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Objectives: Improving Quality of Life (QoL) is an important objective in the treatment of bipolar disorder. The aim of the current study was to examine to which extent resilience, internalized stigma, and psychopathology are correlated to QoL., Methods: We recruited 60 outpatients diagnosed with bipolar I disorder according to DSM-IV criteria and 77 healthy control subjects from the general community. In patients, symptoms were quantified by the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Young Mania Rating Scale (YMRS) and internalized stigma by the Internalized Stigma of Mental Illness (ISMI) scale. In order to assess QoL and resilience, the Berliner Lebensqualitätsprofil (BELP) and the Resilience Scale (RS-25) were used in both patients and control subjects., Results: Despite presenting with a very mild symptom level and relatively low internalized stigma, patients with bipolar I disorder indicated significantly lower QoL and resilience as compared to healthy control subjects. In patients, QoL correlated significantly with resilience, internalized stigma, and residual symptoms of depression. No significant correlations were observed between QoL and residual manic symptoms., Limitations: The cross-sectional design and the relatively small sample size limit the generalizability of our results. Furthermore, levels of resilience and internalized stigma may change over the course of the illness and have different impacts on the long-term outcome of patients with bipolar disorder., Conclusion: Our results show that QoL of patients suffering from bipolar I disorder, even when only mildly ill, is strongly associated with the degree of resilience and internalized stigma, and that particularly residual depressive symptoms have a negative impact on QoL. In addition to drug treatment, psychotherapeutic approaches should be applied to strengthen resilience, to reduce internalized stigma, and, ultimately, to improve quality of life., (Copyright © 2018. Published by Elsevier B.V.)

Internalized stigma, hope and depressive symptoms are important variables in the recovery process of people with schizophrenia spectrum disorders, but little is known about their stability or relationship among each other over time. This study aims to unravel the longitudinal stability and relationships of these variables. 99 participants were included in this prospective study assessing internalized stigma, hope and depressive symptoms at baseline, with a first follow-up after three months and a second follow-up after six months. Multilevel models examined if the variables changed over time and a correlation coefficient was conducted to show their relationship to each other. Hope stayed stable over time, whereas internalized stigma and depressive symptoms significantly decreased over the study period. The correlation coefficient showed that internalized stigma and depressive symptoms influenced each other moderately over time. Thus, while hope was a stable construct over time, internalized stigma and depressive symptoms changed significantly and were correlated to each other positively. This implies that participants may adjust to their chronic condition over time, and recovery focused interventions should target both psychological dimensions at the same time., (Copyright © 2018. Published by Elsevier B.V.)

Those involved in the criminal justice system are swiftly identified as "criminals." Receipt of this label may promote self-stigma, a process wherein criminal stereotypes are internalized and produce negative psychological and behavioral consequences. Research has yet to identify which types of offenders are at risk for, or in contrast, protected from, experiencing self-stigma. The current study examines whether risk and protective factors predict multiple components of the self-stigma process (i.e., perceived stigma, stereotype agreement, internalized stigma, anticipated stigma) in a sample of male jail inmates ( N = 111). Results showed that mental health symptoms were a consistent risk factor across three of four self-stigma components, whereas antisocial characteristics were a risk factor for stereotype agreement and internalized stigma. Self-esteem was a protective factor for internalized and anticipated stigma. Implications for preventing self-stigma among offenders are discussed.

Affiliated stigma often refers to internalized stigma among family members of stigmatized individuals. This study aimed to investigate the relationship between affiliate stigma and quality of life (QOL) among primary caregivers of individuals with mental illness undergoing treatment at the Institute of Mental Health, Singapore. Three hundred and fifty caregivers were recruited for the study. The World Health Organization Quality of Life questionnaire (WHOQOL-BREF) and Family Stigma Scale (FSS) were administered to the primary caregivers of patients with mental illness. Multiple linear regression analyses were conducted to investigate the association of affiliate stigma with QOL. A high proportion of caregivers of individuals with mental illness experience affiliate stigma in Singapore. All four QOL domains were significantly associated with affiliate stigma. These findings entail that it is imperative to improve public's perception of those with mental illness to reduce stigmatization and thus improve caregiver's QOL., (Copyright © 2018. Published by Elsevier B.V.)

Background: Self-stigma represents a major barrier to recovery in people with psychotic disorders but is understudied in early illness stage. Longitudinal investigation of prediction for self-stigma is scarce and none is conducted in early psychosis. We aimed to prospectively examine baseline predictors of self-stigma in early psychosis patients in the context of a 3-year follow-up of a randomized-controlled trial (RCT) comparing 1-year extension of early intervention (EI) with step-down psychiatric care for first-episode psychosis (FEP)., Method: One hundred sixty Chinese patients were recruited from a specialized EI program for FEP in Hong Kong after they had completed this 2-year EI service, and underwent a 12-month RCT. Participants were followed up and reassessed 3years after inclusion to the trial. Comprehensive evaluation encompassing clinical, functional, subjective quality of life and treatment-related variables were conducted. Data analysis was based on 136 participants who completed self-stigma assessment at 3-year follow-up., Results: Fifty patients (36.8%) had moderate to high levels of self-stigma at 3-year follow-up. Multivariate regression analysis revealed that female gender, prior psychiatric hospitalization, longer duration of untreated psychosis and greater positive symptom severity at study intake independently predicted self-stigma at the end of 3-year study period., Conclusion: Our results of more than one-third of early psychosis patients experienced significant self-stigma underscore the clinical needs for early identification and intervention of self-stigmatization in the initial years of psychotic illness. Further research is warranted to clarify prediction profile and longitudinal course of self-stigma in the early illness phase., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objectives: To adapt the Internalized Stigma of Mental Illness scale (ISMI) to examine self-stigma associated with aging and to study the psychometric properties of this adapted version (IS65+). Finally, self-stigma associated with age in older people is studied., Method: The IS65+ was administered to a random sample of 419 people over 65 years from Madrid (Spain) to study the psychometric properties of this adapted version. A regression model was estimated to identify the variables that best predict self-stigma associated with old age., Results: The IS65+ showed good internal consistency (α = .89) and a factorial structure of five factors. The data showed lower levels of self-stigma related to age in the sample than the levels of mental illness self-stigma in people with mental illness. The variables associated with age-related self-stigma are: high levels of perceived loneliness, low levels of coping strategies, gender (female), mental disorder, major depressive disorder, low levels of optimism and quality of life, and high levels of functional impairment., Conclusion: A new version of ISMI (IS65+) with acceptable psychometric criteria has been developed for use in people over 65 years old.

Health-related quality of life is an increasingly critical outcome of mental healthcare, yet its disease-independent attributes, particularly family-focused resilient indicators, for individuals with schizophrenia have not been explicitly examined. The aim of this study was to explore the degree of health-related quality of life and to examine the mediating effect of family sense of coherence on internalized stigma and health-related quality of life in individuals with schizophrenia. A cross-sectional and correlational study design was used. A total of 111 individuals with schizophrenia were enrolled from the in-patient psychiatric rehabilitation services of two psychiatric hospitals in Taiwan. Face-to-face structured interviews were applied to collect information. Data were analyzed with descriptive statistics and multiple regression analyses. The results indicated that affected individuals experienced impaired health-related quality of life. Family sense of coherence partially mediated the relationship between internalized stigma and health-related quality of life. This study indicates that knowledge about the role of family sense of coherence in mental health rehabilitation may assist mental healthcare professionals to provide therapeutic interventions to address internalized stigma, thereby promoting health-related quality of life in individuals living with schizophrenia., (© 2017 Australian College of Mental Health Nurses Inc.)

Background: Research suggests that HIV stigma exerts a detrimental impact on the mental health of HIV-positive gay and bisexual men (GBM). We sought to better understand these processes by examining two forms of HIV stigma (i.e., anticipated and internalized) at two levels (i.e., individual and situational) in association with daily negative affective experiences., Methods: We conducted a 21-day twice-daily ecological momentary assessment study of 51 HIV-positive GBM. Twice-daily stigma measures were disaggregated into individual-level averages and situational fluctuations, and we utilized multilevel models to examine both concurrent and time-lagged effects of HIV stigma on anxious affect, depressed affect, anger, fatigue, and emotion dysregulation., Results: Situational experiences of internalized HIV stigma were associated with increased levels of anxious and depressed affect, anger, and emotion dysregulation in both concurrent and time-lagged analyses. Situational experiences of anticipated HIV stigma were only associated with anger and only within concurrent analyses. Individual-level internalized HIV stigma was associated with anxious affect and emotion dysregulation in both concurrent and time-lagged models, and with depressed affect and fatigue in time-lagged models., Limitations: The small and high-risk sample limits generalizability and results should be replicated in larger and more diverse samples., Conclusions: These findings suggest that, independent of the effects of individual-level stigma, situational experiences of internalized HIV stigma are associated with increases in event-level negative affective experiences. A combination of individually-delivered and mobile interventions may be successful at reducing the impact of internalized HIV stigma on negative affect and emotion dysregulation., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Introduction: People who inject drugs (PWID) are stigmatized by society. Over time people may begin to internalize the stigma about their group. This research examines how implicit and explicit internalized stigma among PWID relates to health care and treatment access, psychosocial functioning, and engagement in risky behaviors., Methods: PWID were recruited from a needle and syringe program (NSP) located in Sydney, Australia. Participants completed a survey examining explicit and implicit internalized stigma, risky behaviors (e.g., sharing injecting equipment, unprotected sex), health care and treatment access (e.g., comfort attending NSPs), and psychosocial functioning (e.g., mental health). Detailed demographic variables were also collected., Results: A total of 115 clients completed the measures. To the degree that participants had internalized the stigma about their group (measured explicitly), they felt less comfortable attending NSPs, had greater severity of dependence, and experienced more depressive symptoms. The implicit measure of internalized stigma was related to treatment engagement and needle sharing, although the direction of these effects was unexpected., Conclusions: This research highlights the importance of ongoing research into the implications of internalized stigma for PWID. Assessing both explicit and implicit internalized stigma appears to be beneficial as these are related to different health and behavioral outcomes., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Despite increasing awareness of stigma from mental health service providers as a barrier to recovery, little research has directly examined how it might influence the service users' self-perceptions and treatment experience. The present study examined the association of service users' perceived provider stigma with their experience of internalized stigma and disempowerment, two psychosocial constructs known to hinder recovery. Mental health service users (N = 350) completed questionnaires assessing perceived stigma from mental health service providers, including perceptions of negative affective reactions towards individual users and desired social distance towards people with mental illnesses across various life domains, internalized stigma, and disempowerment (i.e., diminished self-efficacy and mastery) in mental health treatment settings. Structural equation modeling showed that both perceived negative affective reactions and perceived social distance were positively associated with disempowerment. Furthermore, these associations were significantly mediated by internalized stigma. These findings illuminate how perceived stigma from providers can "get under the skin" of mental health service users and contribute to their overall sense of disempowerment in mental health settings. They also highlight the need for future stigma reduction interventions to specifically target the attitudes and beliefs held by mental health professionals., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Although associated with key recovery outcomes, stigma resistance remains under-studied largely due to limitations of existing measures. This study developed and validated a new measure of stigma resistance. Preliminary items, derived from qualitative interviews of people with lived experience, were pilot tested online with people self-reporting a mental illness diagnosis (n = 489). Best performing items were selected, and the refined measure was administered to an independent sample of people with mental illness at two state mental health consumer recovery conferences (n = 202). Confirmatory factor analyses (CFA) guided by theory were used to test item fit, correlations between the refined stigma resistance measure and theoretically relevant measures were examined for validity, and test-retest correlations of a subsample were examined for stability. CFA demonstrated strong fit for a 5-factor model. The final 20-item measure demonstrated good internal consistency for each of the 5 subscales, adequate test-retest reliability at 3 weeks, and strong construct validity (i.e., positive associations with quality of life, recovery, and self-efficacy, and negative associations with overall symptoms, defeatist beliefs, and self-stigma). The new measure offers a more reliable and nuanced assessment of stigma resistance. It may afford greater personalization of interventions targeting stigma resistance., (Copyright © 2017 Elsevier B.V. All rights reserved.)

To date very little literature exists examining theoretically-based models applied to day-to-day positive and negative affective well-being among lesbian, gay, and bisexual (LGB) persons living with HIV/AIDS (PLWHA). Grounded in the perspective of Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674-697. Minority Stress Model, the present study examined HIV- and sexual orientation-related factors influencing affective well-being (i.e., positive affect, negative affect, life satisfaction, and stress). Participants were 154 HIV-positive LGB adults from an urban area in the southwestern United States. Data were drawn from an archival database (i.e., Project Legacy). The study methodology featured a cross-sectional self-report survey of minority stress, victimization, coping, and emotional well-being, among other subjects. Primary regression results were: (1) males reported less general stress than females; (2) higher internalized HIV-related stigma was associated with elevated negative affect; (3) higher internalized homophobia was associated with elevations in negative affect and general stress; (4) higher coping self-efficacy was associated with lesser negative affect, lesser general stress, greater positive affect, and greater satisfaction with life; (5) a significant interaction between HIV-related victimization and coping self-efficacy showed that coping self-efficacy was positively associated with positive affect only (only for non-victims). Contrary to expectations, coping self-efficacy demonstrated the largest main effects on affective well-being. Results are discussed with regard to potential need for theoretical refinement of Minority Stress Model applied to PLWHA and affective well-being outcomes. Recommendations are offered for future research.

Background: Internalized stigma is a significant difficulty for those who experience psychosis, but it has never been conceptualized using cognitive theory., Aims: The aim of this paper is to outline a cognitive model conceptualizing internalized stigma experienced by people who also experience psychosis., Method: Previous literature is reviewed, critiqued and synthesized to develop the model. It draws upon previous social cognitive models of internalized stigma and integrates cognitive behavioural theory and social mentality theory., Results: This paper identifies key cognitive, behavioural and emotional processes that contribute to the development and maintenance of internalized stigma, whilst also recognizing the central importance of cultural context in creating negative stereotypes of psychosis. Moreover, therapeutic strategies to alleviate internalized stigma are identified. A case example is explored and a formulation and brief intervention plan was developed in order to illustrate the model in practice., Conclusion: An integrative cognitive model is presented, which can be used to develop individualized case formulations, which can guide cognitive behavioural interventions targeting internalized stigma in those who experience psychosis. More research is required to examine the efficacy of such interventions. In addition, it is imperative to continue to research interventions that create change in stigma at a societal level.

Background: Little is known about internalized stigma among primary care patients, and whether the presence of internalized stigma is related to the severity of substance use problems independent of substance use-related variables. We sought to examine the relationship between internalized stigma and substance use problems among primary care patients with opioid or alcohol use disorders (OAUDs)., Methods: We present baseline data from 393 primary care patients who were enrolled in a study of collaborative care for OAUDs. Regression analyses examined the relationship between internalized stigma and substance use problems, controlling for demographics, psychiatric comorbidity, and quantity/frequency of use., Results: The majority of participants reported thinking, at least sometimes, that they "have permanently screwed up" their lives (60%), and felt "ashamed" (60%), and "out of place in the world" (51%) as a result of their opioid or alcohol use. Higher internalized stigma was significantly related to more substance use problems (β=2.68, p<0.01), even after the effects of covariates were accounted for. Stigma added 22%, out of 51% total variance explained, leading to a significant improvement in prediction of substance use problems., Conclusions: Among this group of primary care patients with OAUDs, rates of internalized stigma were comparable to those reported in specialty substance use treatment settings. Consistent with extant specialty care literature, our results suggest that internalized stigma may be a unique contributor that is associated with treatment outcomes, such as substance use problems, among primary care patients with OAUDs., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Although studies have demonstrated that females experience more HIV-related stigma than males do, questions remain regarding the different dimensions of the stigma (i.e., perceived versus internalized) in China. The present study investigated gender differences in perceived and internalized HIV-related stigma, taking into account the potential influence of education. The study was conducted between October 2011 and March 2013. A total of 522 people living with HIV (PLH) were recruited from Anhui Province, China. The PLH participated in a survey using the Computer Assisted Personal Interview (CAPI) method. The gender differences in perceived and internalized HIV-related stigma were calculated with and without stratifying by education level. Female participants had significantly less education than the male participants. No significant difference was observed between females and males with respect to perceived stigma. However, females reported significantly higher internalized stigma than males did (p < .001). When socio-demographic characteristics were controlled, the gender difference in internalized stigma remained significant among educated participants (p = .038). The findings suggested that gender differences in HIV-related stigma were primarily found for internalized stigma. Heightened intervention efforts are encouraged to reduce internalized HIV-related stigma, particularly among female PLH in China and other regions with similar gender dynamics.

Aims: Since evaluation regarding the impact of mental illness related internalized stigma is scarce, there is a great need for psychometric instruments which could contribute to understanding its adverse effects among Greek patients with severe mental illness. The Brief Internalized Stigma of Mental Illness (ISMI) scale is one of the most widely used measures designed to assess the subjective experience of stigma related to mental illness. The present study aimed to investigate the psychometric properties of the Greek version of the Brief ISMI scale. In addition to presenting psychometric findings, we explored the relationship of the Greek version of the Brief ISMI subscales with indicators of self-esteem and quality of life., Methods: 272 outpatients (108 males, 164 females) meeting the DSM-IV TR criteria for severe mental disorder (schizophrenia, bipolar disorder, major depression) completed the Brief ISMI, the RSES and the WHOQOL-BREF scales. Patients reported age and educational level. A retest was conducted with 124 patients., Results: The Chronbach's alpha coefficient was 0 0.83. The test-retest reliability coefficients varied from 0.81 to 0.91, indicating substantial agreement. The ICC was for the total score 0.83 and for the two factors, 0.69 and 0.77 respectively. Factor analysis provided strong evidence for a two factor model. Factors 1 and 2 were named respectively "how others view me" and "how I view myself". They were negatively correlated with both RSES and WHOQOL-BREF scales, as well as with educational level. Factor 2 was significantly associated with the type of diagnosis., Conclusions: The Greek version of the Brief ISMI scale can be used as a reliable and valid tool for assessing mental illness related internalized stigma among Greek patients with severe mental illness., Competing Interests: • Conflict of interest: None declared.

Background and Objectives: Middle-aged and older gay men experience higher rates of depression and anxiety compared to their heterosexual counterparts, with internalized homonegativity and sexual identity concealment known to be major stress-related contributors. This study examined the prospective effect of different types and sources of social support on internalized homonegativity and sexual identity concealment experienced among middle-aged and older gay men., Methods: A longitudinal survey involving two waves of data collection separated by 12 months was conducted among a cohort of 186 gay-identified men aged 40 years and older., Results: Two types of social support were found to be important. Greater baseline tangible or practical support independently predicted lower internalized homonegativity at 12-month follow-up, while greater baseline emotional or psychological support independently predicted a lower tendency toward sexual identity concealment at 12-month follow-up. Greater baseline support from community or government agencies, such as health services and support organizations, predicted higher internalized homonegativity at 12-month follow-up., Conclusions: These findings suggest that tangible and emotional support may be beneficial in reducing internalized homonegativity and sexual identity concealment among middle-aged and older gay men. Ensuring that services provide environments that do not compound the stressful impact of stigma also appears to be important.

Rationale: People diagnosed with a mental disorder are highly discriminated against, and when they internalize the social stigma they suffer severe consequences which have been associated with greater symptomatology and reduced recovery. This research was carried out in order to develop a predictive model about how discrimination contributes to subjective well-being (positive and negative affects experienced) by means of internalization of stigma (alienation, stereotype endorsement and social withdrawal) and deterioration of positive self-concept (self-esteem and self-efficacy)., Method: We conducted a cross-sectional research design. We used Partial Least Squares (PLS) modelling to analyze the data from 94 Spanish participants diagnosed with a mental disorder., Results: A differential effect of blatant and subtle discrimination is found. Both internalized stigma and positive self-concept play a central role in the effects of discrimination on subjective well-being. Internalized stigma contributes to the explained variance of negative and positive affect, while positive self-concept contributes mainly to explain changes in positive affect., Conclusions: Positive self-concept protects the person from the harm that stigma may cause on his well-being. It especially protects positive affect, which we propose is an important resource in the recovery process. These findings have clinical and research implications.

Aim: The aim of this study is to determine the correlation between schizophrenic patients' level of internalized stigma and their level of hope., Material and Method: The population of the study consisted of patients who had been diagnosed with schizophrenia and also met the study inclusion criteria. The study sample selection from the population was not further divided; the study was conducted with 76 patients. The data of the study were collected using a personal information form, the Internalized Stigma of Mental Illness (ISMI) Scale, and Herth Hope Scale., Findings: The patients' mean score on the Internalized Stigma Scale was 72.78±16.05. Their score on the Hope Scale is 50.36±11.91. A significant negative correlation was found between the total mean scores of ISMI and the Herth Hope Scale (r=-0.360, p<0.01). A significant positive correlation was found between the stigma resistance subscale mean score of ISMI and the total mean score of the Herth Hope Scale (r=0.510, p<0.01)., Conclusion: The internalized stigma levels of schizophrenic patients were found to be high, whereas their hope levels were found to be moderate. A significant negative correlation was found between internalized stigma and hope. This study also found a significant positive correlation between the stigma resistance of patients and their hope levels., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self-esteem and life-satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross-sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire-12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease., (© 2017 Japanese Dermatological Association.)

Individuals with substance abuse may suffer from severe public and internalized stigma. Little is known about how social support can reduce stigma and improve mental health and well-being for them. This research examined how perceived stigma influences individuals in treatment for substance abuse, and whether internalized stigma and shame are mechanisms which link social support with better mental health and well-being. Sixty-four participants in treatment for substance abuse (alcohol, drugs), aged between 18 and 64, completed an online survey measuring perceived stigma, internalized stigma, shame, perceived social support, and mental health and well-being (self-esteem, depression and anxiety, sleep). We found that perceived stigma was associated with lower self-esteem, higher depression and anxiety, and poorer sleep. Furthermore, perceived social support followed the opposite pattern, and was associated with higher self-esteem, lower depression and anxiety, and better sleep. The effects of perceived stigma and of perceived social support on our outcome measures were mediated by internalized stigma and by internalized shame. Helping individuals with substance abuse to utilize their social support may be fruitful for combatting the negative impact of internalized stigma and shame on mental health and well-being., (Copyright © 2017. Published by Elsevier B.V.)

Purpose: The aim of this study was to explore associations between internalized stigma, exposure to physical abuse, experiences with sexual abuse, and depression in Muslim women residing in the United States., Materials and Methods: We analyzed self-reported data collected online in late 2015. Women who self-identified as Muslim, were at least 18 years old, and were residents of the United States met the inclusion criteria (n = 373). Logistic regression models were used to estimate associations between socioeconomic status, nativity, and the abovementioned indicators., Results: Internalized stigma measured through heightened vigilance was associated with depression. Each increase in the abbreviated heightened vigilance scale (higher scores indicate lower vigilance) was associated with 7.6% lower odds of meeting the Center for Epidemiologic Studies Depression Scale 10 (CES-D 10) cutoff for depression (OR = 0.924, 95% CI = 0.888-0.962, p < 0.001). Among individual factors, education, household income, experience with physical abuse, and exposure to sexual abuse were associated with depression. Respondents who reported experiencing physical abuse had almost two times higher odds of meeting the cutoff for depression relative to respondents who had not experienced physical abuse (OR = 1.994, 95% CI = 1.180-3.372, p < 0.01). Likewise, respondents who reported exposure to sexual abuse had over two times higher odds of depression compared with respondents who had not been exposed to sexual abuse (OR = 2.288, 95% CI = 1.156-4.528, p < 0.05)., Conclusions: These findings were from a group of well educated wealthy respondents; however, experience with negative exposures and rates of depression were high. Further research replicating these findings and evaluating evidence-based interventions designed to improve screening for mental illnesses and retention in care with this hard-to-reach population could produce valuable outcomes, particularly for clinicians and public health practitioners committed to improving population health.

The goal of this study is to test a model in which personal discrimination predicts internalized stigma, while group discrimination predicts a greater willingness to engage in collective action. Internalized stigma and collective action, in turn, are associated to positive and negative affect. A cross-sectional study with 213 people with mental illness was conducted. The model was tested using path analysis. Although the data supported the model, its fit was not sufficiently good. A respecified model, in which a direct path from collective action to internalized stigma was added, showed a good fit. Personal and group discrimination appear to impact subjective well-being through two different paths: the internalization of stigma and collective action intentions, respectively. These two paths, however, are not completely independent, as collective action predicts a lower internalization of stigma. Thus, collective action appears as an important tool to reduce internalized stigma and improve subjective well-being. Future interventions to reduce the impact of stigma should fight the internalization of stigma and promote collective action are suggested.

Introduction: Although suicidality is frequently the cause of stigma, it is conversely true that stigma may be the cause of suicidality. The present paper focuses on the complex relationships that exist between suicidal behavior and stigmatizing attitudes., Methods: A narrative review of the topic will be presented on the basis of the relevant literature collected from an electronic search of PubMed, ISI Web of Knowledge, and Scopus databases, using stigma, public stigma, structural stigma, perceived stigma, self-stigma, suicide, attempted suicide, and suicidality as key words., Results: A negative perception is frequently held of suicidal people, labeling them as weak and unable to cope with their problems, or selfish. Individuals who have attempted suicide are subject to similar processes of stigmatization and "social distancing"; insurance policies include an exclusion clause against death by suicide. Subjects with a direct personal experience of depression or suicide strongly endorse a feeling of self-stigma; those who have attempted suicide are often ashamed and embarrassed by their behavior and tend to hide the occurrence as much as possible. Similar processes are observed among family members of subjects who have committed suicide or made a suicide attempt, with a higher perceived stigma present in those bereaved by suicide. Perceived or internalized stigma produced by mental or physical disorders, or through belonging to a minority group, may represent a significant risk factor for suicide, being severely distressing, reducing self-esteem and acting as a barrier in help-seeking behaviors., Conclusion: With the aim of preventing suicide, greater efforts should be made to combat the persisting stigmatizing attitudes displayed toward mental disorders and suicide itself. Indeed, the role of stigma as a risk factor for suicide should further motivate and spur more concerted efforts to combat public stigma and support those suffering from perceived or internalized stigma. Experts and scientific societies should form an alliance with the media in an effort to promote a marked change in the societal perception of mental health issues and suicide. As stigma may result in severe consequences, specialist care and psychological interventions should be provided to populations submitted to stigma.

Internalized stigma in people living with HIV is associated with negative outcomes including sexual risk behaviors and depression. Little research has focused on internalized stigma in men who have sex with men living with HIV (MSMLWH) in China. We measured internalized stigma and examined its potential predictors in a sample of 277 MSMLWH from two infectious disease specialist hospitals in Beijing, China. Descriptive analysis showed an intermediate high level of internalized stigma in these men. Multiple linear regression revealed that higher levels of stereotypes, negative affect, older age, lower levels of mastery, and limited information and emotional support were significant predictors of internalized stigma. Cognitive reconstruction interventions should be developed to change negative stereotypes and reduce internalized stigma, and information and emotional support should be provided to develop mastery, foster coping skills for internalized stigma, and alleviate negative affect. MSMLWH of older ages need more attention in stigma reduction programs., (Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.)

Upon conviction, individuals receive the stigmatizing label "criminal offender." Existing stereotypes about criminal offenders may be integrated into the self-concept, a phenomenon known as self-stigma . In many stigmatized groups, self-stigma is a robust predictor of poor functioning (Livingston & Boyd, 2010; Schomerus et al., 2011). However, little is known about how self-stigma occurs (Corrigan et al., 2006), and there has been limited research with criminal offenders. This study examines a theoretical model of self-stigma in which perceived stigma leads to stereotype agreement, internalized stigma, and then to anticipated stigma. A sample of 203 male jail inmates completed assessments of these constructs just prior to release. Results show a significant indirect path from perceived stigma to stereotype agreement to internalized stigma, but not to anticipated stigma. However, perceived stigma was directly related to anticipated stigma. In conclusion, perceived stigma affects the self through two processes: it indirectly leads to internalized stigma through one avenue, and directly leads to anticipated stigma through a separate avenue. Race, criminal identity, and attitudes toward criminals were examined as moderators.

Purpose of the Study: Loneliness is a key health risk for older adults. Utilizing the loneliness model, we examine the relationship between living arrangement and loneliness among lesbian, gay, and bisexual (LGB) older adults, taking into consideration potential correlates including social resources and personal constraints., Design and Methods: We use data from a national survey of LGB adults aged 50 and older (N = 2,444). Types of living arrangement include living with a partner or spouse, living alone, and living with someone other than a partner or spouse., Results: Compared with LGB older adults living with a partner or spouse, both those living alone and living with others reported higher degrees of loneliness, even after controlling for other correlates. The results of a multivariate regression analysis reveal that social support, social network size, and internalized stigma partially account for the relationship between living arrangement and loneliness., Implications: Living arrangement was found to be an independent correlate of loneliness among LGB older adults. Targeted interventions are needed to reduce loneliness for those living alone and those living with someone other than a partner or spouse in part by enhancing social resources and reducing risks of internalized stigma. Eliminating discriminatory policies against same-sex partnerships and partnered living arrangements is recommended., (© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The present study investigated the reliability and validity of a Japanese version of the Internalized Stigma of Mental Illness (ISMI) scale, designed to assess internalized stigma experienced by people with mental illness., Methods: A survey was conducted with 173 outpatients with mental illness who attended psychiatric clinics on a regular basis. A retest was conducted with 51 participants to evaluate the scale's psychometric properties., Results: The alpha coefficient for the overall internal consistency was 0.91, and the coefficients of the individual ISMI subscales ranged from 0.57 to 0.81. The test-retest reliability was r = 0.85 (n = 51, P < 0.01). In terms of criterion-related validity, the Japanese version of the ISMI scale was significantly correlated with the Beck Depression Inventory (r = 0.61, P < 0.01), the Rosenberg Self-Esteem Scale (r = -0.53, P < 0.01), and the Empowerment Scale (r = -0.52, P < 0.01). In addition, factor analyses of the ISMI items demonstrated a four-factor solution for the alienation, stereotype endorsement, discrimination experience, and social withdrawal subscales, with the stigma resistance items excluded., Conclusions: The Japanese version of the ISMI scale demonstrated similar reliability and validity to the original English version. Therefore, the Japanese version of the ISMI scale may be an effective and valid tool to measure internalized stigma among Japanese people who have a mental illness.

Background: Recent studies on insight in people with schizophrenia showed that insight level is linked with treatment compliance. Therefore, many therapies are aimed at increasing the insight level, such as psycho-education. However, insight level is also probably linked with depression level. So, improving insight is at risk of increasing the level of depression. Nevertheless, results on this topic are not consensual in the scientific literature. Presumably, this could be due to the concept of insight itself, although we could hypothesise that some confounding variables are implied in the interaction between insight and depression, such as internalized stigma., Aims: to test the hypothesis that the relationship between insight and depression is mediated by internalized stigma in people with schizophrenia., Method: Sixty-two patients with schizophrenia (DSM-IV or ICD-10) recruited in mental health services in Île de France (75% male), aged 20 to 64 years (m=38.71, σ=0. 43), filled in questionnaires assessing internalized stigma (ISMI), depression (CDSS and BDI) and insight (SAIQ, Q8, IS), after giving their written informed consent. Correlations between insight, depression and different variables were made (Hypothesis 1). Then we ran multiple regressions and partial correlations to test the internalized stigma mediation (Hypothesis 2)., Results: Insight, internalized stigma and depression are statistically significantly correlated with each scales used (except Q8). Insight is correlated with depressed mood (correlations between IS and CDSS: r=0.27, P=0.04, and BDI, r=0.40, P=0.001). We also found negative correlations between SAIQ and CDSS (r=-0.35, P=0.005) and the BDI (r=-0.4265, P=0.000) which means that good insight is linked with depression. This result validates our hypothesis 1. The statistic tests reveal other complementary results: the association between insight and depression is mediated by the level of internalized stigma: when ISMI is controlled, the correlation between insight and depression decreased moderately with CDSS and with small intensity with SAIQ, but clearly. So, ISMI is probably a mediating variable between IS and BDI-CDSS. In conclusion, internalized stigma could be a mediating variable between insight and depression. This validates our second hypothesis., Conclusions: Our results suggest that the relationship between insight and depression is mediated by internalized stigma. Patients with good insight who internalize stigma seem to be more depressed than those who don't. This result could have important consequences in clinical practice: improving insight level should be completed by a specific attention to the level and evolution of internalized stigma to avoid increasing depression. Further studies need to be conducted to confirm these results., (Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

We adopted an intersectionality framework and examined whether the relationship between internalized HIV stigma and depressive symptoms is moderated by internalized substance use stigma. A total of 85 people living with HIV with a history of substance use in the Bronx, New York, completed a survey. Results revealed evidence of moderation: Participants who internalized HIV stigma experienced greater depressive symptoms only if they also internalized substance use stigma. Researchers should examine stigma associated with multiple socially devalued characteristics to best understand how stigma impacts mental health among people living with HIV. Healthcare providers should address stigma associated with the full range of socially devalued characteristics with which people living with HIV live., (© The Author(s) 2013.)

In people suffering from schizophrenia, major areas of everyday life are impaired, including independent living, productive activities and social relationships. Enhanced understanding of factors that hinder real-life functioning is vital for treatments to translate into more positive outcomes. The goal of the present study was to identify predictors of real-life functioning in people with schizophrenia, and to assess their relative contribution. Based on previous literature and clinical experience, several factors were selected and grouped into three categories: illness-related variables, personal resources and context-related factors. Some of these variables were never investigated before in relationship with real-life functioning. In 921 patients with schizophrenia living in the community, we found that variables relevant to the disease, personal resources and social context explain 53.8% of real-life functioning variance in a structural equation model. Neurocognition exhibited the strongest, though indirect, association with real-life functioning. Positive symptoms and disorganization, as well as avolition, proved to have significant direct and indirect effects, while depression had no significant association and poor emotional expression was only indirectly and weakly related to real-life functioning. Availability of a disability pension and access to social and family incentives also showed a significant direct association with functioning. Social cognition, functional capacity, resilience, internalized stigma and engagement with mental health services served as mediators. The observed complex associations among investigated predictors, mediators and real-life functioning strongly suggest that integrated and personalized programs should be provided as standard treatment to people with schizophrenia., (Copyright © 2014 World Psychiatric Association.)