Building on prior work on status-based rejection sensitivity, I propose a social-cognitive model of criminal-status-based rejection sensitivity (RS-criminal record) to account for differences in how people perceive and respond to threats of rejection based on their criminal histories. Study 1 develops a measure of criminal-status-based rejection sensitivity, defined as a tendency to anxiously expect, readily perceive, and negatively react to rejection based on one’s criminal status. Study 2 tests the predictions of the RS-criminal record model that anxious expectations of criminal-status-based rejection are associated with heightened perceptions of criminal-status-based rejection threat and responding to criminal-status-based stressors through self-silencing and anger. Together, Studies 1 and 2 show that RS-criminal record is distinct from general interpersonal rejection sensitivity (RS-personal), race-based rejection sensitivity (RS-race), and other relevant stigma constructs. Study 3 tests the predictions of the RS-criminal record model experimentally, establishing evidence of the negative effects of criminal record disclosure, RS-criminal record, and symptoms of post-traumatic stress disorder (PTSD) on interpersonal effectiveness in an interview (as assessed by an interaction partner and outside observers) and subsequent affective states. The three studies also test the prediction, based on the dynamics of our model and evidence from focus groups, that higher levels of RS-criminal record should predict greater PTSD symptom severity. Together, these studies provide evidence of the utility of RS-criminal record to illuminate the psychological and structural pathways through which stigma can undermine the task of social integration after being released from prison.

The HIV care continuum captures the proportion of people who engage in various steps of the treatment cascade from the time of HIV diagnosis to the achievement of viral load suppression. Viral load suppression is the ultimate goal of HIV treatment as it is the best way to mitigate the spread of HIV and contain the epidemic. The best pathway to viral load suppression is not always clear. There are several factors that aid or hinder HIV patients from engaging in every step of the care continuum until they achieve and sustain viral load suppression. This dissertation aims to measure the underlying enablers of engagement in HIV care, relate them to potential barriers, and assess the effect of each enabler and barrier on future engagement in care and viral load suppression using data collected from people living with HIV (PLHIV) in Eswatini. Firstly, a systematic review was conducted to summarize the methodologies used to measure and analyze barriers and enablers of engagement in HIV care. A search of all peer-reviewed articles published in English globally since 1996 yielded a final selection of 228 articles. The vast majority of the studies were qualitative and descriptive, and there was a scarcity of quantitative studies utilizing predictive methods that can measure the effect of a barrier or enabler on future engagement in care. Secondly, an empirical analysis was conducted to assess the dimensionality (factor structure) of enablers of engagement in care using a sample largely representative of HIV patients in care in Eswatini. This analysis demonstrated the use of psychometric techniques that can capture underlying latent enablers. These techniques are useful for standardizing the measurements of enablers across studies and programs and can be used to predict future engagement in care. This analysis found financial and access enablers to be the most prominent underlying factors supporting engagement in care in Eswatini, suggesting that these should be an important consideration when designing interventions to retain HIV patients in care in resource-limited settings similar to Eswatini. Thirdly, in an additional empirical analysis, the latent enablers previously identified were used to select potential barriers and assess their effect on linkage to care, retention in care, and viral load suppression. The analysis also involved an assessment of the mediational pathway from the potential barriers to care to viral load suppression that goes through retention in care. Only perceived HIV stigma was related to any step of the care continuum, with low perceived stigma being marginally associated with less viral load suppression. Retention in care did not mediate the relationship between perceived stigma and viral load suppression. More psychometric studies are needed to standardize the measurement of underlying factors affecting engagement in HIV care. This dissertation demonstrated their utility by measuring latent enablers of engagement in care, assessing the downstream effects of the latent enablers and corresponding barriers, and assessing the mechanisms by which the barriers affect viral load suppression.

The purpose of the present study is to understand how interpersonal and structural ethnic stigma uniquely and collectively confer risk for adverse mental health outcomes in Latinx individuals living in the U.S. Employing a minority stress mediation framework with 639 self-identified Latinxs, the current study utilized manifest and latent variable correlations and latent variable structural equation modeling to examine distal stressors (interpersonal ethnic stigma, structural ethnic stigma) as predictors of mental health outcomes (psychological distress, psychological well-being), with proximal stressors (expectations of stigma, internalized stigma, perceptions of structural stigma) and a general psychological process (rumination) as potential mechanisms through which stigma experiences confer mental health risk. Findings were mixed in terms of their support for study hypotheses. Overall, results indicate that a minority stress mediation framework is applicable with a Latinx population. Interpersonal ethnic stigma yielded direct and indirect associations with proximal stressors, psychological processes, and mental health outcomes, and both proximal stressors and psychological processes emerged as potential pathways through which stigma experiences confer risk. However, associations among structural ethnic stigma and study variables were mostly nonsignificant. Findings are discussed in terms of their implications for clinical practice, education of mental health practitioners, and immigration policy, along with limitations and future directions.

Stigma has been described as the most significant obstacle to quality of life for individuals with major psychiatric diagnoses (Sartorious, 1998). Much of the psychological literature on stigma focuses on individual attributes and interactions at the micro level, rather than macro level dynamics. In critiquing this traditional focus, Link and Phelan (2001) present a model in which stigma ensues when labeling, stereotyping, separation, status loss, and discrimination co-occur in a situation of power imbalance. Even as the model fills a gap in conceptualizing stigma, its emphasis on power is unidirectional and fails to account for power as a form of resistance to stigmatization. This study explores the question of how a consumer/survivor activist perspective can inform the Link and Phelan model of stigma. A semi-structured interview methodology was used to gather qualitative data on the perspectives of 10 activists who are both the targets of stigma and active change agents in resisting stigma. The content of the interviews was thematically analyzed based on an iterative coding approach in order to identify the points of overlap with and divergence from the Link and Phelan model. The results of the study support the applicability of the model for psychiatric stigma. The participants' experiences illustrate which aspects of stigmatization take precedence in this context, indicating significant points for intervention. The anti-stigma work discussed by the participants illustrates the power of grassroots resistance, expanding the understanding of power presented in the model. Emergent discursive themes include the importance of similarity, the rejection of negative portrayals of mental illness, and a focus on a shared continuum of human experience. Participants' emphasis on the importance of having their voices silenced was a particularly recurring motif. Several respondents challenge the premises of the Link and Phelan model. These participants emphasize the positive aspects of diagnosis and labeling, while several other participants reject the choice of the term stigma because it may obscure the structural aspects of discrimination. These findings can serve as a guideline for designing future interventions, and focusing on strategies for social change.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / This study is a qualitative description of the everyday lives of adolescent girls with epilepsy. The primary purpose of the research was to determine whether or not elements of stigma were present in narratives about participants’ day-to-day living. The researcher used open-ended and semi-structured interview techniques in a series of interviews with four adolescent girls with epilepsy. Elements of stigma were present in some of the constructed themes; however, the researcher also uncovered other unexpected themes. Themes constructed by the researcher included: 1) I Am Like Everyone Else (Except for my Seizures); 2) There are Worse Things than Epilepsy; 3) My Parents Trust Me; 4) Am I Having a Seizure?; 5) Bullying Because of Seizures; 6) Bullying Because of Something other than Seizures; 7) Coping with Bullying; 8) Academic Difficulties;9) Disclosure Management; 10) Seizures are Scary to Have and to See; and 11)If I have a Seizure, Don’t Attract Attention to Me! The researcher considers topics thought to be important to adolescents with epilepsy about which the participants kept silent. The researcher makes suggestions about how the research can be used to improve health care practice and guide educational policies for adolescent students with epilepsy. Based on the findings, the researcher suggests areas for future research in nursing and educational policy.

Research has indicated that Funeral Directors and Embalmers are stigmatized for their work. Studies have shown that, although the decay of dead bodies is a stigmatized process in American culture, these particular deathcare workers are able to shift the focus of their services from the dead to the living. However, there remains a lack of research regarding deathcare workers who are not employed as Funeral Directors or Embalmers— those whose positions are not as obvious to the general public. This research explores how, why, and to what degree stigma is placed on those individuals who spend the majority of their work time in direct contact with dead bodies, as opposed to grieving family members. Interviews with funeral employees have been utilized to provide insight into this phenomenon. Results of the analysis show that frequency of contact with bodies is only one of three major factors influencing the stigma of deathcare workers. These results are examined and directions for future research are offered.

This narrative inquiry explored the schooling and professional experiences of seven teachers who were labeled with learning disabilities, and how those experiences affected their career decisions, teaching strategies, as well as relationships with their students, families, and friends. Their stories also challenged the associated stigmas and societal beliefs about who can be a teacher. The methodology incorporated semi-structured interviews, classroom observations, field notes, and member checks to explore the teachers’ constructed meanings of their experiences and beliefs. This research was undergirded by Disability Studies in Education (DSE), along with the theory of complex embodiment. The purpose of incorporating these theoretical perspectives was to challenge normalizing dominant narratives and to advance the problematization and redefinition of disability as simply a matter of human variation. The findings highlighted three themes. They included: embracing the “Theory of Complex Embodiment”; residual emotions and feelings of (in)competence; and their decisions to disclose their learning disability labels, masquerade as a subjugated identity, or conceal their labels and pass. The participants also described the teaching strategies they utilized with their students and themselves. Following analysis, recommendations were made for both teachers labeled with learning disabilities and students enrolled in special education programs.

This research explored cultural perceptions of HIV&amp / AIDS with students at the University of the Western Cape and attempted to understand how these perceptions of the disease reinforce stigma and stigmatising attitudes towards people living with HIV/AIDS. This study investigated HIV/AIDS stigma as a social phenomenon and analysed the socio-cultural and historical roots of HIV/AIDS stigma.

Approved for public release; distribution in unlimited. / This study examines stigma associated with mental health services counseling in the Marine Corps for the purpose of assessing areas of concern where lack of awareness or stigma exists. Marines with longstanding unresolved personal problems or more immediate emotional distress may be less effective, they may also not know where to go for help. Secondly, stigma may be associated with the fear of negative performance evaluations and decreased future promotions, which may reflect an underutilization of the available mental health services. Results of this study reflect: 1)that stigma does exist; 2)that Marines have a poor knowledge of the availability and variety of mental health services; 3)that there is little in the way of destigmatization training within the Marine Corps. By studying civilian models which may have a destigmatization component, this study presents possible methods for incorporating destigmatization training into the OSCAR program. Theoretically, the results of this study, garnered through interviews with practitioners, literature, and an OSCAR program review, can be used to further the efficacy of Marine Corps mental health services by way of education and destigmatization training. / Captain, United States Marine Corps