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A Mixed Methods Approach to Exploring Social Support and Resilience in Coping with Stigma and Psychological Distress among HIV-Positive Adults

Description: Since its emergence in the U.S., HIV has been a stigmatized illness. People living with HIV (PLH) are a minority and prone to psychological distress and poor mental health outcomes due to HIV-related stigma. PLH who identify with another minority group in addition to being HIV-positive (e.g., gay, African-American) experience multiple forms of oppression or layered stigma. Affirmative social support and resilience are negatively associated with HIV-stigma and are important coping resources for PLH. We used an explanatory sequential mixed methods design study involving a quantitative survey phase and a qualitative interview phase. We explored whether social support and resilience (Positive Psychological Resources) mediate or moderate the relationship between HIV Stigma and Psychological Distress among HIV-positive adults using partial least squares (PLS) path modeling and multiple regressions. Via PLS, we found Positive Psychological Resources partially mediated the relationship between HIV Stigma and Psychological Distress: the path between HIV Stigma and Psychological distress reduced (from t = 5.49, p = .000 to t = 2.39, p = .000) but remained statistically significant. Similarly, via regression, the Sobel test was significant (Sobel = .26, SE = .07, z = 3.63, p = .000). However, moderation was not found (HIV Stigma x Positive Psychological Resources β = .05, t = .66, p = .508). Overall, our quantitative survey and qualitative interview data were consistent. We anticipate that our findings will inform strengths-based therapeutic interventions to mitigate stress and stigma among PLH.
Date: August 2017
Creator: Fritz, Sarah-mee
Partner: UNT Libraries

Oh G-d, A Borderline: Clinical Diagnostics As Fundamental Attribution Error

Description: Researchers raise concerns that the diagnostic approach can create stigma and lead to clinical inferences that focus on dispositional characteristics at the expense of situational variables. From social cognitive theory to strict behavioral approaches there is broad agreement that situation is at least as important as disposition. The present study examined the clinical inferences of graduate student clinicians randomly presented a diagnosis (borderline PD) or no diagnosis and either randomly given context information or no context information before watching a videotaped clinical interaction of a fabricated client. Responses to a questionnaire assessing dispositional or situational attributions about the client’s behavior indicated a diagnosis of borderline personality disorder did not significantly increase dispositional attributions and did not significantly moderate the importance of contextual factors. A notable difference between the attributions made by psychodynamic and third wave behavioral respondents was observed. Conceptual and experimental limitations as well as future directions are discussed.
Date: December 2011
Creator: Schmalz, Jonathan
Partner: UNT Libraries

Licensed Professional Counselors’ Attitudes Toward People with Schizophrenia: Predictors of Interest in Providing Interventions

Description: For individuals with schizophrenia and their caregivers, psychosocial interventions have been shown to significantly improve recovery and reduce relapse rates. Although this population is underserved and stigmatized, counselors have been excluded from most research into attitudes toward and interventions for these families. Using a stratified random sample survey design, researchers explored the relationships between participating U.S. Licensed Professional Counselors’ attitudes towards, recovery beliefs regarding, familiarity with, desire for social distance from, and interest in providing services to individuals with schizophrenia and their caregivers. Most of the 111 participants (11.1% response rate) identified themselves as female (83.8%) and Caucasian (86.5%). A few participants described themselves as Hispanic (6.3%) or Black or African-American (5.4%). Respondents ranged in age in years from 20’s to 60’s with the largest group in their 40’s. Descriptive statistics indicated that the majority of LPC participants reported low to moderate stigmatizing attitudes, strong beliefs in recovery, and moderate to high interest in providing interventions for people with schizophrenia and their caregivers. Furthermore, almost half of participating LPCs reported already working with individuals with schizophrenia. Bivariate correlations and hierarchical regressions indicated that high interest in providing interventions for this population was significantly correlated (p < .01) with high frequency of already working with the population (large effect), low desire for social distance (medium effect), high desire to help socially (medium effect), and strong beliefs in recovery (small effect). The results support including LPCs in all areas pertaining to interventions, research, and recovery for people with schizophrenia and their caregivers.
Date: August 2012
Creator: Hoy, Kathleen Elaine
Partner: UNT Libraries

Back in My Hands: The Role of Self-Forgiveness and Stigma in HIV-Positive Adults

Description: While advancements in treatment have made HIV a more manageable disease, only recently have psychosocial variables associated with the health of persons living with HIV (PLH) began to receive increased scrutiny. HIV-related stigma, considered by some researchers to be a “second epidemic,” is one such psychosocial variable and is associated with negative physiological and psychological health outcomes. In an effort to alleviate the effects of stress, increased research attention has focused on forgiveness as a teachable coping strategy. Current forgiveness interventions demonstrate encouraging results in decreasing anger and neutralizing stress but have not been applied to HIV-positive populations. In this study, Lazarus and Folkman’s transactional model of stress and coping (1984) and Prochaska and Velicer’s transtheoretical model of health behavior (1997) were utilized as theoretical frameworks to inform a randomized clinical trial that examines coping skills, particularly forgiveness, in PLH and perceived HIV-related stigma. An ethnically diverse sample of HIV-positive adults (n = 57) was randomized into a treatment or control group. The treatment group participated in six weeks of cognitive-behavioral group therapy that focused on the teaching of forgiveness as an effective coping tool while the control group was psychoeducational in nature and did not involve mention of forgiveness. Data was obtained on a variety of medical and psychosocial variables, including types of forgiveness (dispositional forgiveness, forgiveness of self, forgiveness of others, and forgiveness of situations) and perceived HIV-related stigma. Data were collected at three time points: at baseline (Time 1) prior to randomization of participants to the treatment or control group, immediately post intervention (Time 2), and at six-month follow-up (Time 3). Importantly, forgiveness was shown to be a teachable skill that PLH can use to potentially improve mental health. Men in the treatment group reported significantly higher levels of dispositional forgiveness and self-forgiveness than men in the ...
Date: August 2012
Creator: Hua, William Q.
Partner: UNT Libraries

Perceptions of Postpartum Depression among Adolescent Mothers and the Social Construction of Related Stigma

Description: Six serial focus groups were used to explore the perceptions of postpartum depression among nine adolescent mothers. The discussions were tape recorded, transcribed and analyzed using symbolic interaction theory, specifically Goffman's concept of stigma. Participants identified major stigma themes in relation to postpartum depression, teenage pregnancy and motherhood, all of which were portrayed negatively in the media. Several key causes of adolescent postpartum depression were also found including self esteem relating to poor body image and social support. The findings indicate a much needed change in the way adolescent mothers are identified and treated for postpartum depression. Additionally, the importance of social support in preventing and treating adolescent postpartum depression is highlighted and programs addressing such concerns must be implemented.
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Date: December 2005
Creator: Gosdin, Melissa M.
Partner: UNT Libraries

“Madness” in the Media: How Can Print Journalists Better Report on Mental Illnesses?

Description: Stereo types and stigmas of individuals with mental illnesses have proved to be a major roadblock preventing these individuals from seeking help. The news media, despite having a responsibility to accurately inform the public, has played a significant role in portraying individuals with mental illness as violent, unpredictable, dangerous, and unfit to live with the rest of “normal” society. This happens through the words journalists choose to use and the information they choose in included, and excluded, when reporting on mental health issues. This study attempts to establish a guideline that journalists can follow that will hopefully reduce the stigma of mental illness in the media, and eventually in society. This study used a 2 x 2 ANCOVA to test two independent variables (amount of labeling terms and amount of corrective information). The variables were manipulated by modifying a news article four times to produce articles with varying levels of labeling terms and corrective information. A control article was also be used. The articles were randomized and passed out to 220 undergraduate college students at the University of North Texas who completed a questionnaire, read their assigned article, and then completed a second questionnaire to determine the impact the article had on their attitudes about individuals with mental illnesses.
Date: August 2014
Creator: Cousineau, Anna Desiree
Partner: UNT Libraries

Complex PTSD As a Less Pejorative Label: Is the Proposed Diagnosis Less Stigmatizing Than BPD?

Description: Clinicians’ attitudes and behaviors toward patients with borderline personality disorder (BPD) are affected by the label’s stigma. Complex posttraumatic stress disorder (CPTSD) was proposed as a comprehensive and less stigmatizing diagnostic category for clients with BPD and a history of complex trauma. Given considerable similarities across both disorders’ diagnostic criteria, the CPTSD framework holds promise as a means to improve therapists’ attitudes towards clients with BPD and a history of complex trauma. However, this quality of CPTSD had not yet been examined empirically. Using vignettes in a between-subjects experimental design, this study investigated whether CPTSD is a less stigmatizing label than BPD for trauma survivors. Participants were 322 practicing psychotherapists. Evidence of BPD stigma was found, as was an affinity for CPTSD. Results generally supported CPTSD as a less stigmatizing label than BPD; therapists presented with a CPTSD-labeled vignette were somewhat less likely to blame the client for her symptomatic behavior and expected slightly stronger working alliance with the client than therapists presented with the BPD-labeled vignette. However, therapists’ agreement with the BPD diagnosis and theoretical orientation were found to be more salient than diagnostic label in affecting concepts related to the stigmatization of BPD clients. Additionally, familiarity with CPTSD was related to more favorable attitudes toward the client and her course of treatment. Regardless of CPTSD’s recognition as a formal diagnosis, education about the construct is widely recommended for therapists.
Date: August 2014
Creator: Miller, Susannah Catherine
Partner: UNT Libraries

The Effects of Labeling and Stigma on the Social Rejection of Striptease Performers

Description: This study uses survey data collected from a convenience sample of undergraduate students (N=89). A vignette survey design is employed to measure social rejection of striptease performers compared to a control group. Data is also collected on negative stereotypes held about striptease performers, which are correlated with social rejection. Link and Phelan's conceptualization of the stigma process provides the theoretical framework for this analysis. Findings suggest that striptease performers experience higher levels of social rejection and are perceived more negatively than the control group and that endorsement of negative stereotypes is associated with social rejection.
Date: December 2006
Creator: Ebeid, Omar Randi
Partner: UNT Libraries

The Relationships among Perception of Stigma, Ethnic Identity, and Acculturation in People Living with HIV/AIDS

Description: The HIV/AIDS epidemic continues to grow and minorities have been affected at a disproportionate rate. Two factors that are hypothesized to be associated with HIV/AIDS stigma include ethnic identity and acculturation. The current study uses a diverse, gender-balanced sample (n= 201, aged 23-68) of African-Americans (54.2%), European Americans (31.8%), and Latinos/Hispanics (10%) to evaluate the relationship among the proposed variables. The study found that higher levels of ethnic identity and other group orientation were associated with lower levels of perceived HIV/AIDS stigma. A stepwise linear regression analysis (adjusted R2 = .13, F(11, 189) = 3.74, p < .001) revealed that as the level of inclusiveness of other ethnic groups (t = -4.263, p < .001) increases, the level of perceived HIV/AIDS stigma decreases. The results from this study suggest that the development of interventions that address stigma and inclusiveness of other ethnic groups may benefit people living with HIV/AIDS.
Date: May 2006
Creator: Chiapa, Ana Luz
Partner: UNT Libraries

Heart Rate Variability as an Indicator of Stress and Resilience in HIV+ Adults: An Analysis of a Stigma Related Stress Induction

Description: Learning of a positive diagnosis of HIV may be one of the most challenging and stressful events in life. The memory of this event is emotionally laden, and even years later evokes an emotional response. Similarly, many people living with HIV (PLH) have memories of the first time they were treated differently because of their diagnosis. While research frequently examines the subjective of stress, few studies have examined biological markers of stress in people living with HIV. Heart Rate Variability offers a non-invasive measure of stress. Beyond serving as a biological marker for stress, changes in HRV are also associated with emotional functioning. Research demonstrates decreased HRV levels in patients with Depression, Anxiety, and PTSD. We conducted a repeated measures MANOVA to examine effects of stress induction on HRV in individuals with high and low levels of HIV-related stigma. We found that the high stigma group was significantly different from the low stigma group in regard to changes in participants’ HRV, Wilks’ λ = .50, F (1, 51) = 11.63, p < .001. A hierarchical linear regression examined the relationship between HRV and other measures of stress (Heart Rate and Blood Pressure). We found that systolic blood pressure and heart rate in the stress condition were predictive of HRV (adjusted R2=.29, F (5,46) =4.07, p<.01). Results of our study support the use of HRV as a measure of stress in HIV-positive adults. Additionally, the results of our study demonstrate significant relationships between stigma, social support and stress in HIV-positive adults.
Date: August 2014
Creator: Lewis, Kimberly
Partner: UNT Libraries