The role of coping humor in the physical and mental health of older adults

Objectives: This study examined the associations among coping humor, other personal/social factors and the health status of community-dwelling older adults.

Method: Survey questionnaires were completed with 73 community-dwelling older adults. Included were measures of coping humor, spirituality, self-efficacy, social support and physical and mental health status.

Results: Correlations across all variables showed coping humor to be significantly associated with social support, self-efficacy, depression and anxiety. Forward stepwise regression analyses showed that coping humor and self-efficacy contributed to outcome variance in measures of mental health status. Contrary to expectation, neither social support nor spirituality contributed to the total outcome variance on any of the dependant measures.

Conclusion: The importance of social support, self-efficacy and spirituality in determining the quality of life of older adults is well supported in the literature. Coping humor as a mechanism for managing the inevitable health stresses of aging has received less attention. This study shows that coping humor and self efficacy are important factors for explaining health status in older adults. Correlations among coping humor, self efficacy and social support suggest that a sense of humor may play an important role in reinforcing self-efficacious approaches to the management of health issues.     

Childhood trauma and resilience in old age: applying a context model of resilience to a sample of former indentured child laborers

Objectives: Psychological resilience has been rarely investigated in elderly populations. We applied a more comprehensive model of trauma-specific coping and resilience, which included Ungar's context model and included decentral factors of resilience (i.e., environments that provide resources to build resilience).

Method: We assessed resilience in a cohort of former Swiss indentured child laborers (N = 74; 59% males) at two time points; first at the mean age of 80 years and then again 20 months later. At each time point, the following measures of resilience were assessed: resilience indicators of life satisfaction and lack of depression. In addition, resilience predictors of trauma exposure, perceived social support, dysfunctional disclosure of traumatic experiences, social acknowledgment as a victim, and self-efficacy; and decentral resilience factors of education, income, number of children, and physical health were measured.

Results: Using path-analysis, we found that life satisfaction and lack of depression were predicted by dysfunctional disclosure, social support, and self-efficacy at various significance levels. Change scores of resilience were predicted by higher trauma exposure, social acknowledgment as a victim, and an interaction between the two. The model for decentral factors also fitted, with physical health and income predicting the resilience indicators.

Conclusion: Applying this comprehensive resilience model in a sample of older adults revealed meaningful findings in predicting resilience at a single time point and over time. Atypical coping strategies, such as perceived social acknowledgment as a victim and disclosure, may be particularly important for former victims who have suffered institutional abuse.     

Risk factors for depression and anxiety in healthcare workers deployed during the COVID-19 outbreak in China

Purpose

This study was conducted to evaluate the status of depression and anxiety of healthcare workers and to explore the risk factors during the outbreak of COVID-19 in China.

Methods

A cross-sectional study was designed using convenience sampling to obtain a sample of healthcare workers. A structured questionnaire was designed to collect the information of the basic characteristics, workload, and the health condition. Burnout, coping style, anxiety, and depression were measured by specific scales. Multiple logistic regression model was performed to explore the risk factors of anxiety or depression.

Results

There were 902 questionnaires received between February 9, 2020 and February 11, 2020. The proportion of healthcare workers with symptoms of moderate/severe anxiety and moderate/severe depression were 16.63% and 18.29%, respectively. There were 24.50% healthcare workers experiencing moderate/severe anxiety and depression at the same time. The increased workload, respiratory symptoms, digestive symptoms, having done specific test(s) related to COVID-19, having family member needs to be taken care of, negative coping style, and job burnout were the independent risk factors of anxiety. Furthermore, the increased workload, respiratory symptoms, digestive symptoms, having done specific test(s) related to COVID-19, negative coping style, and job burnout were the independent risk factors of depression.

Conclusion

More attention should be paid to the mental health of frontline healthcare workers at the outbreak of COVID-19 in China. Taking steps to reduce the intensity of the work and burnout will be effective to stabilize the mental state of them.

     

Worry,Severity, Controllability,and Preventive Behaviours of COVID-19 and Their Associations with Mental Health of Turkish Healthcare Workers Working at a Pandemic Hospital

Previous research suggests that psychological and behavioural factors such as worry, severity, controllability, and preventive behaviours are associated with mental health and well-being. Less is known about simultaneous effects of those factors in predicting mental health and well-being. This study aimed to present the prevalence of mental health problems and identify the predictors of mental health and subjective well-being of healthcare workers during the COVID-19 pandemic. Participants included 245 healthcare workers (M_age?=?33.16?±?7.33; 50.61% females) from a pandemic hospital in Turkey. Healthcare workers reported mild/severe depression, anxiety, and stress. Females tended to be more vulnerable to developing psychiatric symptoms. Worry, severity, and controllability significantly predicted depression, anxiety, stress, and subjective well-being while preventive behaviours only predicted subjective well-being. These findings suggest the importance of assessing healthcare workers’ experiences of mental health and subjective well-being and their associated factors to assist mental health providers tailor assessments and treatment during a pandemic.

     

What has changed in the experiences of people with mental health problems during the COVID-19 pandemic: a coproduced,qualitative interview study

Purpose

We sought to understand how the experiences of people in the UK with pre-existing mental health conditions had developed during the course of the COVID-19 pandemic.

Methods

In September–October 2020, we interviewed adults with mental health conditions pre-dating the pandemic, whom we had previously interviewed 3 months earlier. Participants had been recruited through online advertising and voluntary sector community organisations. Semi-structured qualitative interviews were conducted by telephone or video-conference by researchers with lived experience of mental health difficulties, and, following principles of thematic analysis, were analysed to explore changes over time in people’s experience of the pandemic.

Results

We interviewed 44 people, achieving diversity of demographic characteristics (73% female, 54% White British, aged 18–75) and a range of mental health conditions and service use among our sample. Three overarching themes were derived from interviews. The first theme “spectrum of adaptation” describes how participants reacted to reduced access to formal and informal support through personal coping responses or seeking new sources of help, with varying degrees of success. The second theme describes “accumulating pressures” from pandemic-related anxieties and sustained disruption to social contact and support, and to mental health treatment. The third theme “feeling overlooked” reflects participants’ feeling of people with mental health conditions being ignored during the pandemic by policy-makers at all levels, which was compounded for people from ethnic minority communities or with physical health problems.

Conclusion

In line with previous research, our study highlights the need to support marginalised groups who are at risk of increased inequalities, and to maintain crucial mental and physical healthcare and social care for people with existing mental health conditions, notwithstanding challenges of the pandemic.

     

Developing and testing a principle-based fidelity index for peer support in mental health services

Purpose

Evidence suggests that the distinctive relational qualities of peer support—compared to clinical-patient relationships—can be eroded in regulated healthcare environments. Measurement of fidelity in trials of peer support is lacking. This paper reports the development and testing of a fidelity index for one-to-one peer support in mental health services, designed to assess fidelity to principles that characterise the distinctiveness of peer support.

Methods

A draft index was developed using expert panels of service user researchers and people doing peer support, informed by an evidence-based, peer support principles framework. Two rounds of testing took place in 24 mental health services providing peer support in a range of settings. Fidelity was assessed through interviews with peer workers, their supervisors and people receiving peer support. Responses were tested for spread and internal consistency, independently double rated for inter-rater reliability, with feedback from interviewees and service user researchers used to refine the index.

Results

A fidelity index for one-to-one peer support in mental health services was produced with good psychometric properties. Fidelity is assessed in four principle-based domains; building trusting relationships based on shared lived experience; reciprocity and mutuality; leadership, choice and control; building strengths and making connections to community.

Conclusions

The index offers potential to improve the evidence base for peer support in mental health services, enabling future trials to assess fidelity of interventions to peer support principles, and service providers a means of ensuring that peer support retains its distinctive qualities as it is introduced into mental health services.

     

Autonomy versus support: self-reliance and help-seeking for mental health problems in young people

Purpose

Many young people with mental ill-health do not seek support, and developmental growth in self-reliance may be a barrier to help-seeking. Increasing autonomy is a positive developmental task for youth and a key aspect of resilience. This study examined the influence of perceived social support and resilience on the previously unexamined relationship between self-reliance and intentions to seek help from informal, professional, and self-help sources for mental health problems.

Methods

An online survey was completed by a representative Australian community sample of 5,203 young people aged 12–25 years (half female), in May–June 2020.

Results

Path analysis showed the hypothesised conceptual model did not fit the data well, but a modified model was a good fit. Higher self-reliance was associated with lower intentions to seek informal and professional help, as expected, but not with greater intentions for self-help. The relationship between self-reliance and informal help-seeking intentions was fully mediated by perceived social support, whereas the relationship between self-reliance and professional help-seeking was also direct. Perceived social support fully mediated the relationship between self-reliance and resilience. Intentions to use self-help were not influenced by variables in the study, but higher self-help intentions were associated with higher professional help-seeking intentions. Associations were consistent across age and gender groups.

Conclusion

The results show the critical role of social support for combating some of the unhelpful aspects of self-reliance for mental health help-seeking in young people. Future research should explore how self-reliance can hinder or be harnessed to facilitate accessing appropriate mental health.

     

The impact of the COVID-19 pandemic on the mental health of healthcare workers: study protocol for the COVID-19 HEalth caRe wOrkErS (HEROES) study

Background

Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia.

Methods

Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country’s income level.

Results

As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly.

Conclusions

This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings.

     

Risk factors for anxiety of otolaryngology healthcare workers in Hubei province fighting coronavirus disease 2019 (COVID-19)

Purpose

To ensure the mental health of the otolaryngology healthcare workers in the fight against coronavirus disease 2019 (COVID-19), it is important to know their mental status and to identify possible risk factors. In this study, we investigated the risk factors for the anxiety in the otolaryngology healthcare workers in Hubei province under the COVID-19 epidemic.

Methods

The otolaryngology healthcare workers in Hubei Province were surveyed using an online questionnaire in which anxiety was measured against the Zung Self-rating Anxiety Scale. Univariate and multivariate logistic regression analyses were used to evaluate the risk factors of anxiety.

Results

A total of 449 otolaryngology healthcare workers participated in the study. Of all the participants, 131 (29.18%) had anxiety symptoms. Compared with doctors, nurses were at a higher risk for anxiety (OR = 2.162, 95% CI 1.311–3.566). Participants who often suspected self-infection (OR = 4.239, 95% CI 1.647–10.909) or family member infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (OR = 4.485, 95% CI 1.511–13.313) were more likely to develop anxiety than those who never. The subjects who had colleagues diagnosed with COVID-19 were more vulnerable to anxiety (OR = 2.014, 95% CI 1.205–3.366). Respondents working in infectious isolation wards had a 3.522-fold increased risk of anxiety compared to those on leave (OR = 3.522, 95% CI 1.634–7.593).

Conclusion

Some otolaryngology healthcare workers in Hubei province experienced anxiety during the epidemic, but most of them did not receive treatment. The healthcare providers themselves should be informed about and aware of their own mental health, and should be given support as appropriate.

Trial registration number and date of registration

Chinese Clinical Trial Registry: ChiCTR2000030768, 2020/3/14.

     

The association of adverse childhood experiences with mid-life depressive symptoms and quality of life among incarcerated males: exploring multiple mediation

Objectives: To explore the association of experiencing death, trauma, and abuse during childhood with depressive symptoms and quality of life at mid-life among incarcerated men and to understand how current social support and coping strategies mediate the impact of childhood trauma histories on mental health.

Methods: Study participants were 192 male inmates in a maximum security prison. Participants completed measures of adverse childhood experiences related to death, trauma, and abuse, and depressive symptoms and quality of life. Data were analyzed using multiple mediation modeling.

Results: Men who reported having experienced adverse childhood experiences reported more depressive symptoms and lower quality of life than their counterparts. The results showed that in models both unadjusted and adjusted for age, race, education, number of years served, and whether the inmate had a life sentence, the association between adverse childhood experiences and quality of life were partially explained by the total of the indirect effects (point estimate = ?.5052; CI_.95 = ?1.0364, ?.0429 and point estimate = ?.7792; CI_.95 = ?1.6369, ?.0381), primarily via social support. However, the associations between adverse childhood experiences and depressive symptoms were not explained by social support and coping.

Conclusion: Adverse childhood experiences are associated with deleterious mental health effects in later life. Social support and coping partially mediate the association between adverse childhood experiences and quality of life. The high prevalence of childhood trauma among aging prison inmates warrants attention to increasing social support mechanisms to improve mental health.     

Multi-trajectory group profiles of well-being and associated predictors among adults experiencing homelessness and mental illness: findings from the At Home/Chez Soi study,Toronto site

Purpose

To conduct a multi-dimensional and time-patterned analysis to identify distinct well-being trajectory profiles over a 6-year follow-up period among adults experiencing homelessness and mental illness.

Methods

Data from 543 participants of the At Home Chez Soi study’s Toronto site were examined over a 6-year follow-up period, including measures of quality of life, community functioning, housing stability, and substance use. Well-being trajectories were identified using Group-Based Trajectory Modelling. Multinomial regression was used to identify predictor variables that were associated with each well-being trajectory profile.

Results

Four well-being profiles were identified: low well-being, moderate well-being, good well-being, and high well-being. Factors associated with a greater likelihood of following a better well-being profile included receiving Housing First, reporting female gender and non-white ethnicity, having post-secondary studies, and reporting a high resilience level. Concurrently, factors associated with a lower likelihood of better well-being profiles were having a history of chronic homelessness, experiences of discrimination in the healthcare setting, having comorbid mental disorders and a high level of symptom severity, and reporting a history of traumatic brain injury and childhood adversity.

Conclusions

Individuals experiencing homelessness follow distinct well-being profiles associated with their socio-demographic characteristics, health status, trauma history, resilience capabilities, and access to housing and support services. This work can inform integrated housing and support services to enhance the well-being trajectories of individuals experiencing homelessness.

Trial registration

At Home/Chez Soi trial was registered with ISRCTN, ISRCTN42520374, http://www.isrctn.com/ISRCTN42520374.

     

Family burden,child disability,and the adjustment of mothers caring for children with epilepsy: Role of social support and coping

PurposeThis study was designed to contribute to the existing research on the coping behaviors, social support, and mental health outcomes in parents of children with epilepsy in the United States.MethodsParticipants included 152, predominantly Caucasian (89.5%), married (78.9%) women (95.4%). Via a web-based interface, mothers completed questionnaires assessing the impact of their child's disability on their family (i.e., severity of their child's disability, family burden, and personal stress), social resources (i.e., perceived social support), coping (i.e., emotion-focused and social support seeking), and adjustment (i.e., depression and anxiety).ResultsAfter controlling for demographic variables, mediational analysis revealed that mothers' perceptions of the severity of their child's disability were associated with decreased perceived social support, which was then related to higher reported levels of depression and anxiety. Similarly, low levels of perceived social support partially mediated the relation between family burden and depression, anxiety, and stress. Finally, mothers' perceptions of the severity of their children's disability and family burden were unrelated to their reports of emotion-focused or social support seeking coping. However, their use of emotion-focused and social support seeking behaviors was related to lower levels of depression.ConclusionLow levels of perceived social support may help to explain the mechanisms underlying the relation between mothers' perceptions of the severity of their child's disability and family burden on their mental health adjustment, such as depression and anxiety.     

A psychometric study of recovery among Certified Peer Specialists

The recovery model is wielding a welcome influence in the mental healthcare system. Despite its potential impact, systematic studies of the recovery construct as viewed by consumers and former consumers of mental health services have only recently begun to permeate the literature. We have embarked on an ongoing collaboration with the Georgia Mental Health Consumer Network to study the recovery experiences of Certified Peer Specialists (CPSs). As a first step, we evaluated the psychometric characteristics of a new measure of the recovery construct in CPSs. CPSs (N=84) enrolled in the GMHCN completed the Maryland Assessment of Recovery in Serious Mental Illness (MARS) along with measures of resilience, coping styles, community living, social support, internalized stigma, psychopathology, and personality. Recovery as measured by the MARS was associated with resilience, coping behaviors, quality of social support, community living, internalized stigma, and severity of psychopathology. Recovery did not demonstrate a statistically significant association with personality. Recovery appeared to mediate the effect of psychopathology and episodic stressors on community functioning. Our psychometric study supports the psychometric soundness of the MARS and the construct validity of recovery.     

Suicidal ideation in family carers of people with dementia

Objective: Two small studies have suggested that family carers of people with dementia may be a high-risk group for suicide. The objective of this study was to further explore the rate of suicidal ideation in a large sample of carers and identify psychosocial risk and protective factors.

Method: A cross-sectional survey was conducted with 566 family carers. The survey included measures of suicidality, self-efficacy, physical health, depression, anxiety, hopelessness, optimism, burden, coping strategies, and social support.

Results: Sixteen percent of carers had contemplated suicide more than once in the previous year. There were univariate differences between suicidal and non-suicidal carers on self-efficacy, social support, coping, burden, depression, anxiety, hopelessness, optimism, reasons for living, and symptoms of dementia, as well as age and income management. In a multivariate model, age, depression, and reasons for living predicted suicidal ideation. In tests for mediation, satisfaction with social support and dysfunctional coping had indirect effects on suicidal ideation via depression.

Conclusion: Family carers of people with dementia have high rates of suicidal ideation, with depression a risk factor and increasing age and reasons for living as protective factors. Depression and reasons for living should be targeted in interventions to reduce suicide risk in dementia carers.     

A longitudinal study on the COVID-19 pandemic and its divergent effects on social participation and mental health across different study groups with and without mental disorders

Purpose

With the rapid spread of COVID-19 and the restrictions imposed in many parts of the world, there is growing concern about its impact on mental health. This longitudinal study investigated the social participation, social inclusion and psychological well-being in adults with and without mental disorders before the beginning of the pandemic, as well as during and after strict lockdown restrictions in Germany.

Methods

The sample (n = 106) consisted of three groups: participants with a chronic mental disorder, with an acute mental disorder, and without a mental disorder at the time of the initial survey. Parameters of interest were assessed using the Measure of Participation and Social Inclusion for Use in People with a Chronic Mental Disorder (F-INK), the Index for the Assessment of Health Impairments (IMET) and the Brief Symptom Inventory (BSI-18).

Results

The perceived impairments in social participation and the associated changes in behaviour varied depending on the presence of a mental disorder at the time of the initial survey and were largely temporary, i.e. limited to the period of strict lockdown restrictions. We found no further detrimental effects on mental health 4 weeks after lockdown or later, when a policy of physical distancing was in place.

Conclusion

Overall, our findings suggest a general resilience to the official restrictions and measures as well as the pandemic itself. However, further efforts are needed to improve the situation of people with chronic mental disorders and their limited opportunities for social participation.

     

Resilience,stress, and life quality in older adults living with HIV/AIDS

Objectives: This study tested the mediating effect of resilience on the relationship between life stress and health-related quality of life (HRQoL) in older people, 50 years of age and older, living with HIV/AIDS (OPLWHA).

Method: Data from 299 OPLWHA were analyzed using structural equation modeling (SEM) to define a novel resilience construct (represented by coping self-efficacy, active coping, hope/optimism, and social support) and to assess mediating effects of resilience on the association between life stress and HRQoL (physical, emotional, and functional/global well-being).

Results: SEM analyses showed satisfactory model fit for both resilience and mediational models, with resilience mediating the associations between life stress and physical, emotional, and functional/global well-being.

Conclusion: Resilience may reduce the negative influence of life stress on physical, emotional, and functional/global well-being in OPLWHA. Interventions that build personal capacity, coping skills, and social support may contribute to better management of HIV/AIDS and increase HRQoL.     

A cross-sectional study of coping resources and mental health of Chinese older adults in the United States

ABSTRACT

Objectives: This study examined the potential influence of coping resources at individual (sense of mastery), family (spousal and family support, children's filial piety), and community levels (community cohesion) on the mental health (depression, anxiety) of U.S. Chinese older adults.

Methods: The data were derived from the Population Study of Chinese Elderly in Chicago (N= 3,159). Negative binomial regressions were performed to predict depression and anxiety, respectively, by entering the three sets of coping resources separately and jointly, controlling for socio-demographic and acculturation variables.

Results: Stronger sense of mastery and greater perception of children's filial piety were associated with better mental health outcomes. Spousal support was not associated with any mental health outomes, and family support was actually assciated with greater depression and anxiety. Stronger community cohesion was associated with fewer depressive symptoms but greater anxiety.

Conclusion: Older immigrants’ sense of control and perception that children adhere to traditional family norms are important mental health protective factors. Whereas depending on families for support may compromise their well-being, community cohesion could be a double-edged sword for their mental health. Future studies shall further disentangle the associations among sense of mastery, reliance on family and ethnic enclaves for support, and older immigrants’ well-being.     

Perceived Risk and Mental Health Problems among Healthcare Professionals during COVID-19 Pandemic: Exploring the Mediating Effects of Resilience and Coronavirus Fear

During coronavirus (COVID-19) pandemic, healthcare professionals were particularly at high-risk of developing symptoms of mental health problems due to being on the frontline in the battle against COVID-19. This study examined the mediating roles of resilience and coronavirus fear in the relationship between perceived risk and mental health problems among healthcare professionals including doctors and nurses who were actively treating patients confirmed with COVID-19. We recruited 204 healthcare professionals (50% females) with a mean age of 32.92 years (SD?=?7.01). Results showed that perceived risk and coronavirus fear positively predicted depression, anxiety, and stress while resilience negatively predicted those mental health problems. Coronavirus fear mediated the relationship between perceived risk and resilience, depression, anxiety, and stress. Additionally, resilience mitigated the effect of coronavirus fear on depression, anxiety, and stress. This study is among the first indicating the importance of resilience and fear as a critical mechanism that explains the relationship between perceived risk and mental health problems among health professionals directly caring for COVID-19 patients.

     

Prospective relationships between stigma,mental health,and resilience in a multi-city cohort of transgender and nonbinary individuals in the United States, 2016–2019

Purpose

Gender-based stigma is a fundamental cause of mental health disparities among transgender and non-binary (TGNB) individuals, while resilience factors may be protective. We examined prospective relationships between gender-based enacted stigma, psychological distress, and resilience factors among TGNB individuals.

Methods

Between 2016 and 2017, we enrolled 330 TGNB individuals in three metropolitan areas in the U.S. in a prospective cohort study focused on gender identity development, risk, and resilience across the lifespan. Using multilevel regression, we examined prospective associations between enacted gender-based stigma and psychological distress (measured by the Global Severity Index/BSI-18), and examined transgender pride and social support as moderators, adjusting for age, sex assigned at birth, race/ethnicity, education, and income.

Results

Our sample was diverse in age (M = 34.4, range 16–87) and race/ethnicity (56.4% non-White). Over 2 years of follow-up, there was a decrease in reported gender-based stigma (b = − 0.61, p < 0.001) and transgender pride (b = − 0.14, p = 0.003), increase in social support (b = 0.21, p < 0.001), and no change in psychological distress. In adjusted analyses, gender-based stigma was positively associated with psychological distress (b = 1.10, p < 0.001) and social support was negatively associated with psychological distress (b = − 2.60, p < 0.001). Transgender pride moderated the relationship between stigma and psychological distress (p < 0.01), such that the association was stronger for lower levels of transgender pride.

Conclusions

Our study provides longitudinal evidence for the deleterious role of gender-based stigma among TGNB individuals. Future interventions should consider fostering transgender pride and social support to promote mental health and mitigate negative effects of gender-based stigma.

     

Stigma-related stress,shame and avoidant coping reactions among members of the general population with elevated symptom levels

BackgroundIt is unclear whether mental illness stigma affects individuals with subthreshold syndromes outside clinical settings. We therefore investigated the role of different stigma variables, including stigma-related stress and shame reactions, for avoidant stigma coping among members of the general population with elevated symptom levels.MethodsBased on a representative population survey, general stress resilience, stigma variables, shame about having a mental illness as well as avoidant stigma coping (secrecy and social withdrawal) were assessed by self-report among 676 participants with elevated symptom levels. Stigma variables and resilience were examined as predictors of avoidant stigma coping in a path model.ResultsIncreased stigma stress was predicted by lower general stress resilience as well as by higher levels of perceived stigma, group identification and perceived legitimacy of discrimination. More shame was associated with higher perceived legitimacy. Lower resilience as well as more perceived stigma, group identification and perceived legitimacy predicted avoidant coping. Stigma stress partly mediated effects of resilience, perceived stigma and group identification on avoidant coping; shame partly mediated effects of perceived legitimacy on coping. Stigma stress and shame were also directly and positively related to avoidant stigma coping. Analyses were adjusted for symptoms, neuroticism and sociodemographic variables.ConclusionsStigma may affect a larger proportion of the population than previously thought because stigma variables predicted secrecy and withdrawal among members of the general population with elevated, but overall mild symptom levels. Avoidant stigma coping likely has harmful effects, potentially exacerbating pre-existing psychological distress and undermining social networks. This highlights the need to reduce public stigma as well as to support individuals with subthreshold syndromes in their coping with stigma stress and shame reactions.