Self-labeling and its effects among adolescents diagnosed with mental disorders

While youths are increasingly diagnosed with serious psychiatric disorders, little is known about how they conceptualize their own problems or the impact of mental illness labels on their psychological well-being. These are matters of great concern because of the potential vulnerability of young people to stigma as well as the fact that fear of labels or anticipation of stigma are common barriers to adolescents' ongoing mental health service utilization. This study uses mixed-method interviews with 54 US adolescents receiving integrated mental health services in a mid-sized mid-Western city to examine: (1) the extent to which they use psychiatric terms to refer to their problems (“self-label”), and (2) the relationships between adolescents' self-labeling and indicators of psychological well-being (self-esteem, mastery, depression and self-stigma). Associations between self-labeling and perceived negative treatment by others (public-stigma), clinical and demographic factors are explored to identify which adolescents are more likely to self-label. Based on Modified Labeling Theory [Link, B., Cullen, F., & Struening, E. (1989). A modified labeling theory approach to mental disorders: An empirical assessment. American Sociological Review, 54(3), 400–423.] and Thoits's [(1985). Self-labeling processes in mental illness: The role of emotional deviance. American Journal of Sociology, 91(2), 221–249.] work on self-labeling, it was expected that many youth would not self-label and that self-labelers would demonstrate poorer psychological well-being. As expected, the findings indicated that only a minority of adolescents ‘self-labeled’. Most conceptualized their problems in non-pathological terms or demonstrated uncertainty or confusion about the nature of their problems. Adolescent who self-labeled reported higher ratings on self-stigma and depression, and a trend toward a lower sense of mastery, but there was no association with self-esteem. Certain characteristics and experiences were correlated with a greater propensity to self-label including: more perceived public-stigma, younger age at initiation of treatment, and higher socio-economic status. This work contributes to knowledge about the variation of adolescents' experiences with stigmatizing labels and their impacts.     

Adolescent substance abuse, the importance of family, school and peers: data from the health behaviour in school children

Summary. Objectives: To determine the possible factors associated with adolescent substance use in a country having recently experienced war.Methods: The survey applied the World Health Organization research protocol for cross-national survey – HBSC: a cross-sectional study among 1540 15-year old adolescents in Belgrade was conducted. The research instrument was a self-administered questionnaire.Results: Substance abuse is associated with living in a single parent family, living in a family without support, having a poor commitment to school, displaying aggressive behaviour, and spending a lot of time with friends.Conclusions: Factors associated with adolescent substance use include social background, family, school and peers. Such associations could help to focus on better measures to eliminate or reduce the risk of substance use.

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Zusammenfassung. Missbrauch von Substanzen bei Jugendlichen, Bedeutung von Familie, Schule und peers: Angaben aus BelgradFragestellung: Ziel der Forschung ist, Faktoren zu bestimmen, die für den Substanzmissbrauch bei Jugendlichen mitverantwortlich sind.Methoden: Die Forschung ist ein Teil des Projektes Gesundheitliches Verhalten bei Schulkindern, das gemäss dem Protokoll der WHO für internationale komparative Studien, bei 1540 Jugendlichen in Belgrad durchgeführt wurde. Es wurde ein Fragebogen benutzt, der von den Befragten selbst ausgefüllt wurde. Die Ergebnisse sind mit Methoden der deskriptiven Statistik analysiert worden, d.h. mittels Chi2-Tests sowie der logistischen Regression.Ergebnisse: Die Ergebnisse deuten darauf hin, dass der Substanzmissbrauch mit folgenden Faktoren in Zusammenhang steht: Leben in einer Familie mit nur einem Elternteil, Leben in einer Familie ohne Unterstützung, einem sehr niedrigen Engagement für die Schule, leichter Kommunikation mit Freunden des anderen Geschlechts, mit agressivem Verhalten sowie dem Verbringen eines grossen Teils seiner Freizeit mit den Gleichaltrigen.Schlussfolgerung: Es besteht ein Zusammenhang zwischen dem Substanzenmissbrauch bei Jugendlichen und den verschiedenen sozialen Verhältnissen wie Familie, Schule und Gleichaltrige. Die Erkennung dieses Zusammenhangs wird uns die Fokussierung auf die Massnahmen ermöglichen, die den Expositionseffekt zum Risiko beseitigen, reduzieren oder auf irgendeine Weise schwächer machen können.

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Résumé. Labus de substances chez les adolescents limportance de la famille, de lécole et des pairs (Health Behaviour in School Children – Belgrade)Objectifs: Déterminer les facteurs pouvant provoquer un abus de substances chez les adolescents dans un pays ayant souffert récemment de la guerre.Méthodes: Le projet Health Behaviour in School Children a été réalisé parmi 1540 adolescents à Belgrade selon le protocole de lOMS, avec un questionnaire auto-administré.Résultats: Labus de substances est en lien avec la présence dune structure familiale monoparentale ou avec labsence de soutien familial, avec un comportement agressif, avec un investissement scolaire limité de même quavec le temps passé auprès des pairs.Conclusions: Les facteurs en lien avec labus de substances chez les adolescents à Belgrade sont dorigine sociale comme par exemple la famille, lécole, les pairs. La mise en évidence de ces facteurs pourrait contribuer à améliorer les mesures prises pour éliminer ou réduire le risque dabus de substances.

     

Feasibility, acceptability, and initial efficacy of a knowledge-contact program to reduce mental illness stigma and improve mental health literacy in adolescents

The purpose of this school-based cluster-randomized trial was to determine the initial acceptability, feasibility, and efficacy of an existing community-based intervention, In Our Own Voice, in a sample of US adolescent girls aged 13-17 years (n = 156). In Our Own Voice is a knowledge-contact intervention that provides knowledge about mental illness to improve mental health literacy and facilitates intergroup contact with persons with mental illness as a means to reduce mental illness stigma. This longitudinal study was set in two public high schools located in a southern urban community of the U.S. Outcomes included measures of mental illness stigma and mental health literacy. Findings support the acceptability and feasibility of the intervention for adolescents who enrolled in the study. Findings to support the efficacy of In Our Own Voice to reduce stigma and improve mental health literacy are mixed. The intervention did not reduce mental illness stigma or improve mental health literacy at one week follow up. The intervention did not reduce mental illness stigma at 4 and 8 weeks follow up. The intervention did improve mental health literacy at 4 and 8 weeks follow up. Previous studies have assessed the preliminary efficacy In Our Own Voice among young adults; rarely has In Our Own Voice been investigated longitudinally and with adolescents in the United States. This study provides initial data on the effects of In Our Own Voice for this population and can be used to further adapt the intervention for adolescents.     

家庭环境对中学生心理健康影响的研究

目的探讨家庭环境对中学生心理健康的影响。方法采用症状自评量表（ScL-90）和父母养育方式评价量表（EMBu）对安徽省宣城市某普通中学八年级116名学生进行心理健康测量。结果核心家庭的中学生心理健康水平高于单亲家庭和主干家庭的学生;父母采用情感温暖、理解的教育方式时,中学生出现心理健康方面的症状较少;而采用惩罚严厉、过分干涉、拒绝否认和过度保护的教育方式时,易出现如焦虑、抑郁、敌对情绪及人际冲突等诸多心理健康方面的症状;中学生家庭经济状况与心理健康量表的各个因子之间存在显著相关。结论不同的家庭结构、父母教养方式和家庭经济情况对中学生心理健康状况具有重要的影响。     

青少年传统欺凌、网络欺凌与心理健康的关系研究

目的 调查青少年受欺凌的流行特点,探究遭受传统欺凌、网络欺凌以及欺凌数量对青少年心理健康的影响。方法 采用分层整群随机抽样方法,分别选取华中某市城市、农村青少年3 174名。采用自制受欺凌问卷和《中国中学生心理健康量表》(MMHI - 60)调查青少年校园欺凌及心理健康状况。结果 13.4%(424/3 174)的青少年至少遭受过一种类型的校园欺凌,其中受言语欺凌报告率最高(9.9%),网络欺凌最低(2.9%);受欺凌报告率男生高于女生(χ2 = 6.48,P = 0.011),七年级最高21.6%(114/3 174)。心理健康问题的检出率为10.3%（328/3 174）;受任意类型的欺凌均与心理健康问题相关,遭受多种类型欺凌者发生心理健康问题的风险高于单一受欺凌者;传统欺凌(言语欺凌、躯体欺凌、关系欺凌)对心理健康的独立影响高于网络欺凌。结论 青少年遭受欺凌与心理健康问题的产生密切相关,传统欺凌仍然是影响青少年心理健康的重要因素,应积极治理校园欺凌,促进青少年心理健康发展。     

Effects of contact with treatment users on mental illness stigma: evidence from university roommate assignments

Mental illness stigma refers to negative stereotypes and prejudices about people with mental illness, and is a widespread phenomenon with damaging social, psychological, and economic consequences. Despite considerable policy attention, mental illness stigma does not appear to have declined significantly in recent years. Interpersonal contact with persons with mental illness has been identified as a promising approach to reducing mental illness stigma. This study investigates the effect of contact with mental health treatment users on stigma using an observational research design that is free of self-selection bias. The research design is based on the quasi-experiment in which university students are assigned to live together as roommates. Survey data were collected from first-year undergraduates at two large universities in the United States (N = 1605). Multivariable regressions were used to estimate the effect of assignment to a roommate with a history of mental health treatment on a brief measure of stigmatizing attitudes. Contact with a treatment user caused a modest increase in stigma (standardized effect size = 0.15, p = 0.03). This effect was present among students without a prior treatment history of their own, but not among those with a prior history. The findings indicate that naturalistic contact alone does not necessarily yield a reduction in mental illness stigma. This may help explain why stigma has not declined in societies such as the United States even as treatment use has risen substantially. The findings also highlight the importance of isolating the specific components, beyond contact per se, that are necessary to reduce stigma in contact-based interventions.     

"Not all my fault": Genetics, stigma, and personal responsibility for women with eating disorders

Medical researchers and clinicians increasingly understand and present eating disorders (anorexia and bulimia nervosa) as biologically-based psychiatric disorders, with genetic risk factors established by high heritability estimates in twin studies. But there has been no research on interpretation of genetic involvement by people with eating disorders, who may hold other views. Their interpretations are particularly important given the frequent presumption that biogenetic framing will reduce stigma, and recent findings that it exacerbates stigma for other mental illnesses. To identify implications of genetic framing in eating disorders, I conducted semi-structured interviews with 50 US women with a history of eating disorders (half recovered, half in treatment; interviewed 2008-9 in the USA). Interviews introduced the topic of genetics, but not stigma per se. Analysis followed the general principles of grounded theory to identify perceived implications of genetic involvement; those relevant to stigma are reported here. Most anticipated that genetic reframing would help reduce stigma from personal responsibility (i.e., blame and guilt for eating disorder as ongoing choice). A third articulated ways it could add stigma, including novel forms of stigma related to genetic-essentialist effacing of social factors. Despite welcoming reductions in blame and guilt, half also worried genetic framing could hamper recovery, by encouraging fatalistic self-fulfilling prophecies and genetic excuses. This study is the first to elicit perceptions of genetic involvement by those with eating disorders, and contributes to an emerging literature on perceptions of psychiatric genetics by people with mental illness.     

The effects of harassment and victimization on self-rated health and mental health among Canadian adolescents

Using 1996/1997 to 2000/2001 data from the Canadian National Longitudinal Survey of Children and Youth, this paper examines the effects of harassment on self-rated and mental health status among Canadian adolescents aged 16-17 years. Forty-six percent of the children experienced harassment and victimization (verbal aggression, threat, and physical harm/assault) at school and 40% outside of school. Harassment at school, rather than otherwise, was associated with poor health status and higher levels of depression even when previous health conditions and socio-demographic variables were held constant. The relationship between harassment and mental health is particularly pronounced among girls, immigrant children and those living in single-parent households. Given the sizable proportion of adolescents as victims of harassment at school and its significant relationship with both health status and depression, the issue warrants serious public health attention through school-based intervention programs.     

Church ladies, good girls, and locas: stigma and the intersection of gender, ethnicity, mental illness, and sexuality in relation to HIV risk

Inner city women with severe mental illness may carry multiple stigmatized statuses. In some contexts these include having a mental illness, being a member of an ethnic minority group, being an immigrant, being poor, and being a woman who does not live up to gendered expectations. These potentially stigmatizing identities influence both the way women's sexuality is viewed and their risk for HIV infection. This qualitative study applies the concept of intersectionality to facilitate understanding of how these multiple identities intersect to influence women's sexuality and HIV risk. We report the firsthand accounts of 24 Latina women living with severe mental illness in New York City. In examining the interlocking domains of these women's sexual lives, we find that the women seek identities that define them in opposition to the stigmatizing label of "loca" (Spanish for crazy) and bestow respect and dignity. These identities have unfolded through the additional themes of "good girls" and "church ladies". Therefore, in spite of their association with the "loca", the women also identify with faith and religion ("church ladies") and uphold more traditional gender norms ("good girls") that are often undermined by the realities of life with a severe mental illness and the stigma attached to it. However, the participants fall short of their gender ideals and engage in sexual relationships that they experience as disempowering and unsatisfying. The effects of their multiple identities as poor Latina women living with severe mental illness in an urban ethnic minority community are not always additive, but the interlocking effects can facilitate increased HIV risks. Interventions should acknowledge women's multiple layers of vulnerability, both individual and structural, and stress women's empowerment in and beyond the sexual realm.     

Culture,threat, and mental illness stigma: Identifying culture-specific threat among Chinese-American groups

We incorporate anthropological insights into a stigma framework to elucidate the role of culture in threat perception and stigma among Chinese groups. Prior work suggests that genetic contamination that jeopardizes the extension of one's family lineage may comprise a culture-specific threat among Chinese groups. In Study 1, a national survey conducted from 2002 to 2003 assessed cultural differences in mental illness stigma and perceptions of threat in 56 Chinese-Americans and 589 European-Americans. Study 2 sought to empirically test this culture-specific threat of genetic contamination to lineage via a memory paradigm. Conducted from June to August 2010, 48 Chinese-American and 37 European-American university students in New York City read vignettes containing content referring to lineage or non-lineage concerns. Half the participants in each ethnic group were assigned to a condition in which the illness was likely to be inherited (genetic condition) and the rest read that the illness was unlikely to be inherited (non-genetic condition). Findings from Study 1 and 2 were convergent. In Study 1, culture-specific threat to lineage predicted cultural variation in stigma independently and after accounting for other forms of threat. In Study 2, Chinese-Americans in the genetic condition were more likely to accurately recall and recognize lineage content than the Chinese-Americans in the non-genetic condition, but that memorial pattern was not found for non-lineage content. The identification of this culture-specific threat among Chinese groups has direct implications for culturally-tailored anti-stigma interventions. Further, this framework might be implemented across other conditions and cultural groups to reduce stigma across cultures.     

Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis

An expansive body of research has investigated the experiences and adverse consequences of internalized stigma for people with mental illness. This article provides a systematic review and meta-analysis of the extant research regarding the empirical relationship between internalized stigma and a range of sociodemographic, psychosocial, and psychiatric variables for people who live with mental illness. An exhaustive review of the research literature was performed on all articles published in English that assessed a statistical relationship between internalized stigma and at least one other variable for adults who live with mental illness. In total, 127 articles met the inclusion criteria for systematic review, of which, data from 45 articles were extracted for meta-analyses. None of the sociodemographic variables that were included in the study were consistently or strongly correlated with levels of internalized stigma. The review uncovered a striking and robust negative relationship between internalized stigma and a range of psychosocial variables (e.g., hope, self-esteem, and empowerment). Regarding psychiatric variables, internalized stigma was positively associated with psychiatric symptom severity and negatively associated with treatment adherence. The review draws attention to the lack of longitudinal research in this area of study which has inhibited the clinical relevance of findings related to internalized stigma. The study also highlights the need for greater attention on disentangling the true nature of the relationship between internalized stigma and other psychosocial variables.     

Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review

Socioeconomic inequalities in health are an important topic in social sciences and public health research. However, little is known about socioeconomic disparities and mental health problems in childhood and adolescence. This study systematically reviews publications on the relationships between various commonly used indicators of socioeconomic status (SES) and mental health outcomes for children and adolescents aged four to 18 years. Studies published in English or German between 1990 and 2011 were included if they reported at least one marker of socioeconomic status (an index or indicators, e.g., household income, poverty, parental education, parental occupation status, or family affluence) and identified mental health problems using validated instruments. In total, 55 published studies met the inclusion criteria, and 52 studies indicated an inverse relationship between socioeconomic status and mental health problems in children and adolescents. Socioeconomically disadvantaged children and adolescents were two to three times more likely to develop mental health problems. Low socioeconomic status that persisted over time was strongly related to higher rates of mental health problems. A decrease in socioeconomic status was associated with increasing mental health problems. The strength of the correlation varied with age and with different indicators of socioeconomic status, whereas heterogeneous findings were reported for gender and types of mental health problems. The included studies indicated that the theoretical approaches of social causation and classical selection are not mutually exclusive across generations and specific mental health problems; these processes create a cycle of deprivation and mental health problems. The review draws attention to the diversity of measures used to evaluate socioeconomic status, which might have influenced the comparability of international epidemiological studies. Furthermore, the review highlights the need for individual-level early childhood interventions as well as a reduction in socioeconomic inequalities at a societal level to improve mental health in childhood and adolescence.     

Neighbourhood effects on psychiatric disorders among Finnish adolescents: The moderating impact of family background

We study whether childhood neighbourhood context affects mental health in adolescence in Finland. We also examine heterogeneous effects by family background. By exploiting register data for 1999–2018, we use sibling fixed effects models to gain more robust evidence on the existence of neighbourhood effects. We do not find evidence of an association between neighbourhood characteristics and psychiatric disorders within families. Differences in the effects by family background were not consistent, and variation was mainly found in random effects models. In general, observed family characteristics were strongly associated with psychiatric disorders. This means that interventions should be targeted to children at risk rather than certain neighbourhoods.     

Stigma,trauma and sexuality: the experiences of women hospitalised with serious mental illness

Women with serious mental illness (SMI) occupy a social position in which their experiences are simultaneously influenced by stigmatisation, institutionalisation and gendered dimensions of trauma and power. Women with SMI are stigmatised in society, pushed to the margins and left vulnerable to victimisation and rejection, particularly if hospitalised in psychiatric institutions. Using modified labelling theory, I investigate how women hospitalised with SMI, especially those who have histories of sexual abuse and trauma, experience sexuality and perceive men and masculinity. I extend modified labelling theory by empirically analysing the role of social status and power in the labelling process. Specifically, I focus on gender, and analyse interviews with 55 women in US psychiatric hospitals, focusing on gendered experiences of trauma, stigma and attitudes about sexuality. I show how trauma increases the salience of stigma and potential for retraumatisation, both of which are amplified by the institutional setting. I find meaningful differences in the narratives of women who have experienced trauma and those who have not. Modified labelling theory helps explain how labelling can perpetuate self-stigma, which threatens women's self-esteem, safety and trust in others. The intersection of these experiences extends modified labelling theory and may have profound implications for recovery.     

车祸致颅脑损伤患者家属心理健康状况与社会支持相关性研究

目的 了解车祸致颅脑损伤患者家属的心理健康状况和社会支持状况,探讨其相关性。方法 采用自编一般资料调查表、症状自评量表（SCL - 90）和社会支持量表（SSRS）,对225名到精神专科医院就诊的车祸致颅脑损伤患者家属进行问卷调查。结果 车祸致颅脑损伤患家属的SCL - 90总分为（178.45±82.56）分, SCL - 90总分、阳性项目数和9个因子分均显著高于肿瘤患者家属和全国常模(P＜0.05)。社会支持总分为（38.52±8.23）分,社会支持水平与家属的心理健康状况呈显著的负相关（r = - 0.416, P＜0.05）。多元线性回归分析显示,社会支持总分可以负向预测家属的心理健康状况（β = - 0.399,P＜0.05）。结论 车祸致颅脑损伤患者家属的心理问题发生率较高,应从个人、家庭和社会层面为家属提供社会支持资源。     

Combining education and video-based contact to reduce stigma of mental illness: “The Same or Not the Same” anti-stigma program for secondary schools in Hong Kong

This study examined the effects of three versions of school-based stigma reduction programs against mental illness – education, education followed by video-based contact (education–video), and video-based contact followed by education (video–education). The participants, 255 students from three secondary schools in Hong Kong, completed measures of stigmatizing attitudes (Public Stigma Scale), social distance (Social Distance Scale), and knowledge about schizophrenia (Knowledge Test) at pre-test, post-test, and 1-month follow-up. Results suggested that adding video-based contact to education could significantly improve program effectiveness only when video-based contact was presented after but not prior to education. In comparison with the education condition, the education–video condition showed larger improvements in stigmatizing attitudes at post-test, in social distance at both post-test and follow-up, and in knowledge at follow-up. However, such differences were not observed when the education condition was compared with the video–education condition. Implications of these findings for future research are discussed.     

Spirituality within the family and the prevention of health risk behavior among adolescents in Bangkok, Thailand

This study investigates the influences of a family's spiritual beliefs and practices on substance use and sexual risk behaviors among young adolescents 13-14 years old in Bangkok, Thailand. Independent predictor variables are the parents' and teens' spiritual beliefs and practices in Buddhism and parental monitoring behaviors. The study uses data from the 2007 Baseline Survey of the Thai Family Matters Project, which adapted a U.S. based family prevention program for Thai culture. A representative sample of 420 pairs of parents and teens from the Bangkok metropolitan area was recruited to participate in the study. Structural equation models indicate that positive direct and indirect associations of the spirituality of parents and teens within a family and the prevention of adolescent risk behaviors are significant and consistent.     

From the family universe to the outside world: Family relations, school attitude, and perception of racism in Caribbean and Filipino adolescents

Caribbean and Filipino immigrant families in Canada have much in common: the women have often immigrated as domestic workers, first-generation children may be separated from their parents for long periods, and they must deal with negative stereotypes of their ethnic group. This transcultural study looks at the associations between family relations and adolescents’ perceptions of both their own group and the host society, and analyzes how these affect their mental health. The results suggest that family cohesion plays a key role in shaping adolescents’ perceptions of racism in the host country and in promoting a positive appraisal of their own community, thus highlighting the need for a systemic understanding of family and intergroup relations.     

The importance of social context: neighborhood stressors, stress-buffering mechanisms, and alcohol, drug, and mental health disorders

This study examines the relationship among neighborhood stressors, stress-buffering mechanisms, and likelihood of alcohol, drug, and mental health (ADM) disorders in adults from 60 US communities (n=12,716). Research shows that larger support structures may interact with individual support factors to affect mental health, but few studies have explored buffering effects of these neighborhood characteristics. We test a conceptual model that explores effects of neighborhood stressors and stress-buffering mechanisms on ADM disorders. Using Health Care for Communities with census and other data, we found a lower likelihood of disorders in neighborhoods with a greater presence of stress-buffering mechanisms. Higher neighborhood average household occupancy and churches per capita were associated with a lower likelihood of disorders. Cross-level interactions revealed that violence-exposed individuals in high crime neighborhoods are vulnerable to depressive/anxiety disorders. Likewise, individuals with low social support in neighborhoods with high social isolation (i.e., low-average household occupancy) had a higher likelihood of disorders. If replicated by future studies using longitudinal data, our results have implications for policies and programs targeting neighborhoods to reduce ADM disorders.