the research topic, covering various aspects of mental-health-related stigma and discrimination. These articles explore topics such as the impact of stigma on mental health patients, stigma experienced by healthcare workers during the COVID-19 pandemic, public perceptions and reactions to the pandemic, attitudes of healthcare workers towards seeking psychological help, and the influence of stigma on the location and configuration of mental health establishments. The editorial also addresses the stigma associated with substance use disorder and the urgent need to reevaluate language surrounding addiction. It calls for decriminalization of drug use, allocation of resources towards prevention and treatment, and highlights instances of discrimination by clinicians towards individuals with substance use disorders. The article also discusses the role of the COVID-19 pandemic in relation to stigma and mental health. It concludes by advocating for a comprehensive strategy to overcome mental health-related stigma through public awareness, education, and destigmatizing language. [Extracted from the article]

Introduction: The COVID-19 pandemic has led to physical and psychological complications and social consequences in the form of illness-related stigma. This study aimed (1) to assess the sociodemographic and clinical variable, as well as COVID-19 related knowledge and perception of persons admitted for COVID-19/Suspected COVID-19 in Nepal, (2) to determine their levels of COVID-19-related internalized stigma, depression, and anxiety symptoms, and (3) to evaluate the correlates of COVID-19-related internalized stigma. Materials and methods: It was a cross-sectional exploratory study with a convenience sample of 395 participants (306 confirmed cases, 89 suspected cases) conducted between July-October 2020 in four health facilities in Madhesh and Lumbini provinces of Nepal. We used a semistructured questionnaire to assess sociodemographic details, clinical information, COVID-19-related knowledge, perception, COVID-19-related internalized stigma, and the Hamilton Anxiety Depression Scale (HADS) in Nepali language. Descriptive statistics, correlation analyses, and linear regression analyses were performed. The level of statistical significance was considered at p < 0.05. Results: Around 23.3% of the patients had anxiety symptoms, 32.9% had depressive symptoms, and 20.3% had high COVID-19-related internalized stigma (mean ISMI score: 2.51-4.00). Linear regression analyses showed a significant positive association of COVID-19-related internalized stigma total score, with the following eight factors, i.e., no income in the past one month (p = 0.013), below average socioeconomic status (p = 0.004), anxiety symptoms (p = <0.001), depressive symptoms (p = <0.001), recent testing positive for COVID-19 (p = <0.001), involuntary admission (p = <0.001), prior experience of being in isolation and quarantine (p = 0.045), and those who blame others for COVID-19 (p = 0.025). Conclusion: COVID-19 survivors and suspects are vulnerable to symptoms of depression, anxiety, and COVID-19-related internalized stigma. For the first time from Nepal, our data suggests that COVID-19-related internalized stigma is associated with anxiety and depression symptoms, perceived below-average socioeconomic status, involuntary admission, prior experience of being in isolation and quarantine, recent COVID-19 positive report, self-blame, below-average socioeconomic status and no income in the past one month. Mitigating and preventing internalized stigma associated with a public health crisis such as COVID-19 is imperative by diagnosing and treating such mental health issues early and designing interventions and policies especially targeting vulnerable populations focusing on their economic background and socio-cultural beliefs. [ABSTRACT FROM AUTHOR]

Introduction: Cessation of substance use, a facet of recovery, as well as mitigating stigma experienced by individuals with substance use disorder (SUD), are important to supporting health and well-being of those who use substances. But there is limited and mixed evidence on whether cessation of substance use has a positive impact on individuals' stigma experiences. This study examined whether there were differences in stigma perceptions between those who self-report using substances and those who self-report not currently using substances associated with their SUD. Materials and methods: A survey was conducted among individuals in 10 counties of Michigan with self-identified history with SUD. The survey aimed to understand five dimensions of stigma perceptions: enacted stigma, anticipated stigma, internalized stigma, social withdrawal, and treatment stigma. Survey items for each measure were adapted from prior literature. The mean was calculated for each stigma measure for analyses. Data analyses tested whether there were significant differences in each of the five stigma domains between the two groups using either regression or t-test, depending on the necessity to include covariates. Results: Findings suggested that among the five stigma domains, only internalized stigma showed statistically significant differences between the two groups (b = 0.19, se = 0.08, p < 0.05) after adjusting for covariates (as needed). Those who were no longer using substances had lower internalized stigma compared to those who were currently using substances associated with their SUD. Analyses suggested that the other four stigma domains, enacted stigma, anticipated stigma, social withdrawal, and treatment stigma, did not show statistically significant differences between the two groups. Discussion: While self-stigmatization (i.e., internalized stigma) was lower among those who report no longer using, our patterns suggest a persistence of stigma regardless of cessation of substances associated with SUD, particularly among stigma domains that are based on perceptions of how others may still perceive individuals who have used substances. Though more research is needed, results suggest that public health programmatic, policy, and campaign efforts that aim to eliminate stigma should account for and tailor to both people who report using and those who report no longer using substances to capture the breadth of needs in communities. [ABSTRACT FROM AUTHOR]

Black men who have sex with men and women (BMSMW) experience pressure to fill hypermasculine ideals and may not identify with "gay" cultural norms. Existing measures of gender role expectations and internalized homophobia are not culturally appropriate for BMSMW. Researchers generally measure categorical identification with race, gender, and sexual orientation groups separately, whereas BMSMW may identify with multiple categories. We modified the Gender Role Conflict Scale to create the M-GRCS and the Internalized Homophobia Scale to include biphobia (Internalized Bi/Homophobia Scale, IBHS). To examine identification at the intersection of race, gender, and sexual orientation, we created 11 Integrated Race and Sexuality Scale (IRSS) items. With data from 429 BMSMW, we conducted exploratory factor analysis of the 59 items using categorical principal axis factoring with unweighted least squares extraction and Promax factor rotation. We created simple-summated multi-item scales and evaluated their construct validity. The rotated solution yielded four factors with 47 items and a simple factor structure: M-GRCS defined two factors (α = .93 for restricted emotionality/affection; .87 for success/power/competition); the IBHS (α = .89) and IRSS (α = .74) each defined a single factor. The IRSS factor was positively correlated with the Lukwago Racial Pride Scale, r(417) = .40. The IBHS factor was negatively correlated with the IRSS factor, r(414) = - .22. The two M-GRCS factors suggest that the construct of hypermasculinity impacts BMSMW. The high IBHS reliability indicates that homophobia and biphobia were positively correlated in this sample. These three scales have potential for future studies with BMSMW.

Due to its nature, the army is an environment with a high risk of mental illness. Research shows that mental health stigma is a common and serious barrier to early and effective treatment for mental disorders that result from the stress of military operations. Given the need for timely and effective mental health intervention, it is important to understand the barriers to seeking mental health help in a military context. Although there is stigma related to mental health in the studies and compilations carried out in the civil and military context in the national and international literature, there is no literature on mental health stigmatization in the military context, especially in the national literature. This study is a compilation research created by reviewing the national and international literature. In this article, it is aimed to present some innovative social work interventions in order to address the sources of stigma that hinders access to mental health care and the factors that reinforce them, in a military context, to potentially reduce stigma and to maximize the benefit of mental health care.

IntroductionThe COVID-19 pandemic has led to physical and psychological complications and social consequences in the form of illness-related stigma. This study aimed (1) to assess the sociodemographic and clinical variable, as well as COVID-19 related knowledge and perception of persons admitted for COVID-19/Suspected COVID-19 in Nepal, (2) to determine their levels of COVID-19- related internalized stigma, depression, and anxiety symptoms, and (3) to evaluate the correlates of COVID-19- related internalized stigma.Materials and methodsIt was a cross-sectional exploratory study with a convenience sample of 395 participants (306 confirmed cases, 89 suspected cases) conducted between July–October 2020 in four health facilities in Madhesh and Lumbini provinces of Nepal. We used a semi-structured questionnaire to assess sociodemographic details, clinical information, COVID-19-related knowledge, perception, COVID-19-related internalized stigma, and the Hamilton Anxiety Depression Scale (HADS) in Nepali language. Descriptive statistics, correlation analyses, and linear regression analyses were performed. The level of statistical significance was considered at p

IntroductionCessation of substance use, a facet of recovery, as well as mitigating stigma experienced by individuals with substance use disorder (SUD), are important to supporting health and well-being of those who use substances. But there is limited and mixed evidence on whether cessation of substance use has a positive impact on individuals’ stigma experiences. This study examined whether there were differences in stigma perceptions between those who self-report using substances and those who self-report not currently using substances associated with their SUD.Materials and methodsA survey was conducted among individuals in 10 counties of Michigan with self-identified history with SUD. The survey aimed to understand five dimensions of stigma perceptions: enacted stigma, anticipated stigma, internalized stigma, social withdrawal, and treatment stigma. Survey items for each measure were adapted from prior literature. The mean was calculated for each stigma measure for analyses. Data analyses tested whether there were significant differences in each of the five stigma domains between the two groups using either regression or t-test, depending on the necessity to include covariates.ResultsFindings suggested that among the five stigma domains, only internalized stigma showed statistically significant differences between the two groups (b = 0.19, se = 0.08, p

Purpose: Health-related quality of life (HRQOL) refers to an individual's perception of their physical and mental health status over time. Although emerging evidence has documented a negative association between weight stigma (i.e., negative weight-related attitudes and beliefs towards individuals with overweight or obesity) and mental HRQOL, its influence on physical HRQOL still needs to be fully clarified. This study aims to investigate the impact of internalized weight stigma on mental and physical HRQOL by employing a structural equation modeling (SEM) approach. Methods: The Short Form Health Survey 36 (SF-36) and the Weight Bias Internalization Scale (WBIS) were administered to a sample of 4450 women aged 18–71 (Mage = 33.91 years, SD = 9.56) who self-identified in a condition of overweight or obesity (MBMI = 28.54 kg/m2; SD = 5.86). Confirmatory factor analysis (CFA) was conducted to assess the dimensionality of the scales before testing the proposed structural model. Results: After establishing the adequacy of the measurement model, SEM results revealed that internalized weight stigma was significantly and negatively associated with both mental (β = − 0.617; p < 0.001) and physical (β = − 0.355, p < 0.001) HRQOL. Conclusion: These findings offer additional support to prior research by confirming the association between weight stigma and mental HRQOL. Moreover, this study contributes to the existing literature by strengthening and extending these associations to the physical HRQOL domain. Although this study is cross-sectional in nature, it benefits from a large sample of women and the use of SEM, which offers advantages over traditional multivariate techniques, e.g., by explicitly accounting for measurement error. Level of evidence: Level V, descriptive cross-sectional study. [ABSTRACT FROM AUTHOR]

AIM: This study aimed to examine the relationship between internalized stigma and happiness levels of individuals diagnosed with schizophrenia. METHOD: This cross-sectional study was conducted between March and June 2021 with 100 individuals diagnosed with schizophrenia conducted in a Community Mental Health Centre in the Eastern Black Sea region of Turkey. Data were collected using Internalized Stigma of Mental Illness and the Oxford Happiness Questionnaire. RESULTS: A negative statistically significant relationship was determined between the Internalized Stigma of Mental Illness and Oxford Happiness Questionnaire. In addition, there was a positive correlation between the stigma resistance subdimension of the Internalized Stigma of Mental Illness and Oxford Happiness Questionnaire. The internalized stigma levels of the participating patients accounted for 35.1% of their happiness levels. The stigma resistance subdimension of the Internalized Stigma of Mental Illness scale affected the patients' happiness levels. CONCLUSION: There was a negative significant relationship between the individuals' internalized stigma and happiness levels. More comprehensive interventions are needed to combat the stigma of mental disorders in Türkiye so that individuals diagnosed with schizophrenia can lead a happy life in society. [ABSTRACT FROM AUTHOR]

Black men who have sex with men and women (BMSMW) experience pressure to fill hypermasculine ideals and may not identify with "gay" cultural norms. Existing measures of gender role expectations and internalized homophobia are not culturally appropriate for BMSMW. Researchers generally measure categorical identification with race, gender, and sexual orientation groups separately, whereas BMSMW may identify with multiple categories. We modified the Gender Role Conflict Scale to create the M-GRCS and the Internalized Homophobia Scale to include biphobia (Internalized Bi/Homophobia Scale, IBHS). To examine identification at the intersection of race, gender, and sexual orientation, we created 11 Integrated Race and Sexuality Scale (IRSS) items. With data from 429 BMSMW, we conducted exploratory factor analysis of the 59 items using categorical principal axis factoring with unweighted least squares extraction and Promax factor rotation. We created simple-summated multi-item scales and evaluated their construct validity. The rotated solution yielded four factors with 47 items and a simple factor structure: M-GRCS defined two factors (α = .93 for restricted emotionality/affection; .87 for success/power/competition); the IBHS (α = .89) and IRSS (α = .74) each defined a single factor. The IRSS factor was positively correlated with the Lukwago Racial Pride Scale, r(417) = .40. The IBHS factor was negatively correlated with the IRSS factor, r(414) = - .22. The two M-GRCS factors suggest that the construct of hypermasculinity impacts BMSMW. The high IBHS reliability indicates that homophobia and biphobia were positively correlated in this sample. These three scales have potential for future studies with BMSMW.

One prominent social-cognitive model of internalized stigma by Corrigan and his colleagues (2012; 2002) proposes that individuals are exposed to societal stereotypes about mental illness, at least tacitly agree with them, and may apply them to oneself, engendering harmful self-beliefs. There is limited empirical support for this model in serious mental illness. Moreover, it is not clearly established how internalized stigma and its associated factors impact recovery in this population. The current study uses structural equation modeling (SEM) to assess the social-cognitive model's goodness of fit in a sample of Veterans with serious mental illness (Veteran sample, n = 248), and then validates the model in a second and independent sample of individuals receiving community-based psychiatric rehabilitation services (community sample, n = 267). Participants completed the Self-Stigma of Mental Illness Scale (SSMIS; Corrigan et al., 2006) and measures of self-esteem, self-efficacy, and recovery attitudes. Consistent with Corrigan and colleagues' formulation of internalized stigma, SEM analyses showed a significant indirect pathway from stereotype awareness, to stereotype agreement, to application to self, to self-esteem decrement, to poorer recovery attitudes. Additionally, there was a significant direct effect from stereotype awareness to self-esteem. This study shows that individuals with serious mental illness experience psychological harm from stigma in two ways: (1) through perceived public prejudice and bias, and (2) through internalizing these negative messages. In particular, stigma harms individuals' self-esteem, which then reduces their recovery attitudes.

HIV-related stigma is a known barrier to retention in care. However, no large-scale, multi-site studies have prospectively evaluated the effect of internalized stigma on retention in care. The Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort study integrates medical record and survey data from people living with HIV (PLWH) seen in HIV primary care clinics across the United States, and assesses internalized stigma yearly using a validated 4-item Likert scale. We used multivariable logistic regression models to evaluate associations between mean internalized stigma and two prospective retention in care outcomes: keeping the next primary care appointment and keeping all scheduled primary care appointments in the 12 months following stigma assessment. From February 2016 to November 2017, 5968 PLWH completed the stigma assessment and had adequate follow-up time. Mean stigma was 1.9 (standard deviation 1.08). Increased mean stigma scores were associated with decreased odds of attending the next primary care appointment [adjusted odds ratio (aOR) = 0.93, 95% confidence interval (CI) 0.88-0.99, p = 0.02], and all primary care appointments in the subsequent 12 months (aOR = 0.94, 95% CI 0.89-0.99, p = 0.02). In both models, younger age and Black race were also independently associated with suboptimal appointment attendance. There was no support for interactions between internalized stigma and covariates. Internalized HIV stigma had an independent negative effect on the odds of subsequent appointment attendance. This study highlights the importance of identifying even low levels of internalized stigma. Interventions to address internalized HIV stigma are critical to supporting retention in care and improving clinical outcomes.

BackgroundResearch on how disclosure concerns affect health outcomes for people living with HIV (PLWH) has yielded inconsistent results. Theoretically, disclosure concerns could predict either poorer antiretroviral therapy (ART) adherence (PLWH worried about disclosure may not want to take their medication in front of others) or better ART adherence (stronger concerns may enhance treatment adherence to avoid unintentional disclosure). Furthermore, internalized stigma (which is positively associated with disclosure concerns) predicts worse ART adherence (an effect potentially in the opposite direction of the direct effect of disclosure concerns).Setting/methodsOne hundred eighty-six PLWH initiating HIV care at 4 US clinics completed measures of disclosure concerns, internalized stigma, and ART adherence. Viral load data were obtained from medical records. We examined the indirect effect of disclosure concerns on outcomes, adjusting for the suppressor effect of internalized stigma. That is, we examined whether the association between disclosure concerns and ART adherence/viral suppression is stronger and positive when controlling for the effect of internalized stigma.ResultsDisclosure concerns were more strongly associated with better viral suppression and ART adherence when internalized stigma was in the model, suggesting that internalized stigma suppressed this association. Similarly, internalized stigma led to higher disclosure concerns, which in turn led to better ART adherence and higher likelihood of viral suppression. However, internalized stigma also had a direct effect in the opposite direction of this indirect effect.ConclusionsFindings highlight the importance of addressing effects of internalized stigma and disclosure concerns jointly when attempting to understand effects on health outcomes among new-to-care PLWH.

The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica-tion is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves recovery-oriented, it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patients needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience.

Self-stigma in mental illness is linked to negative clinical and functional outcomes, but little is known about its correlates specifically in psychotic disorders. Here we investigated the role of clinical symptoms, cognition, and vocational status as correlates of self-stigma in 98 individuals with psychotic disorders (36 Black American, 32 White Hispanic, 11 White Non-Hispanic, 11 Asian American). A principal component analysis of the Internalized Stigma of Mental Illness scale yielded three components: Experiential Stigma, Stereotype Endorsement, and Stigma Resistance. Higher Experiential Stigma was associated with greater severity of affective symptoms and lower vocational status. Higher Stigma Resistance was associated with higher social and non-social cognition, and higher vocational status. Stereotype Endorsement did not significantly correlate with any predictor variable. Linear regression models showed that 13% of the variance in Experiential Stigma was explained by affective symptoms and vocational status, and 20% of the variance in Stigma Resistance was explained by non-social cognition and vocational status. These findings provide new information about the correlates of self-stigma in an ethnically and racially diverse psychotic disorder sample. Such information may lead to a better understanding of self-stigma mechanisms in this population.

Background: Stigma toward mental illness is a pervasive concern that impacts the way psychiatric disorders are perceived. Aim: This study was aimed to evaluate the stigma experienced by patients visiting a psychiatric care facility and the associated factors contributing to the development of stigma. Methodology: 150 patients presenting to Psychiatry outpatient department of a tertiary care centre were screened using Mini international neuropsychiatric interview questionnaire to segregate patients into various psychiatric groups. These patients were further assessed for the degree of stigma utilizing the Stigma scale and Internalized Stigma of Mental Illness-10. Results: 60.7% of the participants reported facing discrimination, which was highest in those with mania. 67.3% patients preferred not to disclose their illness, especially those with psychotic disorders. Eighty-six percent did not expect any positive results from their illness, most of them with psychotic disorders. 68.7% of the patients experienced total stigma, highest in mania. Sixty-four percent experienced high internalized stigma mostly in mania. Stigma was irrespective of age, sex, education, employment, and family type. Conclusion: A large segment of participants in the study sample claimed to have suffered from stigma, i.e., they faced discrimination, preferred not to reveal information about their illness, denied any positive outcomes from their illness, and endured self-stigma owing to their illness. Patients with mania faced the most discrimination, total stigma, and internalized stigma whereas disclosure and positive aspects were mostly in psychotic disorders. High levels of stigma observed are a barrier to availing mental health-care facilities. [ABSTRACT FROM AUTHOR]

Introduction: Self-stigma impedes recovery process and is associated with poorer clinical and functional outcomes in people with psychotic disorders. However, there is limited research specifically examining self-stigma in the early stage of illness, and mixed findings were observed regarding factors associated with increased self-stigma. We aimed to investigate the rate and correlates of selfstigma in a cohort of adult patients with early psychosis using a comprehensive array of clinical, treatment and other illness-related variables. Methods: A total of 101 Chinese adult early psychosis patients aged 26-55 years who had received three-year psychiatric treatment for first psychotic episode in Hong Kong and completed self-stigma assessment were included for the current investigation. A broad range of assessments encompassing socio-demographics, premorbid adjustment, onset and illness profiles, symptom severity, psychosocial functioning, treatment characteristics and medication sideeffects were conducted. Results: Twenty-eight (27.7%) patients had moderate-to-high levels of selfstigma. Univariate linear regression analyses showed that age at study entry, sex, educational level, age at psychosis onset, duration of untreated psychosis (DUP), insight level, global psychosocial functioning, and the use of second-generation antipsychotic were related to self-stigma levels. Final multivariable regression model revealed that female sex, younger age at entry, longer DUP and better insight were independently associated with higher levels of self-stigma. Conclusion: More than one-fourth of early psychosis patients experienced significant self-stigma, highlighting an unmet need for early detection and intervention of self-stigma in the initial years of illness. Further investigation is warranted to clarify trajectories and predictors of self-stigma in the early illness course. [ABSTRACT FROM AUTHOR]

There is limited research on the effects of stigma on health outcomes among new-to-HIV care individuals. We examined the effect of changes in internalized stigma over time on health behaviors and outcomes such as viral suppression, antiretroviral therapy (ART) adherence, and visit adherence among new-to-HIV care individuals. We also analyzed the mediating effects of adherence self-efficacy and depressive symptoms in these associations. Participants were 186 persons living with HIV who initiated care at four HIV clinical sites in the United States and had diverse geographical and ethnic backgrounds. Baseline and 48-week follow-up assessments included measures of internalized stigma, ART adherence, depressive symptoms, and adherence self-efficacy. HIV visit adherence and viral load data were extracted from clinic records. Age, race, gender, insurance status, and site were controlled in all analyses. Logistic regression analyses were used to examine predictors of adherence and viral suppression. Change (decrease) in internalized stigma was calculated by subtracting follow-up internalized stigma scores from baseline scores and served as the main predictor. Mediation analyses included calculation of 95% confidence intervals for the indirect effects using bootstrapping. Decreases in internalized stigma over time were positively associated with viral suppression, ART adherence, and visit adherence. Adherence self-efficacy significantly mediated these effects of decrease in internalized stigma on all outcomes. Depressive symptoms only mediated the association between decrease in internalized stigma and ART adherence. Interventions that address internalized stigma and depressive symptoms, as well as adherence self-efficacy, may significantly improve adherence and viral suppression outcomes for individuals new to HIV care.

Background: Stigma toward mental illness is a pervasive concern that impacts the way psychiatric disorders are perceived. Aim: This study was aimed to evaluate the stigma experienced by patients visiting a psychiatric care facility and the associated factors contributing to the development of stigma. Methodology: 150 patients presenting to Psychiatry outpatient department of a tertiary care centre were screened using Mini international neuropsychiatric interview questionnaire to segregate patients into various psychiatric groups. These patients were further assessed for the degree of stigma utilizing the Stigma scale and Internalized Stigma of Mental Illness-10. Results: 60.7% of the participants reported facing discrimination, which was highest in those with mania. 67.3% patients preferred not to disclose their illness, especially those with psychotic disorders. Eighty-six percent did not expect any positive results from their illness, most of them with psychotic disorders. 68.7% of the patients experienced total stigma, highest in mania. Sixty-four percent experienced high internalized stigma mostly in mania. Stigma was irrespective of age, sex, education, employment, and family type. Conclusion: A large segment of participants in the study sample claimed to have suffered from stigma, i.e., they faced discrimination, preferred not to reveal information about their illness, denied any positive outcomes from their illness, and endured self-stigma owing to their illness. Patients with mania faced the most discrimination, total stigma, and internalized stigma whereas disclosure and positive aspects were mostly in psychotic disorders. High levels of stigma observed are a barrier to availing mental health-care facilities.

Abstract Sexual stigma and discrimination toward men who have same-gender sexual experiences are present across the globe. In Ghana, same-gender sexual desires and relationships are stigmatized, and the stigma is sanctioned through both social and legal processes. Such stigma negatively influences health and other material and social aspects of daily life for men who have sex with men (MSM). However, there is evidence that stigma at the interpersonal level can intersect with stigma that may be operating simultaneously at other levels. Few studies provide a comprehensive qualitative assessment of the multi-level sexual stigma derived from the direct narratives of men with same-gender sexual experience. To help fill this gap on sexual stigma, we qualitatively investigated [1] what was the range of sexual stigma manifestations, and [2] how sexual stigma manifestations were distributed across socioecological levels in a sample of Ghanaian MSM. From March to September 2020, we conducted eight focus group discussions (FGDs) with MSM about their experiences with stigma from Accra and Kumasi, Ghana. Data from the FGDs were subjected to qualitative content analysis. We identified a range of eight manifestations of sexual stigma: (1) gossiping and outing; (2) verbal abuse and intrusive questioning; (3) non-verbal judgmental gestures; (4) societal, cultural, and religious blaming and shaming; (5) physical abuse; (6) poor-quality services; (7) living in constant fear and stigma avoidance; and (8) internal ambivalence and guilt about sexual behavior. Sexual stigma manifestations were unevenly distributed across socioecological levels. Our findings are consistent with those of existing literature documenting that, across Africa, and particularly in Ghana, national laws and religious institutions continue to drive stigma against MSM. Fundamental anti-homosexual sentiments along with beliefs associating homosexuality with foreign cultures and immorality drive the stigmatization of MSM. Stigma experienced at all socioecological levels has been shown to impact both the mental and sexual health of MSM. Deeper analysis is needed to understand more of the lived stigma experiences of MSM to develop appropriate stigma-reduction interventions. Additionally, more community-level stigma research and interventions are needed that focus on the role of family and peers in stigma toward MSM in Ghana.

Background and Design: Internalized stigma is the acceptance of negative stereotypes about the disease created by society and withdrawing of oneself from society with emotions such as worthlessness and shame. This study aimed to investigate the internalized stigma status of patients with verruca. Materials and Methods: A total of 58 patients with verruca were included in this study. The sociodemographic and clinical characteristics of these patients were recorded. The Internalized Stigma Scale (ISS) was used. In addition, patients answered the 12-Item General Health Questionnaire-12 (GHQ-12) and the Perceived Health Status question. Results: The mean ISS total score was 52.17+-14.73. Cronbach's alpha coefficient for the whole scale for patients with verruca was 0.92. Among the five ISS subscales in patients with verruca, the lowest internal consistency was found in the 'stigma resistance' subscale (Cronbach's alpha coefficient: 0.572), and the highest internal consistency was in the 'social withdrawal' subscale (Cronbach's alpha coefficient: 0.890). A significant correlation was found between the GHQ-12 and ISS total or ISS subscales, except for the 'stigma resistance' subscale (p

Abstract Background Internalized stigma has been found to be high among people with mental illness (PWMI) and it results in poor treatment outcome, increased disability and high economic burden. So, this study was designed to determine the prevalence and associated factors of high internalized stigma among PWMI attending psychiatric follow-up at University of Gondar Comprehensive Specialized Hospital, Northwest, Ethiopia, 2021. Methods A cross-sectional study was conducted among PWMI (n = 365), and internalized stigma was measured by using internalized stigma of mental illness 29 (ISMI-29) scale. The data was entered in to EPI DATA software (4.6.0.2) and analyzed by Statistical Package for Social Sciences version 20. A binary logistic regression was used to identify factors associated with internalized stigma and reported with 95% confidence interval (CI). P-value

Abstract Background: Internalized stigma can have numerous negative effects on the well-being and employment of people with mental illness. Brief, valid, and reliable measures are needed to get a better understanding of self-stigmatization. The aim of this study is to translate the brief version of the Internalized Stigma of Mental Illness (ISMI-10) scale into a Dutch version and to assess the reliability and validity of this Dutch version in a sample of employees with mental illness. Methods: The ISMI-10 was translated into Dutch using the forward-backward translation procedure. The sample consisted of 161 employees with mental illness. Internal consistency was evaluated and the retest reliability was tested with 68 respondents. The construct validity was evaluated by testing convergent and divergent validity. Results: The Dutch ISMI-10 showed good internal consistency (α = 0.83) and good test-retest reliability (r = 0.73). The Dutch ISMI-10 demonstrated excellent convergent validity; high correlations were found between the Dutch ISMI-10 and hope (r = -0.54), anxiety and depression (r = 0.59), self-esteem (r = -0.56), and empowerment (r = − 0.59). Acceptable divergent validity was indicated; small correlations were found between the Dutch ISMI-10 and the physical functioning subscale (r = -0.27) and the role limitation due to physical problems subscale (r = -0.21), and medium correlations were found between the Dutch ISMI-10 and the general health subscale (r = -0.36). Conclusion: The Dutch ISMI-10 demonstrated adequate psychometric properties for assessing internalized stigma and can be used by researchers in Dutch speaking countries to get a better understanding of self-stigmatization among people with mental illness.

Introduction: Identifying the relationship between internalized stigma and suicide is critical in dealing with schizophrenia. We aimed to examine how internalized stigma and its subcomponents affect suicidality in patients with schizophrenia. The second aim of this study was to identify the risk factors for internalized stigma in schizophrenia. Methods: We assessed 114 patients diagnosed with schizophrenia. Structured Clinical Interview for the DSM-5 (SCID-5), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale (CDS), Internalized Stigma of Mental Illness (ISMI), and Suicide Probability Scale (SPS) were applied to the sample. Multivariable linear regression analysis was conducted to determine the risk factors of internalized stigma. Results: Statistically significant correlation between stigma resistance and all SPS scores was found. The correlation between stigma resistance and suicidal thought was independent of the CDS and PANSS scores of the sample. Stigma resistance and depressive situation were the predictive factors for SPS. Only depressive state of the group predicted the level of internalized stigma in the regression analysis. Conclusions: Stigma resistance is an important risk factor for suicide in schizophrenia. Clinicians should focus on interventions to increase resistance against stigma and to determine the depressive situation of patients with schizophrenia. [ABSTRACT FROM AUTHOR]

BackgroundQueer youth experience high rates of depression and suicidality. These disparities stem from stigma-based stressors, including internalized stigma (i.e., negative social views that minoritized individuals internalize about their own identity). Given the importance of this factor in understanding mental health disparities among queer youth, we completed a systematic review and meta-analysis examining the relationships between internalized stigma and outcomes of depression and suicide risk (i.e., suicidal ideation, non-suicidal self-injury, and suicidal behavior).MethodsWe followed the PRISMA standards. Six bibliographic databases were searched for studies in the United States from September 2008 to March 2022. Dual independent screening of search results was performed based on a priori inclusion criteria.ResultsA total of 22 studies were included for data extraction and review. Most studies examined general internalized homophobia, with few examining internalized biphobia or transphobia. Many studies examined depression as an outcome, few studies examined suicidal ideation or behavior, and no studies examined non-suicidal self-injury. Meta-analyses model results show the association between general internalized queer stigma and depressive symptoms ranged r = 0.19, 95% CI [0.14, 0.25] to r = 0.24, 95% CI [0.19, 0.29], the latter reflecting more uniform measures of depression. The association between internalized transphobia and depressive outcomes was small and positive (r = 0.21, 95% CI [−0.24, 0.67]). General internalized queer stigma and suicidal ideation had a very weak positive association (r = 0.07, 95% CI [−0.27, 0.41]) and an even smaller, weaker positive association with suicide attempt (r = 0.02, 95% CI [0.01, 0.03]).ConclusionImplications for clinical practice, policy, and future research are discussed.

IntroductionSelf-stigma impedes recovery process and is associated with poorer clinical and functional outcomes in people with psychotic disorders. However, there is limited research specifically examining self-stigma in the early stage of illness, and mixed findings were observed regarding factors associated with increased self-stigma. We aimed to investigate the rate and correlates of self-stigma in a cohort of adult patients with early psychosis using a comprehensive array of clinical, treatment and other illness-related variables.MethodsA total of 101 Chinese adult early psychosis patients aged 26–55 years who had received three-year psychiatric treatment for first psychotic episode in Hong Kong and completed self-stigma assessment were included for the current investigation. A broad range of assessments encompassing socio-demographics, premorbid adjustment, onset and illness profiles, symptom severity, psychosocial functioning, treatment characteristics and medication side-effects were conducted.ResultsTwenty-eight (27.7%) patients had moderate-to-high levels of self-stigma. Univariate linear regression analyses showed that age at study entry, sex, educational level, age at psychosis onset, duration of untreated psychosis (DUP), insight level, global psychosocial functioning, and the use of second-generation antipsychotic were related to self-stigma levels. Final multivariable regression model revealed that female sex, younger age at entry, longer DUP and better insight were independently associated with higher levels of self-stigma.ConclusionMore than one-fourth of early psychosis patients experienced significant self-stigma, highlighting an unmet need for early detection and intervention of self-stigma in the initial years of illness. Further investigation is warranted to clarify trajectories and predictors of self-stigma in the early illness course.

Relationships that traverse sociodemographic categories may improve community attitudes toward marginalized groups and potentially protect members of those groups from stigma and discrimination. The present study evaluated whether internalized HIV stigma and perceived HIV-related discrimination in health care settings differ based on individual- and neighborhood-level characteristics of women living with HIV (WLHIV). We also sought to extend previous conceptual and empirical work to explore whether perceived HIV-related discrimination mediated the association between neighborhood racial diversity and internalized HIV stigma. A total of 1256 WLHIV in the Women's Interagency HIV Study (WIHS) attending 10 sites in metropolitan areas across the United States completed measures of internalized HIV stigma and perceived HIV-related discrimination in health care settings. Participants also provided residential information that was geocoded into Federal Information Processing Standard (FIPS) codes and linked with census-tract level indicators. In cross-sectional analyses, greater neighborhood racial diversity was associated with less internalized HIV stigma and less perceived HIV-related discrimination regardless of individual race. Neighborhood median income was positively associated with internalized HIV stigma and perceived discrimination, while individual income was negatively associated with perceptions of stigma and discrimination. In an exploratory mediation analysis, neighborhood racial diversity had a significant indirect effect on internalized HIV stigma through perceived HIV-related discrimination. An indirect effect between neighborhood income and internalized stigma was not supported. These findings suggest that greater neighborhood racial diversity may lessen HIV stigma processes at the individual level and that HIV stigma-reduction interventions may be most needed in communities that lack racial diversity.

Objectives: Many people with mental illness are subject to social and objective exclusion, discrimination, and stigma. One of the mental illnesses most exposed to stigma is bipolar disorder (BD). This study aimed to ascertain patient perceptions of social support and examine the association between internalized stigma, self-esteem, and clinical course in patients with bipolar disorder. Method: This cross-sectional study enrolled 103 patients with BD. Sociodemographic form, Internalized Stigma of Mental Illness Inventory (ISMI), Rosenberg Self-Esteem Scale (RSE), Multidimensional Scale of Perceived Social Support (MSPSS) were used to collect data in this study. Results: The mean age of 103 patients with BD was 40,67±10,53. 46 (44.7%) of these participants were female. The ISMI score was higher in patients who were unemployed than in those who were employed (p=0.050). In terms of ISMI scores, those with residual symptoms had significantly higher scores than those without (p=0,001). The ISMI scores of those whose medication was inconsistent were significantly higher than those who were compliant with their medication (p=0.004). ISMI had a positive correlation between the number of depressions (p

Background: Recovery is a fundamental construct in the health care of patients diagnosed with Schizophrenia. The Recovery Assessment Scale (RAS) is the most widely used with different versions in number of items and factors. Methods: 227 patients from three outpatient mental health centers participated in the study. They were administered the Spanish adapted version of the RAS-41, the Internalized Stigma Scale (ISMI-29) and the Schizophrenia Quality of Life Scale (SQoL-18). Results: the results showed good fit indices for the original five-factor structure (CFI=.95; TLI=.94; SRMR=.054; RMSEA=.059), acceptable internal consistency (α=.90; ω=.91), and significant correlations with the criterion variables. Conclusions: The results support the use of the 18-item version of the RAS in Chile as a valid and reliable measure of recovery for the clinical population diagnosed with schizophrenia. [ABSTRACT FROM AUTHOR]

Sexual stigma and discrimination toward men who have same-gender sexual experiences are present across the globe. In Ghana, same-gender sexual desires and relationships are stigmatized, and the stigma is sanctioned through both social and legal processes. Such stigma negatively influences health and other material and social aspects of daily life for men who have sex with men (MSM). However, there is evidence that stigma at the interpersonal level can intersect with stigma that may be operating simultaneously at other levels. Few studies provide a comprehensive qualitative assessment of the multi-level sexual stigma derived from the direct narratives of men with same-gender sexual experience. To help fill this gap on sexual stigma, we qualitatively investigated [1] what was the range of sexual stigma manifestations, and [2] how sexual stigma manifestations were distributed across socioecological levels in a sample of Ghanaian MSM. From March to September 2020, we conducted eight focus group discussions (FGDs) with MSM about their experiences with stigma from Accra and Kumasi, Ghana. Data from the FGDs were subjected to qualitative content analysis. We identified a range of eight manifestations of sexual stigma: (1) gossiping and outing; (2) verbal abuse and intrusive questioning; (3) non-verbal judgmental gestures; (4) societal, cultural, and religious blaming and shaming; (5) physical abuse; (6) poor-quality services; (7) living in constant fear and stigma avoidance; and (8) internal ambivalence and guilt about sexual behavior. Sexual stigma manifestations were unevenly distributed across socioecological levels. Our findings are consistent with those of existing literature documenting that, across Africa, and particularly in Ghana, national laws and religious institutions continue to drive stigma against MSM. Fundamental anti-homosexual sentiments along with beliefs associating homosexuality with foreign cultures and immorality drive the stigmatization of MSM. Stigma experienced at all socioecological levels has been shown to impact both the mental and sexual health of MSM. Deeper analysis is needed to understand more of the lived stigma experiences of MSM to develop appropriate stigma-reduction interventions. Additionally, more community-level stigma research and interventions are needed that focus on the role of family and peers in stigma toward MSM in Ghana. [ABSTRACT FROM AUTHOR]

Introduction The stigma of mental illness occurs when elements of labeling, stereotypes, separation of emotional reactions, loss of position and discrimination imposed on a group of people from a state of power. Self-stigma arises when people with a mental illness aware of stereotypes and agree with these prevailing beliefs. The result is that they lead to negative emotional reactions and behaviors, towards themselves that respond to prejudices. High levels of self-esteem have been shown to be associated with low levels of selfesteem, functionality and quality of life. They also make it difficult to comply with the treatment and consequently its outcome. In addition, they affect the field of psychosocial rehabilitation of these individuals, such as finding work, living independently and socializing. Aim With the present study, an attempt was made through the systematic review of the literature to identify and present the existing interventions at the medical, psychological, social and nursing contribution for the treatment of self-stigma in people with a mental illness. Method A systematic review of the literature was conducted in order to investigate the interventions and their effectiveness, for the treatment of self-stigma in people with mental illness, in the electronic google scholar databases, PubMed in Greek and English terms, without time restrictions. Results From all the studies it was seen that psychoeducation and cognitive behavioral therapy programs were effective in reducing some components of self-stigma, but without long-term results. Some of these were selfefficacy, self-esteem, and adherence to treatment. Conclusions - Discussion This review has highlighted some of the existing intervention strategies to reduce internalized stigma in people with mental illness. The main categories were those of psychoeducation and cognitive-behavioral, as well as interventions at the level of functionality and cultivation of skills. It is important for nursing to find effective interventions to reduce self-stigma, clarify the phenomenon of selfstigma and develop a tool that clearly measures the phenomenon of self-stigma. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the role of stigma in different diagnoses of mental illness. A cross-sectional study (N = 255) was developed in two groups: users of a rehabilitation network for people with severe mental illness (Group-I) and people with common diagnoses in an ambulatory psychiatric service (Group-II). Internalized stigma, social stigma, self-esteem, and sociodemographic variables were measured. Mean comparisons, ANOVAs, and independent linear regression models were carried out. Similar overall scores were obtained for the internalized stigma, but Group-I reported more discrimination and resistance to stigma and also had less social stigma. The regression model for Group-I revealed social stigma and self-esteem as predictors, while in Group-II only self-esteem was significant. The study reveals differences in internalized stigma according to the care resource and diagnoses, suggesting different intervention lines and underlining the importance of further research on this topic.

Introduction. Self-stigma in mentally ill patients is an urgent problem in psychiatry. In literary sources, the impact of personal characteristics of patients with psychosis on the formation of internalized stigma remains insufficiently studied. This study aims to examine the mutual influence of narcissistic self-regulation and self-stigma factors as well as to identify protective characteristics of narcissistic regulation related to the minimization of internalized stigma. Methods. The study sample comprised 81 psychiatric in-patients, 62 of whom had ICD-10 F2 disorders and 19 had ICD-10 F3 disorders. The study used the following assessment tools: (a) the Internalized Stigma of Mental Illness (ISMI) scale and (b) the Index of Self-system Functioning (ISSF). Statistical procedures were as follows: descriptive statistics, analysis of variance (Mann–Whitney U test), and calculation of the effect size with Cohen’s d. Results. In the surveyed sample, the ISSF results indicated significant decrease in narcissistic regulation for all the subscales and the total ISSF score (21.1 ± 4), compared to the normative value for an ideally strong personality (0). The mean self-stigma level of the surveyed patients was low (2.4 ± 0.24); the threshold of 2.5 points was exceeded among 30 patients (37 %), which indicates a highly intense of self-stigma. We compared the features of narcissistic regulation in patients with high and low levels of self-stigma and observed significant relationship between manifestations of internalized stigma and factors of personal strengths. Cohen’s d effect sizes for eight subscales (Self1, Self2, Self3, Self5, Self6, Self7, Self12, Self18) were 1.1–1.8 at p ≤ 0.05, which indicates a significant decrease in narcissistic regulation among patients with a high level of self-stigma. Discussion. The characteristics of the system of narcissistic regulation determine the decrease in personal strengths, which may contribute to social maladjustment and to the formation of internalized stigma. The individualized profiles related to deficiency of adequate defense mechanisms may be valuable in focused psychotherapeutic interventions.