SAMMANFATTNING Det finns stora skillnader i hälsa mellan olika grupper i samhället gällande bemötande och den vård som erbjuds. Personer med psykiatriska sjukdomar har ökad ohälsa och kortare livslängd. Det har också visat sig att denna grupp ofta får sämre somatisk vård och inte tillgång till rekommenderade läkemedel i samma omfattning som andra patienter. Detta beror på att vården, liksom samhället i stort, fungerar inom en ram av diskriminerande strukturer som skapas av dominerande attityder och värderingar i samhället. Det är därför viktigt att belysa svenska sjuksköterskors attityder till psykisk ohälsa. Syfte: Att undersöka sjuksköterskors attityder till psykisk ohälsa inom den somatiska vården. Metod: Kvantitativ studiedesign, datainsamling via webbenkät med egenkonstruerade påstående, inspirerade av enkäten MICA (Mental Illness: Clinicians’ Attitudes Scale). Urvalet bestod av 103 specialistsjuksköterskestuderande vid ett universitet i Mellansverige. Svarsfrekvensen var 59 enkäter, enkätsvaren samlades in vårterminen 2015. Resultat: Sjuksköterskorna i denna studie visar ingen hög grad av negativa attityder till psykisk ohälsa eller mot personer med psykisk ohälsa. Sjuksköterskans ålder har viss betydelse för vilka attityder hen har till psykisk ohälsa. Detta visar sig tydligt i påståendet, ”Personer med psykisk ohälsa är farligare för sin omgivning än personer utan psykisk ohälsa”. 45 % av sjuksköterskorna som var under 35 år instämde helt eller delvis i detta påstående jämfört med sjuksköterskor över 35 år där 29 % svarade att de instämde och 71 % instämde inte i påståendet. Slutsats: Denna studie visar att sjuksköterskor inom den somatiska vården har olika grad av negativa attityder, främst beroende på sjuksköterskans ålder. Sjuksköterskor i åldern under 35 år har en högre grad av negativa attityder än sjuksköterskor över 35 år. Nyckelord: stigma, sjuksköterska, psykisk ohälsa, attityder / ABSTRACT There are large differences in health between different groups in our society in terms of the treatment and the care offered. People with psychiatric illness have increased illness and a shorter life expectancy. It has also been shown that this group often get worse somatic care and no access to recommended drugs in the same extent as other patients. This is due to the care, as well as society in general, works within a framework of discriminatory structures created by the dominant attitudes and values ​​in society. It is therefore important to highlight the Swedish nurses’ attitudes to mental illness. Aim: To examine nurses' attitudes towards mental illness in somatic care. Method: Quantitative study design, data collection through a web-survey with self-designed statements, inspired by the survey MICA (Mental Illness: Clinicians' Attitudes Scale). The sample consisted of 103 specialist-nursing students at a university in central Sweden. The response rate was 59 surveys, survey responses were collected spring term 2015. Results: The nurses in this study show no high levels of negative attitudes to mental illness, or against people with mental illness. The nurse’s age has some importance to the attitudes towards mental illness. This shows up clearly in the statement, "Persons with mental illness are more dangerous to their environment than people without mental illness." 45% of the nurses who were under the age of 35 years agreed fully or partly with this statement, compared with nurses over the age of 35 years where 29% said they agreed and 71% disagreed with the statement. Conclusion: This study shows that nurses in somatic care have different levels of negative attitudes, mainly due to the nurse's age. Nurses under the age of 35 years have more negative attitudes compared to nurses over the age of 35 years. Keywords: stigma, nurse, mental health, attitudes

This study focuses upon the experiences and perceptions of women Atheists in the Southern U.S., a region which is highly religious and, therefore, has comparatively low numbers of Atheists. Taking a Symbolic Interactionist approach, I examine how these Southern Atheists understood what it means to be an “Atheist,” how they became Atheist, their strategies to manage their stigmatized identity as Atheists, and finally the role gender has in managing this stigma. I utilize a Feminist methodology to investigate and foreground women’s experiences. I conducted participant observation at 23 Atheist and Humanist meetings in two southern cities in two different states; I also interviewed 51 Atheists, 40 female and 11 male. I found a variety of definitions for Atheism, though all participants agreed that they do not believe in god. This identity is also informed by political ideologies and philosophies that cultivate pro-social behavior. Participants also discussed what they perceived to be the best things about what it means to be an Atheist. I also examined the stages by which Atheists come to this identification especially as this relates to the importance of place and their experiences in educational, religious and family institutions and how these affected their decisions to self-identify as Atheist. Additionally, I investigated how Atheists undergo stigma management (and negative interactions) by selectively concealing their identity, which they based on what they believed others assumed about Atheists. Many strategies were used to assuage feelings of being uncomfortable. As a stigmatized group, they discuss the importance of community and social support. In addition, Atheists saw several parallels between their experiences and the LGBT community such as similar language and face prejudice and discrimination, even though they said that the Atheists can more easily “pass.” Atheist women manage their stigma by utilizing various tactics to avoid hurting the feelings of others. Female Atheists walk a fine line between being masculine and assertive when they identify as masculine and caring about the feelings of others. Participants also discussed the role gender plays in self-identifying as Atheist. Lastly, they explained that it is harder to be woman and an Atheist.

Uppsatsen ämnar belysa brännmärkningsfenomenet utifrån ett ungdomsperspektiv samt bidra till ökad kunskap inom området. Syftet med studien är att finna en eventuell koppling mellan ungdomar som blivit placerade på ett hem samt deras upplevelser kring brännmärkning. Detta kopplas följaktligen till Erving Goffmans stigmateori. Frågeställningarna omfattade huruvida ungdomarna upplever och påverkas av sin eventuella brännmärkning samt hur placerade ungdomar upplever att samhället uppfattar dem, bland annat speglat via medier. Uppsatsen har utgått ifrån en kvalitativ ansats där nio intervjuer genomförts och bearbetats. Tre av intervjuerna gjorda med ungdomar som placerats och de återstående sex gjordes med kunnig personal och ansvariga för olika hem i södra och mellersta Sverige. Studien har även kompletterats med litteratur och tidigare forskning inom området. Resultaten visar bland annat att ungdomarna uppfattar sig som missförstådda och stigmatiserade utav samhället. / This paper intends to highlight the branding phenomenon from a youth perspective and contribute to increased knowledge within the field. The purpose of this study is to find a possible link between young institutionalized people and their experiences of branding. This is linked to Erving Goffman's Stigma theory. The questions included whether young people perceive and are affected by their potential branding and how institutionalized adolescents feel that society perceives them, among other things, reflected through the media. The thesis has been based on a qualitative approach where nine interviews were conducted and processed. Three of the interviews done with the young institutionalized people and the remaining six done with skilled professionals and managers of homes in southern and central Sweden. The study was also supplemented with literature and previous research within the field. The results show among other things that young people see themselves as misunderstood and stigmatized out of society.

Denna studie har undersökt hur sociala problem beskrivs inom samtida svensk hiphopmusik. Syftet var att öka kunskapen om hur sociala problem formuleras. Därför har studien syftat till att undersöka vilken social problematik som beskrivs i hiphoptexterna samt hur och varför redogörelserna ser ut som de gör. I studien användes en innehållsanalys för att analysera 105 svenska hiphoptexter. Goffmans teori om stigma och Wacquants begrepp territoriellt stigma har applicerats vid analysen av de empiriska resultaten. Resultaten visar att svensk hiphopmusik tar upp sju sociala problem; missbruk, rasism, fattigdom, kriminalitet, utanförskap, prostitution samt hemlöshet. Dessa sociala problem beskrevs i texterna utifrån teman om förort och kamp. Slutsatserna visar att sociala problem fungerar stigmatiserande för individer och grupper och att detta stigma påverkar såväl livsval och uppfattningen av möjliga livsval. Studiens slutsatser utgör viktig kunskap för det sociala arbetets kontakt med utsatta människor.

This dissertation is composed of three studies that examined illness-related stigma, depressive symptoms and attachment style among patients living with HIV and Hepatitis C (HCV). The first study examined the psychometric properties of a brief HIV Stigma Scale (B-HSS) in a sample of adult patients living with HIV (PHA) (n=94). The second study developed and explored the psychometric properties of the HCV Stigma Scale in a sample of adult patients living with HCV (PHC) (n =92). Psychometric properties were evaluated with classical test theory and item response theory methodology. The third study explored whether illness-related stigma mediated the relationship between insecure attachment styles (anxious attachment or avoidant attachment) and depressive symptoms among PHA (n =72) and PHC (n=83). From June to December 2008, patients were recruited to participate in a questionnaire study at the outpatient clinics in The Ottawa Hospital. Findings indicated that the 9-item B-HSS is a reliable and valid measure of HIV stigma with items that are highly discriminatory, which indicates that items are highly effective at discriminating patients with different levels of stigma. The 9-item HCV Stigma Scale was also found to be reliable and valid with highly discriminatory items that effectively differentiate PHC. Construct validity for both scales was supported by relationships with theoretically related constructs: depression and quality of life. Among PHA, when HIV stigma was controlled the relationship between anxious attachment style and depression was not significant. However, the relationship between avoidant attachment style and depressive symptoms decreased but remained significant. Among PHC when HCV stigma was controlled the relationship between insecure attachment styles and depressive symptoms was not significant. Dissertation results emphasize the importance of identifying patients experiencing illness-related stigma and the relevance of addressing stigma and attachment style when treating depressive symptoms among PHA and PHC.

<b>Background:</b> This is the first epidemiological study of internalised stigma among adolescents living with the human immunodeficiency virus (HIV) in Sub-Saharan Africa. It aims to establish predictors of internalized HIV-stigma among people living with HIV in Sub-Saharan Africa (Paper 1), develop an HIV-stigma scale for use with adolescents (Paper 2) and build and test a model of risk pathways for internalised stigma (Paper 3). The data used for papers 2 and 3 is part of the world's largest social science study of adolescents living with HIV (n=1060). <b>Paper One</b> systematically reviews evidence on the prevalence and predictors of internalised HIV stigma amongst people living with HIV in Sub-Saharan Africa. PRISMA guidelines were followed. An adapted version of the Cambridge Quality Checklist was used to assess the quality of the findings. A total of 18 papers were included. The prevalence of internalised stigma among adults living with HIV was 27% - 66%. The longitudinal predictors for internalised HIV stigma were poor HIV-related health and psychological distress. The review identifies two critical limitations of the literature. First, no studies on adolescents were found. One of the reasons for this may be the lack of a scale for measuring internalised HIV stigma in this population. Second, only individual-level risk factors for internalised stigma were examined. Papers 2 and 3 aim to address these limitations. <b>Paper Two</b> develops an HIV stigma scale with and for adolescents living with HIV. First, a multidimensional stigma scale previously used with adolescents in the US was cross-culturally adapted using semi-structured cognitive interviews with nine South African adolescents living with HIV. These data were interpreted through thematic analysis, and items were adapted in consultation with interviewees. Second, the revised version of the scale was administered to 1060 adolescents living with HIV. Confirmatory factor analysis confirmed the predicted 3-factor structure, and associations with hypothesised correlates provided evidence of validity. <b>Paper Three</b> develops and tests a model of risk pathways to internalised HIV stigma among adolescents living with HIV. Drawing on findings from the systematic review (Paper 1) and using the scale developed in Paper 2, both inter and intrapersonal pathways of risk from HIV-related disability to internalised HIV stigma were hypothesized. Following from modified labelling theory, interpersonal mechanisms were hypothesized to occur through maltreatment within power-unequal relationships, i.e. enacted HIV stigma and violence victimization. Hypothesized intrapersonal risks were anticipated HIV stigma and depression. Structural equation modelling enabled the grouping of theoretically related constructs and assessment of multiple, simultaneous pathways of risk. Prevalence of any internalised HIV stigma among adolescents living with HIV was 26.5%. As hypothesized, significant associations between internalised stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV-related disability, violence victimization, and enacted stigma were not directly associated with internalised stigma. Rather, indirect pathways via intrapersonal risks were observed. <b>Conclusions:</b> More than a quarter of adolescents living with HIV in this study reported experiencing some level of internalised stigma. Findings suggest a need to expand programmatic responses to internalised HIV stigma, from individualistic, clinic-based programmes to integrative, community-based approaches. Providing mental health support and reducing the maltreatment of adolescents living with HIV might interrupt pathways from HIV-related disability to internalised stigma. This highlights the potential for interventions that do not necessarily target HIV-positive adolescents but are sensitive to their needs. Such efforts must be coupled with rigorous process and outcome evaluations, and longitudinal data is urgently needed. It is hoped that the adolescent-friendly stigma scale developed within this DPhil will enable further research with this understudied population. Prior to this thesis, there were no known epidemiological studies of internalised HIV stigma among adolescents living with HIV. Moreover, the broader, adult-focused corpus of research has overlooked interpersonal risk factors. This thesis highlights the relevance of power inequalities and domination for the study of internalised HIV stigma.

Premenstruellt syndrom (PMS) och menstruation är stigmatiserade ämnen. Det kan ge kvinnor bristande självkänsla och hjälper till att upprätthålla den negativa tonen i diskussionen vilket gör att de kan vara svårt eller till och med tabu att prata om. Stigma från våra närstående kan bidra till ökad självstigmatisering. Studiens syfte var att undersöka vilka samband det finns mellan PMS, självstigmatisering, uppfattat stigma och ålderns interaktionseffekt på dessa. Även hur kvinnor talat och talar om PMS undersöktes. Studien utfördes på 88 kvinnor i fertil ålder som besvarade en enkät som innefattade sammanlagt 40 frågor varav tre var öppna. Resultatet visade inget samband mellan PMS och självstigma. Positiva samband fanns mellan PMS och uppfattat stigma. Undersökningen visade också på positiv korrelation mellan självstigma och uppfattat stigma. I och med att undersökningen ej påvisade något samband mellan PMS och självstigma diskuterades om att en diskursförändring kan vara på gång.

This study investigated the relationship between public stigma, self-stigma, and help-seeking attitudes in a sample of undergraduate student-athletes. Student-athletes appear to be at increased risk for developing mental health issues compared to their non-athlete counterparts (Etzel et al., 2006). However, student-athletes appear to underutilize available mental health services for fear of being labeled as mentally ill as well as other factors (Pinkerton, Hinz, and Barrow, 1989). The purpose of the current study is to explore two facets of stigma as a potential explanation for negative attitudes toward help-seeking and thus the underutilization of these mental health services. Sixty-six student-athletes completed a 10-minute paper-pencil survey. The survey included measures of self-stigma, public stigma, help-seeking attitudes, demographic variables, and an open-ended question regarding barriers to help-seeking. Results indicated that self-stigma mediated the relationship between public stigma and help-seeking attitudes, which replicates the mediated model found in Vogel et al. (2007). Self-stigma appears to explain how negative stereotypes about those who seek help are internalized to form negative attitudes toward help-seeking for student-athletes. Further, student-athletes noted barriers to help-seeking such as lack of time or knowledge of resources as well as fear of being labeled as mentally ill. Implications for research and practice are delineated.

This dissertation is composed of three studies that examined illness-related stigma, depressive symptoms and attachment style among patients living with HIV and Hepatitis C (HCV). The first study examined the psychometric properties of a brief HIV Stigma Scale (B-HSS) in a sample of adult patients living with HIV (PHA) (n=94). The second study developed and explored the psychometric properties of the HCV Stigma Scale in a sample of adult patients living with HCV (PHC) (n =92). Psychometric properties were evaluated with classical test theory and item response theory methodology. The third study explored whether illness-related stigma mediated the relationship between insecure attachment styles (anxious attachment or avoidant attachment) and depressive symptoms among PHA (n =72) and PHC (n=83). From June to December 2008, patients were recruited to participate in a questionnaire study at the outpatient clinics in The Ottawa Hospital. Findings indicated that the 9-item B-HSS is a reliable and valid measure of HIV stigma with items that are highly discriminatory, which indicates that items are highly effective at discriminating patients with different levels of stigma. The 9-item HCV Stigma Scale was also found to be reliable and valid with highly discriminatory items that effectively differentiate PHC. Construct validity for both scales was supported by relationships with theoretically related constructs: depression and quality of life. Among PHA, when HIV stigma was controlled the relationship between anxious attachment style and depression was not significant. However, the relationship between avoidant attachment style and depressive symptoms decreased but remained significant. Among PHC when HCV stigma was controlled the relationship between insecure attachment styles and depressive symptoms was not significant. Dissertation results emphasize the importance of identifying patients experiencing illness-related stigma and the relevance of addressing stigma and attachment style when treating depressive symptoms among PHA and PHC.

No description available.