Lecture 30: Stigma

Question 1

Define stigma

Answer 1

Stigma is the situation of a person disqualified from social acceptance as they possess an attributed which is discredited by the other.

The person is seen less as a whole and now a tainted discounted individual.

In mental illness the attribute may diagnosis, need for medication or use of health services

Question 2

Define stigma

Answer 2

Stigma is the situation of a person disqualified from social acceptance as they possess an attributed which is discredited by the other.

The person is seen less as a whole and now a tainted discounted individual.

In mental illness the attribute may diagnosis, need for medication or use of health services

Question 3

Outline the three domains of stigma (Thornicroft, 2006)

Answer 3

Knowledge - ignorance

• Refers to an absence of accurate information about mental illness, the treatment and the individual
• May lead to myths or negative stereotypes

Attitudes - prejudice
- Comprises of both negative thoughts (people with mental illness are lazy) and emotions (fear / disgust)

Behaviour - discrimination
- Includes a wide range of actions from social rejection to lack of opportunity, limited roles and self-limiting behaviours - i.e why try if I will be excluded

Question 4

Apart from Thornicrofts (2006) three domain models of stigma outline other models that exist?

Answer 4

Social Cognitive Model - Corrigan (2000)

• Proposes that for prejudice to be thought/felt then stereotypes first need to be believed, discrimination then follows
• Criticism is that this view focusses on an individual level and doesn’t consider how stigma may be maintained

Sociological perspective model Link & Phelan (2001)
- Includes labelling, stereotypes, separating, emotional reactions, status loss & discrimination & POWER (social, political, economic)

Question 5

What two types of stigma did Pescosolido & Martin (2015) propose?

Answer 5

Action-orientated - describes who it affects/who gives it/who receives it:

• Public stigma
• Self stigma
• Structural stigma
• Courtesy/family
• Provider-based

Experiential - refers to ways stigma is felt by the individual:

• Anticipated
• Endorsed
• Enacted
• Experienced
• Percieved

Question 6

What did the indigo study find?

Answer 6

• 90% of patients with Schizophrenia experienced stigma
• 79% of those with depression experienced stigma

Experienced discrimination - included family, friends, keeping a job, dating/close relationships, marriage

Anticipated discrimination - applying for work, education or training, in close relationships

Question 7

Name one research need for global perspectives on research of stigma?

Answer 7

More research in low and middle income countries (including the effectiveness of stigma-reduction interventions in these areas):

• Few studies in these countries with poor methodological quality and variable designs
• These studies often lack long-term follow up and behavioural outcomes

Stigma in mental illness is a widely described phenomena throughout the world however local and cultural practices will influence prejudice and discrimination. Research in low and middle income countries is required to identify this.

(Note generally for stigma research more studies need to identify the long term effectiveness of anti-stigma campaigns. Studies often fail to incorporate behavioural outcomes too)

Question 8

State the ways we can reduce mental illness stigma and what does research show to most effective

Answer 8

Education - replace inaccuracies of knowledge about mental illness with up to date evidence based content

Contact - through interactions with individuals with mental illness stigma is reduced. Note this can be indirect too through art, media or campaigns

Protest - actions of people or groups to suppress stigmatising attitudes and representations of mental illness

Research suggest contact is the most effective with protest being the least effective

Studies have found that education + contact is generally no more effective than education alone. While stereotypes or attitudes may change the most explanatory factor for the effect of contact is by decreasing anxiety in the stigma enacting individual.

Question 9

Apart from decreased anxiety what other factors may mediate the observed effect of intergroup contact towards reducing stigma?

Answer 9

• Increased empathy & perspective taking

Intergroup contact has been shown to reduce stigma in short, medium and long term.

Question 10

What is the Indigo partnership?

Answer 10

5 year project - a research programme to develop and test the effectiveness of contextually adapted stigma-reduction interventions in LMIC

• Provide evidence on stigma and test anti-stigma interventions
• Create measures to assess stigma