社会污名和歧视经历对新生代农民工心理健康的影响研究——兼析几类因素的中介作用

目的:探讨污名和歧视经历对新生代农民工心理健康的影响方向和途径,以及几类因素的中介作用。方法:采用配额抽样方法,在长沙、湘潭、宁波、杭州、深圳、东莞六个城市共抽取815名新生代农民工作为调查对象,建立结构方程模型对变量间的关系进行检验。结果:(1)社会污名和歧视经历对新生代农民工的心理健康具有直接的负面影响。(2)期望与现实的心理落差、应对方式在污名和歧视经历对新生代农民工心理健康的影响中具有部分中介作用。(3)迁移前的充分准备对新生代农民工的积极应对策略具有显著正相关,有利于提高其心理适应能力。(4)消极应对方式与新生代农民工心理健康具有显著负相关,可以预测新生代农民工的心理健康水平。结论:营造良好的公平竞争环境,建立以提高新生代农民工应对技能的迁移培训机制和做好迁移前的充分准备,有利于改善他们的心理健康状况。     

Experiences of stigma and health service utilization among young rural-to-urban migrants in China: the mediation role of social capital

ABSTRACT

Previous studies revealed that experiences of stigma might negatively affect health service utilization (HSU) among young rural-to-urban migrants. Existing literature also suggested social factors including social capital might mediate such negative effect. However, data are limited regarding the mediation role of social capital among this vulnerable population. Therefore, the current study aimed to examine the associations among experiences of stigma, social capital, and HSU among young rural-to-urban migrants in China. A sample of 641 young rural-to-urban migrants was recruited through a venue-based sampling approach in Beijing, China. Participants were assessed on sociodemographic characteristics, experiences of stigma, and social capital in their urban communities. Self-reported frequency of physical examinations (regularly, irregularly, none) was used as an indicator of HSU. Structural equation modeling (SEM) was performed to examine the direct effect of stigma on HSU as well as the mediation effect of social capital. Among the 641 young rural-to-urban migrants, 32.3% (195/603) reported never having physical examinations while 50.6% (305/603) reported having them irregularly. The final model showed a goodness of fit (χ ²/df = 1.7, CFI = 0.98, RMSEA = 0.03, WRMR = 0.74). Results of SEM revealed that both of the direct and indirect paths from experiences of stigma on HSU were statistically significant. There was a partial mediation effect of social capital on the association between experiences of stigma and HSU (delta z score = ?5.49, p < 0.01). Rural-to-urban migrants had a low rate of regular HSU. Experiences of stigma were associated with decreased likelihood of HSU. Social capital in the urban communities could mediate the negative effect of stigma on HSU and played a mediation role between experiences of stigma and HSU. Therefore, to increase HSU among migrants, targeted interventions to reduce stigma and increase social capital at the migration destinations are needed.     

Internal migration and health: re-examining the healthy migrant phenomenon in China

This study re-examines the healthy migrant phenomenon in China’s internal migration process and investigates the different trajectories of place of origin on migrants’ self-rated physical health and psychological distress. Data came from a household survey (N = 1474) conducted in Beijing between May and October in 2009. Multiple regression techniques were used to model the associations between self-rated physical health, psychological distress, and migration experience, controlling for sociodemographic characteristics. The healthy migrant phenomenon was observed among migrants on self-rated physical health but not on psychological distress. Different health status trajectories existed between physical health versus mental health and between rural-to-urban migrants versus urban-to-urban migrants. The study draws particular attention to the diminishing physical health advantage and the initial high level of psychological distress among urban-to-urban migrants. The initial physical health advantage indicates that it is necessary to reach out to the migrant population and provide equal access to health services in the urban area. The high level of psychological distress suggests that efforts targeting mental health promotion and mental disorder prevention among the migrant population are an urgent need. The findings of the study underline the necessity to make fundamental changes to the restrictive hukou system and the unequal distribution of resources and opportunities in urban and rural areas. These changes will lessen the pressure on big cities and improve the living conditions and opportunities of residents in townships/small cities and the countryside.     

Psychological distress among Ugandan adolescents living with HIV: Examining stressors and the buffering role of general and religious coping strategies

HIV infection increases the risk of psychological distress among adolescents living with HIV (ALHIV), which, in turn, increases risky behaviours such as medication non-adherence, substance use, and sexual risk-taking. The majority of studies on psychological distress among ALHIV have been conducted in high-income countries; data on the prevalence and correlates of psychological distress among ALHIV in sub-Saharan Africa (SSA) are scarce, yet over two-thirds of the global population of ALHIV resides in SSA. The purpose of this study was to identify the contextually relevant correlates of psychological distress among Ugandan ALHIV. Utilizing the stress and coping framework, we explored the risk and protective factors for psychological distress in cross-sectional sample of 464 ALHIV (aged 12–19; 53% female) at a large HIV treatment centre in Kampala, Uganda. The stressors associated with psychological distress included daily hassles, major negative life events, HIV-related quality of life, and stigma. Protective factors included psychosocial resources such as religious coping, satisfaction with social support, and general coping style and behaviours. Social support and optimism were significantly associated with psychological distress. Findings underscore the need for mental health services for ALHIV in Uganda and other resource-limited settings.     

Association of social skills with psychological distress among female nurses in Japan

Nursing is a highly stressful occupation. Because nursing work involves interaction with patients and colleagues, competence in social skills may be a key issue in stress management among nurses. However, there are very few studies among nurses focused on social skills together with social support, both of which are important aspects of job stress. The aim of this study was to examine the interrelationships between social skills and social support with job stressors, problem-solving coping, and psychological distress among Japanese nurses. Data from a self-administered questionnaire of 1,197 female nurses who worked for 5 general hospitals in Japan were analyzed. Covariance structure analysis with structural equation modeling techniques showed that social skills and social support were positively related to each other, while they were negatively associated with psychological distress and job stressors, and positively associated with problem-solving coping. Furthermore, the direct association between social skills and psychological distress was stronger than the association between social support and psychological distress. These findings suggested that improving not only social support at work but also individual social skills is important for nurses' mental health.     

Discrimination experience and quality of life among rural-to-urban migrants in China: the mediation effect of expectation–reality discrepancy

Objective  To examine the effect of expectation–reality discrepancy in mediating the relationship between discrimination experience and quality of life (QOL) among rural-to-urban migrants in China. Methods  A cross-sectional survey was conducted among 1,006 rural-to-urban migrants in 2004–2005 in Beijing, China. QOL was measured using the Chinese version of the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF). The migrants were also asked to report their experience of being discriminated against in the urban areas (i.e., discrimination experience), and their perceived difference between premigratory expectation and postmigratory reality in the city (i.e., expectation–reality discrepancy). Structural equation modeling (SEM) method was employed to assess the mediation effect. Results  Discrimination experience not only had a direct significant negative effect on QOL among rural-to-urban migrants, but also had an indirect effect through expectation–reality discrepancy on their QOL. Migrants’ expectation–reality discrepancy exerted a partially mediation effect in the relationship between discrimination experience and QOL. Conclusions  Health promotion and prevention programs in the future to improve migrants’ QOL should pay more attention to reducing the discrimination against migrants as well as helping migrants to reduce discrepancy between premigratory expectation and postmigratory reality.     

Psychological distress among Thai migrant workers in Israel

The purpose of this cross-sectional study was to examine the associations between migration stressors and psychological distress among Thai migrant agricultural workers in Israel, and to examine the direct and indirect contribution of socio-cultural variables to this relationship. Two hundred and twenty-one Thai male workers were interviewed using a structured questionnaire that included demographic variables and occupational exposures to organophosphate pesticides (as control variables), migration stressors, intervening variables (traditional health beliefs, social support, drinking behavior, and utilization of medical services), and a psychological distress scale. In multivariate analysis, migration stressors, the migrants' traditional health beliefs, quality of current social relationships, drinking behavior, as well as age and occupational exposure were significantly associated with psychological distress. Workers who reported higher migration stressors (perceived the migration to be difficult, and often felt homesick), those with higher levels of traditional health beliefs, those whose social relationships with other Thai co-workers were poor, those who consumed either no alcohol or large amounts of alcohol, and those who reported 'problem drinking' had significantly higher levels of psychological distress. A moderating effect of the quality of social relationships with co-workers on the association between homesickness and psychological distress was found. Additionally, migrants aged 28-34 and those who were experiencing eye irritation from chemicals at work had significantly increased levels of distress. The findings demonstrate the focal role of specific migration stressors and the current socio-cultural context on psychological distress of migrant workers.     

Stigmatization, self-esteem, and coping among the adolescent children of lesbian mothers

Purpose: To examine perceived stigma, coping, disclosure, and self-esteem among adolescents with lesbian mothers.

Method: Interviews were conducted with 76 adolescents ages 11–18 years. Standardized measures of self-esteem and coping skills were used. A measure of stigma was adapted for this study and a measure of disclosure was developed. The relationship between perceived stigma and self-esteem was examined. General coping skills and level of disclosure about the adolescents’ mothers’ sexual orientation were assessed as potential moderators of the relationship between perceived stigma and self-esteem.

Results: Adolescents who perceived more stigma had lower self-esteem in five of seven self-esteem areas, compared to those who perceived less stigma. In addition, coping skills moderated the effect of stigma on self-esteem in three self-esteem areas. However, only one subtype of coping skills, that of decision-making coping, was found to moderate the relationship of perceived stigma and self-esteem in such a way that adolescents using more decision-making coping had higher self-esteem in the face of high perceived stigma. For social support coping, in the face of high perceived stigma, the adolescents with more effective coping skills had lower self-esteem. In the face of high perceived stigma, adolescents who disclosed more about their mother’s sexual orientation had higher self-esteem in the subscale of close friendship than those who disclosed less.

Conclusions: Results suggest that stigma is related to self-esteem among the adolescent children of lesbian mothers. The results indicate that this relationship is moderated by coping skills. These results have implications for intervention and prevention of stigmatization by the establishment of effective coping skills as well as through educational efforts to eradicate stigmatizing attitudes.     

Minority Stress in Lesbian,Gay, and Bisexual Young Adults in Australia: Associations with Psychological Distress,Suicidality, and Substance Use

Lesbian, gay, bisexual, and other same-sex attracted young people have been shown to be at a higher risk of mental health problems, including depression, anxiety, suicidality, and substance abuse, compared to their heterosexual peers. Homophobic prejudice and stigma are often thought to underlie these disparities. In this study, the relationship between such experiences of social derogation and mental health and substance use in same-sex attracted young people was examined using Meyer’s minority stress theory. An online survey recruited 254 young women and 318 young men who identified as same-sex attracted, were aged 18–25 years, and lived in Sydney, Australia. Multivariate logistic regression analyses showed that internalized homophobia, perceived stigma, and experienced homophobic physical abuse were associated with higher levels of psychological distress and self-reported suicidal thoughts in the previous month. Furthermore, perceived stigma and homophobic physical abuse were associated with reporting a lifetime suicide attempt. The association between minority stress and substance use was inconsistent. While, as expected, higher levels of perceived stigma were associated with club drug dependence, there was an inverse association between internalized homophobia and club drug use, and between perceived stigma and hazardous alcohol use. The findings of this study provide support for the minority stress theory proposition that chronic social stress due to sexual orientation is associated with poorer mental health. The high rates of mental health and substance use problems in the current study suggest that same-sex attracted young people should continue to be a priority population for mental health and substance use intervention and prevention.     

农民工、城市居民、农村居民心理韧性及对心理健康的影响

目的 了解农民工、城市居民、农村居民的心理韧性与心理健康现状及差异,分析心理韧性对心理健康的影响。方法 采用心理韧性量表和简要症状量表,通过多水平分层空间随机抽样方法抽取武汉市18～45岁1 135名农民工、1 145名农村居民和1 249名城市居民,使用电脑语音辅助问自答卷技术进行问卷调查。结果 农民工、农村居民、城市居民心理韧性总得分分别为（3.48±0.65）、（3.43±0.65）、（3.39±0.63）分,农民工心理韧性水平高于城市居民,差异有统计学意义（F = 5.655,P = 0.004）。农民工、农村居民、城市居民简要症状量表得分分别为（1.96±0.61）、（1.99±0.57）、（2.05±0.58）分,城市居民心理健康水平低于农民工和农村居民,差异有统计学意义（F = 8.036,P＜0.001）。心理韧性各维度和心理健康状况各维度之间均具有相关性(r为-0.132～-0.062,P值均小于0.001)。广义线性模型分析结果显示,控制其他因素后,心理韧性中的情感韧性对心理健康各维度均有正向预测作用（P＜0.001）。结论 心理韧性可以预测心理健康状况,农民工的心理韧性和心理健康水平都相对较高。     

Health Consequences of Positive and Negative Interracial Interactions at a Predominantly Caucasian Public University

Many studies have reported racial conflict, negative attitudes, and discriminatory behavior among ethnic groups on college campuses. This study examined the prevalence of both positive and negative interracial experiences and their impact on students' health. One hundred fifteen undergraduates (22 African Americans, 25 Asian Americans, 29 Caucasians, 17 Hispanic/Latino Americans, and 22 Bi–multiracial Americans; 46 males and 69 females) completed an Interracial Experiences Survey (IES) and measures of physical and mental health, perceived racial bias, ethnic identity, and just world belief. Hierarchical regression analyses revealed that symptoms of psychological distress and mental health outcome were best predicted by perceived racial bias, male gender, and low belief in a just world. In contrast, improved general health and decreased somatic complaints were associated with positive interracial contact, female gender, lower perceived racial bias, higher just world beliefs, and higher ethnic identity. These analyses revealed that positive interracial experiences had specific effects on physical health outcome, whereas perceived racial bias, a measure of racial mistrust, was a strong predictor of all measures of physical and mental health.     

Perceived stress,internal resources,and social support as determinants of mental health among young adults

BACKGROUND: Mental health is a central determinant of quality of life. While psychiatric morbidity of populations has been studied extensively, the role of perceived stress, social support, and internal resources as determinant of health is still poorly understood. METHODS: We surveyed 2000 randomly selected university students. Perceived stress was measured by the Brief Encounter Psychosocial Instrument, social support by the Duke-UNC Functional Social Support Questionnaire, internal resources (mastery and self-esteem) by a brief version of the Pearlin coping questionnaire. Linear regression models were used to explore the relationships between these variables and mental health, based on the SF-12 health survey. RESULTS: After two reminders, 1257 students answered the questionnaire. In bivariate analysis, mental health was negatively associated with stress and positively associated with internal resources and social support (all p-values < 0.001). In multiple regression analysis, internal resources were positively associated with mental health, and buffered the negative impact of stress on mental health. Internal resources and stress mediated the positive impact of social support on mental health. CONCLUSIONS: Our data confirm that perceived stress is an important risk factor for low mental health and suggest that mastery and self-esteem are important protective factors of mental health among young adults.     

Correlates of HIV-related stigma among HIV-positive mothers and their uninfected adolescent children

The purpose of this study was to examine the degree and impact of HIV-related stigma among HIV positive mothers and their uninfected children. One hundred eighteen HIV-infected mothers and their uninfected early- and middle-adolescent children (mean age=13 years) participated in a study of maternal mental and physical health and child school performance and psychological distress. Mothers and a subset of children (to whom the mother's HIV status had previously been disclosed) were administered a series of questions to measure stigma related to the mother's HIV status. Mothers reporting high levels of HIV-related stigma scored significantly lower on measures of physical, psychological, and social functioning. Mothers' levels of depression were also significantly higher when their levels of stigma were higher. No significant differences were found in children's depression by perceived level of stigma; however, adolescents who perceived high levels of stigma because of their mothers' HIV status were more likely to participate in delinquent behavior, compared with those reporting low HIV-related stigma. The experience of stigma had consequences for many aspects of well-being among the HIV-infected mothers. While their children were aware of and perceived stigma, they appeared to be affected primarily in the realm of delinquent behavior.     

Generational Differences in Psychosocial Adaptation and Predictors of Psychological Distress in a Population of Recent Vietnamese Immigrants

While first-wave Vietnamese immigrants adapted well to life in the United States, subsequent immigrants have had greater adjustment difficulties, including more evidence of psychological distress. This study aimed to analyze psychosocial adaptation differences among three generations of recent Vietnamese immigrants, as well as to examine predictors of mental distress in the sample as a whole. A community sample of 184 recent Vietnamese immigrants, categorized as either elderly, middle-aged, or young adults, was assessed for levels of psychological distress, including depression, anxiety, and PTSD, as well as family conflict, dissatisfaction with life in the U.S., acculturation and biculturalism, social support, coping, and premigratory stressors. Young Vietnamese adults were most acculturated, most bicultural, and reported themselves as healthiest and least depressed. They were most often working, least often on welfare, and had the highest family income. However, they also reported most dissatisfaction with their current lives in the U.S. and most family conflict. Regression analysis explaining approximately one-quarter of the variance in mental distress implicated current dissatisfaction with and lack of adjustment to life in the United States, as well as greater acculturation and increased family conflict. Although young adults scored significantly higher than other generations on most of the risk factors for psychological distress, they appeared to be buffered against poorer mental health outcomes by factors of generation and perceived positive overall well-being. In terms of testing a predictive model of psychological distress, this study found current adjustment factors significantly more important in determining mental health outcomes than premigratory stressors such as war-related traumas.     

Coping and perception of women with HIV infection

OBJECTIVE

To analyze women’s perceptions and coping regarding the discovery of an HIV infection.

METHODS

A qualitative study in an HIV/AIDS Specialist Helpdesk in Recife, PE, Northeastern Brazil, from January to September 2010, involving eight women living with asymptomatic HIV aged between 27 and 37 years, without criteria for diagnosis of AIDS infected through intercourse and monitored by the service for at least one year. Forms were used to characterize the clinical situation and semi-structured interviews to understand perceptions and feelings related to personal trajectory after diagnosis and different ways of facing the diagnosis in family and social life. Content analysis was performed as suggested by Bardin.

RESULTS

The thematic category that emerged was stigma and discrimination. The women had life trajectories marked by stigma, which was perceived as discrimination after the diagnosis and in the experiences of everyday life. The revelation of the infection was perceived as limiting to a normal life, leading to the need to conceal the diagnosis. The discriminatory attitudes of some health care professionals, non-specialist in HIV/AIDS, had a negative impact on future experiences in other health services. Besides the effects of institutional stigma, the perception of women was that the service did not include dedicated space for the expression of other needs beyond the disease, which could help in fighting the infection.

CONCLUSIONS

Living with HIV was strongly linked to stigma. The results show the importance of strengthening educational approaches and emotional support at the time of diagnosis in order to facilitate coping with the condition of seropositivity.     

Perceived discrimination, race and health in South Africa

To assess the levels of perceived acute and chronic racial and non-racial discrimination in South Africa, their association with health, and the extent to which they contribute to racial differences in physical and mental health, data were used from a national probability sample of adults, the South African Stress and Health Study (SASH). All Black groups in South Africa (African, Coloured and Indian) were two to four times more likely than Whites to report acute and chronic experiences of racial discrimination. Africans and Coloureds report higher levels of ill health than Whites, but acute and chronic racial discrimination were unrelated to ill health and unimportant in accounting for racial differences in self-rated health. In contrast, all Black groups had higher levels of psychological distress than Whites, and perceived chronic discrimination was positively associated with distress. Moreover, these experiences accounted for some of the residual racial differences in distress after adjustment for socioeconomic status. Our main findings indicate that, in a historically racialized society, perceived chronic racial and especially non-racial discrimination acts independently of demographic factors, other stressors, psychological factors (social desirability, self-esteem and personal mastery), and multiple SES indicators to adversely affect mental health.     

Effect of trauma on quality of life as mediated by mental distress and moderated by coping and social support among postconflict displaced Ethiopians

Objective An understanding of how quality of life is affected by severe trauma and mental distress may facilitate better intervention strategies for postconflict internally displaced persons, by identifying mediators, moderators, and independent risk factors. We investigate the pathways involved in this process and also study the moderating roles of coping strategies and perceived social support. Method A random sample of 1193 (62% women) internally displaced Ethiopian adults living in shelters in Addis Ababa were interviewed with instruments capturing the relevant concepts, including SCL-90-R and WHOQOL-BREF. Path analysis was employed to elaborate the mediating and moderating effects. Self-reported living conditions were also assessed. Results Mental distress increased and quality of life decreased with age. Mental distress mediated the effects of trauma in reducing the quality of life, and some trauma also reduced quality of life directly. These effects remained after adjusting for living conditions. Living conditions were related to quality of life also on their own. Coping strategies and perceived social support influenced mental distress and quality of life directly as well as indirectly by moderation, in part gender specific. Conclusions Intervention strategies aimed at reducing mental distress, modifying coping strategies, and encouraging social support may turn out to be useful in increasing the overall quality of life in postconflict situations, and are worth considering as complements to strategies that improve the living conditions.     

Urban social exclusion and mental health of China's rural-urban migrants – A review and call for research

China's internal rural-urban migrants experience social exclusion that may have significant mental health implications. This has historically been exacerbated by the hukou system. Echoing recent calls for interdisciplinary research on the interdependencies of urbanization and mental health, this review examines evidence of rural-urban migrants’ mental health status in comparison with nonmigrants and its association with various dimensions of social exclusion. We found conflicting evidence on the mental health status of migrants in comparison with nonmigrants, but strong evidence that social exclusion is negatively associated with migrants’ mental health: limited access to full labour rights and experience of social stigma, discrimination and inequity were the most significant factors. We discuss the limitations of current social epidemiological research and call for an attempt to use close-up, street-level ethnographic data on the daily experience of being a migrant in the mega-city, and describe our aim to produce a new sociological deep surveying instrument to understand migration, urban living, and mental health.     

新型冠状病毒肺炎疫情下护士心理健康与领悟社会支持和应对方式的相关性分析

目的 调查新型冠状病毒肺炎(简称新冠肺炎)疫情下护理人员的心理健康状况,分析心理健康与领悟社会支持和应对方式之间的关系。 方法 采用一般人口学资料调查表、简易心理状况评定量表、领悟社会支持量表以及简易应对方式量表对新型冠状病毒肺炎某三甲定点收治医院的845例护士进行调查分析。 结果 疫情期间845例护理人员的心理健康得分为(19.4±7.6)分,超过1/3的护士心理状况差。与年龄≥41岁的护理人员相比,年龄在31~35岁的护理人员心理状况差的检出率更高;本科及以上学历、高危环境工作、亲友当中有或不确定是否有疑似或确诊患者、不确定是否接触疑似或确诊患者的护理人员心理状况差的检出率更高;工作≥16年、自身健康状况评价好、对医院职业安全防护评价非常完善的护理人员心理状况差的检出率更低。护理人员心理健康总分与朋友支持、家庭支持、其他支持及积极应对方式得分呈负相关(r=-0.30、-0.31、-0.31、-0.38,均 P<0.01),与消极应对方式呈正相关(r=0.28,P<0.01);积极应对方式、消极应对方式在领悟社会支持和心理健康之间有部分中介作用,分别占总效应的37.1%和8.6%。 结论 疫情期间护理人员的心理健康状况不容乐观,领悟社会支持对心理健康有直接和间接的预测作用,应对方式在领悟社会支持和心理健康之间有部分中介作用。     

Body weight,perceived weight stigma and mental health among women at the intersection of race/ethnicity and socioeconomic status: insights from the modified labelling approach

With increasing rates of obesity in the United States, attention to life chances and psychological consequences associated with weight stigma and weight‐based discrimination has also intensified. While research has demonstrated the negative effects of weight‐based discrimination on mental health, little is known about whether different social groups are disproportionately vulnerable to these experiences. Drawing on the modified labelling theory, the focus of this paper is to investigate the psychological correlates of body weight and self‐perceived weight‐based discrimination among American women at the intersection of race/ethnicity and socioeconomic status (SES). Analyses use data from the National Health Measurement Study (NHMS), a national multi‐stage probability sample of non‐institutional, English‐speaking adults, ages 35 to 89 in 2005–2006. Our findings demonstrate that the effect of weight‐based discrimination on psychological well‐being is highly contingent on social status. Specifically, the psychological consequences of discrimination on Hispanic women and women in the lowest household income group is significantly greater relative to White women and women with higher household income, controlling for obesity status and self‐rated health. These results suggest that higher social status has a buffering effect of weight stigma on psychological well‐being.