UK study shows there is less stigma against LGBTQ people than you might think, but people with mental health problems continue to experience higher levels of stigma

European College of Neuropsychopharmacology

A study of stigma against LGBTQ (lesbian, gay, bisexual, transgender and queer) people in British Society has shown that there is less stigma against these groups that might be expected from social and media perceptions. The same study looked at stigma against people with mental health problems and discovered that they continue to experience higher levels of stigma. This work will be presented at the ECNP conference in Milan. This is an advance press release see note below.

Researcher Professor Karen Ersche (University of Cambridge) said, “Our aim was to look at the level of stigma against LGBTQ people in British society, and also to look at stigma against people with mental health problems. This is the first such survey to compare what society thinks to what individuals think about minority groups, the results surprised us”.

The researchers carried out 2 separate studies, measuring stigma via the Perceived Discrimination and Devaluation Scale*. They first questioned 264 people about how mental health problems are perceived by society. The researchers also broke down the answers according to whether or not the respondents had experienced close contact with people with mental health problems or not. They then asked how they personally felt about people with mental health problems.

For the second part of the study, the researchers asked 124 people similar questions about how they felt society would perceive LGBTQ people, and how they themselves felt about them.

Researcher Mr Charlie Evans (University of Cambridge), who conducted the study, said, “It’s difficult for people to admit to any prejudice against a particular group, so we first asked participants what levels of stigma exists in society- this gave them a reference point In each case, we found that respondents perceived society to be less accepting of LGBTQ orientation or mental health problems than they themselves were.

We found that the societal level of stigma against LGBTQ people was less than we might have expected. Personal and societal stigma against LGBTQ people is less than the level perceived against people with mental health problems.

I think this throws up two questions. Why is societal mental health stigma perceived more strongly than LGBTQ stigma? And why do people with mental health problems self-stigmatise more than LGBTQ people? Perhaps this has something to do with the idea that a mental health problem is experienced as a personal deficit rather than an identity; there are no ‘mental health pride” celebrations for example.

Our work may suggest that different approaches are needed to reduce stigma. It seems awareness campaigns have helped reduce LGBTQ stigma, given that  prior contact with LGBTQ people tends to reduce stigma, but this effect is less marked with mental health stigma. We need to be open in looking for what works with overcoming mental health stigma. It may also be useful to undertake similar studies throughout Europe, to understand what level of stigma exists in different countries.”

Commenting, Professor Pedro Morgado (School of Medicine, University of Minho, Braga, Portugal).said:

“The most relevant finding of the study is the existence of significant stigma both against LGBTQ people and against people with mental illness. These are early results and should be interpreted with caution, considering the risk of minimizing the severe impacts (also on mental health) of stigma and discrimination against LGBTQ people. Of course, LGBTQ issues relate to a stable and defining characteristic of individuals, whereas mental illness refers to a pathology.

“Even though the results cannot be generalized beyond the UK, they show that the work being done in the fight against LGBTQ discrimination produces positive outcomes and should be continued and deepened. So, I would welcome studies on stigma from other countries. Regarding mental illness, interventions to reduce stigma should leverage some of the models used in LGBTQ issues, contributing to greater visibility of people with mental illness, increased knowledge about the diseases, and a better understanding of their nature and impacts”.

Dr Morgado (https://icvs.uminho.pt/member/pedro-morgado/) was not involved in this work, this is an independent comment.

Notes

*See Perceived Discrimination and Devaluation Scale: https://supp.apa.org/psycarticles/supplemental/prj0000142/prePRJ20141264Self.pdf

 

Substance-abuse stigma impedes treatment in various ways, scientists say

Peer-Reviewed Publication

ASSOCIATION FOR PSYCHOLOGICAL SCIENCE

Addiction is one of society’s most misunderstood and rebuked health conditions. That stigma discourages many people from seeking treatment for substance dependence, according to a new report published in Psychological Science in the Public Interest, a journal of the Association for Psychological Science. 

Research on stigma toward people with substance use disorder (SUD) is relatively sparse, the report adds.

“Characterizing the nature and etiology of SUD stigma is critical for developing tailored and effective interventions to combat it,” wrote psychological scientist Anne C. Krendl and sociologist Brea L. Perry of Indiana University, Bloomington, in their review.

Substance dependence has become a national health threat. Drug overdose rates in the United States have climbed over the past 20 years, driven primarily by opioid and stimulant use. In a recent national survey, nearly 66 million Americans reported abusing alcohol over a 1-month period, and about 20 million reported using illegal narcotics and prescription drugs for nonmedical reasons.

Researchers measure stigma around both SUD and mental illness\ along three dimensions:

• public stigma—society’s negative beliefs toward those who struggle with those disorders
• self-stigma—negative beliefs that the individuals hold toward themselves
• structural stigma—systemic rules, policies, and practices that discriminate against individuals with those disorders.

Overall, stigma research has focused primarily on mental health problems, the authors wrote. But studies indicate that SUD is typically more stigmatized than mental illness, in part because substance use is viewed as more controllable. (Schizophrenia, however, elicits similar levels of stigma as does SUD, research shows.)

Experiments that have framed SUD as uncontrollable show some reduction in stigma, but that may have the unintended consequence of casting substance dependence as insurmountable, the authors wrote.

Studies of public stigma indicate that Americans express concerns about interacting with substance users, although that resistance ebbs toward individuals described as being in active recovery.  People with SUD may face housing discrimination, reduced employment opportunities, and lowered income.

Studies also show variability in stigma among different types of substance dependence. For example, individuals who abuse illegal drugs such as heroin are perceived as more dangerous than those who abuse alcohol or prescription opioids.

The consequences of public stigma, along with structural and self-stigma, discourage individuals with SUD from seeking and persisting with treatment, research suggests.

Some studies have identified strategies aimed at reducing stigma, such as education designed to counter inaccurate beliefs, but those approaches have shown limited progress. This calls for researchers to develop stronger methods for reducing stigma. Strategies may include emphasizing an individual’s recovery and the reduction of structural treatment barriers, such as inadequate insurance coverage and lack of access to evidence-based interventions.

In a commentary accompanying the report, APS James McKeen Cattell Fellow Stephen P. Hinshaw, a distinguished professor at University of California, Berkeley and University of California, San Francisco, points to successful treatments as possibly the “ultimate game-changer” in stigma reduction. Hinshaw, whose work focuses on developmental psychopathology and mental illness stigma, notes that HIV/AIDS received massive stigma before antiretroviral therapies transformed it from a terminal to survivable condition.

In another commentary, APS Fellow Kenneth J. Sher, a University of Missouri scholar renowned for his work on alcohol use disorder, calls for a more nuanced view of SUD stigma. Terms such as SUD are “grossly nonspecific” and may lead to a broadened array of stereotypes, Sher said. The U.S. National Institutes of Health has proposed developing alternatives to SUD-related terminology such as “addict” and “abuser,” but research should focus on the effects of that relabeling on stigma, he asserted. 

 

The Association for Psychological Science is the home of thousands of leading psychological science researchers, practitioners, teachers, and students from around the world. APS is dedicated to advancing scientific psychology across disciplinary and geographic borders and committed to disseminating psychological science to the public, incentivizing global collaboration among researchers, catalyzing the further development of psychological science, and promoting the application of psychological science to public policy.

---

DOI

10.1177/15291006231198193 

METHOD OF RESEARCH

Literature review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Stigma Toward Substance Dependence: Causes, Consequences, and Potential Interventions

ARTICLE PUBLICATION DATE

14-Dec-2023

Report looks at ‘stigma’ through a new lens to stamp it out of society

Stigma is a glue that holds poverty, inequality and economic insecurity in place enabling and exacerbating inequalities of wealth, health and opportunity, says a new report

LANCASTER UNIVERSITY

Stigma is a glue that holds poverty, inequality and economic insecurity in place enabling and exacerbating inequalities of wealth, health and opportunity, says a new report.

Poverty Stigma is a ‘wicked social problem’, highly complex, difficult to define and challenging to solve, says the report.

Co-authored by Professor Imogen Tyler, from the Department of Sociology at Lancaster University, and Sarah Campbell, the Head of Participation and Advocacy at UK leading poverty charity Joseph Rowntree Foundation, the report is the outcome of a year-long project involving a group of ten people from a diverse range of lived experiences and professional expertise.

The JRF Poverty and Stigma Design team comprises people with lived and learned knowledge of poverty and poverty stigma from a range of sectors including housing associations, local government, care experienced sector, arts and youth work, health and disability charities, and academia.

Loosening the grip of that stigma provides ‘a key lever’ to change the collective work being carried out to combat poverty in the UK.

Published by the Joseph Rowntree Foundation (JRF), the report highlights that poverty and poverty stigma are ‘inextricably entangled social problems’ that reinforce and feed each other, and which need to be tackled together.

With 3.8 million people, including 1 million children, currently recorded as living in situations the JRF defines as destitution, and tens of millions more struggling to make ends meet during a cost-of-living crisis, poverty is seriously impacting on the nation’s health and mental health.

Working with the JRF Poverty and Stigma Design team and lead author of the report, Professor Tyler, a leading expert on stigma, says: “Poverty in the UK is a political choice.

“The stigmatisation of people living in poverty works to shift the blame onto individuals and families experiencing poverty and this helps justify the shockingly high rates of poverty and destitution we are now seeing in our society. To combat poverty, we need to stop the stigma.”

The study recommends anti-poverty work needs to be anti-stigma work at its roots and in every branch of collective action towards ending poverty in the UK.

And designing stigma out of social systems of welfare and support is integral to the fight for economic justice and economic security.

The group concludes that stigma is:

• Not a 'natural outcome' of poverty – rather it is socially produced.
• Manufactured by the powerful, including politicians and media.
• Frames public perceptions about the causes of poverty, shifting blame away from the systems that created it onto individuals.
• Shapes how people living in poverty are represented and how people experience poverty.
• Designed into systems and programmes of welfare and support, and functions as both a deterrent to help-seeking and a tool for rationing resources.
• Seeps into everyday interactions and, for those on the receiving end, the psychological impact can be as devastating as the struggle involved in surviving a low-income.

The report makes recommendations for effective action on poverty which include ‘reframing’ poverty as an issue of economic injustice and in relation to wealth inequality and developing rights-based understandings and approaches to poverty mitigation.

It also suggests combatting rising in-work poverty by challenging the stigmatisation of low paid work as 'low skilled', and by campaigning for real living wages, pay equity and maximum wage ratios as well as rejecting the stigmatising classification of disabled people and those with unpaid caring responsibilities as ‘economically inactive’.

Going forward, the team hope to create and test an array of tools to support organisations to design stigma out of policies and services.

They also want to commission a range of creative projects working with journalists, artists, creative practitioners, community activists and people on the receiving end of stigma to create images and stories which challenge stigmatising poverty narratives to produce ‘anti-stigma’ image and story banks for journalists, news and charitable organisations.

Sarah Campbell from JRF said: “Stigma is repeatedly deemed an issue in need of urgent attention by people who experience poverty.  This new analysis takes the understanding to a new level and is a call for action to all those working to address the issue of poverty. To address poverty, we must undo the glue that holds it in place.”

Steve Arnott, a member of the JRF Stigma and Poverty Design Team who grew up in poverty and is now a youth outreach worker with disadvantaged young people in Hull with Beats Bus, said: “Starting off your life off living in poverty, leaving school in poverty, getting a job but still being in poverty, poverty is a very hard place to get out of.

“The stigma makes everything worse. Stigma holds poverty in place. It harms and silences people. We can get can stuck in our own fear of being judged by others for being poor.

“The media also pushes a lot of poverty stigma, it brainwashes people into blaming people for poverty.

“This JRF project is about raising awareness about poverty stigma, about educating people about the harm it does, and about coming up with tools we need to tackle it. This report is a first step in that work.”

The Joseph Rowntree Foundation works to speed up and support the transition to a future free from poverty, in which people and planet can flourish www.jrf.org.uk 

---

ARTICLE TITLE

Poverty stigma: a glue that holds poverty in place

Stigma: Notes on the Management of Spoiled Identity - DOKUMEN.PUB

95% of surveyed UK adults living with Long Covid report experiencing stigma about their condition at least sometimes, in study to help establish Long Covid Stigma Scale

Peer-Reviewed Publication

PLOS

 

IMAGE: 95% OF SURVEYED UK ADULTS LIVING WITH LONG COVID REPORT EXPERIENCING STIGMA ABOUT THEIR CONDITION AT LEAST SOMETIMES view more 

CREDIT: ROSS SNEDDON, UNSPLASH, CC0 (HTTPS://CREATIVECOMMONS.ORG/PUBLICDOMAIN/ZERO/1.0/)

Article URL:  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277317

Article Title: Long Covid stigma: Estimating burden and validating scale in a UK-based sample

Author Countries: UK, Australia

Funding: The study received no specific funding.
 

---

JOURNAL

PLoS ONE

DOI

10.1371/journal.pone.0277317 

ARTICLE TITLE

Long Covid stigma: Estimating burden and validating scale in a UK-based sample

ARTICLE PUBLICATION DATE

23-Nov-2022

COI STATEMENT

Competing Interests: NAA and MP are co-investigators on the NIHR-funded STIMULATE ICP study (https://www.stimulate-icp.org). NAA is a co-investigator on the HI-COVE study (https://blog.westminster.ac.uk/hicovestudy) and has contributed in an advisory capacity to WHO and the EU Commission’s Expert Panel on effective ways of investing in health meetings in relation to post-COVID-19 condition. MB is supported by the National Health and Medical Research Council, Australia (Investigator Grant 1173043). NZ is supported by NIHR Applied Research Collaboration Wessex. The views expressed are those of the authors’ and not necessarily those of the NIHR or the Department of Health and Social Care. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

stigma_finaldraft.pdf (harvard.edu)

Most people with long Covid face stigma and discrimination

Peer-Reviewed Publication

UNIVERSITY OF SOUTHAMPTON

The majority of people living with Long Covid experience some form of stigma directly related to their condition, according to a new study published in the journal PLOS ONE.

An estimated 2.3 million people are living with Long Covid in the UK according to the Office for National Statistics data, and numbers are not decreasing due to limited treatment options and continued high Covid infection rates. Testimonies illustrate profound stigmas experienced by people living with Long Covid, but until now there has been no quantitative assessment of the burden.

In the study, conducted by researchers at the University of Southampton and Brighton and Sussex Medical School and co-designed by people living with Long Covid (from the charity Long Covid Support), people who took part in the 2020 Long Covid online survey were  invited to complete a follow up survey in November 2021.

More than 1100 people took part, including 966 people from the UK, and were asked about their experiences of stigma in three areas: Enacted stigma where individuals were directly treated unfairly due to their health condition; internalised stigma where people felt embarrassed or ashamed of their health condition, and anticipated stigma, which is the individual’s expectation they will be treated poorly because of their condition.

Ninety-five percent of people experienced at least one type of stigma at least ‘sometimes’, and 76% experiencing it ‘often’ or ‘always’, according to the results.

Dr Marija Pantelic, Lecturer in Public Health at Brighton and Sussex Medical School, who led the development of the stigma questions in the follow up survey, said: “There have been countless anecdotal reports of the stigma, dismissal and discrimination faced by people living with Long Covid. This study was the first to empirically measure this stigma and estimate prevalence. We were shocked to see just how prevalent it is, but the findings also empower us to do something about it. With the stigma questionnaire we developed, we can measure changes over time and the effectiveness of urgently needed anti-stigma interventions.”

In the study, nearly two thirds (63%) of people reported experiences of stigma such as being treated with less respect or people they care about stopping contact with them due to their health condition, while 91% expected to experience stigma and discrimination, for example they thought many people did not consider Long Covid to be a real illness or they anticipated judgment. Eighty-six percent of respondents felt a profound sense of shame related to having Long Covid - they were embarrassed of their illness and felt ‘very different’ from people without Long Covid. 

In the study, 61% of people said they were very careful who they tell about their condition, and about one third (34%) of respondents regretted having told people about it. Overall, the prevalence of experiencing stigma was higher in those who reported having a clinical diagnosis of Long Covid compared to those without or who were unsure (83% v 69%).

Nisreen Alwan, Professor of Public Health at the University of Southampton and co-lead author of the study, added: “We were surprised to find that people with a clinical diagnosis of Long Covid were more likely to report stigma than people without a formal diagnosis. We are not sure why this is - perhaps because they are more likely to share their health status with others or perhaps because they have engaged more with health services. More research is needed to unpack the potential mechanisms of how and where this stigma is manifested, and who is most likely to stigmatise and be stigmatised.”

Claire Hastie from the charity Long Covid Support who also worked on the study, said: “Sadly we see the results of stigma all too often among members of our support group. In addition to the significant health burden of Long Covid, the stigma and discrimination associated with the condition can lead to relationship breakdowns and problems at work. These cause immense additional distress, which itself can compromise healing. It is vital that people with the condition are believed and supported to help their chances of recovery.”

“The stigma attached to Long Covid is harming people living with Long Covid and is likely to leave a devastating mark on our society and health service provision,’ Dr Pantelic added.  “We know from decades of research with other long-term conditions such as asthma, depression, and HIV that stigma has dire consequences for public health. Fear of stigma is also likely to drive people away from health services and other support, which over time has detrimental consequences on people’s physical and mental health.”

Ends
 

Notes to Editors

1. The embargoed paper is available from the press office upon request. The paper will be available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277317 once the embargo lifts.
    
2. The University of Southampton drives original thinking, turns knowledge into action and impact, and creates solutions to the world’s challenges. We are among the top 100 institutions globally (QS World University Rankings 2023). Our academics are leaders in their fields, forging links with high-profile international businesses and organisations, and inspiring a 22,000-strong community of exceptional students, from over 135 countries worldwide. Through our high-quality education, the University helps students on a journey of discovery to realise their potential and join our global network of over 200,000 alumni. www.southampton.ac.uk
    
3. For more about the Brighton and Sussex Medical School, visit: https://www.bsms.ac.uk/index.aspx

For more information please contact the University of Southampton’s Media Relations office at press@soton.ac.uk

---

JOURNAL

PLoS ONE

DOI

10.1371/journal.pone.0277317 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Long Covid stigma: estimating burden and validating scale in a UK-based sample

ARTICLE PUBLICATION DATE

23-Nov-2022

 

Stigma has a profound impact on health outcomes must be addressed

Investing in stigma reduction in health care systems will yield results across the care continuum, and should be supported by governments, health-care institution polices, and licensing bodies, say researchers

University of Toronto

A new article published in Nature Reviews Disease Primers underscores the profound role that stigma can play in health care -- and how addressing stigma-related barriers can significantly improve health outcomes for individuals and communities around the world. 

“Stigma has harmful effects on health, equity and justice,” says lead author Carmen Logie, a professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work (FIFSW). "And while we need more rigorous evaluation of interventions to reduce health-care stigma, we certainly know enough to begin to confront it.”  

Logie and her co-author Laura Nyblade, a fellow at the Social, Statistical and Environmental Sciences, Research Triangle Institute in Washington DC, argue that health-care providers need to be able to identify what drives stigma in health-care settings, so they can take action to address stigmatizing practices as well as internalized, anticipated or perceived stigmatization on behalf of those in need of care. 

Stigma can play a huge role in health outcomes, say the researchers. For example, health-care providers who view weight as a moral issue or lack of personal willpower, may use stigmatizing language in conversation with patients, contributing to their disengagement from care. People who use drugs may be deemed “junkies”, blamed for their substance use and denied services. In some regions, gender-based stigma has resulted in coerced sterilization and lack of informed choices around contraception and education for women living with HIV.  

The good news, say Logie and Nyblade, is that health-care settings are well positioned to identify what drives stigma and make changes to address it through evidence-based approaches. To start, health-care providers can examine misconceptions about disease transmission and infection control, and then make needed changes to institutional policies and practices. “Increasing health providers’ awareness of how stigma is appearing in the ways they deliver services is key,” says Logie, who is also Canada Research Chair in Global Health Equity and Social Justice with Marginalized Populations. 

In Ghana, for example, staff training and activities to reduce fear of HIV infection was shown to improve the caregivers’ willingness to provide services to people with HIV. In Tanzania, stigmatizing beliefs held by HIV clinic staff around substance use was reduced through interventions that addressed commonly held misconceptions. The interventions also successfully conveyed the impact that stigmatizing language used by health-care providers can have on their patients. 

The researchers argue that relationship building and partnerships between health care providers and communities can enhance the ability of both professionals and their clients to strengthen social cohesion, collective resilience and coping strategies. Social movements and dates of significance, such as weight inclusivity movements and World AIDS Day, are examples of ways that people have come together to advocate for awareness and promote change.  

“These approaches move beyond the focus on stigma victimization to recognize and celebrate the strengths of communities who have been marginalized, as well as social histories of mutual support and stigma resistance,” says Nyblade.  

Investing in stigma reduction in health care systems will yield results across the care continuum, and should be supported by governments, health-care institution polices, and licensing bodies, conclude the authors. 

“All types and levels of health-care providers need to be engaged in stigma reduction, through the training curriculums, continuing education programs, and more” says Logie. “The time to act is now.” 

In addition to her role at FIFSW, Logie is affiliated with the United Nations University Institute for Water, Environment and Health, and the Women’s College Research Insitute at Women’s College Hospital in Toronto. 

---

Journal

Nature Reviews Disease Primers

DOI

10.1038/s41572-024-00554-6 

Goffman, E (1968) Stigma: Notes on the Management ...

arasite.org

https://www.arasite.org › goffstig

Goffman, E (1968) Stigma: Notes on the Management of Spoiled Identity, Harmondsworth: Pelican Books. [Here are some notes from this classic. It is hard to ...

 

Pressure to lose weight in adolescence linked to how people value themselves almost two decades later

by University of Bristol

Credit: Unsplash/CC0 Public Domain

People who as teenagers felt pressure to lose weight from family or from the media, females, people who are not heterosexual, and people experiencing socioeconomic disadvantage, are most at risk of 'internalized' weight stigma, new research led by the University of Bristol has found. The study is published in The Lancet Regional Health - Europe.

"Internalized" weight stigma, is when people apply negative obesity-related stereotypes to themselves, such as thinking they are less attractive, less competent, or less valuable as a person because of their weight. This is the first time a study has used a large UK sample to examine who is most at risk.

In England, around one in four people are living with obesity, but it is highly stigmatized. Negative obesity-related stereotypes and weight-related discrimination are widespread in society. Experience of weight stigma is a major public health issue: people affected by weight stigma are more likely to have poor mental health, eating disorders and may delay seeking medical treatment. However, little is known about which population groups are at higher risk of internalized weight stigma, because previous research has used small, nonrepresentative samples.

Using data from Bristol's Children of the 90s (also known as the Avon Longitudinal Study of Parents and Children), this new study examined differences in internalized weight stigma in over 4,000 people aged 31 years by sex, ethnicity, socioeconomic factors, sexual orientation, and family and wider social influences in childhood and adolescence.

The research found that feeling pressure from family to lose weight, weight-related teasing by family members, and feeling pressure from the media to lose weight as a teenager were all linked to higher levels of internalized weight stigma at age 31, and this was not explained by differences in body mass index (BMI). Being bullied in adolescence (at age 17 years) and adulthood (at age 23 years) were also independently linked to internalized weight stigma at age 31.

The study also found there are clear differences in internalized weight stigma between other groups of the population, which were also not explained by differences in BMI. Females and people who did not identify as heterosexual are at greater risk of internalized weight stigma. People who had spent more of their 20s as NEETs (not in education, employment or training), or whose mothers had fewer educational qualifications, are also more at risk of internalized weight stigma.

Dr. Amanda Hughes, Research Fellow in the Bristol Medical School: Population Health Sciences (PHS) and corresponding author, said, "The family environment in adolescence, bullying, and pressure to lose weight from the media may have long-lasting impacts on how people value themselves based on their weight as adults.

"We have an opportunity to reduce weight stigma and its consequences by changing how we discuss weight in the media, in public spaces and in families, and how we respond to bullying in schools, workplaces, and other settings.

"This is crucial considering how common pressure to lose weight and weight-related bullying, stigma and discrimination are in many cultures around the world."

The researchers now plan to explore in detail the psychological processes by which these social factors may influence internalized weight stigma.

More information: Demographic, socioeconomic and life-course risk factors for internalized weight stigma in adulthood: evidence from an English birth cohort study, The Lancet Regional Health - Europe (2024). DOI: 10.1016/j.lanepe.2024.100895

Provided by University of Bristol 

Weight stigma in men associated with harmful health consequences

People struggling with long COVID face increased stigma, new Edmonton study shows

Tue, January 17, 2023 

A recently published study conducted by researchers at the University of Alberta shows that people struggling with long COVID symptoms also face increased stigma. (Shutterstock/panitanphoto - image credit)

Edmonton physician Dr. Daisy Fung stopped playing hockey twice a week after developing long COVID.

After first having COVID-19 in March of 2020, she developed myalgic encephalomyelitis, which is commonly known as chronic fatigue syndrome, and post-exertional malaise.

Her symptoms, which include severe fatigue and muscle aches, worsen about a day or two after intense physical or cognitive activity.

She has also given up playing badminton and tennis and reduced the number of hours she works so she can function as a doctor and a parent.

When Fung posted about her long COVID symptoms on social media, some people were supportive, but others, including fellow medical professionals, told her she was actually struggling with burnout or a mood disorder.

"It was very upsetting to hear that, to say the very least, from people who care for patients with chronic illness," she told CBC News on Monday.

Fung said she feels validated by the results of a new peer-reviewed study published by University of Alberta researchers in the Lancet's eClinicalMedicine.

Dr. Ron Damant, the study's lead author and a physician and U of A professor in the department of medicine, developed a 40-question questionnaire to identify and measure the stigma associated with what the World Health Organization calls "post COVID-19 condition."

Nearly two-thirds of the 145 people who fit the study's criteria and completed all the components were women and the participants' ages ranged from 22 to 80.

The researchers determined that the questionnaire did help identify patients with increased stigma — and it also helped show how stigma was affecting people with long COVID.

"It was comforting, in a way, to know that I'm not alone," said Fung, who participated as a patient in the study.

Daisy Fung/Facebook

The study found that long COVID patients with higher levels of symptoms were more likely to have higher stigma levels than people who were relatively symptom-free.

It also found people who reported high levels of stigma had reduced quality of life. These respondents had reduced perception of social support and reported experiencing more loneliness.

"This study and others that are being published from elsewhere in the world will help increase awareness that long COVID is associated with stigma and that stigma associated with long COVID or other conditions can negatively impact health," Damant said.

When he and his colleagues first conceived of their study, in 2020, Damant said there was little published material about long COVID and stigma, but experts have increasingly been exploring the relationship between the two.

Researchers in the U.K. found that more than three-quarters of surveyed people with long COVID had experienced stigma either often or always.

Their study, published in November in the journal PLOS One, also found that 95 per cent of respondents with long COVID had experienced some stigma.

Kelly Gebo, a professor of medicine and epidemiology at Johns Hopkins University, said many patients with long COVID are able to resume their normal activities with some adaptation, but some have expressed complaints about isolation and stigma.

"There is a feeling of, 'why can't you just be normal, like everybody else is,'" she said.

Gebo said employers should accommodate these patients with sick leaves, offer flexible schedules and allow time for health-care appointments.

"And I think in general, we as a society need to give some people some grace," she said.

Fung said she hopes the study helps people, and especially those in her profession, listen and validate their colleagues, friends and patients with long COVID.

"It's unfortunate that we need a study to show that there's stigmatization against patients with acute and long COVID, but now that we have it, hopefully people can take that first step at looking inwards and approaching this more with kindness," she said.

LGBTQ RIGHTS ARE HUMAN RIGHTS

Suicides among gay men decline as countries become more tolerant


Risk of depression and suicidal thoughts was significantly lower after gay and bisexual men moved to a lower-stigma country, a new study found. Photo by StockSnap/Pixabay

A new study confirms that when a country is more accepting of people who are LGBTQ, fewer gay or bisexual men take their own lives.

In a new study, researchers compared life in a country where LGBTQ folks encounter strong stigma with that in a country where stigma against them is low. The upshot: The risk of depression and suicide dropped significantly when gay men moved to a more tolerant country.

"The study shows that structural stigma shaped gay and bisexual men's daily lives and mental health by increasing their risks for social isolation, concealment of their identity, and internalized homonegativity," said lead author John Pachankis. He is director of the LGBTQ Mental Health Initiative at the Yale School of Public Health in New Haven, Conn.

The risk of depression and suicidal thoughts was significantly lower after gay and bisexual men moved to a lower-stigma country, especially after they lived there for five years or more, the study found.

For the study, the researchers used data from a 2017-2018 online survey completed by more than 123,000 people in 48 Asian and European countries. Most were gay or bisexual men. A smaller number were men who identified as heterosexual or another identity who had sex with men.

The team used 15 laws and policies relating to LGBTQ rights, and social attitudes to gauge structural stigma.

More than 11,000 study participants had moved from higher- to lower-stigma countries, the study authors noted in a news release from the American Psychological Association.

The survey asked about the extent to which they felt compelled to conceal their sexual orientation, internalized negative attitudes they held toward homosexuality and how isolated they felt socially.

A lack of legal recognition of relationships, such as same-sex marriage, was one of the most common forms of structural stigma in the higher-stigma countries, the study found.

Men who moved to lower-stigma countries were more likely to do so in order to live openly as LGBTQ and to seek asylum than men who moved from lower- to higher-stigma countries, the survey revealed.

Surprisingly, the researchers did not find an increased risk for suicidal thoughts and depression in gay and bisexual men who moved from lower- to higher-stigma countries. That finding suggested that growing up in a more tolerant society may have had some lasting mental health benefits, the team said.

Past research in the United States is similar, finding that LGBTQ people who live in states where hate crime and employment non-discrimination laws lack protections based on sexual orientation have significantly poorer mental health.

Pachankis suggested that mental health professionals working in high-stigma environments can help by advocating for reforms while also addressing the social isolation and mental health of LGBTQ clients.

The findings were published online Nov. 15 in the Journal of Abnormal Psychology.

More information

PFLAG has a list of crisis intervention hotlines for people who are LGBTQ and in crisis.

SOURCE: American Psychological Association, news release, Nov. 15, 2021

Copyright 2021 HealthDay. All rights reserved.

 

US National study finds healthcare provider stigma toward substance use disorder varies sharply by condition and provider

Emergency medicine physicians show highest stigma—but also play crucial role in linking patients to treatment

Columbia University's Mailman School of Public Health

LinkedIn
WhatsAppEmail

A new national study from Columbia University Mailman School of Public Health, with colleagues at the University of Miami Miller School of Medicine, University of Chicago, National Opinion Research Center, and Emory University finds that stigma toward patients with substance use disorders (SUD) remains widespread among U.S. healthcare providers—and varies significantly across types of substances. The findings are published in the journal Addiction.

The study is the first national analysis to compare provider stigma across opioid (OUD), stimulant, and alcohol use disorders (AUD) with other chronic but often-stigmatized conditions like depression, HIV, and Type II diabetes. Researchers also assessed how stigma influences whether providers screen for SUD, offer referrals, or deliver treatment.

“While we've made progress in expanding access to evidence-based SUD treatment, stigma remains a profound barrier—often embedded in the clinical encounter itself,” said Carrigan Parish, DMD, PhD, assistant professor in the Department of Sociomedical Sciences at Columbia Mailman School of Public Health. “Our findings show that many providers still feel uncomfortable treating patients with substance use disorders and that hesitancy leads directly to missed opportunities for care. In particular, emergency departments often serve as the first—and sometimes only—point of care for people with substance use disorders. We need to leverage those moments, not miss them.”

The study, conducted from October 2020 to October 2022, surveyed 1,081 primary care providers (PCPs), 600 emergency medicine providers (EMPs), and 627 dentists using a nationally representative random sample licensed from the American Medical and Dental Associations. Participants rated their agreement with 11 standardized stigma statements and reported their screening, referral, and treatment practices for six conditions: three SUDs (opioids, stimulants, alcohol) and three comparison medical conditions (Type II diabetes, depression, HIV).

Key findings:

• Stigma score toward stimulant use disorders was highest (36.3 points, followed by OUD (35.6 points) and AUD (32 points).
• For comparison, stigma scores were far lower for depression (26.2 points, HIV (25.8 points), and Type II diabetes (23.2 points), where providers also reported higher levels of compassion and treatment.
• More than 30 percent of providers said they prefer not to work with patients with OUD or stimulant use disorders—compared to just 2 percent for diabetes, and 9 percent for both HIV and depression.
• Emergency medicine physicians (EMPs) expressed the highest levels of stigma toward SUD, yet were also the most active in providing clinical care:
  • 28.4 percent reported providing drug use treatment
  • 27.2 percent prescribed medications for opioid use disorder (MOUD) compared to just 12 percent and 10 percent of primary care physicians (PCPs) for drug use treatment and prescribing medications, respectively. 
• Dentists reported the lowest stigma levels toward all queried conditions—which may be due to greater clinical and moral distance from SUD treatment and viewing SUD-related practices as outside their scope of practice
• Stigma scores did not significantly differ by provider race, age, gender, region, or rurality, indicating that these attitudes span the healthcare workforce

“Overall, providers were less likely to feel they could effectively help patients with stimulant or opioid use disorders. In fact, 22 percent of providers said, ‘there is little I can do to help patients like this’—a response we almost never saw for other conditions,” said Daniel Feaster, PhD and professor of Biostatistics and one of the lead investigators at University of Miami.

“This isn’t just a matter of attitude—it’s about access. If a provider doubts treatment efficacy or holds stigmatizing beliefs, they’re less likely to screen or refer a patient. That becomes a system failure.”

The study also highlighted key institutional barriers that may reinforce stigma, including:

• Time constraints 
• Lack of training
• Limited referral resources
• Discomfort discussing SUD with patients
• Legal concerns
• Minimal privacy in clinical settings

Senior author Lisa R. Metsch, professor of Sociomedical Sciences at Columbia Mailman School and Dean of the School of General Studies at Columbia University added, “We heard over and over that providers feel unequipped or unsupported to treat SUD—despite being on the frontlines. That’s especially true in primary care settings, where time pressures and limited resources are a daily challenge.” Metsch also added, “Notably, the majority of health providers agreed that insurance plans should cover patients with SUD at the same degree as they cover patients with other health conditions.” 

Dentists, although typically less involved in treating SUD, are well-positioned to recognize oral signs of substance use and refer patients to appropriate care—but they, too, face gaps in training and systemic support. 

“Going forward, we should strive to be more cognizant of the many treatment and provider roles we have distinguished in this study. By unpacking all the variations, we can start to build smarter interventions—tailored by specialty, setting, and substance,” said Parish. 

Other co-authors are Viviana E. Horigian, University of Miami Miller School of Medicine; Harold A. Pollack, University of Chicago School of Social Work; Xiaoming Wang and Petra Jacobs, National Institute of Drug Abuse; Christina Drymon and Elizabeth Allen, National Opinion Research Center; Carlos del Rio, Emory University School of Medicine; and Margaret R. Pereyra and Lauren Gooden, Columbia Mailman School.

The study was supported by the National Institute on Drug Abuse Treatment Clinical Trials Network, grant 5UG1DA013720-23.

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the third largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.

---

Journal

Addiction

DOI

10.1111/add.70122 

Article Title

Healthcare provider stigma toward patients with substance use disorders