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The stigma of leprosy will have reduced effects if people cannot reliably perceive it. Two factors impact these perceptions: familiarity and entitativity. One hundred and forty-five participants tested this assertion using an online platform to complete measures of stigma about leprosy as well as measures of familiarity and entitativity. The group of 145 completed the same measures of stigma, entitativity, and familiarity 1 week later. Standard deviations of time 1 and time 2 measures of stigma were used as indices of consistent (reliable) perceptions at the individual level. Results showed partial support for familiarity being positively associated with reliable responding. Moreover, high entitativity scores were associated with greater stigma perceptions at time 1 and time 2. Ongoing research on these indicators may be important in crafting future anti-stigma programs for leprosy.

Purpose Many people with mental illness experience self-stigma and stigma-related stress and struggle with decisions whether to disclose their condition to others. The peer-led Honest, Open, Proud (HOP) group program supports them in their disclosure decisions. In randomized controlled trials, HOP has shown positive effects on self-stigma and stigma stress on average. This study examined individual predictors of HOP outcomes and tested the hypothesis that stigma stress reduction at the end of HOP mediates positive HOP effects at follow-up. Methods Six RCTs were included with data at baseline, post (after the HOP program) and at 3- or 4-week follow-up. Baseline variables were entered in meta-regression models to predict change in self-stigma, stigma stress, depressive symptoms and quality of life among HOP participants. Mediation models examined change in stigma stress (post) as a mediator of HOP effects on self-stigma, depressive symptoms, and quality of life at follow-up. Results More shame at baseline, and for some outcomes reduced empowerment, predicted reduced HOP effects on stigma stress, self-stigma, depressive symptoms, and quality of life. Younger age was related to greater improvements in stigma stress after the HOP program. Stigma stress reductions at the end of HOP mediated positive effects on self-stigma, depressive symptoms and quality of life at follow-up. Conclusion Participants who are initially less burdened by shame may benefit more from HOP. Stigma stress reduction could be a key mechanism of change that mediates effects on more distal outcomes. Implications for the further development of HOP are discussed.

Formal peer-support services are provided by people with shared lived experience of serious mental illness and recovery to help others with psychiatric disabilities address their priorities in, among other things, transitioning from hospitals, dealing with physical health, and illness management/recovery. This article summarizes a systematic review of the impact of formal peer services on these priorities. We used PRISMA Guidelines to review the existing research literature from 1995 to 2020; the first wave of our review yielded 424 studies which were then reduced to 68 quantitative investigations included for coding and syntheses. A graph of the trajectory of published articles per 5-year period showed a steady increase up to 2015 when the frequency of studies then leveled out. Using randomized controlled trials (RCTs) as one index of design quality, we found more than two-thirds of studies included an RCT. We used inferential analyses based on primary impact as defined by hypotheses as outcome indicator. Four of 68 studies suggested iatrogenic effects of peer services related to hospitalization, physical quality of life, and employment. A frequency of significant positive benefits for outcome ranged from 46.2% to 100% of findings. Future research should seek to identify personal-level factors that indicate greater benefits for peer support; this provides direction for tailoring the intervention. Personal-level variables include the role of diversity and social disadvantage in the benefits of formal peer-support programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Purpose Education programs seek to increase the public’s mental health literacy so they are better able to, among other things, help others engage in care when in need. This task may be diminished when such programs overwhelm participants with too much information. In addition, participants might arrive to the program with information overload related to the covered health topic. Information overload about health topics has been shown to influence attitudes and behavioral intentions. The overall purpose of the current study was to examine the relationship between mental health information overload, topic interest, and care seeking recommendations. Design/methodology/approach The current study tested a path suggesting high mental health information overload diminishes interest in learning about mental health, which in turn reduces recommendations to others to seek appropriate help when in need. Participants completed online measures of mental health information overload, topic interest and recommendations for care seeking. The data set analyzed represents valid responses from 221 participants. Structural equation modeling was completed to confirm the path model hypothesized for this study. Findings Structural equation modeling showed satisfactory fit and significant betas for the hypothesized path. Originality/value This study adds to the emerging literature on the impact of health information overload and is the first to the best of the authors’ knowledge to measure mental health information overload. Program developers should consider information overload in the ongoing development of public mental health education programs.

Mental health professionals with lived experience often experience heightened stigma and fear that their competency may be questioned. We present a new intervention (HOP-MHP) designed to support them in decisions about sharing their lived experience and preliminary results regarding the intervention’s acceptability and feasibility.

Purpose This study aims to examine the reliability and validity of the Arabic version of the attribution questionnaire (AQ). Design/methodology/approach The AQ is designed to assess attitudes, affects and behavioral intentions related to a hypothetical person diagnosed with schizophrenia. The original English version was translated into Literary Arabic. A total of 310 students registered in different universities, with medical and paramedical establishments excluded completed the Arabic version of AQ. Reliability was tested using Cronbach’s alpha coefficients. Structural equation modeling was used to test hypothesized paths. Correlations among exogenous (e.g. responsibility) and endogenous (e.g. help) variables in the path were examined. Fit indicators were then examined for equations that were identified. Findings The results revealed that the Arabic version of AQ showed acceptable psychometric properties in the assessment of stigma in the Tunisian population. All factors of this Arabic version showed Cronbach’s alpha values equal to or greater than 0.72. Structural equation models for the responsibility and dangerousness models were mostly supported. The Arabic version of AQ is valid and reliable for the assessment of stigma in Tunisian and Arabic-speaking populations. Practical implications The Arabic version of AQ may be used to promote research on stigma toward people with mental illness in larger and more representative Tunisian and Arabic-speaking populations, which will help to further address the complex and multifaceted phenomenon of stigma toward people with mental illness. Originality/value This is the first validated stigma measure in the Tunisian socio-cultural context.

Viewing a stigmatized group as different from everyone else is believed to be a contentless stigma that leads to disdain. This study tests whether three emotions-intergroup anxiety, anger, and empathy-mediate the path between difference and disdain. Six hundred thirty-eight research participants from MTurk provided valid responses to an online survey via Qualtrics. The survey used standardized measures of difference, disdain, intergroup anxiety, anger, and empathy. The hypothesized path model was tested using structural equation modeling (SEM). Fit indicators from SEM and corresponding betas supported a two-mediator model. Specifically, difference was found to be significantly associated with disdain. The path between the two was positively mediated by anger and negatively mediated by empathy. Difference and disdain may become important constructs in predicting and assessing stigma change. Perspective-taking that enhances empathy may prove especially useful for decreasing difference and disdain perceptions about people with mental illness.

Purpose The decision whether to disclose a mental illness has individual and social consequences. Secrecy may protect from stigma and discrimination while disclosure can increase social support and facilitate help-seeking. Therefore, disclosure decisions are a key reaction to stigma. The first aim of this study was to test a newly developed scale to measure disclosure attitudes, the Attitudes to Disclosure Questionnaire (AtDQ). The second aim was to examine the impact of attitudes towards disclosing a mental illness on quality of life and recovery. Methods Among 100 participants with mental illness, disclosure attitudes, quality of life, recovery, benefits of disclosure, secrecy, social withdrawal, self-stigma, and depressive symptoms were assessed at weeks 0, 3 and 6. Psychometric properties of the AtDQ were analysed. Longitudinal associations between disclosure attitudes at baseline and quality of life and recovery after 6 weeks were examined in linear regressions. Results The analyses of the AtDQ indicated one-factor solutions, high acceptability, high internal consistency, and good retest reliability for the total scale and the subscales as well as high construct validity of the total scale. Results provided initial support for sensitivity to change. More positive disclosure attitudes in general and in particular regarding to family at baseline predicted better quality of life and recovery after 6 weeks. Conclusion The current study provides initial support for the AtDQ as a useful measure of disclosure attitudes. Disclosing a mental illness, especially with respect to family, may improve quality of life and recovery of people with mental illness.

Introduction: This study sought to examine self-stigma at the intersection of two identities: mental illness and gender. Methods: Using an MTurk panel, 100 self-identified men and women with and without mental illness (total N = 400) completed the Difference and Disdain Self-Stigma Scale. Results: Significant effects were found for mental illness (participants with mental illness reported greater perceptions of being different from the population and disdain themselves because of that) but not for gender or the interaction. Discussion: Failure to find intersectionality may reflect classic findings from social psychological research that suggests people do not necessarily diminish self-esteem because of socio-demographic identity (I am a woman or African American). Future studies need to test for an intersection effect for public stigma.

The stigma of young children with mental health and/or neurodevelopmental disorders is experienced by their parents in at least two ways: self-stigma and vicarious stigma. Secrecy may diminish stigma through impression management or strategic disclosure. The present study explores the relationship between vicarious stigma, self-stigma, secrecy coping, depression, and quality of life. Additionally, we examine the structure of a novel measure of vicarious stigma. Fifty parents of children with mental health and/or neurodevelopmental disorders completed measures. Self-stigma and sadness due to vicarious stigma were significantly associated with greater depression and diminished quality of life. Higher secrecy coping was also associated with higher depression and lower quality of life, supporting the benefits of disclosure. This research meaningfully adds to our understanding of stigma in general, and as experienced by parents of children with mental health and/or neurodevelopmental disorders. Implications for ongoing stigma change development and evaluation are discussed.

PurposeAs many as half of all college students meet DSM-5 criteria for a mental illness; less than 5% report the ability to successfully navigate and complete their degrees. This is in part due to the lack of knowledge of reasonable accommodations for psychiatric disabilities.MethodIn the current study, we conducted qualitative interviews with students and faculty to identify types of reasonable accommodations students receive for their mental illness and factors that influence their ability to avail these accommodations.ResultsFactors included lack of awareness of accommodations, achieving fairness between students, and using accommodations as a disclosure tool.ConclusionsHigher education institutions should better support the awareness training on accommodations for both faculty and staff. Self-advocacy training is recommended to help students in disclosing mental illness, requesting accommodations, and managing negative social reactions. Perhaps in vivo coaching is a promising tool to accommodate emotional and interpersonal disabilities.

Objective Currently there is no universally agreed upon language for those seeking psychiatric treatment, and labels commonly include patient, client, consumer, and service user. Although there is some research regarding preferences for label (Dickens & Picchioni, 2012), little is known about how people perceive an individual differently based on the label used. The current study examined whether specific labels were associated with more stigmatizing attitudes. Method Participants recruited through MTurk (N = 526) were randomized to read a vignette of a man named Harry, described as a patient, client, consumer, or service user with mental illness. After correctly recalling the label from the vignette, participants were assessed for stigmatizing attitudes toward Harry. Results ANOVAs indicated a no main effects of label on stigmatizing attitudes. A number of variables (e.g., overall stigma, dangerousness, segregation, and distance) revealed a significant interaction between label and prior mental health treatment: For those who have sought prior mental health treatment, the term client may be more stigmatizing than other labels. Conclusions and implications for practice The current study did not find general differences in stigmatizing attitudes associated with mental health treatment label. Although preliminary, these findings suggest treatment labels may not significantly impact stigmatizing attitudes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

People with mental illness are viewed as different and disdained by the general population leading to public stigma. When public stigma becomes internalized, it results in self-stigma. Content-less measures of stigma have shown to benefit studying public stigma, but research on self-stigma is limited.This study sought to validate the use of content-less measures (Difference and Disdain) to assess self-stigma of mental illness.Participants with lived experience (Factor structure was not supported. Reliability analysis suggested a two-stage conceptualization of self-stigma for Difference and Disdain characterized by early (i.e. aware, agree) and late stages (i.e. apply, harm). Disdain was found to independently contribute to significant harmful outcomes, especially in the late stages.Disdain seems to be the driver of the egregious effects of self-stigma for people with mental illness. Anti-stigma efforts should focus on stereotypes of Disdain in the future.

Purpose: This study aimed to evaluate the effectiveness of cognitive behavior therapy (CBT) on reducing self-stigma in Chinese people with depression. Methods: By adopting a randomized controlled trial design, 62 participants with clinical depression were randomly assigned to a 10-session CBT or treatment as usual. Standardized assessment tools were used to assess the self-stigma and depressive symptoms in the pre- and posttreatment periods by a research assistant who was blind to the group assignment of the participants. Results: The results of the 2 × 2 repeated measures of covariance (analysis of covariance) demonstrated that after completing the therapy, the treatment group had significantly lower self-stigma scores than the control group. Additionally, the reduction in self-stigmatizing beliefs predicted a reduction in depressive symptoms in participants. Conclusion: This study demonstrates the efficacy and effectiveness of a CBT group intervention in reducing self-stigma for people with clinical depression living in Chinese society.

Purpose While serious mental illness (SMI) and substance use disorders (SUD) are common, less research has focused on causal beliefs across conditions. This is an important question when trying to understand the experience of dual diagnosis. The purpose of this paper is to examine how three factors representing causal beliefs (biogenetic, psychosocial or childhood adversity) differ by SMI and SUD. This study also examined how causal beliefs were associated with overall, process and outcome beliefs about recovery. Design/methodology/approach Using Mechanical Turks online panel, 195 research participants from the general public completed measures of recovery – overall, outcome and process – for SMI and SUD. Participants also completed the Causal Beliefs Scale yielding three causal factors for SMI and separately for SUD: biogenetic, psychosocial and childhood adversity. Findings Results indicated participants endorsed biogenetic cause more for SMI and SUD. Moreover, research participants endorsed biogenetic causes more than the other two for SMI. Results also showed the psychosocial cause was positively associated with recovery for SMI. Biogenetic causes were not. Almost none of the causal indicators was significantly associated with recovery for SUD. Originality/value Implications of these findings for future research and public efforts to enhance attitudes about recovery are discussed.

People with serious mental illness die up to 20 years younger than others in the same age group, with people of color showing even earlier death. The social disadvantages experienced by this group-for example, poverty, criminal legal involvement, and immigration-are further determinants of this disparity. Peer health navigators (PHNs) are people with experiences of recovery who may share a racial-ethnic background, history of poverty, experience with criminal legal systems, or immigration status with current patients and who assist in practical and timely tasks that help people engage with fragmented health systems. This column describes the PHN practice, including the putative components that define it.

Strategies to diminish stigma’s harm are driven by three agendas. (1) A services agenda, which seeks to decrease stigma so people better engage in care, (2) a rights agenda, which seeks to stem the injustice of stigma so people are able to meet life goals and aspirations, and (3) a self-worth agenda, which strives to replace shame with self-affirming attitudes in people impacted by stigma. With these agendas in mind, we summarize research on anti-stigma strategies in terms of public stigma and self-stigma. Two approaches have dominated efforts to lessen public stigma approaches: education and contact. Contrary to the predominance of education in public health approaches to attitude change, education effects are relatively muted, especially compared to contact. Research consistently shows that public encounters with people in recovery lead to significant improvements in stigma. Several approaches to self-stigma change have emerged, including psychoeducation, cognitive-behavioral, and strategic disclosure. Psychoeducation teaches people who internalize stereotypes about how these stereotypes are false. Cognitive-behavioral strategies then guide participants in challenging the false stereotypes they have used to cause personal shame. Strategic disclosure reflects insights on how being in the stigma closet harms self-esteem and self-efficacy. People who decide to come out with their mental health experiences report less self-stigma and greater empowerment. Unlike public stigma, research is unclear about the success of these self-stigma approaches vis-à-vis the others.

Diagnosing personality disorders (PDs) in adolescence is a complex and often controversial decision. While early diagnosis provides a pathway to treatment, stigmatizing labels might unintentionally increase prejudice and discrimination for youth and their families, resulting in harm and treatment avoidance. In this paper, we outline stigma-related considerations for diagnosing PDs in adolescence, including types of stigma (public stigma, self-stigma, associative stigma) and moderators of stigma (continuum beliefs, biogenetic attributions, PD sub-diagnosis). Research indicates that PDs are among the most stigmatizing diagnoses in adults, particularly among healthcare providers. Experiences with stigma may differentially impact adolescents, who are undergoing rapid changes in identity development and profound influences from educational systems, peers, and social media. Youth who receive mental health services (especially those embedded in schools) worry about whether and how to talk about a diagnosis. However, adolescents with significant behavioral symptoms are often seen as different from their peers even prior to a formal diagnosis. Systematic efforts are needed to anticipate and mitigate stigma-related impacts on adolescents who might be diagnosed with PDs.

Stigma toward people with mental illness and substance use problems is a significant global concern, and prevents people with these conditions from accessing treatment, particularly in primary health care (PHC) settings. Stigma is a cultural phenomenon that is influenced by particular contexts and can differ by country and region. The majority of stigma research focuses on Europe or North America leading to a lack of culturally relevant stigma research instruments for the Latin American context. The present study describes and discusses the methodology for cross-culturally adapting four stigma measurement scales to the Chilean context. The cross-cultural adaptation process included nine phases: (1) preparation; (2) independent translations; (3) synthesis 1 with expert committee; (4) focus groups and interviews with researchers, PHC professionals, and PHC users; (5) synthesis 2 with expert committee; (6) independent back translations; (7) synthesis 3 with expert committee; (8) pilot with PHC professionals; and (9) final revisions. The adaptation process included an array of diverse voices from the PHC context, and met three adaptation objectives defined prior to beginning the process (Understandability, Relevance, and Acceptability and Answer Options). The resulting, culturally adapted questionnaire is being validated and implemented within PHC settings across Chile to provide in-depth insight into stigma among PHC professionals in the country. The authors hope it will be useful for future research on mental illness and substance use stigma in similar settings across Latin America.

People with alcohol-related liver disease (ALD) experience stigma and discrimination. This review summarises the evidence on stigma in healthcare and its implications for people with ALD, drawing from the literature on the stigma associated with mental illness and, specifically, alcohol use disorder (AUD). Public stigma, self-stigma and structural stigma all contribute to failure to seek help or delays in seeking help, inferior healthcare, and negative health outcomes, which increase the overall burden of ALD. Stigma can be experienced, but also anticipated and avoided, with both scenarios negatively impacting on ALD healthcare. Blaming people with ALD for their condition is central to the stigma of ALD. Stigma affects ALD healthcare at all stages, from prevention, early detection and intervention, to allocation of scarce resources in liver transplantation. People with lived experience need to be empowered to lead action against the stigmatisation of patients with ALD. Promulgating a dynamic model of individual and social responsibility for AUD, a continuum model of harmful alcohol use, and establishing training on ALD-related stigma for healthcare professionals are strategies to address stigma. Integrating addiction and ALD services, providing stigma-free prevention, and overcoming the frequent separation of addiction services from general healthcare are necessary. Beyond healthcare, addressing social inequality, the social dimensions of ALD risk and outcomes, and ensuring equal access to services is necessary to improve outcomes for all people with ALD. More research is needed on the stigma of ALD in low- and middle-income countries and in countries with restrictive drinking norms. Interventions to reduce the stigma of ALD and facilitate early help-seeking need to be developed and evaluated.

While symptoms of mental illness (MI) are often disruptive to the lives of those who experience them, effects of the stigma that often come with a label or perception of mental illness can be even more damaging to one’s ability to live, thrive, and experience full social inclusion. Furthermore, internalized stigma or self-stigma can lead to decreased self-esteem and self-efficacy, known as the “why try” effect – “Why try to get a job? I can’t handle it on my own, I have a mental illness” (Corrigan et al., 2009). Various programs have been created to decrease the impacts of self-stigma on people with MI, including educational and cognitive behavioral approaches to challenge stereotypes and negative self-talk about MI (Alvidrez et al., 2009; Hammer & Vogel, 2010; Link et al., 2002; Mittal et al., 2012). To combat the pernicious effects of stigma the medical model might encourage distancing from the label and identity of being “mentally ill.” Evidence to the contrary indicates that “coming out” by owning and embracing one’s identity as having a mental illness may serve as empowering and enhancing to self-esteem, while also potentially combatting public stigma (Corrigan, Kosyluk, et al., 2013). To empower those with mental illness to decide if, how, and to whom they want to disclose their mental illness, a group of people with lived experience developed Honest, Open, Proud (HOP, previously Coming Out Proud or COP), now a recognized Evidence-Based Practice by the Substance Abuse and Mental Health Services Administration. This chapter will delineate the types of stigma often experienced by people with mental illness, provide an overview of HOP and the evidence supporting it, and review its limitations, considerations for use, and potential for adaptation.

Despite the importance of the stigma construct for the rehabilitation of people with severe mental illness, there are still no scales that offer a measurement for public stigma in Spanish with good psychometric properties. The aim of this paper is to refine and improve an existing scale to measure public stigma towards people with severe mental illness among the Spanish population. We also intended to decrease the number of items in order to facilitate its applicability.402 college students (73% women) responded to the attributional questionnaire (AQ27) in two subsamples. Exploratory and confirmatory factorial analysis with high cutoffs were conducted. The convergent validity with the resource allocation questionnaire was also tested.We have obtained a parsimonious tool, with 14 items and four factors, and some reliable psychometric indexes and convergent validity. The factors obtained were dangerousness-fear, lack of solidarity, coercion and avoidance.These results improve the findings from other studies that try to validate the AQ27 in other languages. We discuss the different factors that should be considered in the estimation of public stigma and the necessity to implement programmes to reduce it to enable recovery.IMPLICATIONS FOR REHABILITATIONSince the public stigma of mental illness is an obstacle to recovery and rehabilitation, reliable instruments are needed to assess it.A parsimonious instrument in Spanish with good psychometric characteristics for measuring public stigma is obtained.Using exploratory and confirmatory factor analysis, a questionnaire of 14 items is obtained.Four factors constitute the instrument: "dangerousness-fear", "coercion", "lack of solidarity", and "avoidance".

OBJECTIVE Recovery from severe mental illnesses (SMI) has been described as an outcome (end state where persons are symptom free) or as a process (despite symptoms, people can pursue life goals). Less clear is whether recovery as a process has credibility in the substance use disorders (SUD) community. We examined how public perceptions and expectations of outcome and process between SMI and SUD differed. A severity effect within SMI and SUD categories was also examined. METHOD Participants (N = 195) read definitions of SMI and SUD and completed an online survey of their agreement on: perceptions of recovery from SMI and SUD as outcome and process, and expectations of recovery as outcome and process. Participants were then given more and less severe SMI (i.e., schizophrenia vs. depression) and SUD (opiate vs. alcohol use) definitions. They then responded to recovery items SMI and SUD conditions with low and high severity. RESULTS For SMI, perceptions and expectations of recovery as process were endorsed more than outcome. Severity effect led to greater increases in perceptions and expectations about recovery as process. Specifically, differences between outcome and process for schizophrenia were significantly larger than for depression. For SUD, expectations of process were significantly lower than outcome ratings. One negative interaction was found for SUD expectations; difference scores for opiate users were smaller than for alcohol. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE We discussed implications for interventions that enhance recovery for people with SMI and SUD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

This study considers two of many messages that are used in antistigma campaigns: normalcy, that mental illness is like most kinds of illness-"You are just like me," and solidarity, that one's mental illness is accepted-"I stand with you." This study examined how research participants rated message merit: understandable, effective, and compelling. We particularly examined how views on message merit varied by whether participants reported previous mental health experience. Three hundred seventy-three participants rated the merit of the two messages provided in random order. They also reported previous experience with mental health services. Overall, participants viewed solidarity messages with greater merit than normalcy. Participants with self-reported mental illness viewed the solidarity message even better than participants without mental illness; this pattern varied by specific mental health experience. Findings suggest a greater understanding of stigma reduction methods from those who are more likely to have experienced stigma.

Self-stigma in parents of children with a mental health disorder is a painful experience, yet the process by which it is formed is poorly understood. A model of this process would improve our understanding and inform intervention development. The two existing models of self-stigma have not been tested with parents of children with a mental health disorder specifically, and are inconsistent with qualitative research findings suggesting an alternative explanation. Thus, this study aimed to test a model of parents’ self-stigma drawn from qualitative research, in which parents’ awareness of stigma predicts parents’ self-doubt about their parenting, self-doubt predicts self-stigma, which in turn predicts affective distress. Parents of children with a mental health disorder (n = 424) completed measures representing each of these model components. Using structural equation modelling and after controlling for child symptoms and demographics, significant direct pathways were found from awareness of stigma to self-doubt, self-doubt to self-stigma, and self-stigma to affective distress. These findings suggest that self-doubt is an important step in internalising stigma as self-stigma. Furthermore, self-stigma is related to serious consequences for parents’ psychological wellbeing and hence, the parent-child relationship. Findings are discussed in terms of their implications for theory and self-stigma interventions.

Purpose Nurses and nursing students often hold stigmatizing attitudes toward patients with mental illness, contributing to poor health outcomes. To address this, direct contact with persons with lived experience in mental illness (i.e. consumers) has been integrated into training curricula. This has shown decreased negative attitudes and increased empathy, but gains are not typically maintained at follow-up. The purpose of this paper is to explore acceptability (i.e. feasibility, process and fidelity) and stigmatizing attitudes of nursing students after the completion of a mentor-based direct-contact curriculum to decrease stigmatizing attitudes toward persons with mental illness. Design/methodology/approach A five-week manualized contact-based mentorship program, with a mentor (i.e. consumer)–mentee (i.e. student) pairs implemented as a supplement to the clinical curriculum for 23 baccalaureate-nursing students. Feasibility (i.e. attendance), acceptability, fidelity and stigmatizing attitudes were evaluated. The Error Choice Test and the Attribution Questionnaire (AQ-9) were used to assess stigmatizing attitudes. Findings Feasibility was 100 percent for face-to-face meetings and participants were satisfied with the integration of the program into their curriculum, indicating high acceptability. A repeated measures ANOVA yielded significant findings for stigmatizing attitudes (F (2, 21)=6.96, pη2=0.23). This suggests that a consumer-led mentoring program may reduce mental health stigma within student-nursing populations. The AQ-9 did not yield significant results. Research limitations/implications This study lacked a comparison group. Future research should include a randomized controlled trial. Originality/value This study demonstrates capacity for high feasibility and acceptability for an anti-stigma curriculum in this educational context.

This paper reviews studies on familiarity of mental illness to determine the relationships that familiarity has with public stigma. We propose a U-shaped relationship between familiarity and stigma that includes the expected inverse distribution (greater familiarity leads to less public stigma) and a provocative, positive relationship (familiarity in some groups leads to worse public stigma). Note that despite many studies in this arena, the U-shaped curve is not definitively supported by existing research. We believe its value, however, lies as a heuristic for hypotheses development to better understand the relationship between familiarity and public stigma. After reviewing research, we focus on two roles that comprise the surprising positive relationship: nuclear family members and mental health service providers like clinical psychologists. We then review research that suggests burden and associative stigma might account for the positive relationship between these groups and stigma. We end by using these findings to propose directions for future research, including on the development and evaluation of anti-stigma approaches.

BackgroundSelf-stigma (the internalisation of negative stereotypes) is known to reduce help-seeking behaviours and treatment adherence in people who have a mental illness, resulting in worsening health outcomes. Moreover, self-stigma diminishes self-esteem and self-efficacy, and leads to higher levels of depression. Half of all lifetime cases of mental illness have manifested by the age of 14, and therefore young people are vulnerable to the negative impact of suffering mental illness self-stigma. While literature in this field has been flourishing in recent years, mental illness self-stigma remains poorly understood in youth. It is important that we seek to understand what is currently known about mental illness self-stigma in young people, and subsequently use this information to guide future research to advance knowledge of this topic. To date, a scoping review which maps the available literature on mental illness self-stigma in young people has yet to be conducted. Here, we outline the protocol for a scoping review on mental illness self-stigma in young people.MethodsThis protocol outlines the process of conducting a scoping review of primary research concerning mental illness self-stigma in young people. The Joanna Briggs Institute guidance on best practice for conducting a scoping review will utilised throughout. A systematic search of appropriate databases will be conducted which will allow for a two-step screening process and data charting. Inclusion criteria for this review dictates that eligible studies will i) include a population within the age range of 10-35 (or mean age within this range), ii) include the term ‘self-stigma’ or ‘internalised stigma’ relating to mental health/illness/disorder, iii) be primary research, iv) be published post-2009 (following the seminal study by Moses, 2009) and v) be published in English.DiscussionThe findings of the scoping review outlined in this protocol will be used to inform future research which aims to explore self-stigmatising attitudes and beliefs of young people experiencing mental illness. This research will result in co-produced, impactful resources for young people on the topic of mental illness self-stigma with the aim of raising awareness and stigma reduction.

The lived experience of people with mood disorders may be leveraged to inform priorities for research, define key treatment outcomes, and support decision-making in clinical care. The aim of this mixed-methods project was to provide insight into how people with depression and bipolar disorder experience the impact of symptoms, their treatment preferences, and their definitions of wellness.The project was implemented in two phases. In Phase 1, community-based participatory research was used to develop a web-based survey enquiring about living with a mood disorder, treatment experiences, and wellness priorities. In Phase 2, a series of focus groups were conducted to explore aspects of wellness in greater detail.Respondents (n= 6153) described the symptoms of mood disorders as having a significant, chronic impact on their lives. A holistic approach to treatment was desired by participants, but not necessarily experienced. Qualitative findings were used to further describe four highly ranked wellness priorities identified in the survey: ability to act independently or according to my own will; purpose in life; getting through the day; and contentment.Experience of a mood disorder was self-reported, and no formal confirmation of diagnosis occurred. Although the survey could not incorporate all possible wellness definitions, this was supplemented by qualitative focus groups.The present findings provide important insights from the perspectives of individuals with lived experience of mood disorders. Implications of this for research and clinical practice are discussed, particularly with regards to measurement-based care and use of wellness-oriented clinical outcome assessments.