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Frontiers in Psychiatry 2024Mental disorders are often stigmatized in society. The stigma of mental illness affects people with a mental illness themselves as well as their family members-a...
INTRODUCTION
Mental disorders are often stigmatized in society. The stigma of mental illness affects people with a mental illness themselves as well as their family members-a phenomenon called stigma by association (SBA). Children of parents with a mental illness (COPMI) are a particular vulnerable group for SBA. In our systematic review, , , , and were identified as relevant stigma dimensions for children of parents with a mental illness. To assess SBA in adolescents who grow up with a parent with a mental illness, the COPMI-SQ was developed.
METHODS
= 930 adolescents completed the study. Of those, = 380 adolescents (sample 1; 72.6% female, mean age 17.12 ( = 2.01) years) reported growing up with at least one parent with a mental illness. Using confirmatory (CFA) and exploratory factor analyses (EFA) as well as standard item and reliability analyses, we analyzed and revised the COPMI-SQ in the first sample. To validate the factorial structure of the revised COPMI-SQ, CFA was also conducted in the independent sample of the other = 550 adolescents (sample 2; 80.0% female, mean age 16.36 ( = 1.98) years) who reported not growing up with a parent with a mental illness. To test four measurement invariance, a multiple-group CFA was conducted in the combined sample of adolescents who reported growing up with and without a parent with a mental illness (sample 1 and sample 2).
RESULTS
CFA in sample 1 resulted in an inadequate model fit for the theoretically assumed four-factor structure (CFI = .687; RMSEA = .064 (90% CI = .062-.066); SRMR = .092; AIC = 229 155.63). Following EFA and item and reliability analyses in sample 1, the COPMI-SQ was reduced to four scales ("Experienced SBA," "Affiliate SBA," "Shame," and "Anticipated SBA") and two additional screening scales ("Healthcare" and "Social support"). To facilitate questionnaire use, only the three best items were retained in each scale, reducing the total item number to 12 plus five additional screener items. CFA in sample 2 also resulted in an inadequate model fit for the theoretically assumed four factor structure (CFI = .667; RMSEA = .065 (90% CI = .063-.066); SRMR = .101; AIC = 335 651.99). In comparison, the final version of the COPMI-SQ-r showed the best model fit (CFI = .945; RMSEA = .062 (90% CI = .052-.072); SRMR = .049; AIC = 60 008.05). In the multiple-group CFA (sample 1 and sample 2), metric invariance was established (χ (208) = 481.58, p < .001; CFI = .939; RMSEA = .053 (90% CI = .047-.059); SRMR = .056). In sample 2, internal consistency was found to be good for the total scale (α = .84) and almost acceptable to almost good for the subscales (α = .64 to.78).
DISCUSSION
The revised version of the COPMI-SQ (COPMI-SQ-r) is a reliable and economic questionnaire to assess SBA in adolescents who grow up with a parent with a mental illness. The COPMI-SQ-r can be used to help develop and evaluate anti-stigma and general interventions for affected adolescents.
PubMed: 38952634
DOI: 10.3389/fpsyt.2024.1376627 -
Basic and Clinical Andrology Jul 2024Although men with premature ejaculation (PE) always show more negative emotions, including embarrassment, guilt and worry, this may be related to the stigma of PE. To...
BACKGROUND
Although men with premature ejaculation (PE) always show more negative emotions, including embarrassment, guilt and worry, this may be related to the stigma of PE. To investigated stigma and its associations with self-confidence and sexual relations in 4 PE syndromes, a survey was conducted in our hospital from December 2018 to December 2019 among 350 men with self-reported PE and 252 men without self-reported PE. The stigma, self-confidence and sexual relations were assessed by the Social Impact Scale (SIS) and Self-Esteem and Relationship questionnaire (SEAR), respectively. Ejaculation control, sexual life satisfaction and distress caused by PE were evaluated by the Index of PE.
RESULTS
Men with self-reported PE had higher internalized shame and social isolation scores and lower SEAR scores than control subjects. The highest score of internalized shame and social isolation and the lowest score of SEAR appeared in men with lifelong PE (LPE). After age adjustment, the positive relationships were stronger between distress about PE and internalized shame. Whereas, the stronger negative associations were found between social isolation and sexual satisfaction. The strongest association was observed between social isolation and sexual relationship. Therefore, the stigma associated with PE adversely affects the self-confidence, self-esteem, and sexual relationships of men with PE.
CONCLUSION
Men with PE, especially LPE, have a high level of stigma and disharmonious sexual relations, and often lack self-confidence and self-esteem, which have a certain negative impact on their physical and mental health and life. These will be the key issues to be considered when we formulate a personalized treatment plan for PE.
PubMed: 38951750
DOI: 10.1186/s12610-024-00226-1 -
Diabetic Medicine : a Journal of the... Jun 2024People with Type 1 diabetes (T1D) face an increased risk of eating disorders/disordered eating (ED/DE), with adolescents being particularly vulnerable. Empirical...
OBJECTIVE
People with Type 1 diabetes (T1D) face an increased risk of eating disorders/disordered eating (ED/DE), with adolescents being particularly vulnerable. Empirical knowledge on the mechanisms underlying development of ED/DE in T1D is crucial for evolving prevention strategies.
RESEARCH DESIGN AND METHODS
Fourteen semi-structured interviews with adolescent females with T1D and ED/DE between 14 and 18 years were conducted and analyzed using reflexive thematic analysis.
RESULTS
Analyses identified four main themes; 'Interconnected afflictions', 'Judgment', 'Feeling Different', and 'Chaos & Control', These themes explore the interconnectedness of T1D and ED/DE, with shame and guilt emerging as common underlying mechanism. The development of a biopsychosocial model was based on the integration of these data with existing models.
CONCLUSIONS
The study extends previous developmental pathways of ED/DE in adolescents with T1D. We propose a biopsychosocial model that incorporates various factors: predisposing factors such as parental management of T1D and weight gain during adolescence; precipitating factors including comments on weight, frequency of weighing, perceptions of surveillance; the perpetuating bilateral influence of ED/DE and T1D and finally highlighting the protective mechanisms of disease acceptance encompassing parental handling of diagnosis and the contribution of healthcare professionals (HCP's) role in psychoeducation. The present study highlight the vulnerability of adolescence in the presence of T1D, particularly concerning issues related to eating, weight, and body. It offers clinically relevant insights, with the aim to improve communication and management strategies for this very specific group.
PubMed: 38946057
DOI: 10.1111/dme.15397 -
Annals of Vascular Surgery Jun 2024Our objective is twofold: determining if simulation allows residents to reach proficient surgeons' performance concerning Fundamental technical skills of EndoVascular...
OBJECTIVES
Our objective is twofold: determining if simulation allows residents to reach proficient surgeons' performance concerning Fundamental technical skills of EndoVascular Surgery (FEVS) and to while investigating the effects of the program on surgeon's stress.
MATERIAL & METHODS
Using a FEVS training simulator, 8 endovascular FEVS were performed by vascular surgery residents (simulator-naive (SNR) or simulator-experienced (SER)) and seniors. Total time needed to complete the 8 tasks, called Total Completion Time (TCT), was the main evaluation criterion. Analgesia Nociception Index (ANI), was monitored during simulation. Likert scale questionnaire was filled after each simulation.
RESULTS
For each task, TCT was significantly lower for SER and seniors than SNR (p=0.0163). After only 5 simulations, SER were able to reach and even exceed the seniors' level in terms of TCT, with a median time of 10.8 minutes for SER and 11.9 minutes for seniors, and wire's movements with a median distance during cannulation of 4.44 m for SER and 4.17m for seniors. Seniors remained better than SER in terms of precise wire manipulation (wire movement after cannulation), 4.17m against 4.44m (3.72-5.96) respectively. Based on the Likert scale, stress analysis, seniors felt less stressed than both residents' groups (p=0.0618). Seniors' initial ANI and mean ANI over the session was were significantly lower than those of the residents, p=0.0358 and p=0.0250 respectively.
CONCLUSION
We showed that 5 simulation sessions allowed residents to reach experienced surgeons' capacities on FEVS concerning TCT. Subjectively, seniors felt less stressed than residents, contrary to the results of our objective measures of stress.
PubMed: 38942373
DOI: 10.1016/j.avsg.2024.05.004 -
Clinical Psychological Science : a... May 2024Despite the prominence of shame in stigma theories, its role in explaining population-level mental health disparities between the stigmatized and non-stigmatized has not...
Despite the prominence of shame in stigma theories, its role in explaining population-level mental health disparities between the stigmatized and non-stigmatized has not been investigated. We assessed shame explicitly (via self-report) and implicitly (via a behavioral task) in a prospective, representative cohort of sexual minority and heterosexual young adults in Sweden (baseline =2,222). Compared to heterosexuals, sexual minorities evidenced higher explicit and implicit shame, which explained sexual orientation disparities in depression, social anxiety, and suicidal thoughts. Among sexual minorities, there was an indirect effect of shame in the association between interpersonal stigma (i.e., past-year family rejection and childhood bullying) and later experiences of adverse mental health; an indirect effect did not exist for the related construct, internalized stigma. Results suggest extending existing stigma theories to consider emotions like shame as characteristic reactions to stigma and guide the search for treatment targets focused on reducing the mental health sequelae of stigma.
PubMed: 38938414
DOI: 10.1177/21677026231177714 -
Frontiers in Public Health 2024This article deals with combat experiences and their consequences and could be potentially disturbing.
TRIGGER WARNING
This article deals with combat experiences and their consequences and could be potentially disturbing.
INTRODUCTION
Moral injury (MI) is a severe form of combat trauma that shatters soldiers' moral bearings as the result of killing in war. Among the myriad ways that moral injury affects veterans' reintegration into civilian life, its impact on political and societal reintegration remains largely unstudied but crucial for personal, community, and national health.
METHODS
13 in-depth interviews examine combat soldiers' exposure to potentially morally injurious events (PMIEs) that include killing enemy combatants, harming civilians, and betrayal by commanders, the military system, and society. Interviewees also described their political activities (e.g., voting, fundraising, advocacy, protest) and social activism (e.g., volunteering, teaching, charitable work). Interviewees also completed the Moral Injury Symptom Scale.
RESULTS
Two distinct narratives process PMIEs. In a narrative, soldiers hold themselves or their in-group morally responsible for perpetrating, witnessing, or failing to prevent a morally transgressive act such as killing or injuring civilians or placing others at unnecessary risk. In contrast, a perspective blames an out-group for leaving soldiers with no choice but to act in ways that trigger moral distress. Associated with shame and guilt, the humanitarian perspective triggered amends-making and activism after discharge. In contrast, a national security perspective associated with anger and frustration fostered protest and intense activism.
DISCUSSION
Despite its harmful health effects, moral trauma and injury can drive intense political and social activism, depending upon the narrative veterans adopt to interpret PMIEs. Aside from moral injury's personal, familial, and social effects, moral injury drives veterans' return to the political arena of civil society. As such, veterans play a central role in politics and dramatically affect post-war policy in democratic nations following conflict.
Topics: Humans; Veterans; Male; Adult; Israel; Political Activism; Morals; Military Personnel; Female; Middle Aged; Interviews as Topic; Qualitative Research
PubMed: 38932767
DOI: 10.3389/fpubh.2024.1336406 -
Brain Sciences May 2024Patients with borderline personality disorder (BPD) report to be especially prone to social emotions like shame and guilt. At the same time, these emotions seem to play...
OBJECTIVE
Patients with borderline personality disorder (BPD) report to be especially prone to social emotions like shame and guilt. At the same time, these emotions seem to play an important role in BPD pathology. The present study aimed to deepen the knowledge about the processes behind shame and guilt in patients with BPD.
METHODS
Twenty patients with BPD and twenty healthy controls (HCs) took part in an experiment that induced shame and guilt by imagining scenarios during scanning using functional brain imaging. Participants also filled out self-report questionnaires and took part in diagnostic interviews.
RESULTS
BPD patients reported more proneness to guilt but not to shame than the HCs. There was no difference in the self-reported intensity rating of experimentally induced emotions between the groups. Between-group contrast of neural signals in the shame condition revealed a stronger activation of cingulate and fusiform gyrus for the BPD patients compared to the controls, and a more pronounced activation in the lingual gyrus and cuneus for the HCs. In the guilt condition, activation in the caudate nucleus, the fusiform gyrus, and the posterior cingulate cortex was stronger in BPD patients, while HC showed stronger activations in cuneus, lingual gyrus, and fronto-temporal regions.
CONCLUSIONS
Differences in the neuro-functional processes between BPD patients and HC were found, even though the two groups did not differ in their self-report of subjective proneness to guilt and emotional intensity of shame and guilt during the experiment. While the HCs may be engaged more by the emotional scenarios themselves, the BPD patients may be more occupied with cognitive regulatory and self-referential processing.
PubMed: 38928549
DOI: 10.3390/brainsci14060549 -
International Journal of Geriatric... Jul 2024To explore healthcare practitioners' views on management practices of self-harm in older adults.
OBJECTIVES
To explore healthcare practitioners' views on management practices of self-harm in older adults.
METHODS
Semi-structured interviews were conducted with healthcare practitioners, including consultant psychiatrists, general practitioners, clinical psychologists, psychotherapists, clinical nurse specialists and social workers. Purposeful sampling was used to recruit participants in the Republic of Ireland ensuring diverse perspectives of healthcare practitioners were included. Healthcare practitioners were recruited advertising via professional and clinical research networks, social media, and snowballing methods. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis.
RESULTS
We conducted interviews with 20 healthcare practitioners from April to July 2023. Three main themes were generated: first, a perceived greater risk of suicide, and increased awareness of complexity in older adults' self-harm presentations. Second, integrated care as an avenue for improving the management of self-harm in older adults. Third, the importance of safety planning in risk assessments of older adults.
CONCLUSIONS
Healthcare practitioners viewed self-harm in older adults as complex, challenging, and associated with high suicide risk, approaching patients with care and caution. The need for integrated support and improved collaboration between relevant healthcare practitioners was identified. Suggestions were made for primary care having a lead role in identifying and managing older adults after self-harm. Increased mental health promotion and awareness of mental health and self-harm in this age group would help address current stigma and shame.
Topics: Humans; Self-Injurious Behavior; Ireland; Qualitative Research; Male; Female; Attitude of Health Personnel; Aged; Middle Aged; Health Personnel; Adult; Risk Assessment
PubMed: 38925890
DOI: 10.1002/gps.6116 -
Clinical Psychology & Psychotherapy 2024Severe shame is a distressing negative emotion, accompanied by intense feelings of worthlessness that contributes to a broad panoply of psychological disorders. This... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
BACKGROUND
Severe shame is a distressing negative emotion, accompanied by intense feelings of worthlessness that contributes to a broad panoply of psychological disorders. This study aimed to compare the effects on shame dysregulation of two transdiagnostic treatments, the Unified Protocol (UP) and Self-Acceptance Group Therapy (SAGT). We additionally addressed the question of whether borderline personality disorder (BPD) can properly be regarded as an emotional disorder. The focus was on outcome measures, primarily shame that cut across individual diagnostic categories and capture emotional dysfunction broadly conceived.
METHODS
Individuals suffering from a range of emotional disorders (including BPD) and high levels of shame were randomly allocated to treatment by either UP (N = 280) or SAGT (N = 282). Outcomes were measures of emotion dysfunction-shame, loneliness, neuroticism, emotional dysregulation, positive and negative affect-measured pre-treatment, post-treatment and at 3- and 6-month follow-ups.
RESULTS
UP was superior to SAGT in showing better post-treatment retention of therapeutic gains on all outcome measures over the 6-month follow-up period. Compared with those without a BPD diagnosis, those diagnosed with BPD showed significantly higher neuroticism and emotion dysregulation at baseline and a similar post-treatment reduction in almost all outcomes.
CONCLUSIONS
The results support the use of both the UP and SAGT in the treatment of severe shame. The superiority of the UP over SAGT in reducing negative emotionality is interpreted in terms of the specific mechanisms targeted by the UP. The results provide support for the theoretical rationale for the UP as a treatment for dysregulated shame and for emotional dysfunction generally.
Topics: Humans; Shame; Female; Male; Adult; Psychotherapy, Group; Borderline Personality Disorder; Middle Aged; Treatment Outcome; Young Adult
PubMed: 38924181
DOI: 10.1002/cpp.3022 -
The British Journal of Sociology Jun 2024How are we to understand the contemporary preoccupation-at least in many English-speaking societies-with 'random acts of kindness' and the idea of kindness more...
How are we to understand the contemporary preoccupation-at least in many English-speaking societies-with 'random acts of kindness' and the idea of kindness more generally? Should this be seen as a challenge to the logic of capitalism or reinforcing of it, an example of commodification of emotion within our everyday lives? By introducing and mapping the contours of an emergent 'kindness industry', placing emotion (and enchantment) at the heart of how attachment to the idea of kindness is theorised, and marshalling existing empirical research on contemporary framings of everyday kindness, I argue that there is a need for a critical sociological engagement with the 'pro-social' that does justice to its profound ambivalence. In the case of contemporary kindness this involves understanding both the regulatory nature of the enchantment sold by a kindness industry and the problem-solving potential of the enchantment of kindness in the everyday, where it both helps address contemporary feelings of hopelessness and shame and facilitates the possibility of making life materially liveable.
PubMed: 38922695
DOI: 10.1111/1468-4446.13128