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This chapter examines the effects of mental health services and stigma on changes in self-concept and well-being for individuals with SPMI.

Data for this chapter come from structured interviews and service data for 140 individuals with severe and persistent mental illnesses. We use structural equation modeling to examine the relationship between perceived and internalized stigma, as well as the relationships among stigma, self-concept (self-esteem and mastery), and well-being (quality of life and functioning).

We find that case management is negatively related to quality of life and psychiatric services are positively related to functioning. Crisis services and assessment are associated with mastery in opposite directions. Internalized stigma is positively associated with self-esteem and mastery, and negatively associated with functioning. We do not find a relationship between services and stigma.

A limitation to this chapter is the sample size, which prohibits us from examining a full range of services and outcomes. Nonetheless, our findings provide information about how services and stigma impact well-being, and may be used as a starting point for considering strategies for improving services and reducing stigma. Future work should consider pairing outcomes with services to determine their effectiveness.

This chapter builds on previous research that examines the relative effects of services and stigma among individuals in community health care by extending measures of both services and stigma, and by examining the relationship between them, in order to better determine their implications for self-concept and well-being.

This paper aims to determine whether criminal justice (CJ) stigma affects health outcomes and health care utilization.

The authors reviewed medical and public health literature through May 2020. Structured terms were used to search four databases identifying articles that related to CJ stigma. Included articles were in English, examined CJ stigma and had people with CJ involvement as subjects. The studies without health outcomes were excluded. Quantitative and qualitative studies were reviewed and assessed for bias. Results were synthesized into a systematic review.

The search yielded 25 studies relating to CJ stigma and health. Three stigma domains were described in the literature: perceived or enacted, internalized and anticipated stigma. Tenuous evidence linked CJ stigma to health directly (psychological symptoms) and indirectly (social isolation, health care utilization, high-risk behaviors and housing or employment). Multiple stigmatized identities may interact to affect health and health care utilization.

Few studies examined CJ stigma and health. Articles used various measures of CJ stigma, but psychometric properties for instruments were not presented. Prospective studies with standard validated measures are needed.

Understanding whether and how CJ stigma affects health and health care utilization will be critical for developing health-promoting interventions for people with CJ involvement. Practical interventions could target stigma-related psychological distress or reduce health care providers’ stigmatizing behaviors.

This was the first systematic review of CJ stigma and health. By providing a summary of the current evidence and identifying consistent findings and gaps in the literature, this review provides direction for future research and highlights implications for policy and practice.

We examine whether self-stigmatization may affect the everyday social interactions of individuals with a diagnosed, affective mental health disorder. Past research demonstrates self-stigmatization lowers self-esteem, efficacy, and personal agency, leading to the likely adoption of role-identities that are at the periphery of major social institutions. We advance research on self-stigma by examining the likely interactional and emotional consequences of enacting either a highly stigmatized self-identity or a weakly stigmatized self-identity.

Using affect control theory (ACT), we form predictions related to the interactional and emotional consequences of self-stigmatization. We use the Indianapolis Mental Health Study and Interact, a computerized instantiation of ACT, to generate empirically based simulation results for patients with an affective disorder (e.g., major depression and bipolar disorder), comparing simulations where the focal actor is a person with a mental illness who exhibits either high or low levels of self-stigma.

Self-stigma is predicted to negatively influence patients’ behavioral expression, leading the highly self-stigmatized to enact behaviors that are lower in goodness, power, and liveliness than the weakly self-stigmatized. Their corresponding emotional expressions during these types of interactions are similarly negatively impacted. Even though these likely interactions are the most confirmatory for people with high levels of self-stigma, they lead to interactions that are behaviorally and emotionally more negative than those who have been better able to resist internalizing stigmatizing beliefs.

This piece has implications for the literature on the interactional and life course challenges faced by psychiatric patients and contributes to the self-stigma literature more broadly. This work will hopefully inform future research involving the collection of non-simulation-based data on the everyday interactional experiences of people with mental health problems.

The purpose of this study is to contribute to the social understanding of stigma as a societal and cultural barrier in the life of a survivor of human trafficking. The findings illustrate several ways where stigma is internal, interpersonal and societal and impacts survivors’ lives, including the care they receive.

This study used qualitative methods. Data collection occurred during 2018 with efforts such as an online survey (n = 45), focus groups (two focus groups of seven participants each) and phone interviews (n = 6). This study used thematic analysis of qualitative data.

The research team found that a multiplicity of stigma occurred for the survivors of human trafficking, where stigma occurred across three levels from micro to meso to macro contexts. Using interpretive analysis, the researchers conceptualized how stigma is not singular; rather, it comprises the following: bias in access to care; barriers of shaming, shunning and othering; misidentification and mislabeling; multiple levels of furthering how survivors are deeply misunderstood and a culture of mistrust.

While this study was conducted in a single US city, it provides an opportunity to create dialogue and appeal for more research that will contend with a lens of seeing a multiplicity of stigma regardless of the political climate of the context. It was a challenge to recruit survivors to participate in the study. However, survivor voices are present in this study and the impetus of the study’s focus was informed by survivors themselves. Finally, this study is informed by the perspectives of researchers who are not survivors; moreover, collaborating with survivor researchers at the local level was impossible because there were no known survivor researchers available to the team.

There are clinical responses to the narratives of stigma that impact survivors’ lives, but anti-trafficking response must move beyond individualized expectations to include macro responses that diminish multiple stigmas. The multiplicity in stigmas has meant that, in practice, survivors are invisible at all levels of response from micro, meso to macro contexts. Therefore, this study offers recommendations for how anti-trafficking responders may move beyond a culture of stigma towards a response that addresses how stigma occurs in micro, meso and macro contexts.

The social implications of examining stigma as a multiplicity is central to addressing how stigma continues to be an unresolved issue in anti-trafficking response. Advancing the dynamic needs of survivors both in policy and practice necessitates responding to the multiple and overlapping forms of stigma they face in enduring and exiting exploitative conditions, accessing services and integrating back into the community.

This study offers original analysis of how stigma manifested for the survivors of human trafficking. Building on this dynamic genealogy of scholarship on stigma, this study offers a theory to conceptualize how survivors of human trafficking experience stigma: a multiplicity of stigma. A multiplicity of stigma extends existing research on stigma and human trafficking as occurring across three levels from micro, meso to macro contexts and creating a system of oppression. Stigma cannot be reduced to a singular form; therefore, this study argues that survivors cannot be understood as experiencing a singular form of stigma.

The transgender community faces prejudice and stigma and is one of the most ostracised groups in society. One of the ways to reduce prejudice is through intergroup contact. This may be achieved through direct or indirect contact. The purpose of this paper is to compare the impact of direct and indirect contact on reducing transphobia.

Direct contact was achieved through a transgender speaker panel and indirect contact involved a video presentation. In total, 159 students enroled in undergraduate courses at a prominent university in India were enlisted for this study. Perceptions regarding transgenders were measured using the genderism and transphobia scale. Perceptions were measured at three different time points – before the contact, immediately after the contact and one month post contact.

Results indicate that both direct and indirect contact cause a significant immediate decrease in transphobia at the post intervention stage. However, only direct contact caused significant reduction at the follow-up stage (one month after the intervention). Direct contact also effected a greater reduction in transphobia than indirect contact.

This study extends previous research that shows that speaker panels involving sexual minority speakers can result in reducing stigma (e.g. Croteau and Kusek, 1992). The present study shows that such speaker panels can also be useful for reducing stigma against transgender individuals. Another important outcome of this study is the relative effectiveness of direct contact in reducing transphobia compared to indirect contact. Direct contact resulted in greater reduction in transphobia both at the post-test and follow-up stages compared to indirect contact.

The results of this study may benefit HR practitioners and policy makers in designing workplace initiatives and policies in creating an inclusive workplace. This study shows that meaningful interaction with transgenders would be a key step in reducing stigmatisation. Since direct contact is rarely expensive or time consuming, it can be a valuable tool to improve the integration of transgender individuals within society. Therefore, students and employees may be encouraged to interact with transgender individuals through panel discussions and workshops. Indirect contact may be used as a preliminary intervention in certain cases where direct contact may be difficult to organise.

The stigma faced by transgender individuals has a significant negative impact on their quality of life (Grant et al., 2014; Reisner and Juntunen, 2015). It is, therefore, necessary to recognise and reduce prejudice against transgenders at both the college and school levels as well as in work organisations. Educators and managers have a significant role to play in this societal change. This study shows that stigma reduction can be achieved in a fairly simple way through contact theory.

This study is one of the first to investigate Indian students’ perceptions of transgenders. It improves on earlier studies using similar interventions in two main ways. First, this study includes a follow-up assessment, which was not performed in most studies. Second, random assignment of participants to one of two conditions improves the reliability of the findings.

This study primarily aims to evaluate the mental health literacy (MHL) of the Lebanese adult population in an attempt to yield results that can help fill the gap in the literature and support the development of new strategies to counter mental health stigma.

A cross-sectional survey was composed of the Mental Health Knowledge Schedule and select questions from the Community Attitudes toward the Mentally Ill and MHL Scale. The surveys were collected from a representative population of sample size (n = 386) among the different governorates of Lebanon. The participants, aged 18–65 years and literate, were recruited between July 2018 and September 2018 from supermarkets widely distributed across the country.

The results showed that the Lebanese population possesses average knowledge and certain stigmatizing attitudes toward mental illnesses. Curricular education and awareness campaigns may help refine the image of mental illness among the population.

To the best of the authors’ knowledge, this paper is one of the first in Lebanon to assess the MHL of its population as a whole. It gives insight into the common misconceptions about mental illness and patterns of the related stigma that are prevalent in the Lebanese society today.

The purpose of the study is to investigate the perceived stigma among residents of Sanandaj, west of Iran, following COVID-19 pandemic.

This is a cross-sectional study conducted from March to April 2020. The sample consisted of 1,000 participants who live in Sanandaj. The data collection tool was a self-report electronic questionnaire. ANOVA and T-test were used to analyze the data.

The mean perceived stigma for COVID-19 was 5.50±2.24 (IQR: 3.75–6.87) out of 10-point scale. The highest point was seen for perceived external stigma (6.73±2.49, IQR: 5–8.75) followed by disclosure stigma (4.95±3.92, IQR: 0–10). Interestingly, self-employers were more concerned about disclosing their illness than those with governmental jobs (25±3.93 vs. 4.31±4.14, P<0.05), and also had an overall higher stigma score; 5.72±2.23 vs. 5.19±2.37, P<0.05).

COVID-19 stigma is high among Iranians and more common among men, youngsters and self-employers.

Lesbian, gay, and bisexual (LGB) individuals experience institutionalized prejudice within society and in their working lives. This prejudice increases the stress that these individuals experience within the workplace. Thus, in this chapter, we outline the mechanisms of LGB-workplace stress, detailing the antecedents, outcomes, and strategies to remediate this form of stress. We first outline theoretical conceptualizations of workplace stress before explaining how sexual orientation minorities experience additional workplace stressors due to their specific, stigmatized identities. Then, we explain how the stressors of formal discrimination, interpersonal discrimination, stigma consciousness, internalized heterosexism, concealment, and social isolation each contribute to workplace stress and ultimately health and workplace outcomes. Finally, we discuss several strategies that organizations, stigmatized individuals, and allies can engage in to prevent and cope with each of these LGB-related workplace stressors. In so doing, this chapter encourages researchers and practitioners to continue to develop more comprehensive and effective strategies to combat the negative outcomes experienced by these and all other stigmatized employees, thereby promoting more healthy and inclusive organizations.

Every employee embodies manifestations of every demographic that attach to him or her different minority and majority statuses at the same time. As these statuses are often related to organizational hierarchies, employees frequently hold positions of dominance and subordination at the same time. Thus, a given individual’s coping strategies (or coping behavior) in terms of minority stress due to organizational processes of hierarchization, marginalization, and discrimination, are very often a simultaneous coping in terms of more than one demographic. Research on minority stress mostly focuses on single demographics representing only single facets of workforce diversity. By integrating the demographics of age, disability status, nationality, ethnicity, race, sexual orientation, and religion into one framework, the intersectional model proposed in this chapter broadens the perspective on minorities and related minority stress in the workplace. It is shown that coping with minority stress because of one demographic must always be interpreted in relation to the other demographics. The manifestation of one demographic can limit or broaden one’s coping resources for coping with minority stress because of another dimension. Thus, the manifestation of one demographic can determine the coping opportunities and coping behavior one applies to situations because of the minority status of another demographic. This coping behavior can include disclosure decisions about invisible demographics. Therefore, organizational interventions aiming to create a supportive workplace environment and equal opportunities for every employee (e.g., diversity management approaches) should include more demographics instead of focusing only on few.

We argue that self-stigma places patients on a path of marginalization throughout their life course leading to a negative cycle of opportunity and advancement. Mental health patients with higher levels of self-stigma tend to have much lower self-esteem, efficacy, and personal agency; therefore, they will be more inclined to adopt role-identities at the periphery of major social institutions, like those of work, family, and academia. Similarly, the emotions felt when enacting such roles may be similarly dampened.

Utilizing principles from affect control theory (ACT) and the affect control theory of selves (ACTS), we generate predictions related to self-stigmatized patients’ role-identity adoption and emotions. We use the Indianapolis Mental Health Study and Interact, a computerized version of ACT and ACTS, to generate empirically based simulation results for patients with an affective disorder (e.g., major depression and bipolar disorder) with comparably high or low levels of self-stigmatization.

Self-stigma among affective patients reduces the tendency to adopt major life course identities. Self-stigma also affects patients’ emotional expression by compelling patients to seek out interactions that make them feel anxious or affectively neutral.

This piece has implications for the self-stigma and stigma literatures. It is also one of the first pieces to utilize ACTS, thereby offering a new framework for understanding the self-stigma process. We offer new hypotheses for future research to test with non-simulation-based data and suggest some policy implications.