From medieval to modern times, mental illness is a construct that has been deeply misunderstood and stigmatized by humankind (Dubin & Fink, 1992). Individuals living in the United States experience a fear of being judged or ridiculed for their psychopathological symptomology as a result of mental illness stigma (Bharadwaj et al. 2015). Mental illness stigma impacts how individuals choose to seek help and whether they choose to seek help at all (Rusch et al., 2005). Individuals from diverse cultural and ethnic backgrounds face unique barriers to access to mental healthcare (Cauce et. al, 2002). Specifically, individuals from diverse backgrounds are affected by the social and cultural environment they are a part of where cultural factors can impact whether or not these individuals choose to seek help from mental health service providers (Cauce et. al, 2002). The theory of “Double Stigma” (Gary, 2005) proposed that individuals from diverse ethnic and cultural backgrounds face impactful barriers to mental healthcare as a result of of mental illness stigma combined with racial discrimination. Different ethnic minority groups face unique barriers to mental healthcare. African Americans are a group of individuals who have been found to associate seeking mental health treatment with feelings of embarrassment when compared to European Americans (Snowden, 2001). Additionally, Asian Americans are a group of individuals who have often referred to as the “model minority,” a problematic notion which suggests that in terms of mental illness, this ethnic group has had little to no social or psychological problems and have assimilated well to life in the United States (Sue & Morishima, 1982). This theory has contributed to Asian American communities internalizing the idea that they must uphold the standard that has been set for them, ultimately impacting their decision to seek help for mental illnesses (Sue & Morishima, 1982). Within the Asian American community, South Asians are the third largest and fastest growing ethnic group in the United States (U.S. Census Bureau, 2000). Within the South Asian community, stigma is highly prevalent and perpetuated by discrimination (Neelam, Mak, & Wessely, 1997). This discrimination and judgement from one’s own community impacts if and how individuals from South Asian communities choose to seek help. Loya, Reddy and Hinshaw (2010) found that relative to European American college students, South Asian college students presented with higher level of reluctance to seek help through University-based counseling services. Loya and colleagues (2010) also found over all poorer attitudes toward individuals with mental illness from South Asian college students. This study investigated perceptions of mental illness and help seeking across racial groups, with a specific focus on South Asian communities. Specifically, a model examining informal and formal help seeking was utilized to explore differences in perceptions of help seeking practices across racial groups. Through multigroup structural equation modeling (SEM), changes in model fit were explored to assess whether negative perceptions of mental illness predicted informal and formal help seeking behaviors across racial groups. Participants included 355 individuals, 18 and older, across the United States who identified as South Asian, White/European American or Black/African American. Based on previous research which has found that ethnic minority groups face unique barriers to accessing appropriate mental healthcare (Cauce et. al, 2002; Gary, 2005; Snowden, 2001; Sue & Morishima, 1982; Neelam, Mak & Wessely, 1997; Loya, Reddy & Hinshaw, 2010), it was hypothesized that South Asian individuals would have more negative perceptions of individuals with mental illness as well as more negative attitudes towards all modes of help seeking compared to their non-South Asian counterparts. Additionally, it was hypothesized that South Asian females will have more positive attitudes towards mental illness than South Asian males. Results indicated that a more positive perception of mental illness is associated with more likelihood of seeking help for mental illness for all racial groups examined through SEM. Results also indicated similar fit indices and invariance across all racial groups examined through SEM. Through univariate analyses, South Asian females were found to have a more positive view of individuals with mental illness than South Asian males. Univariate analyses also revealed that compared to White/European Americans, individuals who identified as Black/African American perceived mental illness more negatively when assessing individuals their own racial group. Implications, strengths, limitations, and directions for future research are discussed. / School Psychology

Individuals experiencing a mental illness are often stigmatized. Children also stigmatize those who experience a mental illness. There is national interest in reducing the negative effects of stigma, especially in children. Unfortunately, children anti-stigma interventions are being used without being empirically tested for their effectiveness. A goal of the Opening Minds Anti-stigma initiative of the Mental Health Commission of Canada is to identify programs and resources that have been empirically tested and found to be effective in reducing stigma. This study was funded by the Opening Minds Initiative of the Mental Health Commission of Canada to: First, investigate the effectiveness of providing children ages 11-14 with mental illness education using a storybook in order to reduce their mental illness stigma; and, second, to examine children’s perceptions of the anti-stigma book used to provide the education. A quasi-experimental design was used to test the effectiveness of the mental illness educational storybook in reducing mental illness stigma. The Youth Opinion Survey for Stereotype and Social Distance measurement was used to obtain baseline information before the education was provided. A pre-test, post-test process was used. Several qualitative questions, embedded in the post-test questionnaire, were provided to the children participating with an opportunity to use their own words to describe what they thought about mental illness before and after the education, what they learned from the educational storybook and whether or not they liked the education they received. The results show that the exposure to an educational storybook about children mental illness stigma was effective in reducing the percentage of negative responses at post-test. The participants used less negative words to describe someone “with a mental illness”. An improvement in the overall scores at post-test was seen for both stereotype and social distance. After the study was completed, the feasibility of conducting a study of this type was evaluated. Recommendations for the possibility of using this method for future studies are included. / Thesis (Ph.D, Nursing) -- Queen's University, 2013-07-03 11:39:54.603

The internalization of mental illness stigma is associated with an array of negative consequences; however, not all individuals experience the deleterious effects of internalized mental illness stigma. The present dissertation focuses on factors associated with internalized stigma, and will be the first to examine simultaneously both risk (i.e., shame, shame proneness and shame aversion, insight, and centrality and valence) and protective factors (social support and self-compassion) of internalized mental illness stigma. Using two of the most widely used assessments of internalized mental illness stigma (i.e., Self-Stigma of Mental Illness Scale [SSMIS] and the Internalized Mental Illness Scale [ISMI]), risk and protective factors were examined among adults recruited through Amazon Mechanical Turk (AMT; n = 215) and Facebook (n = 153) who self-reported a mental illness diagnosis. Whereas among AMT participants, shame proneness and centrality were significant predictors of the process of internalization of mental illness stigma (measured by the Stereotype Self-Concurrence subscale of the SSMIS), among Facebook participants centrality was the only significant predictor of process of the internalization of mental illness stigma. In addition, whereas among AMT participants, shame proneness (measured by the PFQ-2), centrality, valence, and social support were significant predictors of the experience of internalized stigma (measured by the ISMI), among Facebook participants state shame, centrality, valence, and social support were significant predictors of the experience of internalized stigma. Thus, centrality was the only significant risk factor across measures and samples. It is possible that the current dissertation may help to differentiate individuals at particular risk for internalization and ultimately to harness resilience for those diagnosed with a mental illness, particularly among those diagnosed with mood or anxiety-related diagnoses.

In the past two years, six National Football League players have died by suicide. Investigations into most of the deaths revealed that the players suffered from brain damage likely caused by repeated concussions. As is the case with many health issues, tragedy often precedes action; the suicides of these high profile football stars have catalyzed action on concussion policy and practice, as well as opened up the conversation about the overall mental health of athletes. This thesis joins the conversation around mental health and athletes, specifically Canadian varsity football players. Mental health problems and illnesses are presented as especially common, affecting about 1 in 5 Canadians. That is not to underestimate the severity of mental illnesses, which can deteriorate an individual’s quality of life, significantly impact friends and family and, in the most severe cases, also lead to death by suicide. That said, this thesis adopts a theoretical perspective that focuses on the promotion and protection of good mental health. This thesis is primarily concerned with investigating the social, political, and external factors that negatively impact how football players conceptualize mental health and mental illness, and also the recommended behaviour to seek professional help if needed. The growing body of research concerning the negative impact of mental illness stigma is compelling and leaves no doubt that stigma is a significant barrier to recovery. This thesis explores the stigma process as well as its social function in groups. Next, it investigates how the already powerful stigma around mental illness is further exacerbated by gender and more specifically, how traditional masculine ideology (i.e. men should be strong and powerful) conflicts with stereotypical beliefs about mentally ill people (i.e. weak and/or incompetent). Gender and health are further linked in terms of behaviour. In other words, rejecting health behaviours becomes a strategy some men utilize to project their masculinity, paradoxically contributing to the creation or worsening of many health problems. A health behaviour that is explored in detail is psychological help-seeking, and the psychosocial processes of help-seeking, which are also mainly regulated by masculinity. An overview of the most common mental health problems and illnesses found in male varsity athletes is provided. All of the above components are then applied to the unique context of varsity football players. The thesis draws on the literature as well as qualitative interview data that explores the experiences of 8 varsity football players at the University of Ottawa. Regarding mental health promotion, the findings show that football players may require adapted communication approaches. To that end, the thesis transitions into an early-stage health communication plan supported by the literature and the primary data. The plan proposes overall outcomes, short term/intermediate objectives, a communication strategy, and a tactical approach. Next, a web-based health resource is suggested as a primary communication vehicle and is outlined in detail. The plan then suggests potential partnerships for extending the strategic communication plan’s reach and credibility. This is followed by suggestions for evaluating both the short term/intermediate objectives as well as the strategic communication plan’s overall impact. This thesis concludes with a chapter exploring the contributions lifted from the eight qualitative interviews, as well as suggested directions for research, policy and practice.

Dissertation (Ph.D.)--The University of North Carolina at Greensboro, 2008. / Title from PDF t.p. (viewed Aug. 13, 2009). Directed by Craig Cashwell; submitted to the School of Education. Includes bibliographical references (p. 130-139).

In the past two years, six National Football League players have died by suicide. Investigations into most of the deaths revealed that the players suffered from brain damage likely caused by repeated concussions. As is the case with many health issues, tragedy often precedes action; the suicides of these high profile football stars have catalyzed action on concussion policy and practice, as well as opened up the conversation about the overall mental health of athletes. This thesis joins the conversation around mental health and athletes, specifically Canadian varsity football players. Mental health problems and illnesses are presented as especially common, affecting about 1 in 5 Canadians. That is not to underestimate the severity of mental illnesses, which can deteriorate an individual’s quality of life, significantly impact friends and family and, in the most severe cases, also lead to death by suicide. That said, this thesis adopts a theoretical perspective that focuses on the promotion and protection of good mental health. This thesis is primarily concerned with investigating the social, political, and external factors that negatively impact how football players conceptualize mental health and mental illness, and also the recommended behaviour to seek professional help if needed. The growing body of research concerning the negative impact of mental illness stigma is compelling and leaves no doubt that stigma is a significant barrier to recovery. This thesis explores the stigma process as well as its social function in groups. Next, it investigates how the already powerful stigma around mental illness is further exacerbated by gender and more specifically, how traditional masculine ideology (i.e. men should be strong and powerful) conflicts with stereotypical beliefs about mentally ill people (i.e. weak and/or incompetent). Gender and health are further linked in terms of behaviour. In other words, rejecting health behaviours becomes a strategy some men utilize to project their masculinity, paradoxically contributing to the creation or worsening of many health problems. A health behaviour that is explored in detail is psychological help-seeking, and the psychosocial processes of help-seeking, which are also mainly regulated by masculinity. An overview of the most common mental health problems and illnesses found in male varsity athletes is provided. All of the above components are then applied to the unique context of varsity football players. The thesis draws on the literature as well as qualitative interview data that explores the experiences of 8 varsity football players at the University of Ottawa. Regarding mental health promotion, the findings show that football players may require adapted communication approaches. To that end, the thesis transitions into an early-stage health communication plan supported by the literature and the primary data. The plan proposes overall outcomes, short term/intermediate objectives, a communication strategy, and a tactical approach. Next, a web-based health resource is suggested as a primary communication vehicle and is outlined in detail. The plan then suggests potential partnerships for extending the strategic communication plan’s reach and credibility. This is followed by suggestions for evaluating both the short term/intermediate objectives as well as the strategic communication plan’s overall impact. This thesis concludes with a chapter exploring the contributions lifted from the eight qualitative interviews, as well as suggested directions for research, policy and practice.

Although research demonstrates significant stigma towards individuals with mental illness, the relative importance of observed behavior and a psychiatric diagnosis in eliciting stigma remains poorly understood. Using video vignettes, three experiments (ns = 195, 749, and 791) examined the effect of irritable (vs. calm) behavior and the presence (vs. absence) of a psychiatric diagnosis (schizophrenia in Studies 1 and 2; schizophrenia and depression in Study 3) on attitudinal, emotional, and behavioral dimensions of stigma towards a fictitious emergency room patient seeking migraine treatment. In line with labeling theory, irritable behavior resulted in greater blameworthy attributions for behavior, greater fear and anger, less caring emotions, and lower perceived warmth. Both a depression and schizophrenia diagnosis elicited stigma by leading to greater endorsements of other stigmatizing attributions (e.g., substance use) as a reason for behavior. Irritable behavior and both psychiatric diagnoses resulted in patients being rated as less predictable and more dangerous, whereas irritable behavior and schizophrenia only resulted in decreased competence. Irritable behavior and psychiatric diagnosis also interacted to predict desire for social distance. When calm, a psychiatric diagnosis predicted greater distance, such that a patient with no label was least stigmatized, one with depression was moderately stigmatized, and one with schizophrenia was most stigmatized. When irritable, the patient elicited a higher desire for distance regardless of psychiatric diagnosis. Mediational analyses show that when controlling for behavior, perceived dangerousness and fear mediate the effect of a diagnosis on desire for distance. In all, results suggest both diagnostic labels and irritable behavior result in stigma via different attitudinal and emotional mechanisms, and that individuals with psychiatric diagnoses face stigma even if behaving calmly. By enriching understanding of the relative importance of irritable behavior and a psychiatric diagnosis on multiple dimensions of mental illness stigma, this work has implications for anti-stigma interventions.

Stigmatizing mental illness involves negative perceptions or attitudes about mental illness and the individuals who have mental illness, generating problematic consequences for both the general population and for people with mental illness. The theory of multiple intelligences proposes that intelligence includes skills and abilities in any area; emotional intelligence (EI), therefore, includes an individual's ability to identify, interpret, and regulate emotions and emotional responses. This study was designed to evaluate level of familiarity with mental illness as a potential predictor for stigmatizing mental illness, to assist in evaluating the relationship between stigmatizing mental illness and EI. The study was specifically designed to determine whether having higher EI is associated with a decreased likelihood to stigmatize mental illness, and whether increased familiarity is associated with greater EI and a decreased likelihood to stigmatize mental illness. It used bivariate correlations and hierarchical regression analyses, respectively, using data collected from a demographic questionnaire, the TEIQue-SF, the AQ-27, and the LOF. The target population consisted of emergency department (ED) staff (N = 43). Findings suggested that EI and mental illness stigma are correlated (r = -.514, p < .001) and that there is a significant interaction between EI and level of familiarity with mental illness (R2 = .269, F(3, 38) = 4.653, p = .007). ED staff are on the frontline of healthcare and serve as a gateway to systems of care and treatment; as a result, this study's findings are important and are intended to inform healthcare and stigma-combating organizations of factors that can improve the sensitivity and quality of care for individuals with mental illness who admit to healthcare systems.

Thesis (M.S.W.) - Carleton University, 2006. / Includes bibliographical references (p. 117-125). Also available in electronic format on the Internet.

This thesis is concerned with philosophical perspectives on the stigma of mental illness, with each chapter exploring different philosophical issues. Chapter one delineates the central concept around which the rest of the work revolves: the stigma of mental illness. It provides an outline of the stigma mechanism, how it applies to mental illness, why it is such a large public health concern and what has been done so far to combat it. Chapter two is concerned with the application of recent literature in the philosophy of implicit bias to the topic of mental illness. It suggests that we have hitherto been preoccupied with explicit formulations of the stigma mechanism, but argues that there are distinctive issues involved in combatting forms of discrimination in which the participants are not cognisant of their attitudes or actions, and that anti-stigma initiatives for mental illness should take note. Chapter three applies the philosophical literature concerning the ethics of our epistemic practices to the stigma of mental illness. It contains an analysis of how epistemic injustice- primarily in the forms of testimonial injustice and stereotype threat- affects those with mental illnesses. The fourth chapter brings in issues in the philosophy of science (particularly the philosophy of psychiatry) to explore the possibility of intervening on the stigma process to halt the stigma of mental illness. The first candidate (preventing labelling) is discounted, and the second (combatting stereotype) is tentatively endorsed. The fifth chapter is concerned with how language facilitates the stigma of mental illness. It suggests that using generics to talk about mental illness (whether the knowledge structure conveyed is inaccurate or accurate) is deeply problematic. In the former, it conveys insidious forms of social stereotyping. In the latter, it propagates misinformation by presenting the category as a quintessential one.