Stigma and health inequality experienced by ethnic minorities during the COVID-19 pandemic in a Chinese community: an implication to health policymakers.

Introduction: Ethnic minorities are considered one of the most vulnerable groups during the COVID-19 pandemic. However, the explanatory pathway of how their disadvantaged experiences during epidemics are related to the embedded and longstanding stigmas against them and how these embedded stigmas can affect their resilience in disease outbreaks are not well understood. This study investigated the experiences of ethnic minorities in the COVID-19 pandemic, and how their experiences were related to the embedded stigma toward them. Methods: This study adopted a qualitative approach, interviewed 25 individuals (13 women and 12 men) from ethnic minority groups residing in Hong Kong from August 2021 to February 2022 in a semi-structured format. Thematic analysis was conducted to analyze the data. Results: The participants were isolated and stereotyped as infectious during the COVID-19 pandemic at community and institutional levels. Their experiences did not occur suddenly during the pandemic but were embedded in the longstanding segregation and negative stereotypes toward ethnic minorities in different aspects of life before the pandemic. These negative stereotypes affected their resilience in living and coping with the pandemic. Conclusion: The participants' experiences during the COVID-19 pandemic were mostly disadvantageous and predominantly initiated by the mainstream stigmatization toward them by the local Chinese residents and government. Their disadvantaged experiences in the pandemic should be traced to the embedded social systems, imposing structural disparities for ethnic minorities when accessing social and medical resources during a pandemic. Because of the preexisting stigmatization and social seclusion of ethnic minorities in Hong Kong, the participants experienced health inequality, which stemmed from social inequality and the power differential between them and the Chinese locals. The disadvantaged situation of the participants negatively affected their resilience to the pandemic. To enable ethnic minorities better cope with future epidemics, merely providing assistance to them during an epidemic is barely adequate, but a more supportive and inclusive social system should be established for them in the long run.

Can social isolation caused by physical distance in people with psychosis be overcome through a Phone Pal?

The current pandemic has forced many people into self-isolation and to practice social distancing. When people are physically isolated and distant from each other, technology may play a fundamental role by enabling social connection and reducing feelings of loneliness caused by this prolonged social isolation. In response to the COVID-19 pandemic, many mental health services worldwide have had to shift their routine face-to-face outpatient appointments to remote telepsychiatry encounters. The increased pressure on mental health services highlights the importance of community-led health-promotion interventions, which can contribute to preventing mental illness or their relapses, and to reduce the burden on health services. Patients with psychosis are particularly socially isolated, have sedentary lifestyles, and commonly face stigma and discrimination from the general population. At the same time, patients with psychosis value technology, are interested in, use and own smart-phones to digitally connect, and are satisfied with their use. Thus, among psychosocial interventions, a helpful resource may be "Phone Pal," a complex intervention which facilitates remote communication between volunteers and socially isolated patients with psychosis through different smart-phone tools. While "Phone Pal" has been originally developed for people with psychosis, it may also be useful to the wider population, helping to overcome the social isolation caused by physical distancing, particularly in these times of widespread isolation. "Phone Pal" may be a potential public health resource for society, providing important support to those that may need it the most, and possibly benefit most from it.

Lessons from the stigma of COVID-19 survivors: A Marxist criticism appraisal.

Stigma refers to devalued stereotypes that create barriers for stigmatized individuals. During the COVID-19 pandemic, the stigmatization of survivors worsened existing inequalities and triggered mass hysteria. The paper delves into the stigmatization experienced by COVID-19 survivors and the role of Marxist criticism in analyzing this issue. The main findings from the empiricist tradition approach suggest that the perception of COVID-19 stigma is higher among those who are older, belong to ethnic minorities, lack social support, have manual occupations, and possess lower levels of education. The proposed destigmatization pathways include psychological counseling services, social support, and health education. Employing a Marxist perspective can aid in illuminating how economic practices and material conditions influence prevalent ideologies related to stigma. The stigmatization of COVID-19 survivors may be perceived as a consequence of social power inequality, although the current emphasis on individual characteristics as triggers for stigma may neglect the wider systemic forces in operation. Thus, it's crucial to establish improved social care policies to combat exploitation and oppression due to power imbalances. The ultimate objective of such an examination is to identify effective approaches to tackle and eradicate stigma regarding health-related concerns. An interdisciplinary approach integrating a pluralistic perspective would benefit investigating how social systems and individual attributes contribute to the exacerbation of social inequality and stigmatization.

Perceived stigma among discharged patients of COVID-19 in Wuhan, China: A latent profile analysis.

Background: Perceived stigma has greatly influenced the life quality of the COVID-19 patients who recovered and were discharged (RD hereafter). It is essential to understand COVID-19 stigma of RD and its related risk factors. The current study aims to identify the characteristics of perceived COVID-19 stigma in RD using latent profile analysis (LPA), to explore its psycho-social influencing factors, and to determine the cut-off point of the stigma scale using receiver operating characteristic (ROC) analysis. Methods: A cross-sectional study was conducted among COVID-19 RD in 13 communities in Jianghan District, Wuhan City, Hubei Province, China from June 10 to July 25, 2021, enrolling total 1,297 participants. Data were collected on demographic characteristics, COVID-19 perceived stigma, post-traumatic stress disorder (PTSD), anxiety, depression, sleep disorder, fatigue, resilience, social support, and peace of mind. LPA was performed to identify different profiles of perceived COVID-19 stigma level. Univariate analysis and multinominal logistic regression analysis were conducted to explore the influencing factors in different profiles. ROC analyses was carried out to identify the cut-off value of perceived stigma. Results: Among the participants, three profiles of perceived stigma were identified: "low perceived COVID-19 stigma" (12.8%), "moderate perceived COVID-19 stigma" (51.1%), and "severe perceived COVID-19 stigma" (36.1%). Multinominal logistic regression analysis revealed that older age, living with other people, anxiety, and sleep disorder were positively associated with moderate perceived COVID-19 stigma, while higher educational level was negatively associated with moderate perceived COVID-19 stigma. Female, older age, living with other people, anxiety, and sleep disorder were positively associated with severe perceived COVID-19 stigma, while higher educational level, social support, and peace of mind were negatively associated with severe perceived COVID-19 stigma. ROC curve of the Short Version of COVID-19 Stigma Scale (CSS-S) for screening perceived COVID-19 stigma showed that the optimal cut-off value was ≥ 20. Conclusion: The study focuses on the issue of perceived COVID-19 stigma and its psycho-socio influencing factors. It provides evidence for implementing relevant psychological interventions to COVID-19 RD.

Social and self-stigma during COVID-19 pandemic: Egyptians' perspectives.

BACKGROUND: Social stigma associated with infectious diseases existed throughout the history of pandemics due to fears of contagion and death. This study aims to assess social and self-stigma resulting from COVID-19 infection and other associated factors in Egypt during the pandemic. METHODS: A cross-sectional study was conducted on 533 adult Egyptians via an online questionnaire. The questionnaire included social stigma toward current and recovered COVID-19 patients and the negative self-image of being a COVID-19 patient. RESULTS: The mean calculated overall COVID-19-related stigma score for the studied sample was 4.7±3.1. The highest reported stigma category was mild stigma: Social stigma towards current COVID-19 patients (88.2%), Social stigma toward recovered COVID-19 patients (64.2%), Negative self-image for being a COVID-19 patient; perceived self-stigma (71.6%) and total stigma score (88.2%) respectively. The overall stigma score was negatively associated with a higher level of education and getting information from healthcare workers and positively associated with getting information from social networks. CONCLUSION: Social and self-stigma related to COVID-19 infection was mild from the Egyptian perspective but found in a large proportion of the population and mainly affected by getting information from healthcare workers or through social media and being more among those with lower education levels. The study recommends more legislative control on social media for disseminating health-related information and conducting awareness campaigns to counteract these adverse effects.

Human rights as the key driver for development of Learning Disability services in Qatar.

Growing international consensus in recognising rights of individuals with disability to enabling environments has spurred on provision of services for support for these individuals. The provision of this support has however been variable across the globe, often depending upon the economic development and social stigma associated with disability within individual countries. Individuals with Mental health learning disability have experienced even more stigma and limitations to access care. Qatar, a young and economically prosperous country, has adopted this rights-based approach to developing services for individuals with learning disability. This has led to the development of a specialist mental health learning disability services which is taking its initial steps within the country. This specialist service places the individual and their family at the centre of developing and delivering care and aims at reducing stigma and improving access to specialist evidence-based care.

A qualitative study on health stigma and discrimination in the first year of the COVID-19 pandemic: Lessons learnt from a public health perspective.

Background: Stigmatisation, misinformation and discrimination have been magnified globally due to the COVID-19 pandemic. The healthcare sector was not spared from this. We conducted a transnational study, using the Health Stigma and Discrimination framework (HSDF) to explore public perception and reactions to the COVID-19 pandemic in a multicultural context. Findings from the Asian arm of the study, sited in Singapore, are reported in this paper. Methods: This phenomenological research deployed semi-structured informant interviews using non-probability sampling approaches to recruit members of the public. Interviews were coded independently by two researchers and thematic analysis was used to analyse the responses. Results: Twenty-nine members of the public (23-80 years old) were interviewed between Oct 2020 to Feb 2021. Five major themes were identified: (i) perception of stigma amongst respondents, (ii) experiences of stigma amongst respondents, (iii) views on what drove stigma and misinformation, (iv) facilitators in preventing and reducing stigma and misinformation, and (v) ageist attitudes towards older adults. Overall, construction workers living in dormitories, healthcare workers, and to some extent tourists from China, were perceived to have been stigmatised and shunned by the public. Place-based stigmatisation was common; participants responded by avoiding places that had confirmed cases of COVID-19. Perceived stigma was temporary and not enduring, driven at the outset by fear of being infected. This study also identified the role played by trust in reducing stigmatisation. The relative absence of politicising of issues and high-quality information readily disseminated to the public were reported as factors that could have reduced and prevented stigma and misinformation on the various groups. Ageist attitudes were observed in some participants with older adults being labelled as vulnerable, susceptible to misinformation and being less able to cope during the pandemic. Conclusion: Through the lens of the HSDF, this study provided an exploratory account of the nature of stigma that resulted from the COVID-19 pandemic in an Asian context. It also shed light on facilitators in preventing and reducing stigma during an outbreak especially the role of trust and communications during a public health crisis.

Association between self-compassion and cyber aggression in the COVID-19 context: roles of attribution and public stigma.

Self-compassion is negatively associated with aggressive behaviors. However, the association between self-compassion and cyber aggression toward stigmatized people (e.g., people infected with COVID-19) has not been investigated in the COVID-19 context and the mechanism underlying this association remains underexplored. On the basis of emotion regulation theory and attribution theory, this study examined the indirect effects of self-compassion on cyber aggression toward people infected with COVID-19 through attribution and public stigma of COVID-19. Data were collected from 1162 Chinese college students (415 male, mean age = 21.61 years). Participants completed an online questionnaire including measurement of the key variables and basic demographic information. Results indicated that self-compassion was negatively associated with cyber aggression through the lower attribution of COVID-19 and lower public stigma of COVID-19. A sequential pathway from the attribution of COVID-19 to public stigma of COVID-19 was identified in the relationship between self-compassion and cyber aggression. Our findings are consistent with emotion regulation theory and attribution theory, which posit that emotion regulation strategies are associated with interpersonal mistreatment through cognitive pathways. These findings suggest that emotional self-regulation strategies can be used to reduce cyber aggression toward stigmatized people by reducing attribution and public stigma in the COVID-19 context. Self-compassion improvement could be target for the interventions aiming at alleviating public stigma and interpersonal mistreatment toward stigmatized people.

Help-Seeking Intentions for Depression and Associated Factors among Chinese Perinatal Women: A Cross-Sectional Study.

A low help-seeking intention for depression is an important reason for the low number of women with perinatal depression who have sought professional help. However, evidence of help-seeking intentions for depression is still lacking in Chinese perinatal women. We aimed to investigate the help-seeking intention for depression and its associated factors among Chinese perinatal women. Participants were recruited from three comprehensive hospitals in Changsha. A total of 874 perinatal women were included in the study. The score for the help-seeking intention for depression in Chinese perinatal women was 3.65 ± 0.79, with about half of participants (58.3%) reporting that they were "likely" and "strongly likely" to seek professional help if they suffered from depression during the perinatal period. Favorable help-seeking attitudes and sufficient knowledge of mental illness help-seeking resources were positively associated with help-seeking intentions for depression. However, self-stigma decreased the help-seeking intention for depression. Chinese perinatal women had relatively positive help-seeking intentions for depression. Reducing the stigma of mental illness and help-seeking, enhancing mental health literacy, and improving attitudes toward professional psychological help-seeking of perinatal women may be the potential key components of interventions to encourage perinatal women to actively seek professional psychological help.

Psychometric development and evaluation of a COVID-19 social stigma scale in Indonesia.

Stigma remains a significant problem globally, creating barriers to services for individuals in need, regardless of access to services. The stigma of COVID-19 primarily happened because it is a new disease with several unknowns, and these unknowns generate fear. This study aimed to conduct a psychometric development and evaluate the Public COVID-19 Stigma Scale that follows the Indonesian community's cultural background. This study used research and development design to measure the COVID-19 stigma through six steps that include seven dimensions and is culturally sensitive, starting from a literature review through to psychometric evaluation. This study was community based and was conducted in 26 regions in the Sumedang Regency. The research and development step ran from July 2021 to November 2022, with a total of 1,686 respondents. The results showed that the social stigma scale for COVID-19 consisted of 11 valid and reliable items that were separated into seven dimensions: social distancing (1 item), traditional prejudice (7 items), exclusionary sentiments (2 items), negative affect (2 items), treatment carryover (1 item), disclosure carryover (2 items), and perception of dangerousness (1 item). Further research needs to be conducted to examine the level of stigma and determine interventions to overcome the social stigma around COVID-19 in the community.

Stigmatization in the context of the COVID-19 pandemic: a survey experiment using attribution theory and the familiarity hypothesis.

BACKGROUND: The COVID-19 pandemic has created a global health crisis, leading to stigmatization and discriminatory behaviors against people who have contracted or are suspected of having contracted the virus. Yet the causes of stigmatization in the context of COVID-19 remain only partially understood. Using attribution theory, we examine to what extent attributes of a fictitious person affect the formation of stigmatizing attitudes towards this person, and whether suspected COVID-19 infection (vs. flu) intensifies such attitudes. We also use the familiarity hypothesis to explore whether familiarity with COVID-19 reduces stigma and whether it moderates the effect of a COVID-19 infection on stigmatization. METHODS: We conducted a multifactorial vignette survey experiment (28-design, i.e., NVignettes = 256) in Germany (NRespondents = 4,059) in which we experimentally varied signals and signaling events (i.e., information that may trigger stigma) concerning a fictitious person in the context of COVID-19. We assessed respondents' cognitive (e.g., blameworthiness) and affective (e.g., anger) responses as well as their discriminatory inclinations (e.g., avoidance) towards the character. Furthermore, we measured different indicators of respondents' familiarity with COVID-19. RESULTS: Results revealed higher levels of stigma towards people who were diagnosed with COVID-19 versus a regular flu. In addition, stigma was higher towards those who were considered responsible for their infection due to irresponsible behavior. Knowing someone who died from a COVID infection increased stigma. While higher self-reported knowledge about COVID-19 was associated with more stigma, higher factual knowledge was associated with less. CONCLUSION: Attribution theory and to a lesser extent the familiarity hypothesis can help better understand stigma in the context of COVID-19. This study provides insights about who is at risk of stigmatization and stigmatizing others in this context. It thereby allows identifying the groups that require more support in accessing healthcare services and suggests that basic, factually oriented public health interventions would be promising for reducing stigma.

COVID-19 stigma and depression across race, ethnicity and residence.

Our cross-sectional study seeks to understand how COVID-19 stigma, race/ethnicity [Asian, Black, Hispanic/Latinx, white] and residency [New York City (NYC) resident vs. non-NYC resident] associated with depression. Our sample includes 568 participants: 260 (45.77%) were NYC residents and 308 (54.3%) were non-NYC residents. A series of multiple linear regression were run to examine the relationship between race/ethnicity, COVID-19 stigma, and depressive symptoms. Irrespective of residency, older age and ever being diagnosed with COVID-19 were negatively associated with depressive symptoms. Stigma and thinking less of oneself significantly associates with depressive symptoms across residency. Our study expects to benefit mental health care providers and public health professionals in designing best practices to mitigate stigma in ongoing or future pandemics.

Exploring Canadian perceptions and experiences of stigma during the COVID-19 pandemic.

Background: The COVID-19 pandemic has led to stigmatization of individuals based on race/ethnicity, age, gender, and occupation, among other factors. We canvassed Canadian residents to explore perceptions of and experiences with stigma during the COVID-19 pandemic. Methods: We conducted an online survey between June 10 and December 31 2020. The survey was rooted in the Health Stigma and Discrimination Framework and included multiple choice, Likert and open-ended questions related to perceived and experienced stigma. Residents of Ontario, Canada were eligible to participate and we aimed to recruit a sample that was diverse by race/ethnicity and age. Results: A total of 1,823 individuals participated in the survey (54% women, 39% men; 54% 18-40 years old, 28% 41-60 years old, 12% 61+ years old; 33% White, 26% East/SouthEast Asian, 14% Black, 12% South Asian). Fifty-one percent of participants agreed/strongly agreed that racist views had increased toward certain racial/ethnic groups in Canada during the pandemic. Participants perceived that people in Canada were stigmatized during the pandemic because of race/ethnicity (37%), political beliefs (26%), older age (24%), being a healthcare worker (23%), younger age (22%), being an essential worker (21%), and gender (11%). Thirty-nine percent of respondents feared experiencing and 37% experienced stigmatization during the pandemic. Men, individuals aged 18-40, and racialized participants were more likely to fear or experience stigma. With respect to health behaviors, 74, 68, and 59% of respondents were comfortable masking in public, seeking medical care if they became ill, and getting tested for COVID-19, respectively. Men were less likely to indicate comfort with mask wearing or seeking medical care. Participants aged 18-40 and Black participants were less likely to indicate comfort with all three behaviors compared to those over age 41 and White participants, respectively. South Asian participants were less likely to be comfortable seeking medical care compared to White Participants. Discussion: Participants feared or experienced stigmatization towards various demographic characteristics during the COVID-19 pandemic. It is critical that the factors driving stigma during health emergencies in Canada be better understood in order to develop effective public health messaging and interventions.

Adolescents with chronic conditions: Engagement with children's mental health systems during the Covid-19 pandemic.

PURPOSE: The Covid-19 pandemic contributed to adverse adolescent mental health outcomes globally. Adolescents with chronic conditions have four times the odds of self-harm than peers. Little evidence exists to guide pediatric nurses on how to engage this vulnerable population with mental health support as the pandemic continues. In adults with chronic conditions, positive health assets (health access literacy, health self-efficacy, and emotional well-being) are directly related to improved patient engagement. The objective of this study was to gain a deeper understanding of engagement with mental health supports in adolescents with chronic conditions to inform practice. DESIGN AND METHODS: Using mixed methods, we surveyed and interviewed adolescents with chronic conditions aged 10-20 years. Random sampling was applied to avoid bias. Valid and reliable scales were used to measure health access literacy, health self-efficacy, and emotional well-being. Textual data were collected using a semistructured interview guide. Integrated data analysis was conducted using structural equation models and interpretive phenomenology. RESULTS: One hundred fifty-four participants provided numerical data and 17 participants provided textual data (mean age 15.5 years; 56% female, 5.8% agender; 56% White; 16.9% Black or African American, 4.5% Asian; 51.9% Hispanic or Latinx; 23.4% LGBTQ+). The structural model was an acceptable fit for the data (comparative fit index [CFI] = 0.97, Tucker-Lewis index [TLI] = 0.95). Participants reported higher levels of health access literacy (M = 3.88, SD = 0.848) than health self-efficacy (M = 2.98, SD = 0.646), and engagement (M = 1.78, SD = 1.71). Health access literacy predicted emotional well-being (ß = .33, p < .001, 95% confidence interval [CI] [.20, .50]) and health self-efficacy (ß = .52, p < .001, 95% CI [0.42, .062]). Emotional well-being positively predicted health self-efficacy (ß = .21, p < .003, 90% CI [0.10, 0.033]). Health self-efficacy predicted engagement (ß = .20, p < .01, 90% CI [0.07, 0.034]). Participants reported not engaging until "it was really, really bad" citing fear, stigma, and lack of connectedness with providers as barriers. PRACTICE IMPLICATIONS: Regardless of health access literacy and health self-efficacy, adolescents with chronic conditions may not engage until crisis levels. Pediatric nurses can aim to engage with this vulnerable population proactively.

A Communication-Based Intervention Study for Reducing Stigma and Discrimination against Tuberculosis among Thai High-School Students.

The current study aims to explore the effectiveness of communication-based intervention on the reduction in TB stigma and discrimination among high-school students in Bangkok, Thailand, during the COVID-19 outbreak. This study is quasi-experimental in nature and is conducted in two high schools (n = 216 students). The study adopts purposive and systematic sampling techniques to select schools and students. The experimental group received a communication program for three months, whereas the control group received no intervention. The study uses generalized estimating equations to assess the overall program between the experimental and control groups at baseline, intervention, and follow-up periods. The outcomes reveal that the communication program effectively reduced TB stigma (p-value < 0.05, CI = 4.962, -1.723) and increased knowledge about TB (p-value < 0.05, CI = 1.825, 2.537), attitudes toward TB (p-value < 0.05, CI = 4.493, 6.280), and self-efficacy on TB stigma and discrimination (p-value < 0.05, CI = 7.133, 9.483) compared with the control group. However, the study finds no significant within- and between-group differences in TB discrimination (p-value > 0.05, CI = -1.398, 0.810). This study is applicable as a supplement for knowledge and attitudes about TB and to the reduction in TB stigma in schools.