Stigma and Health最新文献

Self-stigma among persons with substance use disorders (SUDs) represents a significant barrier to patient recovery. Numerous studies have identified that experienced or enacted stigma deters people from seeking health treatment, impacting their well-being. Considering that chronic exposure to SUD-related stereotypes is associated with the internalization of such stereotypes and that self-stigma has been linked to lower levels of self-efficacy, the present study examined the association of experienced or enacted substance use stigma, self-efficacy, and self-stigma with emotional well-being among Latinxs with SUD. The sample consisted of secondary data from (N = 412) people aged 21 years or older with a history of SUD. In the original study, participants were recruited by availability from two settings in Puerto Rico: correctional facilities (n = 311) and community programs that provide primary care services to people living with HIV and SUD (n = 101), many of whom have a history of imprisonment. Hierarchical regression was performed to determine the statistically significant variance of emotional well-being explained by experienced or enacted stigma, self-efficacy, and self-stigma. The full model with experienced or enacted stigma, self-efficacy, and self-stigma accounted for 31.8% of the variance in emotional well-being. These findings suggest the need for longitudinal studies examining how self-stigma and self-efficacy contribute to emotional well-being to inform patient-centered behavioral interventions that offer providers insightful knowledge to treat this population appropriately.

Studies have shown that disease- and race-based discrimination in healthcare exacerbate pain, yet little is known about the role of psychological processes and symptoms, such as internalized stigma and depressive symptoms, in the relationship between discrimination (i.e., enacted stigma) and pain. In a sample of 284 Black adults living with sickle cell disease (SCD) (54% women, M_age = 35.37), we examined internalized stigma and depressive symptoms as mediators between disease- and race-based discrimination in healthcare and pain severity and interference. Disease-based but not race-based discrimination in healthcare was associated with internalized stigma, depressive symptoms, and pain severity and interference. Furthermore, internalized stigma and depressive symptoms partially mediated the association between disease-based discrimination in healthcare and pain severity and interference. Results suggest that individuals with SCD who experience discrimination, including based on their SCD status, may internalize these discriminatory messages from others, leading to negative thoughts and feelings about having SCD. These negative internalized beliefs may then contribute to depressive symptoms and subsequent worse pain. Internalized stigma and depressive symptoms may be potential treatment targets in behavioral and psychological interventions. More research is needed to understand the impact of intersecting experiences of discrimination and stigma on health outcomes in adults living with SCD.

Objective: Experiences of discrimination, a notable psychosocial stressor, are considered an important risk factor for problematic opioid use. We examined whether pain severity, pain interference, anxiety, and depressive symptoms are pathways through which discrimination may be associated with increased prescription opioid misuse behaviors among individuals with chronic pain.

Method: A total of 234 participants who reported being prescribed opioids for chronic pain management were included from a parent longitudinal study collected from Amazon's MTurk. Study variables were collected at baseline and 12-month follow-up. Path analyses tested the hypothesized model, with socio-demographic variables and outcomes measured at baseline included as covariates. Mediated effects were examined using percentile bootstrap method.

Results: After controlling for socio-demographic covariates, pain severity, pain interference, anxiety, and depressive symptoms, baseline discrimination was significantly associated with greater prescription opioid misuse behaviors (p=.020) at 12 months. Baseline discrimination was also significantly associated with anxiety (p<.001) and depressive symptoms (p<.001) at 12 months. However, pain severity, pain interference, anxiety, and depressive symptoms were not significantly associated with prescription opioid misuse at 12 months. Mediation analyses indicated no significant effects.

Conclusions: Discrimination may play an important role in prescription opioid misuse behaviors among individuals with chronic pain. Furthermore, discrimination is a risk factor contributing to elevated anxiety and depressive symptoms, with broad clinical implications for individuals coping with chronic pain. However, pain severity, pain interference, anxiety and depressive symptoms did not emerge as underlying mechanisms that link discrimination and prescription opioid misuse. Replication and extension in future studies are warranted.

In this study, we explored the associations between endorsing two stereotypes of people with social anxiety disorder (SAD; i.e., the social inhibition stereotype and the oddity stereotype), and interpersonal outcomes. We performed a secondary data analysis on a sample of participants with SAD (n = 75) and without SAD (n = 60) who completed multiple study visits, including diagnostic interviews, and brought friends (n = 91) and romantic partners (n = 61) into the study. To investigate effects of endorsing stereotypes of SAD on relationship satisfaction, we examined participant self-report ratings of relationship satisfaction as well as friend- and romantic partner-reported ratings. Higher endorsement of the social inhibition stereotype was associated with lower participant self-reported friendship satisfaction but was not associated with friend-reported ratings. Neither endorsement of social inhibition nor endorsement of oddity predicted participant-reported or partner-reported romantic relationship ratings. Neither endorsement of the social inhibition nor oddity stereotype was associated with self-reported number of interpersonal problems due to coldness, but higher endorsement of the social inhibition stereotype was associated with more self-reported interpersonal problems due to submissiveness. Our results suggest that: (1) of the two stereotypes, the social inhibition stereotype may be more predictive of interpersonal variables among those with SAD; (2) SAD stereotype endorsement is associated with self-reported relationship satisfaction among those with SAD, but is not associated with partner-reported ratings; and (3) SAD stereotype endorsement may not predict interpersonal outcomes among individuals with SAD to the extent that we originally hypothesized.

Sexual and gender minority (SGM) adolescents have high risk for suicidal behavior, and structural homophobia could contribute to inequities in suicidal ideation and behavior among SGM youth. Limited prior research has examined how comprehensive indicators of structural homophobia are related to suicidal ideation and behavior among SGM adolescents. Anti-gay legislation has been increasing in many states, and studies that enhance our understanding of the associations between structural homophobia and risk for suicidal behavior among SGM youth must be prioritized. We examined associations between structural homophobia at the state level and suicidal thoughts and behaviors in a nationwide sample of SGM adolescents ages 14-18 in the United States (n = 1837) who completed a cross-sectional online survey. Participants were diverse with regard to race, ethnicity, and geographic location. SGM adolescents who lived in states with higher levels of structural homophobia had higher odds of reporting lifetime suicidal ideation (aOR=1.22; p=.047) and suicidal planning (aOR=1.24; p=.013) after adjusting for demographic variables. Lifetime suicide attempt was not related to structural homophobia. Results indicate that SGM youth living in states with more structural homophobia had a higher likelihood of experiencing lifetime suicidal ideation and suicidal planning but not higher suicidal behavior directly. Reducing risk for suicidal behavior among SGM youth is a pressing public health concern. Public policies, societal conditions, and public attitudes that contribute to an affirming and inclusive environment for SGM youth have the potential to reduce suicidal ideation and planning among SGM adolescents.

A growing body of evidence has documented the adverse health consequences of structural stigma across multiple marginalized groups, including sexual minorities. In light of these advancements, scholars have urged the field to refine conceptualizations of structural stigma to guide future empirical work. We heed this charge by analyzing two sets of qualitative data among gay and bisexual men obtained from a probability-based panel: 1) responses to an open-ended survey question about structural stigma (n=385) and 2) in-depth interviews about their subjective experiences of structural stigma (n=60). Our findings revealed three key dimensions underlying structural stigma. First, participants described structural stigma using metaphors conveying that their freedom had been severely constrained; structural stigma was variously portrayed as a "cage," a "prison," and a "net" where "there is no exit." Second, structural stigma communicated a lack of recognition by others, whereby participants were treated as "sub-human" and "a second-class citizen." Third, in contexts with high levels of structural stigma, participants reported a lack of social safety, including that their sense of belonging had been threatened; for one participant, structural stigma felt "like knocking on a door and being able to see people on the other side laughing at you for trying to get in." Based on these themes, we offer a revised definition: Structural stigma is manifest when institutional policies, practices, and cultural norms produce societal conditions that create unfreedom, engender failures of recognition, or undermine social safety. Implications for structural stigma measurement, and for research with other stigmatized groups, are discussed.

Stark racial and socioeconomic disparities in COVID-19 case rates manifested across the U.S. during the COVID-19 pandemic and were also observed in rates of COVID-19 testing. Targeted testing of populations at greatest risk for COVID-19, while effective in containing the spread of COVID-19, could propagate stigma and discrimination, especially when directed toward already marginalized communities. As is known from other health areas, stigmatization can drive people to deny or hide their illness, prevent or delay timely healthcare seeking, and can discourage people from adopting healthy behaviors, such as testing or precautions. In this study we sought to adapt and validate two scales from the HIV stigma literature to measure aspects of COVID-19 stigma, including measures of 1) negative attitudes toward people who get COVID-19 and 2) perceptions of stigma faced by people who get COVID-19 in the community. After working with stigma experts and community partners to adapt the scales, we implemented the items in a community-based survey of African American residents of neighborhoods with high social vulnerability in two counties in Alabama (n=302). Analytic methods included internal reliability testing and scale item reduction, construct validity examination, and bivariable and multivariable linear regression analyses to examine associations with conceptually important and statistically significant predictors. The final COVID-19 stigma scales developed through this process have good reliability and validity and can be used in future research and programs to understand and address disparities in uptake of testing and precautions for COVID-19 and future pandemics.