Differential labeling of mental illness by social status: a new look at an old problem

Whether the higher rates of mental hospitalization and involuntary treatment for marginal social groups are due to differential labeling or simply to the occurrence of higher rates of disorder in these groups remains unresolved. I reexamine this issue with data from the National Comorbidity Survey (N = 5,877) that allow comparisons between disturbed individuals living in the community untreated and disturbed persons who have been hospitalized or seen a professional for their mental health problems under pressure or voluntarily. Contrary to labeling theory, members of lower status groups are not consistently overrepresented among those who have been hospitalized or seen a professional against their will. Consistent with self-labeling theory, persons with greater education and those not in poverty are disproportionately present among individuals who sought treatment by choice. Additional analyses show that factors that predict service utilization are important determinants of mental health service use but do not account systematically for status disparities in hospital or outpatient treatment, especially disparities by poverty status. Although I do not confirm a central tenet of labeling theory here, the negative consequences of labeling and stigma continue to be well-supported in the literature.     

Trauma-informed services for children with incarcerated parents

Children of incarcerated parents have often experienced not only the trauma of family separation, but also other forms of adverse events. Social workers can improve service delivery to this population by incorporating SAMHSA’s components of trauma-informed care (TIC). Translating TIC concepts into practice is an important but challenging goal for social work practitioners. The first half of this article reviews the literature about the effects of parental incarceration on attachment, stigma, physical and mental health, and intergenerational transmission of trauma. The latter half of the article applies principles of TIC by offering specific recommendations for conceptualizing cases through the lens of trauma and utilizing trauma-informed responses with these children.     

Bisexual Stigma,Sexual Violence,and Sexual Health Among Bisexual and Other Plurisexual Women: A Cross-Sectional Survey Study

Bisexual women experience higher rates of sexual victimization relative to heterosexual and lesbian women, and worse sexual health outcomes. Though these health disparities are well documented in the literature, few empirical data have been published on what factors are driving these disparities. Further, research documenting sexual victimization and health of plurisexual (i.e., attracted to more than one gender) women group all participants as bisexual. We do not know whether these experiences are similar across subgroups of plurisexual women. The current study reports on data from a cross-sectional survey, analyzing the relationships between bisexual-specific stigma and sexual violence, as well as other sexual health outcomes, across a sexually diverse group of plurisexual participants. Findings indicate that bisexual stigma is a significant predictor of lifetime sexual violence (odds ratio [OR] = 1.99, p = .015) and verbal coercion (OR = 2.60, p = .004), but not other outcomes. There are differences across sexual identity categories, with bisexual participants being less likely to report sexual violence and verbal coercion, and less likely to access sexually transmitted infection/human immunodeficiency syndrome testing, compared to other plurisexual groups. Our findings support that bisexual stigma is an important factor to consider in understanding sexual violence disparities experienced by bisexual and other plurisexual women.     

Social Stigma, Social Capital Reconstruction and Rural Migrants in Urban China: A Population Health Perspective

In this study, we examine migrant stigma and its effect on social capital reconstruction among rural migrants who possess legal rural residence but live and work in urban China. After a review of the concepts of stigma and social capital, we report data collected through in-depth interviews with 40 rural migrant workers and 38 urban residents recruited from Beijing, China. Findings from this study indicate that social stigma against rural migrants is common in urban China and is reinforced through media, social institutions and their representatives, and day-to-day interactions. As an important part of discrimination, stigma against migrant workers creates inequality, undermines trust, and reduces opportunities for interpersonal interactions between migrants and urban residents. Through these social processes, social stigma interferes with the reconstruction of social capital (including bonding, bridging and linking social capital) for individual rural migrants as well as for their communities. The interaction between stigma and social capital reconstruction may present as a mechanism by which migration leads to negative health consequences. Results from this study underscore the need for taking measures against migrant stigma and alternatively work toward social capital reconstruction for health promotion and disease prevention among this population.     

Variance Function Regression in Hierarchical Age-Period-Cohort Models: Applications to the Study of Self-Reported Health

Two long-standing research problems of interest to sociologists are sources of variations in social inequalities and differential contributions of the temporal dimensions of age, time period, and cohort to variations in social phenomena. Recently, scholars have introduced a model called Variance Function Regression for the study of the former problem, and a model called Hierarchical Age-Period-Cohort regression has been developed for the study of the latter. This article presents an integration of these two models as a means to study the evolution of social inequalities along distinct temporal dimensions. We apply the integrated model to survey data on subjective health status. We find substantial age, period, and cohort effects, as well as gender differences, not only for the conditional mean of self-rated health (i.e., between-group disparities), but also for the variance in this mean (i.e., within-group disparities)-and it is detection of age, period, and cohort variations in the latter disparities that application of the integrated model permits. Net of effects of age and individual-level covariates, in recent decades, cohort differences in conditional means of self-rated health have been less important than period differences that cut across all cohorts. By contrast, cohort differences of variances in these conditional means have dominated period differences. In particular, post-baby boom birth cohorts show significant and increasing levels of within-group disparities. These findings illustrate how the integrated model provides a powerful framework through which to identify and study the evolution of variations in social inequalities across age, period, and cohort temporal dimensions. Accordingly, this model should be broadly applicable to the study of social inequality in many different substantive contexts.     

Intersections of Stigma,Mental Health,and Sex Work: How Canadian Men Engaged in Sex Work Navigate and Resist Stigma to Protect Their Mental Health

Men engaged in sex work experience significant stigma that can have devastating effects for their mental health. Little is known about how male sex workers experience stigma and its effects on mental health or their strategies to prevent its effects in the Canadian context. This study examined the interrelationships between stigma and mental health among 33 Canadian indoor, male sex workers with a specific goal of understanding how stigma affected men’s mental health and their protective strategies to mitigate against its effects. Men experienced significant enacted stigma that negatively affected their social supports and ability to develop and maintain noncommercial, romantic relationships. Men navigated stigma by avoidance and resisting internalization. Strategy effectiveness to promote mental health varied based on men’s perspectives of sex work as a career versus a forced source of income. Programming to promote men’s mental health must take into consideration men’s diverse strategies and serve to build social supports.     

Paternal Incarceration and Father–Child Contact in Fragile Families

High rates of incarceration in the United States have motivated a broad examination of the effects of parental incarceration on child well‐being. Although a growing literature documents challenges facing the children of incarcerated men, most incarcerated fathers lived apart from their children before their arrest, raising questions of whether they were sufficiently involved with their families for their incarceration to affect their children. The author used the Fragile Families and Child Wellbeing Study (N = 4,071) to examine father–child contact among incarcerated fathers and found that most incarcerated fathers maintained a degree of contact with their children through either coresidence or visitation. Moreover, the results revealed robust reductions in both father–child coresidence and visitation when fathers are incarcerated—between 18% and 20% for coresidence and 30% to 50% for the probability of visitation. The findings suggest that these reductions are driven by both incapacitation while incarcerated and union dissolution upon release.     

Health and Justice: Framing incarceration as a social determinant of health for Black men in the United States

There has been growing interest in improving the health of Black men and the social determinants of health affecting them. In this paper, we argue that incarceration is an important social determinant of health in contemporary U.S. society for Black men and their families. Mass incarceration has deleterious health effects for those directly affected by it (the incarcerated), and mass incarceration contaminates the communities where it is geographically concentrated. Given the enormous differences in exposure to incarceration for Black men, this group is the most burdened by its effects. By extension, the larger Black community is disproportionately impacted due to the cascading effects of incarceration for families and neighborhoods. Therefore, it is necessary to include incarceration in research and policy addressing the health of Black men in the United States.     

The labeling paradox: stigma, the sick role, and social networks in mental illness

Although research supports the stigma and labeling perspective, empirical evidence also indicates that a social safety net remains intact for those with mental illness, recalling the classic "sick role" concept. Here, insights from social networks theory are offered as explanation for these discrepant findings. Using data from individuals experiencing their first contact with the mental health treatment system, the effects of diagnosis and symptoms on social networks and stigma experiences are examined. The findings suggest that relative to those with less severe affective disorders, individuals with severe diagnoses and more visible symptoms of mental illness have larger, more broadly functional networks, as well as more supporters who are aware of and sympathetic toward the illness situation. However, those with more severe diagnoses are also vulnerable to rejection and discrimination by acquaintances and strangers. These findings suggest that being formally labeled with a mental illness may present a paradox, simultaneously initiating beneficial social processes within core networks and detrimental ones among peripheral ties.     

Stigma as a barrier to engaging in mental health services among adolescents who survive natural disasters

Many barriers impact the utilization of mental health services among adolescents who survive natural disasters. Although stigma has been identified as one of these barriers, minimal work examines the etiological factors that impact stigma and how these factors operate in perpetuating stigma among adolescents after a disaster. Understanding the role that stigma plays is a critical step to raising awareness of the cognitive and behavioral processes that preserve adolescents’ well-being, timely attainment of developmental milestones, and the potential for engagement in meaningful opportunities. We modify an existing adolescent self-stigma model to better understand how youth might respond psychologically to natural disasters both immediately after the event as well as during the long-term recovery phase. Future empirical research should assess the validity of these barriers within the suggested temporal framework. If this proposed conceptual piece is validated, interventions could be designed that directly address the role of stigma.     

HIV/AIDS stigma manifestations during clinical interactions with MSM in Puerto Rico

HIV/AIDS stigma can have detrimental effects on physician/patient interactions when manifested by health professionals. Unfortunately, HIV/AIDS stigma is usually manifested in an intersectional manner with other preexisting stigmas, including stigma toward men who have sex with men (MSM). Therefore, our study aimed to examine the behavioral manifestations of HIV/AIDS stigma among physicians in training during simulated clinical interactions with MSM, and explore the interrelation between HIV/AIDS stigma attitudes and behaviors. We implemented an experimental design using Standardized Patient simulations with a sample of 100 physicians in training in Puerto Rico. Results show a significant difference in the two groups’ means (p?<?.001), with a higher number of stigma behaviors in the HIV MSM patient condition (M?=?6.39) than the common cold control condition (M?=?5.20). Results evidence that stigma manifestations toward MSM with HIV may continue to be an obstacle for public health in Puerto Rico, and that medical training to prevent stigma is still needed.     

Associative stigma among mental health professionals: implications for professional and service user well-being

In contrast with growing attention given to the stigma experiences of mental health service users, the stigma literature has paid almost no attention to mental health professionals. This study focuses on experiences of associative stigma among these professionals. We investigate the link between associative stigma and three dimensions of burnout as well as job satisfaction among mental health professionals, and the link of associative stigma with self-stigma and client satisfaction among service users. Survey data from 543 professionals and 707 service users from diverse mental health services are analyzed using multilevel techniques. The results reveal that among mental health professionals associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction. In addition, in units in which professionals report more associative stigma, service users experience more self-stigma and less client satisfaction. The results reveal that associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction among mental health professionals.     

Stress,Stigma, and Sexual Minority Status: The Intersectional Ecology Model of LGBTQ Health

One of the four overarching goals of Healthy People 2020 is to achieve health equity, eliminate health disparities, and improve the health of all groups, including the health of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) populations. In 2011, the Institute of Medicine (IOM) released a report that drew attention to the unique health disparities experienced by sexual minorities and underscored the need for a comprehensive approach to sexual minority health research. This article proposes a new model of LGBTQ health to help measure, explore, explain, and predict the impact of sexual minority status on health outcomes. The Intersectional Ecology Model of LGBTQ Health (IEM) demonstrates how the relentless hypervigilance of LGBTQ individuals in a heteronormative society impacts health outcomes through the primary vehicles of stigma and chronic, elevated stress. The purpose of the IEM is to guide future research and enhance public health practice for LGBTQ populations.     

Participatory action research with asylum seekers and refugees experiencing stigma and discrimination: the experience from Scotland

Using evidence from a participatory action research process with over 100 asylum seekers and refugees in Scotland, this study explores participants’ views on mental health problems, stigma and discrimination. The study found that migration can have adverse effects on mental health and well-being, due to racism and the asylum process, and this is worsened by stigma and discrimination. This stigma is influenced by both social and cultural causal factors, including fear, past trauma, isolation, racism and the stress of the asylum process coupled with negative cultural beliefs about mental health problems. The paper considers the international relevance of this approach and the value of a model grounded in principles of community development and grassroots action.     

Does self-help increase rates of help seeking for student mental health problems by minimizing stigma as a barrier?

Objective: This study examined whether self-help (books, websites, mobile apps) increases help seeking for mental health problems among college students by minimizing stigma as a barrier. Participants and Methods: A survey was conducted with 200 college students reporting elevated distress from February to April 2017. Results: Intentions to use self-help were low, but a significant portion of students unwilling to see mental health professionals intended to use self-help. Greater self-stigma related to lower intentions to seek professional help, but was unrelated to seeking self-help. Similarly, students who only used self-help in the past reported higher self-stigma than those who sought professional treatment in the past. Although stigma was not a barrier for self-help, alternate barriers were identified. Conclusions: Offering self-help may increase rates of students receiving help for mental health problems, possibly by offering an alternative for students unwilling to seek in-person therapy due to stigma concerns.     

An exploration of social & emotional factors impacting well-being in women who have sex with women (WSW)

Abstract

“Women who have sex with women” or WSW have unique perspectives within the LBGTQ spectrum. The purpose of this study included documenting perceptions, feelings, and experiences among WSW. Thirty-seven women participated in six focus groups, ages ranged from 20–64 years. Responses were transcribed and thematically coded. Four themes emerged as influencing factors: shame and fear, community, gender roles, and normalcy. Each major theme produced minor themes providing a context within major themes. Results offer valuable insights that can assist community members, health professionals, and scientists to better appraise the disparities and stigma impacting social and emotional well-being among WSW.     

The Role of Job Insecurity in Explanations of Racial Health Inequalities

The literature documenting substantial health differences for racial minorities in the United States is well developed and has considered a multitude of explanations for such disparities. However, the literature seldom addresses the health effects for racial minorities produced in the workplace. This study bridges these two literatures in order to understand the mediating role of job insecurity in explanations of racial health disparities. Our central argument is that racial differences in job insecurity resulting from the marginalized labor market positions of racial minorities are partially responsible for racial disparities in health. This study utilizes adjacent category and partial adjacent category logit models of general health using data from the 2000 to 2010 General Social Survey in order to test this claim. Overall, the results from this study indicate that there are substantial racial differences in job insecurity, and both race and job insecurity are important predictors of general self‐rated health. Additionally, racial differences in job insecurity help explain a portion of the racial disparities in health. We conclude with a discussion of the implications for the study of health disparities in the United States.     

Assortative Mating and the Intergenerational Transmission of Parental Incarceration Risks

Research on the intergenerational transmission of incarceration tends to emphasize the strong association between fathers' involvement with the criminal justice system and sons' behavioral outcomes, such as experiencing incarceration. The father–son association in incarceration risks is, however, not the only mechanism through which these risks may travel across generations. Although female rates of incarceration are generally low (even for women who experienced parental incarceration when they were girls), women could transmit incarceration risks across generations through their choice of partner. This article uses administrative data on three generations in Denmark to show that assortative mating—the nonrandom selection of partners with similar characteristics—indeed make women just as likely as men to transmit incarceration risks across generations.     

A Review of: “Dattilio,Frank M. (2010). Cognitive-Behavioral Therapy with Couples and Families: A Comprehensive Guide for Clinicians.”

This conceptual study focuses on health disparities among African Americans in the Arkansas Delta. The author uses an ecosocial perspective to explore several social and individual-level influences upon patients' perceptions of health care quality, including health beliefs and life experiences of discrimination that can lead to not accessing health care systems. The study findings identify community-based strengths that can inform the development of strategies and programs to reduce rural health disparities. The discussion includes the potential implications of the Patient Protection and Affordable Care Act for progress in health care quality and health equality, especially for rural racial/ethnic minorities.     

Father Absence and Youth Incarceration

This study measured the likelihood of youth incarceration among adolescent males from father‐absent households, using data from the National Longitudinal Survey of Youth (N=34,031 person‐years). At baseline, the adolescents ranged from 14 to 17 years, and the incarceration outcome measure spanned ages 15 to 30 years. This study tested whether risk factors concentrated in father‐absent households explained the apparent effects of father absence. Results from longitudinal event‐history analysis showed that although a sizable portion of the risk that appeared to be due to father absence could actually be attributed to other factors, such as teen motherhood, low parent education, racial inequalities, and poverty, adolescents in father‐absent households still faced elevated incarceration risks. The adolescents who faced the highest incarceration risks, however, were those in stepparent families, including father–stepmother families. Coresidential grandparents may help attenuate this risk, although remarriage and residential instability increased it. Social policies to support children should broaden beyond an emphasis on marriage to address the risks faced by adolescents living in stepfamilies as well.