Six serial focus groups were used to explore the perceptions of postpartum depression among nine adolescent mothers. The discussions were tape recorded, transcribed and analyzed using symbolic interaction theory, specifically Goffman's concept of stigma. Participants identified major stigma themes in relation to postpartum depression, teenage pregnancy and motherhood, all of which were portrayed negatively in the media. Several key causes of adolescent postpartum depression were also found including self esteem relating to poor body image and social support. The findings indicate a much needed change in the way adolescent mothers are identified and treated for postpartum depression. Additionally, the importance of social support in preventing and treating adolescent postpartum depression is highlighted and programs addressing such concerns must be implemented.

The HIV/AIDS epidemic continues to grow and minorities have been affected at a disproportionate rate. Two factors that are hypothesized to be associated with HIV/AIDS stigma include ethnic identity and acculturation. The current study uses a diverse, gender-balanced sample (n= 201, aged 23-68) of African-Americans (54.2%), European Americans (31.8%), and Latinos/Hispanics (10%) to evaluate the relationship among the proposed variables. The study found that higher levels of ethnic identity and other group orientation were associated with lower levels of perceived HIV/AIDS stigma. A stepwise linear regression analysis (adjusted R2 = .13, F(11, 189) = 3.74, p < .001) revealed that as the level of inclusiveness of other ethnic groups (t = -4.263, p < .001) increases, the level of perceived HIV/AIDS stigma decreases. The results from this study suggest that the development of interventions that address stigma and inclusiveness of other ethnic groups may benefit people living with HIV/AIDS.

HIV/AIDS has done a great damage to families and their children. Due to HIV/AIDS, grandmothers find themselves caring for their sick children, grandchildren and orphaned grandchildren. Because of the large number of AIDS orphans, the existing pool of community-based support has become saturated. Therefore these children now have to fend for themselves. They are forced to become heads of the households and breadwinners. In this situation the older children have to assume the role of looking after their siblings. Death caused by HIV/AIDS leaves children vulnerable, in great distress and poverty. The stigma and discrimination related to the HIV/AIDS pandemic has resulted in the isolation of infected persons and their family members. Sometimes the isolation continues until and even after the children become orphans. It is a fact that HIV/AIDS orphans as heads of households are undergoing traumatic experiences. On the psychological level children are traumatized by the illness of their parent(s). Because of the high rate of unemployed and pervasive poverty in this country many families are reluctant to take in orphans. Other problems are: the cost of treating illnesses caused by HIV/AIDS places a huge economic burden on families. After death, funeral expenses contribute to the toll exacted by HIV/AIDS. It becomes increasingly impossible for families and communities to absorb the cost and support the large numbers of children alone. Some women hesitate to take in the orphaned children of their relatives because they fear that their husbands will abuse the children Investigation into the existing literature reveals that previous studies concentrated mostly on the educational, psychosocial and emotional needs of people with HIV/AIDS. Studies on child headed households’ deals primarily with children’s rights and the accessibility of social grants for children infected and affected by HIV/AIDS. Although not much was available statistically, for the purpose of this study I have identified several households headed by children, whether the cause of this was HIV/AIDS or misfortunes such as parental suicide or accidents. This study has focused on the experiences of HIV/AIDS orphans in child headed households. This study has also investigated whether HIV/AIDS orphans suffer more deeply psychologically and emotionally than children who have been orphaned by other circumstances other than AIDS. This study highlights the many difficulties and setbacks experienced by HIV/AIDS orphans who become heads of households after the death of their parents. An exploratory research design was utilised and qualitative approach was followed. Five households were chosen as samples that complied with requirements of this study. Participants in these households were between ages 13 and 18 years old. The information gathered by means of literature and empirical research reveals that the children affected by HIV/AIDS are not only physically impoverished, but also psychologically, socially and spiritually. They suffer from fear, depression, stress, anxiety, stigmatisation and discrimination, isolation, and are often scorned by peers. HIV/AIDS orphans experience psychological trauma on account of witnessing their parent’s illness and death (or departure), carrying the responsibility of caring for sick parents, and after their death, for siblings. The socio-economic circumstances of HIV/AIDS orphans in child headed household often force them to drop out of school, in order to find ways of providing for the family. The traumatic experience of HIV/AIDS orphans and children who have been orphaned to other circumstances, are similar. The following themes can be considered for future research:<ul> <li>Stress experienced by HIV/AIDS orphans in child headed households due to HIV/AIDS</li>. <li>The role of churches in identifying and supporting orphans in child headed households</li>.</ul> / Dissertation (MTheol(Practical Theology))--University of Pretoria, 2006. / Practical Theology / unrestricted

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)