This study explored the experiences of individuals who were raised in single-mother families. Children of single mothers (COSM) constitute an understudied population that has often been misrepresented in literature on diverse family structures. The present study builds on current knowledge about the barriers to thriving COSM experience and how COSM build strength in the face of challenges. Data were gathered through 20 semi-structured interviews with self-identified adult children of single mothers. Analysis of the data was guided by constructivist grounded theory methodology (Charmaz, 2014). A theoretical framework emerged from the data that suggested a core narrative of cultivating capacities through strategies that manage social stigma and at-home strain. Participants described taking an active role in navigating the complexities of holding an identity that falls outside of dominant norms. A combination of participants’ at-home, familial environment and their broader, societal environment provided the foundational context for this process to emerge. Cultivating growth-fostering capacities or simply “capacities” was a process that allowed COSM participants to take agency in managing their circumstances. This process was described by participants as “bittersweet,” as it was born through experiences of overcoming, yet left them with traits that had the potential to be assets. Often, these capacities served COSM participants well across different contexts and throughout the lifespan. The findings of this study therefore offer a broadened understanding of a group that is represented by more than 17.2 million children being raised by a single mother in the U.S. today (U.S. Census Bureau, 2016). Findings also provide insight into the impact of stigma and how strength is built in the context of the various life stressors, negative attitudes, and discrimination that previous studies have shown COSM experience (e.g., Dowd, 1995; Hoffman & Avila, 1998; Jarrett, 1996; Kennelly, 1999; Kjellstrand, 2011; Wilson, 2011; Worell, 1986). The present investigation serves as a foundation to inform future research and practice with COSM, and it assists in repositioning single-mother households so that greater validation may be given to these families as legitimate social constructs, while counteracting the stigma that presents barriers to optimal functioning. Specific implications for practice, training, research, and policy are provided and include a need for greater attention to family structure diversity as well as the accompanying process of “othering” that can result when this is lacking. Among clinicians, COSM identity ought to be seen as an important clinical consideration, rather than a concern. Suggestions for future research include: (a) continuing to explore COSM adversity management and strength construction within today’s societal context; (b) seeking a deeper understanding of how capacities built under hardship are utilized; and (c) examining further the impact of intersectionality of COSM identity with other social group affiliations. Implications for policy suggest that addressing the systemic shaming that this group has faced for decades requires structural-level work.

Prior research has indicated that public stigma towards individuals diagnosed with mental illness may be reduced by exposing individuals to the truths about mental illness and by exposing individuals to a mentally ill person who by society's standards is a productive functioning adult. This study detemined whether the conditions shown to be effective for the public may, in turn, decrease the extent to which individuals diagnosed with mental illness stigmatizes themselves. Four conditions (education alone, contact alone, education-contact, control) were used to determine which method was more effective in reducing the effects of stigma. Stigma was measured using the Internalized Stigma of Mental Illness total and subscale scores and Devaluation-Discrimination Scale which were administered before the treatment session (pre), at the end of the treatment session (post), and at a 2-week follow-up. Conducting 4 (condition) X 3 (time) ANOVAs showed no significant results for any measure. Due to low power from poor participation-in-the-2--week-follow-up, 4 x 2 mixed_factorial ANOVA's were conducted without the follow-up data. The ISMI and Devaluation-Discrimination scores for each condition differed significantly for pre/post scores but not for conditions, with no significant interactions.

There is a growing acknowledgement of the importance of mental health and well-being among refugees and asylum-seekers as a result of high rates of mental distress. Most research, however, has focused on refugees and asylum-seekers who live in high-income countries, even though the vast majority (approximately 80 percent) reside in lower- and middle-income countries (LMICs). This three-paper dissertation brings attention to this research gap and examines issues surrounding the mental health of refugees and asylum-seekers living LMICs. Three different cross-sectional data sources were included in this dissertation from study participants recruited from Malaysia, Jordan, and Turkey in 2018. Additionally, three separate analyses were conducted, which include descriptive analyses and multivariable regressions. The first dissertation paper examines the scope and prevalence of mental health counseling utilization in Malaysia. Using Andersen’s Health Service Utilization as a conceptual framework, I examine how certain predisposing factors (socio-demographic characteristics), enabling factors (availability of resources), and need factors (mental health symptom severity) are associated with counseling utilization. The second dissertation paper examines suicidal behaviors among Syrian refugee women living in Jordan. Incorporating the Three-Step Theory (3ST) of suicidal behaviors, I examine how psychological pain, connectedness, and postmigration stressors are associated with suicidal behaviors. Lastly, my third dissertation paper examines the scope and prevalence of vicarious posttraumatic growth (VPTG) among service providers working with Syrian refugees in Istanbul, Turkey. Using a constructivist self- development theory, I examine how greater exposure to traumatic material, in addition to having a greater support system, and having greater years of professional experience is associated with higher levels of VPTG. Study results from Malaysia emphasize the need to understand individual and contextual determinants of mental health service use. I hypothesize that refugees and asylum seekers with certain predisposing factors (female, older age, married, higher education, lived longer in Malaysia, registered refugee), have greater enabling factors (easy access to healthcare, larger household income, do not need interpreter services, greater health literacy, and live with greater number of people in household), and have greater need factors (higher PTSD symptoms) will be more likely to attend counseling services. Almost three-quarters (71.89%) of participants surveyed had never attended mental health counseling services. The majority (71.89%) had never attended mental health counseling services, and among those who screened positive for PTSD, only a minority (16.49%) attended counseling services. My hypothesis was partially supported. Participants from Afghanistan and Myanmar were less likely to attend mental health counseling compared to Somalia and other countries (p<0.001). Not having easy access to health facility (OR:0.10, 95% CI:[0.03, 0.32]), needing interpreter services (OR:0.23, 95% CI:[0.07, 0.75]), and higher PC-PTSD scores (OR:0.69, 95% CI:[0.52, 0.91]) was associated with lower odds of counseling attendance. Other determinants of health service use such as gender, marital status, education level, years in Malaysia, registration status, household income, health literacy, and number of people in household did not show significant associations. Study results from Jordan highlight that greater research and public awareness regarding suicidal behaviors is needed among Syrian refugee women. I hypothesize that screening positive for PTSD, social isolation (have no friends or family members available to help), and greater number of postmigration stressors is associated with suicidal behaviors. Approximately one-tenth (9.86%) of participants reported suicidal behaviors (suicidal ideation and/or attempt) in the past 6-months. My hypothesis was partially supported. Screening positive for PTSD (aOR:4.02, 95% CI:[1.33, 12.15]) was associated with increased odds of suicidal behaviors, while having 1 friend or family member available to help when in need (OR:0.31, 95% CI:[0.13, 0.78]) decreased odds of suicidal behaviors. No associations between the number of postmigration stressors and suicidal behaviors were found. Lastly, results from Turkey emphasizes the importance of focusing on service providers wellbeing. I hypothesize that greater exposure to traumatic material, in addition to having a greater support system, and having greater years of professional experience is associated with higher levels of VPTG. Among service providers recruited 44.66% reported moderate-to-high levels of VPTG. My initial hypothesis was partially supported. Moderate/high/severe secondary traumatic stress (aOR:3.98, 95% CI:[1.26, 12.59]), greater social support (aOR:1.05, 95% CI:[1.00, 1.10]), and greater organizational support (OR:1.11, 95% CI:[1.02, 1.20]) was associated with moderate-to-high VPTG. Proportion of clients who disclose trauma, and years in profession did not show significant associations. Mental health utilization, suicidal behaviors, and the well-being of service providers are issues that have all been linked to the mental health and well-being of refugees and asylum-seekers. These topics have been minimally examined among forcibly displaced people living in LMICs. Clinicians and organizations must promote greater awareness of and screening for mental health conditions. Additionally, mental health and suicidal behaviors is often associated with stigma and discrimination, which means that providing basic psychoeducation surrounding mental health, its impact, as well as awareness of services available, and normalizing treatment at the individual and clinic level is essential for increasing engagement of mental health services. To further reduce global mental health disparities and provide equity in mental health care and treatment, future research and psychosocial interventions must prioritize and focus on the well-being of refugees and asylum-seekers living in LMICs.

Uganda has experienced substantive shifts in HIV prevention and treatment resulting in marked declines in HIV incidence and mortality rates across the country despite being among the top 5 highest new prevalence rates for HIV transmission and infection among women (Uganda Ministry of Health, 2019). Prior research has revealed that fear of stigma and discrimination, disclosure of HIV status, and quality of services are key factors in women’s healthcare decisions and care-seeking behaviors (Akatukwasa et al. 2021; Lancaster et al., 2016; Grossman & Stangl, 2013). Yet, there continue to be significant knowledge gaps regarding the mechanisms through which intersectional stigma exacerbates health outcomes for people living with HIV. This dissertation draws on baseline data, from the Kyaterekera project an efficacy trial testing the effects of a structural intervention on the HIV-health outcomes of women engaged in sex work within the Masaka region, Uganda. Using an explanatory sequential mixed method design, this study utilized Structural Equation Modeling (SEM) to test the direct and indirect effects of intersectional stigma on mental health, while also evaluating mechanisms (i.e., social support and quality of care) through which stigma impacts mental health, treatment adherence and subsequent viral load. There were no direct or indirect effects of intersectional stigma on mental health, but intersectional stigma was positively associated with social support. Additionally, depression and adherence were negatively associated with viral load. Next, in-depth interviews (n=52) explored personal and community-level factors that may influence women’s care-seeking attitudes and overall health decisions. The following themes were most salient for women: 1) disclosure risk, 2) Intersectional community stigma permeates marginalized women’s health decisions, 3) adaptive behaviors and coping strategies are essential to maximizing care experiences, and 4) the Care Seeking Cost-Benefit Tradeoff. Through an integrative framework, quantitative and qualitative findings were then juxtaposed through a joint display and found to be predominantly complementary (McCrudden, M. T., Marchand, G., & Schutz, P. A., 2021). Findings suggest that a positive association between intersectional stigma and social support may underscore the significant long-term effects of living with HIV. Moreso, holding other stigmatized social statuses. Moreso, this link between intersectional stigma and social support may be due to women anticipating the likelihood of experiencing community-level/interpersonal stigma with HIV disclosure and extensive contact with their social support network. Also, more contact with social networks, particularly those in which stigma norms and discriminatory attitudes are pervasive on the community/ interpersonal level (or perceived to be so) may account for the positive associations between HIV stigma and social support. Sex work had a higher degree of concealability than HIV. As such, sex work was disclosed less frequently than HIV to healthcare providers, family, and friends due to anticipatory community stigma. Despite the finding that the explanatory sequential design produced no direct or indirect effects of intersectional stigma on mental health or viral load via SEM, the exploratory analysis provides substantive insights into the negative impact of HIV-related intersectional stigma on women’s care-seeking experiences and broader health decisions. Women’s care-seeking attitudes and behaviors reveal the intrinsic adaptive skills, strength, and resilience they possess to address individual health needs despite known barriers to care. Overall, this study provides further support for holistic interventions that can enhance and build resilience and successful adaptive strategies to mitigate the effects of HIV-related intersectional stigma.

The purpose of the study was to examine the impact of internalized stigma of mental illness on the career development of college students with hidden disabilities. The availability of research investigating career variables within this population is limited and is primarily focused within the vocational rehabilitation arena. Therefore, one of the goals of the current study was to link separate bodies of literature on college students with disabilities, career development, and internalized stigma of mental illness. The second goal was to examine the interaction of internalized stigma of mental illness between career decision self-efficacy and career exploration on the perceived likelihood of achieving hoped for occupational possible selves (OPS). The study included college students with hidden disabilities and investigated variables related to mental illness and career. Participants were administered a background information questionnaire, the Career Decision Self-Efficacy scale (CDSE-SF), selected subscales of the Career Exploration Survey (CES), and the Internalized Stigma of Mental Illness scale (ISMI). Contrary to hypotheses, career decision making self-efficacy, career self-exploration, and internalized stigma of mental illness did not have a direct effect on the perceived likelihood of achieving hoped for OPS. However, career environment exploration did have a direct and positive association with perceived likelihood of achieving hoped for OPS. Results further indicated internalized stigma of mental illness did not moderate the effect of career decision self-efficacy and career exploration on the perceived likelihood of achieving one's hoped for occupational self. Study implications, limitations, and future directions are discussed.

Although the negative impact of HIV stigma is well documented, a gap exists in exploration of constructs that mediate the relationship between HIV stigma and psychological QOL (PQOL). Self-esteem is often conceptualized as a protective factor. We used PLS-SEM to explore the relationships between HIV stigma, PQOL and self-esteem, where PQOL and self-esteem are latent constructs represented by direct observations. Our hypotheses were supported - stigma is negatively related to self-esteem (as measured by self-blame, forgiveness of self, acceptance without judgment and self-esteem), self-esteem is positively related to PQOL (as measured by depression, mental health, QOL and perceived stress) and when the two aforementioned relationships are controlled for, a previously significant relation between stigma and PQOL changes its value significantly. These findings have implications for interventions designed to mitigate the negative psychosocial effects of stigma in PLH.

Text in Afrikaans / The aim of this study was to determine the effect of labeling on a person's being from an educational-psychological perspective. The focus was therefore placed mainly on the following: § Labeling as a phenomenon, with specific reference to what labeling is and its effect on a person's being. § The use of the Edu-Psychological Relation Theory as a theoretical basis for determining the effect of labeling on a person's being. § The compilation of a diagnostic questionnaire within the framework of the Edu-Psychological Relation Theory that was used in the empirical study. It was found that the consequences of labeling are generally permanent and irreversible, and that they result in isolation of the individual. A diagnostic questionnaire was operationalised in terms of the Edu-Psychological Relation Theory, and was used to determine the effect of labeling. / Educational Studies / M. Ed. (Guidance)

The purpose of this research was to explore HIV/AIDS stigma in the workplace, with a special focus on the stigmatised. The sample consisted of 10 HIV/AIDS positive employees. A qualitative interview schedule was designed. The interview guide was used to facilitate one-on-one interviews with each participant. An analysis of the data revealed that the majority of the participants were shunned by family, friends and partners. Others were too ashamed or afraid to reveal their positive status. The majority of the participants did not feel comfortable revealing their positive status to their line managers and to their co-workers. All participants felt that others viewed people living with HIV/AIDS as dirty and unclean and many had been exposed to stigmatising behaviours towards them due to their HIV/AIDS positive status. As a coping mechanism, most participants noted that they would walk away if stigmatised against. Recommendations were made to address HIV/AIDS stigma in the workplace. / Industrial & Organisational Psychology / M. A. (Industrial and Organisation Psychology)

Thesis (MTh (Practical Theology and Missiology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The focus of the thesis is on the HIV and AIDS-related stigma and stigmatisation of people who try to live positively with HIV/AIDS within the pandemic. The basic assumption is that there is interplay between the HIVAIDS-related stigma as a cultural phenomenon and the negative perception of the human body. Since a human being is created corporeal and re-created due to the fact that human embodiment is a fundamental ingredient for the understanding of soul, It is argued that in a pastoral approach, a person should be understood holistically. Anthropology within the traditional kerygmatic approach focused mainly on the notion of sin (corruption totalis) within the theological understanding of God’s judgement (judgemental attitude). I have proposed that pastoral anthropology should adopt constructive paradigms and point towards the integration of embodiment (wholeness) in a realistic approach rather than emphasising the notion of sin and forms of dualism. The thesis departs from an eschatological and pneumatological view of the human being, in which the concepts of resurrection and hope are equally crucial. I further argue that a Christian spiritual perspective on embodiment is potentially destigmatising itself. In terms of a pastoral hermeneutic I have shown that in destigmatisation the transformation of the HIV and AIDS-related stigma corresponds to the transformation of the mindset and paradigm of a person (habitus). Through the process of destigmatisation people discover meaning and are enabled to live fully embodied and responsible lives. The thesis is designed as a literature study based on text analysis and hermeneutical reflection. Moreover, in order to develop a pastoral anthropological view, the Scripture is used as a reference point. / AFRIKAANSE OPSOMMING: Die navorsing fokus op die fenomeen van stigmatisiering binne die HIV/AIDS pandemie. Die kernargument is dat stigmatisering as 'n sosiaal-kulturele konstrukt binne die netwerk van verhoudinge direk in verband staan met 'n bepaalde destruktiewe persepsie wat die vraagstuk van liggaamlikheid onmiddellik raak. Vandaar die verdere fokus op die verband tussen liggaamlikheid en die verstaan van die menslike siel binne die raamwerk van 'n pastorale antropologie. Die teologiese invalshoek is die eskatologiese paradigma, die mens as 'n pneumatiese wese en nuwe skepping. Liggaamlikheid deel gelykoorspronklik aan hierdie nuwe wees-funksie van die mens sodat verstaan van die mens as „beliggaamde siel“ en „besielde liggaam“ alle vorme van dualisme in teologiese antropologie teëwerk. Die totale mens is as ‘n beliggaamde mens geskep sodat in pastorale antropologie die menslike persoon holisties verstaan moet word. Om menswees bloot vanuit die perspektief van sonde te benader hou nie rekening met die realisme van die Bybel wat die mens binne die raamwerk van die wysheidsliteratuur sien vanuit die perspektief van genade en vernuwing. Eensydige fokus op die paradigma van sonde dra by tot destruktiewe veroordelende houding (judgemental attitude). Volgens die aard van kruisteologie is die „smet“ en „stigma“ van sonde daar oorwin. In die lig van die opstandingsperspektief is die „dood van stigma“ totaal uitgewis. Hierdie opstandingperspektief moet verreken word in teologiese model wat gerig is op prosesse van destigmatisering binne pastorale hermeneutiek. Die implikasie hiervan is die transformasie van stigmatisernde paradigmas en die skep van pastorale houding (habitus) van begrip en medelye. Deur ‘n dergelike proses van destigmatisasie word mense in die kern van hul weesfunksie kwalitatief bemagtig ten einde vervulde lewens te kan ly. Die tesis volg kwalitatiewe benadering. Dit is voorts literêre studie gebaseer op teks-analises, kritiese reflektering en hermeneutiese metodologie.

Thesis (MPhil)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Worldwide the stigma attached to psychiatric patients, psychiatric disorders, psychiatrists and the field of Psychiatry is of great concern. The stigmatising perceptions of medical practitioners and medical students towards psychiatric patients have a negative impact on effective treatment, considering the increasing burden psychiatric disorders are placing on communities and health systems. Numerous efforts were attempted and recommendations made for destigmatising medical students' perceptions towards psychiatric patients. It was found that perception usually improved after a clinical rotation in Psychiatry, but the stigmatising perceptions mostly returned a year later. The first clinical exposure to Psychiatry for medical students at the Faculty of Medicine and Health Sciences, Stellenbosch University, is during the fourth or fifth year of study. This rotation was revised in 2010 and a service-learning component added. The research question which consequently developed, is: What is the influence of a service-learning approach on destigmatising students' perceptions towards psychiatric patients? The research followed a phenomenological school of thought in an interpretative paradigm with a qualitative-inductive approach. On the last day of a rotation students handed in their written reflections and an in-depth focus group interview was conducted. The focus group interviews were repeated a year later. Students' reflections and the transcribed texts were analysed. This served as the basis for conclusions from which recommendations were made. It was found that students had stigmatising perceptions towards psychiatric patients before their first clinical rotation in Psychiatry. Directly after that students' perceptions were destigmatised to a greater extend. A year later non-stigmatising perceptions of understanding, acceptance, comfortableness, compassion, respect and responsibility were still present, although a few students experienced the limited return of stigmatising perceptions. Students attributed the positive changes to their service-learning experience in combination with the clinical placement at a psychiatric hospital with a friendly atmosphere and where they were exposed to patients not suffering from complex and extreme psychiatric disorders. The non-stigmatising perceptions a year after a clinical rotation in Psychiatry demonstrates the transformative value of service-learning. Service-learning is where meaningful and relevant service is rendered with and in the community, social responsiveness is purposefully emphasised and structured reflections are done to enhance academic learning. As a result of this study medical schools worldwide can take cognisance that a service-learning approach made a significant contribution to the stained destigmatisation of medical students' perceptions towards psychiatric patients. / AFRIKAANSE OPSOMMING: Stigma teenoor psigiatriese pasiënte, psigiatriese steurings, psigiaters en Psigiatrie as vakgebied is wêreldwyd ʼn groot bron van kommer. Medici en mediese studente se stigmatiserende persep-sies teenoor psigiatriese pasiënte het ʼn negatiewe impak op effektiewe behandeling, veral gesien in die lig van die groterwordende las wat die toename in psigiatriese steurings op gemeenskappe en gesondheidsisteme plaas. Heelwat pogings is aangewend en aanbevelings gemaak om mediese studente se persepsies teenoor psigiatriese pasiënte te destigmatiseer. Daar is bevind dat persepsies gewoonlik verbeter direk na ʼn kliniese rotasie in Psigiatrie, maar dat stigmatiserende persepsies meestal binne ʼn jaar terugkeer. Mediese studente aan die Fakulteit Geneeskunde en Gesondheidswetenskappe, Universiteit Stellenbosch, se eerste kliniese blootstelling aan Psigiatrie is tydens die vierde of vyfde studiejaar. In 2010 is dié rotasie hersien en ʼn diensleerkomponent bygevoeg. Die navorsingsvraag wat hieruit ontwikkel is, is: Wat is die invloed van ʼn diensleerbenadering op die destigmatisering van mediese studente se persepsies teenoor psigiatriese pasiënte? Die navorsing het ʼn fenomenologiese denkrigting gevolg in ʼn interpretatiewe paradigma met ʼn kwalitatief-induktiewe benadering. Studente het skriftelike refleksies op die laaste dag van ʼn rotasie ingehandig en ʼn in-diepte fokusgroeponderhoud is gevoer. ʼn Jaar later is die fokus-groeponderhoude herhaal. ʼn Ontleding van studente se refleksies en die getranskribeerde tekste en gedoen. Dit het gedien het as basis vir die gevolgtrekkings waaruit aanbevelings gemaak is. Daar is gevind dat studente voor hulle eerste kliniese rotasie in Psigiatrie, stigmatiserende persepsies teenoor psigiatriese pasiënte gehad het. Direk daarna was studente se persepsies grotendeels gedestigmatiseer. Na ʼn jaar was nie-stigmatiserende persepsies van begrip, aanvaar-ding, gemaklikheid, deernis, respek en verantwoordelikheid steeds teenwoordig, alhoewel stigma-tiserende persepsies tot ʼn mate by sommige teruggekeer het. Studente het die positiewe verande-ring toegeskryf aan die diensleerervaring in kombinasie met 'n kliniese plasing in die psigiatriese hospitaal waar ʼn vriendelike atmosfeer geheers het en waar daar blootstelling was aan pasiënte wat nie aan komplekse en ekstreme psigiatriese steurings gely het nie. Die nie-stigmatiserende persepsies ʼn jaar na ʼn kliniese rotasie in Psigiatrie toon die transformatiewe waarde van diensleer. Met diensleer word sinvolle en relevante diens met en in die gemeenskap gelewer, doelbewuste klem word op sosiale verantwoordbaarheid gelê en ge-struktureerde refleksie word gedoen om beter akademiese leer te laat plaasvind. Na aanleiding van hierdie studie kan mediese skole wêreldwyd kennis neem dat ʼn diensleer-benadering ʼn betekenisvolle bydrae gelewer het tot die volhoubare destigmatisering van mediese studente se persepsies teenoor psigiatriese pasiënte.