COPD is a highly stigmatised condition. To develop effective measures to reduce COPD-related stigma, it is important to understand patients' experiences and identify contributing factors. This systematic review explores qualitative evidence regarding the features of COPD leading to stigmatisation and how it can potentially influence health outcomes. Electronic databases were searched to identify primary qualitative studies focussing on stigma-related experiences of adults with COPD, published between January 1988 to August 2024. Data were synthesised using framework synthesis. Twenty-nine studies with 427 participants were included in this review. Findings fit well into six themes identified from Jones et al.'s framework of stigma dimensions and provide rich description. Smoking habit was not the only factor of stigma but also factors that contributed to disability of individuals. Patients experience COPD-related stigma mainly from themselves and healthcare professionals. Potential consequences of stigma identified are mental distress, isolation, reduced help-seeking behaviour and non-compliance to management. Collective effort by society and healthcare systems will be necessary to alleviate the stigma associated with chronic symptoms and smoking behaviour of COPD and to promote the benefit of pulmonary rehabilitation and available mental health support.

Suicide is a leading cause of death among college students, but inconsistent data and a lack of meta-analysis make it difficult to identify and recognize the risk factors for suicidal ideation, planning, and attempts in this group. To gain a comprehensive understanding of previous research, this study summarized risk factors for suicidal ideation, planning, and attempts among college students through a review and meta-analysis.

We systematically searched six electronic databases from inception to May 18, 2024, to identify longitudinal studies of factors associated with suicidal ideation, planning, and attempts among college students. The effect sizes of the risk factors were pooled using a random effects model. Based on the results of the meta-analysis, we developed a risk prediction model for suicidal ideation among college students.

Thirty-three studies involving 193,517 college students were included. This study identified 18 risk factors, such as sexual orientation and traumatic experiences, and identified two protective factors, namely, social support and positive coping. Suicidal ideation is considered an important precursor to suicide. This study developed a predictive model for suicidal ideation with the results of the meta-analysis.

This review demonstrated the importance of several risk and protective factors for suicidal ideation, planning, and attempts among college students. A predictive model was developed based on the results of this meta-analysis, thus providing novel insights for translating evidence into clinical practice.

In the United States, posttraumatic stress disorder (PTSD) disparities among sexually minoritized men (SMM) are well-documented, but diverse PTSD symptom manifestations and related vulnerabilities in this group are understudied. From October 2020 to January 2021, we collected cross-sectional demographic, HIV status, sexual behavior, and mental health data from 6319 trauma-exposed SMM in the American Men's Internet Survey. We used latent class analysis, multinomial logistic regression, and the Bolck-Croon-Hagenaars method to identify PTSD symptom classes, associations with class membership, and prevalence of serodifferent condomless anal sex with a male partner, respectively. Mean age was 33 years; most participants identified as gay (n = 4820, 76.3%) and non-Hispanic White (n = 3829, 60.6%). Classes included Intrusive-Avoidant (n = 1086, 17.2%; moderate/high intrusive thoughts, related discomfort, trauma-reminder avoidance), Dysphoric-Inattentive (n = 1230, 19.5%; moderate/high negative beliefs, anhedonia, concentration problems), Pervasive (n = 1471, 23.3%; high on all symptoms), and Resistant (n = 2532, 40.1%; low on all symptoms). Non-Hispanic Black (aOR = 1.77, 95% CI = 1.35, 2.33) and multiracial identity (aOR = 1.48, 95% CI = 1.03, 2.13) were associated with Intrusive-Avoidant class membership. Unknown (aOR = 1.24, 95% CI = 1.01, 1.52) and positive HIV status (aOR = 1.56, 95% CI = 1.16, 2.09) were associated with Pervasive class membership. Housing instability, mental distress, and suicidal ideation were associated with membership in each symptomatic class. Serodifferent condomless anal sex was higher in the Pervasive (23.9%, p < 0.001) and Intrusive-Avoidant (21.8%, p = 0.008) classes relative to the Resistant class (16.5%). Improving the response to PTSD and related vulnerabilities among SMM merits combined trauma-focused, sexual risk-reduction approaches tailored to symptom profiles.

Stigma is the state of social devaluation due to a trait or group identity; weight and smoking-based self-, felt-, and enacted stigma may have detrimental health effects and pose barriers to smoking cessation. This study examined associations between stigma, discrimination, and health for people with overweight or obesity (body mass index [BMI] ≥ 25) who smoke cigarettes (cigarettes smoked/day ≥ 5) who reported interest in quitting smoking and minimizing weight gain. Participants (N = 63; predominantly women (81.0 %), White (63.5 %) or Black/African American (31.7 %), and heterosexual (85.7 %) with 50 % having a yearly income below $50,000) completed the measures of stigma (i.e., Weight Bias Internalization Scale and Internalized Stigma of Smoking Inventory), discrimination (i.e., Everyday Discrimination Scale), and symptoms of depression, weight, smoking, nicotine dependence, and concerns about gaining weight while quitting smoking were measured. Those who reported more internalization of weight bias and more everyday discrimination reported greater depressive symptomatology and greater concern about gaining weight while quitting smoking, with depressive symptomatology fully mediating both internalization of weight bias and everyday discrimination's relation with concern about gaining weight while quitting smoking. There was also an association of smoking felt-stigma, but not self- or enacted-stigma, with symptoms of depression. Stigma's associations with symptoms of depression and post-cessation weight concern suggest barriers to effective behavior change, and interventions may consider targeting processes for coping with stigma experienced by this population.

The occurrence of multiple morbidities of postpartum depression (PPD), hypertension and diabetes mellitus (DM) among postpartum mothers poses a health care challenge because it not only affects the mother but also the life of the new born baby and that of close family members. Therefore, this study aimed at examining the prevalence and factors associated with these comorbidities among mothers in public health facilities in Mbarara, south western Uganda.

We conducted a facility based cross sectional study using parallel convergent mixed methods to collect information from 309 postpartum mothers from 6 weeks to 6 months after childbirth. Using consecutive sampling, mothers were enrolled from postnatal clinics of two health facilities: Mbarara Regional Referral Hospital and Bwizibwera Health Center IV in urban and rural southwestern Uganda respectively. A psychiatric classification based on the Mini-International Neuropsychiatric Interview (MINI 7.0.2) for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) was used. DM was diagnosed by measuring Hemoglobin A1c (HbA1c). Hypertension was diagnosed when a person's systolic blood pressure (SBP) was ≥140 mm Hg and/or their diastolic blood pressure (DBP) was ≥90 mm Hg following repeated examination. The primary outcome was multiple morbidity defined as co-occurrence of PPD, hypertension and DM. Logistic regression was used to determine the factors associated with multiple morbidity. In the qualitative phase, 20 key informant interviews each lasting 30-45 min were conducted purposively. The interviews were audio recorded, transcribed verbatim and translated from the local dialect of Runyankore to English and analyzed thematically.

The prevalence of multiple morbidity was 13.6% (95% CI: 10.2-19.3%). The prevalence of multi - morbidity did not vary significantly across age categories, p = 0.056. Having high cortisol levels between 6 weeks and 6 months postpartum was the only factor significantly associated with multi-morbidity among mothers with postpartum depression in both bivariate analysis and multivariate analysis adjusted OR = 6.9, (95% CI: 3.29-14.47), p < 0.001. In addition, this study revealed that psychological and socioeconomic factors, intimate partner violence and life style changes were likely to predispose the mothers to the multiple morbidity of PPD, Hypertension and DM.

Both quantitative and qualitative data offered complementary insights. The quantitative analysis highlighted high cortisol levels and diabetes mellitus as key biological factors associated with the multiple morbidity of PPD, hypertension and DM and qualitative findings enriched this understanding by illustrating the psychological, socioeconomic hardships, IPV and lifestyle changes context of these biological changes as they were frequently reported, offering a more holistic view of the factors influencing multiple morbidity among postpartum mothers.

This paper aims to better understand how structural determinants of health inequalities shape disengagement from healthcare for vulnerable groups across a range of social conditions. Using a sub-sample (N = 20) from a qualitative interview UK study of those missing from primary-care, it illuminates how structural drivers of health inequalities operate at organisational and practice levels to weaken engagement with primary-care. Finding ways of better analysing and demonstrating the causal chains between structural determinants and patterns of disengagement is important because previous research has shown that practitioner and policy understanding of structural determination, an important precursor for mitigatory action, is not always sufficient, and research on healthcare utilisation can itself be weak in investigating structures of inequality. We address this deductively by testing a novel combination of Link and Phelan's Fundamental Cause Theory and Dixon-Woods and colleagues' Candidacy framework. Combining elements of these frameworks compensates for identified gaps in each. We demonstrate how Candidacy can be strengthened through incorporating more systematic theorisation of structural processes and that the more abstract arguments of fundamental (structural) causes can be made concrete via Candidacy's focus on inequalities in patients' access to, and utilisation of, healthcare. We also argue that both theories are enhanced by including Metzl and Hansen's concept of 'structural competency' as a potential mitigatory mechanism operating between fundamental causes and patient engagement.

Stigma remains a significant burden for people living with HIV and while studies have examined the impacts of gender, ethnicity, and sexual orientation on stigma separately, little is known about how these factors may intersect and potentially exacerbate levels of stigma. This study examines how these intersecting social positions may relate to levels of internalised, enacted and anticipated HIV stigma. Participants were recruited in Ontario, Alberta, and Québec (n = 1040) as part of the People Living with HIV Stigma Index study in Canada. Three-way interaction models were constructed by creating interaction terms from the product of gender, ethnicity, and sexual orientation variables that predicted each type of stigma. Levels of internalised, enacted and anticipated stigma were consistent across most intersecting groups; however, people occupying certain intersections experienced significantly higher levels of stigma. Three-way interaction analyses showed that for internalised stigma, people at the intersection of African/Caribbean/Black, lesbian, cis-women identities had significantly higher scores (b = 0.90, p = 0.06), while people at the intersection of Indigenous, lesbian, and cis-women identities had higher scores for enacted stigma (b = 1.21, p = 0.01) compared to the White, heterosexual, cis-men reference group. Interventions designed for populations that take intersectionality into account may be effective in reducing HIV stigma, although more quantitative intersectionality work must be done to understand these implications fully.

Sexual and gender minority (SGM) individuals living with mental illness often experience stigma associated with marginalized identities of sexual orientation, gender identity, and mental illness (MI). Sharing stories of lived experiences is an effective approach to reducing various forms of stigma; however, it is unclear whether stories shared by SGM living with mental illness (SGM MI) can reduce MI- and SGM-related stigma.

Using a randomized controlled trial design, participants watched digital stories of self-identified SGM individuals living with a mental illness, non-SGM individuals living with mental illness, or a control condition (TedTalks on environmental issues and growing up in China) to examine the use of representative digital stories in addressing SGM- and MI-related stigma.

In a sample of 218 participants, digital stories of SGM MI effectively reduced MI-related stigma (personal stigma (from 33.19 to 31.90) and discrimination (from 8.33 to 7.57)), but were ineffective at reducing SGM-related personal stigma (negative attitudes toward lesbians and gay men, transphobia, or genderism; p > .05).

Our study highlights the need to develop culturally adapted anti-stigma programs in collaboration with individuals with lived intersectional SGM and MI experiences.

Postcoital dysphoria (PCD) refers to a counter-intuitive experience of sadness, tearfulness, irritability or dysphoria following an otherwise satisfactory and consensual sexual experience. Research to date has primarily focused on heteronormative samples. The current study explored the prevalence of PCD, and potential correlates of internalized sexual prejudice, perceived discrimination, and sex life satisfaction within a LGBTQIA+ population. One hundred and seventy-two adults identifying as LGBTQIA+ completed an online survey. Main outcome measures included the Post Sex Experience Scale (p-SES), Everyday Discrimination Scale (EDS), Internalized Homophobia Scale (IHS), Satisfaction with Sex Life Scale (SWSLS), and study specific questions. Prevalence of PCD was 42% of males attracted to other males and 81% of participants identifying as bisexual/sexual fluid. A significant and a moderate inverse correlation was found between sex life satisfaction and PCD (r = -.75) for individuals identifying as bisexual/fluid sexual orientation. Significant correlations were found between perceived discrimination and PCD (weak positive correlation, r = .28), and sex life satisfaction and PCD (moderate negative correlation, r = -.59) in men attracted to men. This research suggests being a member of a sexual minority is associated with sex-related dysphoria and dissatisfaction. Further research is needed to further elucidate PCD.

This study investigated whether police stops in adolescence are associated with cognitive function in adulthood, with a particular focus on racial/ethnic heterogeneity. Moreover, this study explored how the timing of first stops affects these associations. Using data from waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health, this study employed ordinary least squares regression models with school fixed effects. Participants' memory performance was used to measure cognitive function. Police stops in adolescence were negatively associated with cognitive function in adulthood, even after controlling for a set of individual- and family-level characteristics, as well as unobserved school-level confounders. Earlier experiences of first police stops (before age 15) exhibited a stronger association with adult cognitive function compared to later experiences (after age 16). These associations were more pronounced among racial/ethnic minorities, particularly Hispanics, compared to whites. The findings of this study suggest that policies aimed at reducing the stress and trauma of police stops could help alleviate disparities in cognitive function across different groups. Given the vulnerabilities of young adolescents and racial/ethnic minorities, policies and programs targeting these groups should carefully consider the nature of police encounters, promoting health equity through less intrusive law enforcement practices.

Stigma prevents societal acceptance, reinforces social inequities, and greatly complicates the management of diabetes for those dealing with homelessness. Various forms of media, such as film, can educate audiences and play a role in reducing stigma, but the effectiveness of such interventions in changing individuals' knowledge, attitudes, and beliefs (KAB) requires further exploration. This study assessed the impact of a film on diabetes and homelessness through pre- and post-surveys of audience members (n = 202) at 12 screening events. The surveys measured changes in KAB through Likert scale questions, with scores ranging from 1 to 5. Statistical analyses, including Wilcoxon signed-rank and Kruskal-Wallis tests, were used to assess differences in KAB before and after viewing the film, as well as variations based on prior familiarity with diabetes and homelessness. Respondents' knowledge increased significantly across all topics related to both diabetes and homelessness. There were significant differences in all questions that assessed respondents' attitudes. Notably, respondents' beliefs changed significantly to be more positive, except for a single question where the pre-scores already demonstrated reasonably high baseline knowledge. In several domains, respondents familiar with diabetes did not have as significant of a change compared with individuals who were less familiar with diabetes at baseline. These findings suggest that narrative films can positively influence audience members' KAB about stigmatized conditions like diabetes and homelessness. Future research will examine the lasting impact of such interventions on audience members' KAB.

Lipedema is a chronic disease in adipose tissue affecting women. The distinctive body appearance in lipedema, often mistaken for obesity, may be detrimental to social life. In our online cross-sectional survey study, conducted from June to September 2021 among 245 women with lipedema, we found significantly more health-related stigma compared to an aged-matched general female population (N = 1872), leading to an overall lower quality of life. Conversely, strong social support was associated with better social and emotional functioning. As such, healthcare professionals must, even in the early stages, recognize this disease and address its impact on psychosocial health and well-being.

Adherence and retention in care are key targets to achieve favorable health outcomes for people with HIV. Challenges with adherence and retention are pronounced for marginalized communities facing intersectional structural oppression. Community health worker delivery of Managed Problem Solving (MAPS+), an evidence-based behavioral intervention, has the potential to improve adherence and retention, yet understanding structural inequities affecting people with HIV is necessary to increase the likelihood of equitable implementation. The current study explores systemic inequities influencing HIV care adherence and retention, and approaches to address these challenges. We conducted semi-structured interviews with 13 clinics and 4 constituent groups: prescribing clinicians, non-prescribing clinical team members (e.g., medical case managers), clinic administrators, and policymakers. Through reflexive thematic analysis within a constructionist paradigm, we identified two key themes. The first elucidated experiences of systemic inequities such as access to resources, healthcare system navigation difficulties, power differentials, medical mistrust, intersectional stigma and potential patient burden associated with MAPS+. The second theme highlighted the ways in which staff and clinicians shoulder the burden of addressing inequities by approaching people with HIV with dignity and developing trusting relationships and how MAPS + can bolster this approach by partnering with and centering patient needs. While these individual and organizational efforts are valuable, ending the HIV epidemic requires structural changes to address systemic inequities directly. This research underscores the complex interplay between structural oppression and HIV care, calling for comprehensive approaches to achieve health equity.

Self-stigma of loneliness is a major predictor of psychological distress among older adults, but its mechanism has not been further discussed. Drawing on classical relative deprivation theory and conceptualizing stigma model, this study aimed to examine the relationship between self-stigma of loneliness and psychological distress among older people and analyzed the mediation effect of relative deprivation and the moderation effect of positive solitude.

The study applied a cross-sectional study design to conduct questionnaire survey by administrating the Stigma of Loneliness Scale (SLS), 6-item Kessler Psychological Distress Scale (K6), Relative Deprivation Questionnaire, and Positive Solitude Scale (PS) among 1179 Chinese older adults. The Pearson correlation analysis explored the correlation between variables and Model 4 in PROCESS examined the mediating effect of relative deprivation. The moderating effect of positive solitude in the mediation model was tested through Model 59.

The correlation analysis shows a significant and positive correlation between the stigma of loneliness, relative deprivation, and psychological distress (r = 0.530 ~ 0.714); while positive solitude is significantly and negatively correlated with the stigma of loneliness, relative deprivation, and psychological distress (r = -0.128 ~ -0.179). Additionally, relative deprivation plays a mediating role in the relationship between self-stigma of loneliness and psychological distress. Meanwhile, it is invalid of the moderating effect of positive solitude in the direct path, first half of and second half of the path in the mediation model.

Self-stigma of loneliness could both directly affect psychological distress in older people and indirectly through the role of relative deprivation. Furthermore, positive solitude does not significantly buffer the impact of self-stigma of loneliness on relative deprivation and psychological distress. As research findings suggested, it is conducive to reducing psychological distress in older adults by adopting appropriate interventions to diminish self-stigma of loneliness and relative deprivation.

Emerging studies link the mental health of lesbian, gay, and bisexual (LGB) adults to structural stigma, focusing on state policies. Limited work considered cultural norms and the time changing nature of culture and policy. In this study, we draw from the structural stigma theory and hypothesize that both policy protection and cultural acceptance will independently promote LGB mental health and explore their interactive roles. Composing a novel state-year longitudinal dataset on policy and culture related to sexual minority people, we link it to a sample of cisgender LGB adults from the large-scale, representative Behavioral Risk Factor Surveillance System (2016-2023). Our multilevel regression models predicted depressive diagnosis and frequent mental distress from varied stigma measures, controlling for state-level and individual-level factors. The results revealed that LGB adults especially bisexual women faced elevated mental health challenges. Models generally showed structural stigma measures in the policy and culture domains were not independent, significant predictors of LGB mental health. Moreover, there was generally no significant and sizable interactions between policy and culture. One exception came from lesbian women, where policy protection was negatively associated with worse mental health, reducing frequent mental distress by around 6 percentage points across policy score ranges. We conclude by discussing the varied findings and encouraging future studies to incorporate the time-changing nature of policy and culture when linking structural stigma to LGB mental health.

BackgroundHepatocellular carcinoma is a burdensome form of liver cancer with an increasing global prevalence. Emerging evidence has shown that early palliative care introduction at diagnosis of any life-limiting illness improves patient and carer outcomes. Despite this, patients with hepatocellular carcinoma usually receive palliative care late. These patients are important stakeholders in the provision of palliative care, but their perceived barriers regarding its delivery are poorly defined.AimThis pilot study aimed to identify the barriers perceived by patients to integrating palliative care into the hepatocellular carcinoma treatment algorithm.DesignPatients living with hepatocellular carcinoma undertook semi-structured interviews about their perceptions of palliative care. We compared these perceptions before and after providing a brief explanation of palliative care. Interview data was inductively coded in NVivo 12 (2018) and thematically analysed.ResultsTwenty-one patients were interviewed. 16 perceived palliative care to mean end-of-life therapy, and nine participants had no prior knowledge of palliative care. After hearing a definition of palliative care, 17 participants reported changed positive attitudes. Seven participants supported a name change, including four participants who continued to reject palliative care following the explanation due to the negative stigma associated with the term 'palliative care'.ConclusionThere is significant misperception about the purpose of palliative care among patients with hepatocellular carcinoma, constituting a barrier to early integration. This can be feasibly addressed with a two-folded educational and renaming initiative to dispel patient misconceptions regarding palliative care. Effective strategies to achieve this should be developed and tested with relevant stakeholders, particularly patients.

Researchers, interventionists, and clinicians are increasingly recognizing the importance of structural stigma in elevating the risk of mental illnesses (MIs) and substance use disorders (SUDs) and in undermining MI/SUD treatment and recovery. Yet, the pathways through which structural stigma influences MI/SUD-related outcomes remain unclear. In this review, we aim to address this gap by summarizing scholarship on structural MI/SUD stigma and identifying pathways whereby structural stigma affects MI/SUD-related outcomes. We introduce a conceptual framework that describes how structural-level stigma mechanisms influence the MI/SUD treatment cascade via (a) interpersonal- and individual-level stigma mechanisms and (b) mediating processes among people with MI/SUD (i.e., access to resources, psychological responses, behavioral responses, social isolation). We consider intersections between MI/SUD stigma and stigma based on race/ethnicity, gender identity, and sexual orientation. Finally, we discuss the implications of this review for future research, interventions, and clinical practice.

Prior studies have highlighted potential inequities in provider-documented alcohol use disorder (AUD) across race, ethnicity, and sex. Whether subgroup differences in AUD reflect true variation or diagnostic disparities is unknown. This study aims to describe variations in the prevalence of provider-documented AUD across race, ethnicity, and sex: 1) after adjustment for alcohol consumption, and 2) after additional adjustment for patient-reported AUD symptoms.

In Kaiser Permanente Washington, patients with high-risk drinking (AUDIT-C score 7-12; 2.4 % of screened patients) complete a validated Alcohol Symptom Checklist of DSM-5 AUD symptoms with results documented in electronic health records. This study included Asian, Black, Latine, and White patients in primary care settings (03/2015-02/2022) who indicated high-risk drinking and thus completed an Alcohol Symptom Checklist. The prevalence of AUD was estimated for women and men across race or ethnic groups using marginally standardized generalized linear models. Models were first unadjusted, then adjusted for consumption (AUDIT-C scores 7-12), and then consumption plus AUD symptom counts (0-11).

Among 14,442 patients with high-risk drinking (6.0 % Asian, 5.8 % Black, 7.8 % Latine, 80.4 % White; 32.1 % women), provider-documented AUD increased with alcohol consumption and the number of AUD symptoms. The prevalence of AUD across 8 subgroups defined by race, ethnicity, and sex varied in analyses adjusted for alcohol consumption alone (range 11.6 % [95 % CI: 9.3-14.4] to 20.2 % [18.9-21.5]). However, after adjustment for both alcohol consumption and AUD symptoms, the prevalence of AUD ranged from 11.2 % [95 % CI: 7.9-15.6] to 15.0 % [95 % CI: 13.9-16.3] in women, and from 11.0 % [95 % CI: 8.7-13.8] to 15.1 % [95 % CI: 14.3-16.0] in men. AUD did not appear to vary across race or ethnicity.

In this study of primary care patients with high-risk drinking in a regional healthcare system that routinely assesses AUD symptoms, variations in provider-documented AUD diagnosis across race, ethnicity, and sex were observed after adjusting for alcohol consumption but were diminished after adjusting for AUD symptoms. This may suggest that among patients with similar alcohol consumption and AUD symptoms, intersectional variations in AUD diagnosis may be less apparent. Assessing AUD severity with Alcohol Symptom Checklists may help support equitable clinical AUD diagnosing.

Research on the disparity in common mental health problems borne by sexual minority individuals has entered a stage of increasing theoretical complexity. Indeed, such a substantial disparity is likely not determined by a singular cause and therefore warrants diverse etiological perspectives tested with increasingly rigorous methodologies. The research landscape is made even more complex by the constant and rapid shift in the ways in which sexual minority people understand and characterize their own identities and experiences. This review introduces readers to this complexity by summarizing the historical legacy of research on the sexual orientation disparity in mental health, describing five contemporary theoretical explanations for this disparity and their supporting evidence, and suggesting theoretically informed interventions for reducing this disparity. Last, we offer an agenda for future research to accurately model the complexity of the pathways and solutions to the disproportionately poorer mental health of sexual minority populations.

Narcissistic personality disorder (NPD) is widely thought to be highly stigmatized; however, little empirical research has characterized this stigma. In this investigation, we draw on seminal theories and constructs from the stigma literature to improve the field's understanding of NPD stigma across stigma levels (individual, interpersonal, and structural) and dimensions (concealability, origin, course, disruptiveness, aesthetics, and peril). Participants were mental health clinicians (N = 9) with experience treating NPD. Participants completed semistructured qualitative interviews exploring their observations of NPD stigma. Interview questions were guided by existing stigma frameworks. Responses were then coded thematically using inductive and deductive techniques. Results are reported by theme. Overall, clinicians agreed that NPD was a highly stigmatized disorder in both public and healthcare settings. NPD stigma was consistently reported at the individual, interpersonal, and structural levels and was most salient in the dimensions of course, origin, and peril. Stigma is thought to be a central barrier to diagnosing and treating NPD. More research and clinician education are critical next steps in reducing stigma. This investigation represents an important step forward in the characterization and conceptualization of NPD stigma. Additional work is needed to understand the experience of NPD stigma from the perspective of patients, further quantify potential mental health implications, and identify opportunities for stigma intervention.

Previous research has documented how people living on low incomes in the United Kingdom (UK) and internationally experience various forms of poverty stigma. The purpose of this study was to quantitatively examine how experiences of poverty stigma are associated with mental health outcomes.

An online, cross-sectional survey was conducted with 1,000 adults living in predominantly low- and middle-income households in the UK. The survey included a questionnaire designed to measure participants' experiences of different forms of poverty stigma, as well as measures of anxiety, depression and mental well-being.

Exploratory and confirmatory factor analyses of the poverty stigma questionnaire supported a two-factor solution. One factor reflected participants' experiences of being mistreated and judged unfairly by other people because they live on low income (received stigma) and the other factor reflected participants' perceptions of how people living in poverty are treated by media outlets, public services and politicians (perceived structural stigma). Both received and perceived structural stigma were independently associated with anxiety, depression and mental well-being and these relationships persisted after controlling for socioeconomic indicators. There was also evidence that received stigma and perceived structural stigma partially mediated the relationships between financial hardship and mental health outcomes.

Experiences of received and perceived structural poverty stigma are both associated with mental health and well-being. This suggests that addressing interpersonal and structural forms of poverty stigma may help to narrow socioeconomic inequalities in mental health.

This study explores well-being strategies and challenges for Black LGBTQ individuals in Montreal, Canada. Semi-structured interviews were conducted between March and May 2023 with key informants, or advocates and service providers for LGBTQ communities in the Montreal metropolitan area. Thematic analysis was used and involved transcription, memo-writing and a multi-step, inductive coding process using MAXQDA. The findings highlight three areas of well-noted challenges for Black LGBTQ individuals: systemic barriers; lack of targeted support; and challenges to accessing services. Two strategic domains emerged as innovative approaches to support well-being: transcendental practices and intersectional sociopolitical awareness raising. Transcendental practices, ranging from fine arts and dance to reiki energy healing, offered avenues for healing and community-building. Intersectional sociopolitical awareness was described as crucial in informing and contributing to existing efforts to improve well-being such as therapeutic engagement with clients and facilitating mutual aid. The identified transcendental practices and political awareness offer promising avenues for holistic well-being and comprehensive approaches to challenges such as inequitable HIV burden. Recognising the convergence of identities and social power axes can inform future interventions to foster more inclusive and empowering health strategies for Black LGBTQ communities.

Physical activity and social support are recognized as contributing to preventing depression. Community-based group exercises are activities that combines both functions. Fewer studies have examined the association between community-based group exercises and the depression severity of middle-aged and older adults. In this study, we were trying to estimate such correlation and explore the potential mechanisms. Data from the China Longitudinal Study of Health and Retirement was analyzed (N = 17,481). Participation in community-based group exercises and depression severity were self-reported by the surveyed middle-aged and older adults. The ordered probit model was used to analyze the association between participation in community-based group exercises and depression severity. Compared with middle-aged and older adults who did not participate in community-based group exercises, those who engaged in such activities exhibited improved depression severity in the current year (coefficient = 0.229, p < 0.01) and two years later (coefficient = 0.199, p < 0.01). The relationship was more pronounced among women. Improved physical fitness and more frequent visits to neighbors and relatives for social support are potential mechanisms. In addition to medical interventions, social support and physical fitness are effective strategies for depression prevention. Policymakers could enhance the mental health of middle-aged and older adults, particularly among women, by encouraging participation in community-based group exercises. This is particularly important in rapidly ageing societies.

Globally, transgender and other gender diverse (trans) people experience widespread prejudice, discrimination, violence, and other forms of stigma, which contribute to negative health outcomes. Most anti-trans stigma research has been conducted in high-income countries. Measurement of anti-trans stigma in low- and middle-income countries (LMICs) is important for understanding and improving the health of trans populations globally. Accordingly, this scoping review explores the use of quantitative anti-trans stigma measures in LMICs. This scoping review follows the guidance of the PRISMA extension for Scoping Reviews (PRISMA-ScR) Checklist and examines empirical research with trans populations in LMICs published in English, Spanish, Arabic, and Russian between 2001-2024. Study eligibility criteria included: 1) trans study population, 2) LMIC study location, 3) quantitative or mixed-method study design, and 4) quantitative measurement of anti-trans stigma. The search yielded 82 articles (representing 65 unique studies) from 34 LMICs. Most articles were published since 2018. No articles focused exclusively on trans men. About 62% of articles included a primary focus on stigma; health outcomes primarily examined HIV and mental health. Nearly all articles (95%) measured enacted stigma; other forms of stigma (e.g., internalized and anticipated) were less commonly measured, and structural stigma was only measured in 4 articles. More than half of the articles (55%) measured stigma both broadly and within specific contexts (e.g., from family, in health care). More research exploring anti-trans stigma is needed, especially with trans-masculine and other gender diverse people, measuring outcomes beyond HIV and mental health, and measuring forms of stigma beyond enacted stigma. Expanding and improving measurement of anti-trans stigma in LMICs can improve our understanding of the mechanisms shaping health equity to inform context specific and tailored health interventions to support trans communities worldwide.

Heterosexist victimization constitutes a severe source of social stress with enduring effects on mental health and the adrenocortical functioning of lesbian, gay, bisexual, transgender, and queer (LGTBQ) emerging adults. However, it is unknown what roles lower or higher diurnal cortisol at waking (cortisol intercepts) and less variable fluctuations ("flatter" slopes) play in the links between heterosexist victimization and depressive symptoms. In accordance with diathesis-stress, allostatic load, and biological embedding perspectives, we examined whether cortisol intercepts and slopes moderated or mediated the predictive associations of heterosexist victimization with depressive symptoms over 24-months. Heterosexist victimization was expected to predict depressive symptoms most strongly for LGBTQ emerging adults with flatter cortisol slopes (i.e., moderation), and cortisol intercepts and slopes were expected to indirectly link heterosexist victimization with depressive symptoms (i.e., mediation). Latinx and White LGBTQ emerging adults (N = 97; ages 18-29, M = 23.91 years, SD = 2.63) provided saliva samples and questionnaire responses during a four-day testing protocol at baseline; two additional assessments of depressive symptoms were completed 9- and 24-months later. Cortisol intercepts and slopes moderated associations of heterosexist victimization with both contemporaneous and prospective depressive symptoms. Heterosexist victimization was positively associated with contemporaneous depressive symptoms and decreases in depressive symptoms over two years when LGBTQ emerging adults also had steeper cortisol slopes. Heterosexist discrimination was associated with increases in depressive symptoms prospectively among participants with lower cortisol intercepts. There was no evidence for mediation. Thus, patterns of diurnal adrenocortical functioning may distinguish between LGBTQ emerging adults who are more prone to acute versus prolonged depressive symptoms when they experience heterosexist victimization.

Mental health issues, particularly depression, often carry a stigma that can infiltrate various societal institutions, including the legal system. This study investigates the structural stigma associated with depression within the context of second-instance criminal trials in China, examining trial verdicts from 2009 to 2023. Through a detailed analysis of 171 cases using Semantic Network Analysis, Critical Discourse Analysis, and logistic regression, this research elucidates the complex ways in which depression is considered in judicial decisions. The findings identify three thematic responses-Neutral Evaluation, Sympathetic Consideration, and Rigorous Standards-that encapsulate diverse judicial attitudes towards the impact of depression on criminal responsibility. Critical Discourse Analysis further reveals three prevailing legal discourses-Stringent Criteria, Inconsistent Approaches, and Individual Negligence-that significantly influence the treatment of defendants with depression. The results also show a declining trend in recognizing depression as a mitigating factor, jointly influenced by crime type, defendant gender, and defendant's education level, suggesting a shift towards more stringent judicial interpretations over time. These findings underscore the critical need for judicial reforms aimed at reducing stigma and promoting a more equitable treatment of mental health issues in the legal system.

This study examines the conditional indirect effect of discrimination on alcohol problems among transfeminine people of color, moderated by financial instability. An online cross-sectional survey (N = 80) was conducted from October 2021 to May 2022 with transfeminine adults of color with a history of alcohol problems. Using Hayes' PROCESS Macro, results showed that past-year discrimination was associated with higher drinking motives, greater alcohol use, and more alcohol-related problems. Among participants experiencing financial instability, past-year discrimination was associated with greater alcohol use and subsequent alcohol problems. Conversely, among financially stable participants, past-year discrimination was associated with less alcohol use and fewer alcohol problems. Findings highlight that economic deprivation amplifies the impact of discrimination-related stress on alcohol problems. Addressing basic needs is essential to mitigating these effects. This study underscores the importance of transgender inclusive policies while calling for further research on longitudinal outcomes.

Purpose: We evaluated the performance of computational phenotypes (CPs) in commercial insurance claims for identifying transgender (TG) individuals and assessed trends in population size and depression and anxiety prevalence of the TG population. Methods: We compared two previously defined CPs by measuring their concordance. We combined CPs to establish a cohort of TG individuals from MerativeTM MarketScan® commercial insurance claims (2007-2021) to measure population and mental health trends using joinpoint regression. Results: Due to high levels of overlap between CPs, we combined CPs to reach our sample size of 67,809 unique individuals. TG-related International Classification of Diseases (ICD) diagnoses codes increased from 59% of TG claims in 2007 to 97% in 2021. We observed a sharp increase in the prevalence of TG-related claims in 2012 by 42.3% (95% confidence interval [CI] = 35.8-56.8) per year then by 17.0% per year (95% CI = 6.1-23.7) from 2017 to 2021. Among TG individuals there was a gradual increase in mental health-related claims from 2007 to 2015, which remained stable until there was a 10% decrease in 2021. Conclusion: The combined CP identified the largest TG population in commercial insurance claims to date. Most TG individuals were identified through TG-related ICD codes for both CPs. Increases over calendar time may represent an increased access to insurance-covered gender-affirming services. Persistently high depression and anxiety-related claims suggest an ongoing need to reduce the burden of psychiatric-related claims in this population.

Black individuals in the U.S. report experiencing the highest levels of racial discrimination in healthcare. Racial discrimination in healthcare contributes to mental health issues and has been shown to be associated with loneliness. Despite this, there is limited research on the role loneliness plays in the relationship between racial discrimination in healthcare settings and mental health outcomes. This study explored the relationship between racial discrimination in healthcare, loneliness, and mental health outcomes (depression and anxiety) among Black individuals.

This study was part of the PhillyCEAL (Community Engagement Alliance) initiative. Between February 2024 and April 2024, 327 Black Philadelphia residents completed online surveys. Multiple linear regression analyses examined the associations between racial discrimination in healthcare, loneliness, depression, and anxiety. Covariates included Hispanic ethnicity, age, insurance, lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) status, sex assigned at birth, relationship status, employment, medical conditions, income, and education.

Racial discrimination in healthcare was positively associated with loneliness (b = 0.66, 95% CI: 0.29 to 1.04), depression (b = 0.52, 95% CI: 0.19 to 0.86), and anxiety (b = 0.85, 95% CI: 0.50 to 1.19). When controlling for loneliness, the association between racial discrimination in healthcare and depression became non-significant (b = 0.29, 95% CI: -0.03 to 0.61), while the association between racial discrimination in healthcare and anxiety remained significant (b = 0.62, 95% CI: 0.29 to 0.94).

Addressing racial discrimination within healthcare settings is crucial for improving mental health outcomes among Black populations. Given the significant role of loneliness in this relationship, interventions aimed at reducing loneliness may help mitigate the adverse mental health effects of racial discrimination in healthcare for Black populations.

In 2023 the Supreme Court of Mauritius cited human rights and public health arguments to strike down a colonial-era law criminalizing consensual same-sex sex. The parliament of Singapore recently did the same through legislative means. Are these aberrations or a shifting global consensus? This article documents a remarkable shift international legal shift regarding LGBTQ+ sexuality. Analysis of laws from 194 countries across multiple years demonstrates a clear, ongoing trend toward decriminalization globally. Where most countries criminalized same-sex sexuality in the 1980s, now two-thirds of countries do not criminalize under law. Additionally, 28 criminalizing countries in 2024 demonstrate a de facto policy of non-enforcement, a milestone towards legal change that all of the countries that have fully decriminalized since 2017 have taken. This has important public health effects, with health law lessons for an era of multiple pandemics. But amidst this trend, the reverse is occurring in some countries, with a counter-trend toward deeper, harsher criminalization of LGBTQ+ sexuality. Case studies of Angola, Singapore, India, Botswana, Mauritius, Cook Islands, Gabon, and Antigua and Barbuda show many politically- and legally-viable pathways to decriminalization and highlight actors in the executive, legislative, and judicial arenas of government and civil society engaged in legal change.

Transgender (trans) and gender-diverse (TGD) people are a small but increasingly visible population who experience worsening marginalisation characterised by toxic political and media discourse, violent hate crimes and discriminatory laws targeting healthcare and public access. Governments in both the United Kingdom (UK) and the United States (US) have pushed anti-trans policies which threaten to further exclude TGD people. Understanding the public health impacts of transphobia is vital, especially regarding disproportionate drug-related harms.

TGD people are more likely than their cisgender counterparts to experience both acute and chronic drug-related harm. This is, in part, driven by rising transphobia and perpetuated by limited access to gender-affirming and harm reduction services. Current health data systems fail to accurately capture the scale of drug-related harms faced by TGD people due to suboptimal gender measurement. Inclusive data collection and culturally competent harm reduction services are urgently needed to address these disparities. Digital interventions, such as telehealth, and peer-led support may improve the accessibility and effectiveness of care for this group.

Evidence suggests that TGD individuals face disproportionate drug-related harm compared to cisgender people, a disparity likely to widen as government-led hostility increases in countries such as the UK and the US. Immediate action is required to ensure TGD people are fully represented in research, public health monitoring, and support services.

This study investigated the experiences of stigma and somatization among middle-aged adults with mental health issues. Using frameworks of public stigma, self-stigma, affiliate stigma, and somatization (both presenting and functional), the study explores how individuals navigate the stigma associated with mental health. Interviews were conducted with middle-aged adults in rural areas, and the data were analyzed using Interpretative Phenomenological Analysis (IPA) to gain insights into their lived experiences. The findings reveal that mental health stigma in rural China significantly influences how individuals express mental distress, often leading to somatization. Patients tend to frame their mental health issues in terms of physical symptoms, such as headaches or fatigue, to avoid stigma. The study also highlights the role of cultural norms in shaping these expressions, particularly within the context of close-knit rural communities where mental health issues is stigmatized. The implications for education and policy are discussed, emphasizing the need for improved public mental health education and more equitable distribution of healthcare resources between urban and rural areas. This study contributes to the understanding of mental health stigma in rural China and offers practical suggestions for addressing mental health challenges in underserved communities.

Studies that have investigated client-provider interactions in HIV service delivery have focused mainly on the views of sexual and gender minorities. This study explored the views of both Healthcare Providers (HCPs) and Sexual Minority Men (SMM) in Zambia about factors that influence client-provider interactions and how this could affect HIV service delivery. We conducted in-depth interviews with 20 HCPs (>25 years old) and 20 SMM (20-34 years old) purposively recruited from Lusaka with help from local partners in 2021. Interviews lasted 30-80 min, were conducted in English, and were audio-recorded. Verbatim transcripts of audio files were iteratively coded using Nvivo. Thematic analysis was performed using the inductive approach. Study findings suggest that a lack of trust in HCPs among SMM and the religious and cultural persuasions of some HCPs negatively impact communication between SMM and HCPs. The above factors will likely make establishing a good working relationship between HCPs and SMM difficult and could negatively influence HIV service delivery. Therefore, promoting an SMM-friendly environment at health facilities and promoting HCPs' understanding of the health needs of SMM are critical to ensure the delivery of quality HIV services to SMM in Zambia.

The COVID-19 pandemic placed significant psychological strain on healthcare workers. Our study tracked health care workers in the Czech Republic throughout the pandemic to examine the impact of stressors on psychological distress over time and explore gender differences in these associations. We studied health care workers from the Czech arm of the international COVID-19 HEROES Study who took part in all three waves of data collection in 2020, 2021 and 2022 (n = 264). We employed a path model to examine the relationships among six stressors (low trust in workplace, assignment of new tasks, prioritization of patients, experience of death due to COVID-19, experience of discrimination or violence, contact with COVID-19 patients), psychological distress (measured by General Health Questionnaire), and covariates (age, gender, occupation). We incorporated autoregressive paths and interactions to assess the longitudinal impact of stressors. Prior levels of distress predicted subsequent distress, with significant carry-over effects observed between each wave. Stressors had direct association to distress in the same wave of data collection (2020 and 2021), but not in subsequent waves, and stressors in 2022 did not have a significant direct effect to distress. Men reported lower distress in 2020 and 2021, but not in 2022. Furthermore, no significant interactions between stressors and gender were found. Age and occupation were not related to distress levels. There is a need for adaptable mental health support that addresses current stressors through targeted interventions, while also providing ongoing monitoring beyond crises, particularly for individuals with high distress levels.

Health-related stigma is associated with adverse outcomes including depression, stress and reduced engagement in health behaviours which are particularly harmful in pregnancy and the postpartum. Women with gestational diabetes mellitus (GDM) report negative psychosocial experiences and may be at risk of stigma related to the condition. We aimed to understand women's experiences of GDM-specific stigma. Individual interviews were conducted with n = 53 women living in the UK with a current or past (within 4 years) GDM. Grounded theory methodology was used to analyse the data. Four themes were identified: (1) Preconceptions and misconceptions; (2) Locating, regaining, and negotiating agency; (3) Tension about and resisting the dominant discourse of stigma; and (4) Reclaiming control over the body. GDM-specific stigma was diverse and far reaching and may have broader implications for perinatal mental health and postnatal wellbeing. It is pertinent to investigate possible prospective associations between GDM-specific stigma, and biomedical and mental health outcomes.

While public health practitioners and scholars have long theorized that structural forms of stigma shape the health of disadvantaged groups, they have frequently bemoaned the lack of research on this topic. A unique opportunity to address this lacuna occurred in the past two decades, with the advent of dramatic changes in laws, social attitudes, and other structural manifestations of stigma surrounding LGBTQ+ individuals. In a review of this literature, we conducted a meta-analysis of LGBTQ+ structural stigma and health, finding an effect size comparable to several other well-established macrolevel risk factors for poor health (e.g., income inequality, racial residential segregation, neighborhood socioeconomic status). In addition, we enumerated a range of established methodological strategies that studies have used to strengthen inferences; these strategies include documenting result specificity (i.e., structural stigma is unrelated to the health of cisgender heterosexuals), addressing alternative explanations (e.g., social selection), and triangulating evidence across multiple methods, measures, and health outcomes. We offer suggestions for future research to advance this rapidly expanding field, including identifying sources of unexplained heterogeneity in the structural stigma-health association. Finally, we discuss implications for other marginalized groups and for public health interventions and policies to reduce LGBTQ+ health disparities.

Oral healthcare settings can be a challenging environment for people with HIV. Combined with problematic insurance policies, insufficient health literacy, and higher treatment fees, HIV stigma contributes to barriers when accessing oral healthcare. We conducted a descriptive study via an online survey with open-ended questions to understand the experiences of people with HIV in oral healthcare settings. The survey was administered by non-governmental organizations. Thematic analysis was used to analyze the data via a critical realist approach. Seventy-five participants responded to survey between August and September 2023. Thematic analysis yielded three main themes: occurrences of stigma in healthcare, coping with HIV stigma and anxiety, and barriers beyond stigma. Participants reported a problematic understanding of HIV literature and stigma among dentists, which was manifested as excessive precaution measures, denial of care, unnecessary referrals, gossiping, discriminatory remarks and disclosure of HIV status without consent. This was reflected in people with HIV as self-stigma, fear of healthcare workers and avoidance of healthcare services. Advancements in dental education and post-qualification training are needed in infection control and ethics, while people with HIV need health education to preserve their rights and sustain good health and well-being to prevent adverse outcomes.

Lung cancer screening can reduce lung cancer-specific mortality, but it is widely underutilized, especially among minoritized populations that bear a disproportionate burden of lung cancer, such as Black Americans. Racism, discrimination, medical mistrust, and stigma contribute to lower uptake of preventive screenings in general, but the role these factors play in lung cancer screening is unclear. We therefore conducted a scoping review to synthesize the literature regarding how racism, discrimination, medical mistrust, and stigma relate to lung cancer screening.

Informed by PRISMA-ScR guidelines, we searched five databases for relevant literature, and two trained researchers independently reviewed articles for relevance. We conducted a narrative, descriptive analysis of included articles.

A total of 45 studies met our inclusion criteria. Most articles reported on medical mistrust or one of its cognates (e.g. trust and distrust, n = 37) and/or stigma (n = 25), with several articles focusing on multiple constructs. Few articles reported on racism (n = 3), and n = 1 article reported on discrimination. Results from empirical studies suggest that medical mistrust, distrust, and stigma may be barriers to lung cancer screening, whereas trust in health care providers may facilitate screening. The articles reporting on racism were commentaries calling attention to the impact of racism on lung cancer screening in Black populations.

Overall, novel interventions are needed to promote trust and reduce mistrust, distrust, and stigma in lung cancer screening initiatives. Dedicated efforts are especially needed to understand and address the roles that racism and discrimination may play in lung cancer screening.

ObjectiveLimited research has explored how the attributions of discrimination in later life are related to cognitive functioning.MethodsWe analyzed responses from 12,279 adults ages 65+ in the 2008 to 2018 waves of the Health and Retirement Study. Multilevel mixed models assessed whether cognitive functioning was associated with (1) everyday discrimination (without reference to attribution) and (2) frequency of 11 attributions of discrimination.ResultsDescriptive analyses highlighted variability in the characteristics associated with specific attributions of discrimination. We found that age was the most reported attribution of discrimination, followed by gender. Discrimination was associated with worse cognitive functioning, and frequent reports of certain attributions of discrimination (e.g., disability, sexual orientation) were associated with cognitive functioning.DiscussionThese results suggested that discrimination was harmful for cognitive health and that the perceived reasons for discrimination may have unique and negative implications for cognitive functioning among older adults.

Purpose: Sexual minority (SM) women have more dementia risk factors than heterosexual women, but it remains unknown whether they experience increased symptoms of subjective cognitive decline (SCD)-a key predictor of dementia. Methods: We investigated sexual orientation-related disparities in SCD in Nurses' Health Study II (N = 70,772). Sexual orientation subgroups included completely heterosexual (n = 62,884); participants identifying as heterosexual with same-sex experience ("heterosexual-SM", n = 5017); and participants identifying as mostly heterosexual (n = 1825), bisexual (n = 287), or lesbian/gay (n = 759). SCD was measured using seven symptoms from the Structured Telephone Interview for Dementia Assessment, controlling for demographics with Poisson regression models. Results: Relative to completely heterosexual participants, SM participants had 29% more SCD symptoms (95% confidence interval [CI] = 1.26-1.32). Symptoms were elevated in every SM subgroup; the largest disparities were among bisexual and mostly heterosexual subgroups (adjusted risk ratios for 1-unit increment in symptoms [aRR]: 1.60, 95% CI = 1.45-1.77; 1.48, 95% CI = 1.42-1.54, respectively) followed by lesbian/gay (aRR: 1.22, 95% CI = 1.14-1.31) and heterosexual-SM participants (aRR: 1.21, 95% CI = 1.18-1.25). Conclusion: SM women-particularly bisexual and mostly heterosexual women-had more symptoms of SCD than completely heterosexual women. These findings align with known sexual orientation-related disparities in dementia risk factors (e.g., mental health, substance use), and indicate that better understanding and closer monitoring of cognitive health in SM groups remains important for prevention efforts as an increasing proportion of aging Americans identifies as SM.

People who are stigmatized along concealable features (e.g., individuals reporting adverse childhood experiences) often experience challenges to the self-concept, which can promote psychological distress. Developing a stigmatized identity might counter these effects, but the internality of concealable features can forestall this process: individuals may look to similarly-stigmatized others, but if these group members remain concealed (i.e., are not "out"), they are less identifiable as guides for development. In two studies (Ntotal = 845), less outness among similarly-stigmatized others in the social environment predicted increased distress-but only for individuals reporting low progress in processes of positive meaning-making (Studies 1 and 2) and exploration (Study 2). The interaction held when controlling for stigmatizing views endorsed by non-stigmatized counterparts (Study 2). Findings highlight similarly-stigmatized others as important constituents of the social environment: low group visibility and accessibility may uniquely contribute to distress for individuals at early phases of developing a positive and clear stigmatized identity.

Thailand has been particularly affected by the HIV epidemic in the middle of the years 1990s. Thousands of children living with perinatal HIV have been exposed to HIV-related stigma/discrimination, but its frequency and expressions have been little studied. Our objectives were to assess, among adolescents living with perinatal HIV, the prevalence of stigma/discrimination, the factors associated with it and its expressions.

All caregivers of adolescents aged 12-19 years living with perinatal HIV and receiving antiretrovirals in 20 hospitals throughout Thailand were invited to complete a face-to-face questionnaire on their adolescent's life, and to report their adolescents' experiences of stigma/discrimination. Stigma/discrimination as perceived by the caregivers was analyzed using both quantitative and qualitative approaches.

A total of 712 adolescents living with perinatal HIV and their caregivers were interviewed as part of the TEEWA study between March 2010 and November 2012. Of the 572 adolescents living in family settings, 464 had their HIV-status known in the community. Among them, the overall stigma/discrimination prevalence was 46%. The multivariable analysis showed that the risk of being stigmatized was nearly 3 times higher in the northeast region (OR: 2.93, 95%CI: 1.36-6.45) and when having a low intellectual ability (OR: 3.35, 95%CI: 1.66-7.10). It was nearly twice higher in case of conflicts with caregivers (OR: 1.81, 95%CI: 1.17-2.79) and when caregivers were members of a support group (OR: 2.28, 95%CI: 1.48-3.53), while having a BMI >18.5 was associated with a lower risk of stigma/discrimination (OR: 0.61, 95%CI: 0.37-0.98). Expressions of stigma/discrimination included bullying, social isolation, behavioral discrimination and public disclosure. Consequences of stigma/discriminations included voluntary withdrawal from school, painful awareness of HIV status, marginalization from the community, and separation of drinks and food.

We found that the prevalence of stigma/discrimination among adolescents living with perinatal HIV was high. Despite existing policies, stigma eradication remains necessary to normalize their life as they grow into adulthood and may face the consequences of past/current discrimination in terms of access to university studies or occupation, at work, in the community or in their romantic life.

This article offers a unique interdisciplinary theoretical examination of the stigmatisation of 'drug addicts' and its impacts on health and wellbeing. In the present conjuncture, drug addiction has become a metaphor for a 'wasted' life. The stigmatisation of addicts creates artificial monsters. They constitute matter out of place-addiction is dirt and the addict a form of symbolic pollution-as their excessive consumption means they are ostracised and branded as failures. Providing a tripartite framework-of failure, feast, and phoenix-this article will suggest that addiction occupies a contradictory social and conceptual space, at once cause, effect, and solution. It is in this context that the stigmatisation of addiction operates, despite the fact addicts constitute a consumer par excellence, solicited by the very system that seeks to punish, control, and cure them. Drawing on Girard's generative scapegoat alongside the philosophical concept of the Muselmann, which parallels it, this paper will examine the hypocritical and contradictory portrayal, consumption and treatment of addiction; the social harm and stigmatisation arising from this portrayal; the systems of power and privilege that reproduce this; and how these systematically affect not only the health and wellbeing of addicts, but also their medical care and treatment. The health impacts arising from this framework will illustrate how scapegoating can lead to worsening mental and physical health, social isolation, and create barriers to treatment, which ultimately perpetuate the cycle of addiction that create public health challenges (e.g., drug-related deaths). The ensuing discussion will show how the addict is a symptom of capitalism and colonialism before it, sustaining it as well as serving as a convenient distraction from the systematic problems and illustrating the brutal realities of biopolitical power and its inherent contradictions. Only by understanding the broader socio-cultural and political implications of addiction within the context of late capitalism can we start to reduce stigma and scapegoating and focus on addiction as a medical issue rather than a moral and/or criminal one; a key to improving health outcomes.

BACKGROUND

Stigma is a barrier to care for people affected by TB and HIV in Uganda, where these conditions remain endemic. While scales have been adapted and validated to measure stigma among TB-affected households in Uganda, there is a need for scales that measure the experiences of persons with TB (PWTB).

METHODS

We adapted the Van Rie 12-item individual perspectives TB scale and 10-item individual perspectives HIV scale for use in Uganda through cross-cultural discussions with a multidisciplinary research team and four cognitive interviews with community health workers and PWTB. We then conducted a cross-sectional study administering each scale to 125 PWTB. We performed exploratory factor analysis, evaluated internal validity, and assessed convergent validity with perceived social support.

RESULTS

Exploratory factor analysis yielded a one-factor solution for both scales, with marginal model fit (standardised root mean square residual = 0.09 for TB, = 0.07 for HIV). There was evidence of convergent validity through a positive correlation of the TB (r = 0.22, p = 0.01) and HIV stigma (r = 0.22, p = 0.01) scales with perceived social support. Both scales had good internal validity (Cronbach's α = 0.86 for TB, = 0.87 for HIV).

CONCLUSION

Adapted scales to measure perceived HIV and TB stigma among PWTB in Uganda demonstrated promising psychometric properties by removing one and two items, respectively..

Although sexual minority men experience substantial discrimination, in addition to increased risk for several serious mental and somatic health problems, the biological mechanisms underlying these effects are unclear. To address this issue, we examined how experiences of social safety (i.e., community connection) and social threat (i.e., discrimination, in the forms of homophobia and racism) were related to conserved transcriptional response to adversity (CTRA) gene expression profiles across time, and whether these associations differed across HIV status, in a well-characterized, racially diverse sample of sexual minority men (Mage = 22.61, SD = 1.90).

Experiences of community connection, homophobia, and racism were assessed via self-report, and blood samples were obtained at three timepoints over approximately 2 years. We then used these blood samples to characterize participants' CTRA gene expression, which we quantified using an a priori 53-transcript composite score derived from RNA sequencing data from peripheral blood leukocytes.

As hypothesized, greater community connection was significantly related to decreased CTRA gene expression across time. These effects were similar regardless of HIV status and were robust to statistical adjustment for several potential confounding factors. In contrast, neither homophobia nor racism were related to CTRA gene expression.

These results suggest that community connection may be a protective factor that reduces biological processes known to negatively impact health. Consequently, interventions and policies aimed at reducing health disparities in marginalized populations may benefit from increasing community connection and inclusion. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

In the 2020 Bostock v Clayton County decision, the US Supreme Court extended employment nondiscrimination protection to sexual minority adults. The health impacts of this ruling and similar policies related to sexual orientation-based discrimination are not currently known.

To estimate changes in mental health following the Bostock decision among sexual minority adults in states that gained employment nondiscrimination protection (intervention states) compared with those in states with protections already in place (control states).

This cross-sectional study used 2018-2022 data from the Behavioral Risk Factor Surveillance System and a difference-in-differences approach to evaluate changes in mental health after the Bostock decision by comparing sexual minority adults (aged ≥18 years and identifying as lesbian, gay, or bisexual) in 12 intervention states with those residing in 9 control states. Models were estimated for all participants and separately for employed participants. Data were analyzed between February and September 2024.

Residing in a state that gained employment nondiscrimination protection after the Bostock decision.

The primary outcome was number of poor mental health days during the past 30 days, and the secondary outcome was severe mental distress (defined as 14 or more past-month poor mental health days).

Of 597 462 participants (306 365 in intervention states [77.7% aged 18-64 years and 22.3% aged ≥65 years; 51.7% female] and 291 097 in control states [77.5% aged 18-64 years and 22.5% aged ≥65 years; 50.6% female]), 5.1% in intervention states and 6.0% in control states self-identified as sexual minority adults. The mean (SE) number of past-month poor mental health days was unchanged after the Bostock decision among sexual minority adults in both intervention (from 8.70 [0.27] to 9.59 [0.24] days; adjusted difference, 0.57 [95% CI, -1.02 to 2.16] days) and control (from 8.53 [0.21] to 10.15 [0.20] days; adjusted difference, 1.17 [95% CI, -0.46 to 2.79] days) states, resulting in no differential change between the 2 groups (difference-in-differences, -0.60 days; 95% CI, -1.25 to 0.06 days). Among the subset of employed sexual minority adults, the mean (SE) number of poor mental health days did not change in intervention states (from 7.99 [0.38] to 8.83 [0.30] days; adjusted difference, 0.87 [95% CI, -0.49 to 2.22] days) but increased in control states (from 7.75 [0.27] to 9.75 [0.26] days; adjusted difference, 1.84 [95% CI, 0.44-3.24] days). These findings corresponded to a significant relative reduction in poor mental health days among employed sexual minority adults in intervention vs control states (difference-in-differences, -0.97 days; 95% CI, -1.74 to -0.21 days). Mean (SE) rates of severe mental distress increased less among employed sexual minority adults in intervention (from 26.35% [1.59%] to 29.92% [1.46%]; adjusted difference, 6.81% [95% CI, 2.20%-11.42%]) vs control (from 26.53% [1.27%] to 34.26% [1.16%]; adjusted difference, 10.30% [95% CI, 5.99%-14.61%) states, also corresponding to a significant relative reduction among employed sexual minority adults (difference-in-differences, -3.49%; 95% CI, -6.71% to -0.27%).

These findings show significant relative reductions in past-month poor mental health days and severe mental distress among employed sexual minority adults after the implementation of a federal ban on employment discrimination based on sexual orientation. Larger and more consistent mental health benefits observed among sexual minority adults in the workforce underscore the importance of broadening protections to other social domains.

The lived experiences of higher-weight people vary; homogenous samples may fail to capture this diversity. This study develops an in-depth understanding of the lived experiences of higher-weight (Body Mass Index ⩾ 30) older adults (⩾60 years of age) in a Canadian Atlantic province. Participants (n = 11) were interviewed face-to-face using a semi-structured interview guide twice at 2-to-3-month intervals regarding their perceived treatment in social and health situations; how positive and negative healthcare experiences affected their health, lifestyles and healthcare seeking-behaviour; and recommendations in terms of patient experiences, access and inclusion. Participants infrequently reported negative experiences; however, participants' experiences were informed by uptake of moralistic, neoliberal discourses. Thematic content analysis identified two major themes: active citizenship (participants demonstrated internalisation of the imperative for weight loss, healthy lifestyles and active ageing) and bright-siding (participants expressed that a positive attitude could prevent/help cope with stigma). Results suggest that individualistic, rather than collective, political solutions to health and stigma have been taken up by higher-weight older adults in a Canadian Atlantic province, which may hinder attempts at structural reforms addressing stigma.