Lawrence H Yang
Lawrence H Yang
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Chair and Professor of Social and Behavioral Sciences
Associate Director, Global Center for Implementation Science
Founding Director, Global Mental Health and Stigma Program
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Professional overview
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Dr. Lawrence Yang is Professor and Chair of the Department of Social and Behavioral Sciences; Associate Director of the Global Center for Implementation Science at NYU; and Founding Director of NYU’s Global Mental Health and Stigma Program. He is also PI of a generous donor gift from the Li Ka Shing Foundation to fund an initiative to promote Global Mental Health and Wellness (see link).
Dr. Yang has received extensive interdisciplinary training, including clinical psychology (Boston University), psychiatric epidemiology (Columbia University) and medical anthropology (Harvard University). Dr. Yang has received six national awards in stigma, including the Maltz Prize for Innovative and Promising Schizophrenia Research in 2021 (Brain and Behavior Research Foundation; see link). Dr. Yang has >175 peer-reviewed publications, including in journals such as the JAMA, JAMA Psychiatry, British Journal of Psychiatry, and the American Journal of Public Health. Regarding currently-funded NIH grants, he is PI of three separate R01 grants (below), is multiple PI of a D43 Implementation Science Training Grant in Vietnam, and is co-investigator on 4 R01-level grants. Lawrence is also applying his expertise to address the novel topic of “Migration Stigma”, where he led a think tank and conference sponsored by the prestigious Ernst Strüngmann Forum (June, 2022; see link), which has resulted in a recently-published book by MIT press (Migration Stigma (mit.edu)) and a publication in JAMA (see link).
Brief Research Narrative: If every public health researcher had a calling card, Dr. Lawrence Yang's would be stigma.
What began as a curiosity to think, study and write about his own culture -- Chinese culture and its influences on how stigma is expressed-- drove the GPH Professor to develop a framework for how stigma acts to impede social recovery that could be applied to cultural groups to improve the lives of countless people with mental illness and their families around the world. Dr. Yang also conducts several ongoing research studies on the forefront of global mental health and implementation science.
Building upon dissertation research conducted in Beijing, China, Lawrence initiated his stigma research via an NIMH K-award (2005-2010). Lawrence conducted a study in New York City of how stigma shapes the course of mental illness among Chinese immigrants. Lawrence formulated how culture relates to stigma--i.e. the “What Matters Most” framework—to help implement interventions to improve recovery for stigmatizing conditions. He learned that upholding face (to achieve lineage obligations) was essential, as it is for Asians in many countries. Lawrence then formulated an anti-stigma intervention to help people with mental illness take a powerful step towards regaining face. To inform global programs, Lawrence then applied the ‘what matters most’ approach to HIV stigma in Botswana. Lawrence identified that “womanhood” in Botswana is signified by “having and caring for children” (AJPH, 2021). These cultural imperatives bring pregnant women into contact with free antenatal services, including routine HIV testing, where their HIV status is discovered before their male partners, leading women diagnosed with HIV to be blamed and stigmatized. Lawrence used this framework in a completed NIMH-funded R21 grant to implement an intervention to counter culturally-salient aspects of HIV stigma that impede anti-retroviral treatment. This stigma intervention, by utilizing the perspective that a woman in Botswana who achieves ‘what matters most’ can be protected from HIV stigma, has shown promising results. Lawrence has received a new R01 (R01 TW012402) to expand this intervention for use with women with HIV with serious mental illness in Botswana. He also participated as a Scientific member of the “NIH Office of AIDS Research & NIMH HIV-Related Intersectional Stigma” Working Group (2020).
Lawrence has advanced global mental health research in China as PI of two NIMH-funded R01 studies (R01MH108385; R01 MH127631) with co-PI's, Dr.’s Michael Phillips, William Stone and Matcheri Keshavan, seeking to characterize the cognition of completely untreated psychosis in China. Recently, China has implemented programs to detect untreated psychosis countrywide. Ascertaining participants in rural China, the study has enrolled~ 300 untreated psychosis participants, who are then matched with ~300 treated psychosis participants and an additional ~300 healthy control participants. The study’s first publication shows that cognitive performance may continue to decrease as the duration of untreated psychosis becomes prolonged (JAMA Psychiatry, 2020), thus potentially shifting the scientific thinking about schizophrenia by suggesting possible novel neurodegenerative processes in the natural course of chronic psychosis. A 3-year Supplement also examines the neurobiological markers of untreated psychosis to validate three psychosis subgroups that exhibit neurobiologically distinct differences (or ‘biotypes’). A follow-up longitudinal, 5-year R01 proposal (2021-2026) to capitalize upon this rare cohort has been funded by NIMH.
Relevant to implementation science, Lawrence leads a project to help address the gap in global mental health treatment among those who need but do not receive care for mental disorders, which is disproportionately high in low- and middle-income countries. There has been a call to scale-up mental health services via sharing of mental health care with a broader array of nonspecialists (e.g., community health workers). Yet, knowledge on how to successfully implement task-sharing mental health strategies in real-world settings is lacking. Lawrence is PI of a third NIMH-funded R01 (with co-PI, Dr. Judy Bass; R01 MH122851) to validate a newly-developed measure that enables rapid assessment of modifiable critical factors affecting the implementation of task sharing mental health strategies. This R01 is based upon the “Shared Research Project”, where Dr.’s Yang and Bass examined the barriers and facilitators to scale-up task-sharing interventions in four previous, NIMH-funded global regional networks spanning 4 global hubs (i.e., Latin America; Africa, and India/ Pakistan). This current study will validate this measure within three additional, ongoing NIMH-funded task-sharing mental health programs in South Africa, Chile, and Nepal, thus advancing implementation science globally.
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Education
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BA, High Honors and Phi Beta Kappa, Wesleyan University, Middletown, CTPhD, Boston University, Boston, MAClinical Fellowship, Harvard Medical School (Massachusetts Mental Health Center)Postdoctoral Fellowship, Columbia Mailman School of Public Health (NIMH funded T32 Training Program in Psychiatric Epidemiology)
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Honors and awards
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Maltz Prize for Innovative and Promising Schizophrenia Research -- Brain and Behavior Research Foundation (2021)NIH Fellow-Training Institute for Dissemination & Implementation Research in Health (TIDIRH) (2019)Fellow (Elected), American Psychopathological Association (2018)Award for Emerging Leadership, Americal Psychological Association (2012)Award for Advancing Minority Mental Health, American Psychiatric Foundation (2012)Young Investigator Award, NARSAD/ Brain and Behavior Foundation (2010)Emerging Leader Award for Significant Contributions to the Advancement of Ethnic Minority Psychology, American Psychological Association (2010)Calderone Award for Junior Faculty, Columbia University School of Public Health (2009)REACH for the R01 Award, Columbia University Irving Institute for Clinical and Translational Research (2009)Early Career Research Award, American Psychological Association (2008)Early Career Award, Asian American Psychological Association (2008)Dalmas A. Taylor Outstanding Student Dissertation Award, American Psychological Association (Division of Clinical Psychology- Ethnic Minority Focus) (2002)Outstanding Dissertation Award, American Psychological Association (Division of International Psychology) (2002)
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Areas of research and study
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Cognition and PsychosisGlobal HealthImplementation scienceMental HealthStigma of Health Conditions“At-Risk” States for Psychosis
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Publications
Publications
Reproduction and genetic causal attribution of epilepsy
AbstractOttman, R., Wetmore, J. B., Camarillo, I. A., Rodriguez, S., Misiewicz, S., Siegel, K., Chung, W. K., Phelan, J. C., Leu, C. S., Yang, L. H., & Choi, H. (n.d.).Publication year
2022Journal title
EpilepsiaVolume
63Issue
9Page(s)
2392-2402AbstractObjective: This study addresses the contribution of genetics-related concerns to reduced childbearing among people with epilepsy. Methods: Surveys were completed by 606 adult patients with epilepsy of unknown cause at our medical center. Poisson regression analysis was used to assess the relations of number of offspring to: (1) genetic attribution (GA: participants' belief that genetics was a cause of their epilepsy), assessed via a novel scale developed from four survey items (Cronbach's alpha =.89), (2) participants' estimates of epilepsy risk in the child of a parent with epilepsy (1%, 5%–10%, 25%, and 50%–100%), and (3) participants' reports of the influence on their reproductive decisions of “the chance of having a child with epilepsy” (none/weak/moderate, strong/very strong). Analyses were adjusted for age, education, race/ethnicity, religion, type of epilepsy (generalized, focal, and both/unclassifiable), and age at epilepsy onset (<10, 10–19, and ≥20 years). Results: Among participants 18–45 years of age, the number of offspring decreased significantly with increasing GA (highest vs lowest GA quartile rate ratio [RR] =.5, p <.001), and increasing estimated epilepsy risk in offspring (with 5%–10% as referent because it is closest to the true value, RR for 25%:.7, p =.05; RR for 50%–100%:.6, p =.03). Number of offspring was not related to the reported influence of “the chance of having a child with epilepsy” on reproductive decisions. Among participants >45 years of age, the number of offspring did not differ significantly according to GA quartile or estimated offspring epilepsy risk. However, those reporting a strong/very strong influence on their reproductive decisions of “the chance of having a child with epilepsy” had only 60% as many offspring as others. Significance: These findings suggest that overestimating the risk of epilepsy in offspring can have important consequences for people with epilepsy. Patient and provider education about recurrence risks and genetic testing options to clarify risks are critical, given their potential influence on reproductive decisions.Stigma and coping experiences in Latinx individuals at clinical high-risk for psychosis
AbstractRuiz, B., Ceccolini, C. J., Shah, B. B., Crump, F., Girgis, R. R., Brucato, G., Yang, L. H., & Corcoran, C. M. (n.d.).Publication year
2022Journal title
Early Intervention in PsychiatryVolume
16Issue
1Page(s)
34-41AbstractAim: The experiences of culturally diverse individuals at clinical high-risk for psychosis (CHR) is not well studied. Exploratory research needs to examine whether differences exist between racial/ethnic groups within the CHR population. Understanding experiences of Latinx patients is of importance, as the Latinx population represents the most rapidly growing paediatric population in the United States and they face significant barriers to mental health treatment. Because Latinx persons experience high rates of mental illness-based stigma and discrimination in their communities, they may face additional stigma-based barriers to CHR treatment. Method: Twenty-six participants (15 Latinx, 11 non-Latinx white/NLW) who met CHR criteria based on the Structured Interview for Psychosis-Risk Syndromes (SIPS) were interviewed regarding stigma associated with CHR identification and symptoms. Using a consensus-based open-coding thematic analysis approach, data were analysed for stigma, discrimination, and coping responses. Results: Instances of internalization of stereotypes appeared to be more salient to NLW participants than Latinx participants, and Latinx participants reported seemingly more anticipated rejection from stereotypes than NLW participants. Experiences of discrimination also appeared to be more salient to Latinx participants than NLW participants. Moreover, Latinx participants reported evidently greater instances of discrimination across anticipated, individual, and structural discrimination. Finally, while covering strategies appeared to be more salient to NLW's, Latinx clients more often described using secrecy as well as a greater range of coping responses, including empowerment. Conclusion: While the experience of anticipated rejection appeared to be more salient to Latinx CHR participants and they seemingly report more secrecy than NLW, they also engaged in empowerment-related coping strategies. Future research should continue to explore the roles of cultural values in influencing coping strategies among CHR individuals.Structural Racism and Inequities in Incidence, Course of Illness, and Treatment of Psychotic Disorders Among Black Americans
AbstractMisra, S., Etkins, O. S., Yang, L. H., & Williams, D. R. (n.d.).Publication year
2022Journal title
American journal of public healthVolume
112Issue
4Page(s)
624-632AbstractPsychotic disorders (e.g., schizophrenia, schizoaffective disorder) are a leading cause of morbidity and premature mortality and an overlooked health inequity in the United States. European data indicate inequities in incidence, severity, and treatment of psychotic disorders, particularly for Black communities, that appear to be primarily attributable to social adversities. The dominant US narrative is that any observed differences are primarily a result of clinician bias and misdiagnosis. We propose that employing the framework of structural racism will prompt European and US research to converge and consider the multifaceted drivers of inequities in psychotic disorders among Black Americans. In particular, we describe how historical and contemporary practices of (1) racialized policing and incarceration, and (2) economic exploitation and disinvestment, which are already linked to other psychiatric disorders, likely contribute to risks and experiences of psychotic disorders among Black Americans. This framework can inform new strategies to (1) document the role of racism in the incidence, severity, and treatment of psychotic disorders; and (2) dismantle how racism operates in the United States, including defunding the police, abolishing carceral systems, and redirecting funds to invest in neighborhoods, housing, and community-based crisis response and mental health care. (Am J Public Health. 2022;112(4):624-632. https://doi.org/10.2105/AJPH.2021.306631).The Association Between Mental Health Stigma and Face Emotion Recognition in Individuals at Risk for Psychosis
AbstractHerrera, S. N., Larsen, E. M., Deluca, J. S., Crump, F. M., Grivel, M., Blasco, D., Bryant, C., Shapiro, D. I., Downing, D., Girgis, R. R., Brucato, G., Huang, D., Kufert, Y., Verdi, M., West, M. L., Seidman, L. J., Link, B. G., McFarlane, W. R., Woodberry, K. A., … Corcoran, C. M. (n.d.).Publication year
2022Journal title
Stigma and HealthVolume
8Issue
1Page(s)
31-39AbstractSelf-stigma has been associated with reduced accuracy of face emotion recognition in individuals at clinical high risk for psychosis (CHR). Stigma may also relate to slowing of performance during cognitive tasks for which a negative stereotype is relevant. This study aimed to investigate the association of mental illness stigma with face emotion recognition among CHR individuals. Participants were 143 CHR individuals identified using the Structured Interview for Psychosis-Risk Syndromes (SIPSs). Face emotion recognition was assessed using the Penn emotion recognition task (ER-40). Stigma was assessed using discrimination, stereotype awareness, and stereotype agreement subscales of the Mental Health Attitudes Interview for CHR. We tested associations of ER-40 accuracy and response times with these stigma variables, including the role of clinical and demographic factors. Racial/ethnic minoritized participants had higher attenuated positive symptoms than nonminoritized participants. Longer ER-40 response times were correlated with greater stereotype agreement (r =.17, p =.045) and discrimination (r =.22, p =.012). A regression model predicting ER-40 response times revealed an interaction of stereotype agreement with minoritized status (p =.008), with slower response times for minoritized participants as stereotype agreement increased. Greater disorganized symptoms and male gender also predicted longer response times. ER-40 accuracy was not associated with stigma. Overall, minoritized CHR individuals with greater internalized stigma took longer to identify face emotions. Future research is needed to assess whether slower response times are specific to social cues, and if internalized stigma interferes with performance in real-world social situations. Reducing stigma may be an important target for interventions that aim to improve social skills.The stigma system: How sociopolitical domination, scapegoating, and stigma shape public health
AbstractFriedman, S. R., Williams, L. D., Guarino, H., Mateu-Gelabert, P., Krawczyk, N., Hamilton, L., Walters, S. M., Ezell, J. M., Khan, M., Di Iorio, J., Yang, L. H., & Earnshaw, V. A. (n.d.).Publication year
2022Journal title
Journal of Community PsychologyVolume
50Issue
1Page(s)
385-408AbstractStigma is a fundamental driver of adverse health outcomes. Although stigma is often studied at the individual level to focus on how stigma influences the mental and physical health of the stigmatized, considerable research has shown that stigma is multilevel and structural. This paper proposes a theoretical approach that synthesizes the literature on stigma with the literature on scapegoating and divide-and-rule as strategies that the wealthy and powerful use to maintain their power and wealth; the literatures on racial, gender, and other subordination; the literature on ideology and organization in sociopolitical systems; and the literature on resistance and rebellion against stigma, oppression and other forms of subordination. we develop a model of the “stigma system” as a dialectic of interacting and conflicting structures and processes. Understanding this system can help public health reorient stigma interventions to address the sources of stigma as well as the individual problems that stigma creates. On a broader level, this model can help those opposing stigma and its effects to develop alliances and strategies with which to oppose stigma and the processes that create it.The Tōhoku Theater Project in Postdisaster Japan: An Exemplar for Addressing Community Mental Health in the Context of Disaster
AbstractPike, K. M., Rebello, T. J., Hanasaki, S., Narita-Ohtaki, R., Kaufman, P., Akiyama, T., Doerries, B., Yang, L. H., Suzuki, N., Magill, E. B., & Yasumura, S. (n.d.).Publication year
2022Journal title
Hospital and Community PsychiatryVolume
73Issue
6Page(s)
712-715AbstractThe Tōhoku Theater Project was completed 2 years after the natural and nuclear disasters in Tōhoku, Japan, on March 11, 2011. It employed the dramatic arts to support the healing process, promote resilience, and increase dialogue and understanding about mental health among individuals who were directly affected by the disasters. The four performances fostered important discussions regarding the psychological impact of the Tōhoku disasters. Participants (N=143) found the theater performance effective at facilitating discussion, increasing empathy, and enhancing mental health knowledge, coping, and resilience. The performances provided critical information about access to services; many participants reported that they had not known where to seek help for mental health prior to their involvement with the Tōhoku Theater Project. Lessons learned may inform community-based strategies that promote mental health and healing in the wake of the COVID-19 pandemic and other public health disasters.Understanding Users’ Perspectives of Psychosocial Mechanisms Underpinning Peer Support Work in Chile
AbstractLe, P. T. D., Agrest, M., Mascayano, F., Dev, S., Kankan, T., Dishy, G., Tapia-Muñoz, T., Tapia, E., Toso-Salman, J., Pratt, C., Alves-Nishioka, S., Schilling, S., Jorquera, M. J., Castro-Valdez, J., Geffner, N., Price, L. S. N., Conover, S., Valencia, E., Yang, L. H., … Susser, E. S. (n.d.).Publication year
2022Journal title
Community mental health journalVolume
58Issue
1Page(s)
111-120AbstractThis study explores the beliefs and attitudes about the psychosocial mechanisms of peer support work among users who participated in Critical Time Intervention-Task Shifting (CTI-TS), which tested the acceptability and feasibility of a peer support work model to improve community-based mental health care for individuals with psychosis in Latin America. We conducted a secondary analysis of 15 in-depth interviews with CTI-TS participants in Chile, using the framework method and defined the framework domains based on five major mechanisms of peer support work identified by a recent literature review. The analysis revealed that users’ perceptions of peer support work mechanisms were strongly shaped by personal motivations, beliefs about professional hierarchies, familial support, and the Chilean mental health system’s incipient recovery orientation. The findings underscore the importance of adopting culturally tailored strategies to promote peer support work, such as involving mental health professionals and fostering equal-powered relationships between PSWs and users.Behavioral correlates of COVID-19 worry: Stigma, knowledge, and news source
Disengagement from early intervention services for psychosis: A systematic review
AbstractMascayano, F., Van Der Ven, E., Martinez-Ales, G., Henao, A. R., Zambrano, J., Jones, N., Cabassa, L. J., Smith, T. E., Yang, L. H., Susser, E., & Dixon, L. B. (n.d.).Publication year
2021Journal title
Psychiatric ServicesVolume
72Issue
1Page(s)
49-60AbstractObjective: Therapeutic benefits associated with early services for psychosis are influenced by the degree to which participants engage in treatment. The main objective of this review was to analyze rates of disengagement in early psychosis services and identify predictors of disengagement in these settings. Methods: A systematic search for studies published in the 1966-2019 period was conducted in PubMed, Google Scholar, EBSCO, Ovid, and Embase. The Observational Cohort and Cross-Sectional Studies scale was used to assess the methodological quality of reports identified in this search. A revised version of the behavioral model of health service use was employed to evaluate and understand predictors of disengagement (categorized as predisposing, enabling, and need factors) identified in the studies with the highest quality. Results: Twenty studies met the inclusion criteria. Disengagement rates (12% to 53%) and definitions of disengagement varied widely across these studies. Most did not find a compelling association between predisposing factors (e.g., age) and disengagement. Enabling factors, such as lack of family support and living alone, were consistently found to be related to increased disengagement across studies. Finally, need factors, such as lower medication adherence and higher drug misuse, were associated with higher risk for disengagement. Conclusions: Enabling and need factors seemed to be the most predictive of disengagement from early psychosis services. Substantial between-study variation in identified predictors of disengagement may be addressed by developing and applying a consensus definition of disengagement in future research.Emotional and stigma-related experiences relative to being told one is at risk for psychosis
AbstractWoodberry, K. A., Powers, K. S., Bryant, C., Downing, D., Verdi, M. B., Elacqua, K. M., Reuman, A. R., Kennedy, L., Shapiro, D. I., West, M. L., Huang, D., Crump, F. M., Grivel, M. M., Blasco, D., Herrera, S. N., Corcoran, C. M., Seidman, L. J., Link, B. G., McFarlane, W. R., & Yang, L. H. (n.d.).Publication year
2021Journal title
Schizophrenia ResearchVolume
238Page(s)
44-51AbstractObjective: Despite the appeal of early intervention in psychosis, there is concern that identifying youth as having high psychosis risk (PR) may trigger stigma. This study employed a pre-post design to measure change in PR participants' emotions about PR upon being told of their PR status and according to whether this was the first time receiving this information. Methods: Participants (n = 54) identified as at PR via structured interview rated their emotions about PR before and after being told they were at PR. Qualitative analyses explored the valence of participant reflections on being given this information. Results: Participants reported significantly less negative emotion after being told of their PR status (p < .001), regardless of whether they were hearing this for the first time (p = .72). There was no change in positive emotions or the predominant belief that they should keep their PR status private. Most participants commented positively about the process of feedback but negatively about its impact on their self-perceptions and/or expectations of others' perceptions of them. Conclusion: This is the first study to collect pre-post data related to being told one is at PR and to examine quantitative and qualitative responses across and within individuals. For a majority of participants, clinical feedback stimulated negative stereotypes even as it relieved some distress. To actively address internalized stigma, clinicians providing feedback to PR youth must attend to the positive and negative impacts on how youth think about themselves as well as how they feel.Identifying “What Matters Most” to Men in Botswana to Promote Resistance to HIV-Related Stigma
AbstractMisra, S., Mehta, H. T., Eschliman, E. L., Rampa, S., Poku, O. B., Wang, W. Q., Ho-Foster, A. R., Mosepele, M., Becker, T. D., Entaile, P., Arscott-Mills, T., Opondo, P. R., Blank, M. B., & Yang, L. H. (n.d.).Publication year
2021Journal title
Qualitative Health ResearchVolume
31Issue
9Page(s)
1680-1696AbstractDespite a comprehensive national program of free HIV services, men living with HIV in Botswana participate at lower rates and have worse outcomes than women. Directed content analysis of five focus groups (n = 38) and 50 in-depth interviews with men and women with known and unknown HIV status in Gaborone, Botswana in 2017 used the “what matters most” (WMM) and “structural vulnerability” frameworks to examine how the most valued cultural aspects of manhood interact with HIV-related stigma. WMM for manhood in Botswana included fulfilling male responsibilities by being a capable provider and maintaining social status. Being identified with HIV threatened WMM, which fear of employment discrimination could further exacerbate. Our findings indicate how cultural and structural forces interact to worsen or mitigate HIV-related stigma for urban men in Botswana. These threats to manhood deter HIV testing and treatment, but interventions could capitalize on cultural capabilities for manhood to promote stigma resistance.Implementation of a pilot community-based psychosocial intervention for patients with psychoses in Chile and Brazil: a comparative analysis of users’ perspectives
AbstractDev, S., Kankan, T., Blasco, D., Le, P. T. D., Agrest, M., Dishy, G., Mascayano, F., Schilling, S., Jorquera, M. J., Dahl, C., Cavalcanti, M. T., Price, L. S., Conover, S., Yang, L. H., Alvarado, R., & Susser, E. S. (n.d.).Publication year
2021Journal title
Global Mental HealthVolume
8AbstractBackground. Few studies provide clear rationale for and the reception of adaptations of evidence-based interventions. To address this gap, we describe the context-dependent adaptations in critical time intervention-task shifting (CTI-TS), a manualized recovery program for individuals with psychosis in Rio de Janeiro, Brazil and Santiago, Chile. Implications of the adaptations – incorporating a task-shifting approach and modifying the mode of community-based service delivery – are examined from users’ perspectives. Methods. A secondary analysis of in-depth interviews with CTI-TS users (n = 9 in Brazil; n = 15 in Chile) was conducted. Using the framework method, we thematically compared how participants from each site perceived the main adapted components of CTI-TS. Results. Users of both sites appreciated the task-shifting worker pair to provide personalized, flexible, and relatable support. They wanted CTI-TS to be longer and experienced difficulty maintaining intervention benefits in the long-term. In Chile, stigma and a perceived professional hierarchy toward the task-shifting providers were more profound than in Brazil. Engagement with community-based services delivery in homes and neighborhoods (Chile), and at community mental health centers (Brazil) were influenced by various personal, familial, financial, and social factors. Uniquely, community violence was a significant barrier to engagement in Brazil. Conclusion. CTI-TS’ major adaptations were informed by the distinct mental health systems and social context of Santiago and Rio. Evaluation of user experiences with these adaptations provides insights into implementing and scaling-up task-shifting and community-oriented interventions in the region through the creation of specialized roles for the worker pair, targeting sustained intervention effects, and addressing socio-cultural barriers.Naturalistic conceptions of genetic optimism and precision psychiatry among those at clinical high-risk for psychosis
AbstractBlasco, D., Stortz, S. W., Grivel, M. M. R., Dishy, G. A., Samuel, S. S., Pilla, D., Crump, F. M., Lieff, S. A., Williams, J., Phoummavong, P., Guo, X., Brucato, G., Girgis, R. R., & Yang, L. H. (n.d.).Publication year
2021Journal title
Early Intervention in PsychiatryVolume
15Issue
3Page(s)
742-745AbstractAim: Fuelled by genomics advances, recent emphasis on the concept of “precision medicine,” and public optimism towards genetic advances, it is important to understand how those who are considered to be at clinical high-risk for psychosis (CHR) perceive possible benefits of genetic testing to inform future stakeholder education efforts. Methods: Semistructured interviews were completed with 20 participants who met CHR criteria. Coding for genetic optimism was completed. Results: Participants endorsed many conceptualizations of the link between genetics, the development of psychosis, and the benefits of genetic testing. Specifically, themes emerged surrounding how genetic testing may lead to greater genetic knowledge and tailored treatment. Conclusions: Our results demonstrate that CHR participants generally endorse several precision psychiatry concepts, including how genetic testing may lead to tailored treatment advances. This knowledge may aid development of best communication practices regarding forthcoming genetic advances in diagnosis and treatment among CHR.Peer-to-peer contact, social support and self-stigma among people with severe mental illness in Hong Kong
AbstractLi, X. H., Zhang, T. M., Yau, Y. Y., Wang, Y. Z., Wong, Y. L. I., Yang, L., Tian, X. L., Chan, C. L. W., & Ran, M. S. (n.d.).Publication year
2021Journal title
International Journal of Social PsychiatryVolume
67Issue
6Page(s)
622-631AbstractBackground: Self-stigma exerts a range of adversities for persons with severe mental illness (SMI), however, little is known about the association between peer contact, social support and self-stigma. Aims: This study aimed to explore the mediating role of social support on the relationship between peer contact and self-stigma among persons with SMI in Hong Kong. Methods: A total of 159 persons with SMI (schizophrenia and mood disorder) in community service centres participated in the study through completing a survey on self-stigma, social functioning, social support, perception of peer contact and mass media. Logistic regression was utilised to explore the influencing factors of self-stigma among the participants. Results: The results showed that 81.1% of participants reported moderate to severe levels of self-stigma. Self-stigma was significantly associated with diverse factors (e.g. social functioning). Importantly, positive peer contact was significantly associated with lower self-stigma of persons with SMI. Social support acted as a mediator between peer contact and self-stigma. Conclusion: The results of this study suggest that contact-based interventions, such as enhancing positive peer-to-peer contact, should be conducted for reducing self-stigma among persons with SMI.Psychometric Validation of a Scale to Assess Culturally-Salient Aspects of HIV Stigma Among Women Living with HIV in Botswana: Engaging “What Matters Most” to Resist Stigma
AbstractYang, L. H., Ho-Foster, A. R., Becker, T. D., Misra, S., Rampa, S., Poku, O. B., Entaile, P., Goodman, M., & Blank, M. B. (n.d.).Publication year
2021Journal title
AIDS and BehaviorVolume
25Issue
2Page(s)
459-474AbstractPerceived stigma deters engagement in HIV care and is powerfully shaped by culture. Yet few stigma measures consider how cultural capabilities that signify “full personhood” could be engaged to resist stigma. By applying a theory conceptualizing how culturally-salient mechanisms can worsen or mitigate HIV stigma in relation to “what matters most” (WMM), we developed the WMM Cultural Stigma Scale for Women Living with HIV in Botswana (WMM-WLHIV-BW) and psychometrically evaluated it among 201 respondents with known and unknown HIV status. The two subscales, Cultural Factors Shape Stigma (CFSS) and Cultural Capabilities Protect against Stigma (CCPS) were reliable (both α= 0.90). Among WLHIV, the CFSS Subscale showed initial construct validity with depressive symptoms (r =.39, p =.005), similar to an established HIV stigma scale, whereas the CCPS Subscale showed initial construct validity with self-esteem (r =.32, p =.026) and social support number (r =.29, p =.047), suggesting that achieving local cultural capabilities mitigates stigma and is linked with positive psychosocial outcomes. This culturally-derived scale could help WLHIV in Botswana experience improved stigma-related outcomes.Reducing Stigma among Youth at Risk for Psychosis: A Call to Action
Deluca, J. S., Yang, L. H., Lucksted, A. A., Yanos, P. T., Devylder, J., Anglin, D. M., Landa, Y., & Corcoran, C. M. (n.d.).Publication year
2021Journal title
Schizophrenia bulletinVolume
47Issue
6Page(s)
1512-1514Reducing Stigma Toward Individuals with Schizophrenia Using a Brief Video: A Randomized Controlled Trial of Young Adults
AbstractAmsalem, D., Yang, L. H., Jankowski, S., Lieff, S. A., Markowitz, J. C., & Dixon, L. B. (n.d.).Publication year
2021Journal title
Schizophrenia bulletinVolume
47Issue
1Page(s)
7-14AbstractObjective: Stigma decreases healthcare seeking and treatment adherence and increases the duration of untreated psychosis among people with first-episode psychosis (FEP). This study evaluated the efficacy of a brief video-based intervention in reducing stigma among youth toward individuals with FEP and schizophrenia. We hypothesized that the social-contact-based video intervention group would reduce stigma more than written vignette and control groups, and the vignette more than the control group. Methods: Using Amazon Mechanical Turk, we recruited and assigned 1203 individuals aged 18-30 to either (a) video intervention, (b) written description of the same content ("vignette"), or (c) nonintervention control arm. In the 90-second video intervention, an empowered young woman with schizophrenia described her FEP and the aspects of successful coping with her everyday life difficulties, exposing the viewer to schizophrenia in the context of her personal narrative. Web-based self-report questionnaires assessed stigma domains, including social distance, stereotyping, separateness, social restriction, and perceived recovery. Results: A MANOVA showed a significant between-group effects for all 5 stigma-related subscales (P <. 001). Post hoc pairwise tests showed significant differences between video and vignette vs control for all 5 stigma domains. Video and vignette groups differed significantly on social distance, stereotyping, and social restriction. Secondary analyses revealed gender differences across stigma domains in the video group only, with women reporting lower stigma. Conclusions: A very brief social contact-based video intervention efficaciously reduced stigma toward individuals with FEP. This is the first study to demonstrate such an effect. Further research should examine its long-term sustainability.Sociodemographic and Behavioral Factors Associated With COVID-19 Stigmatizing Attitudes in the U.S.
Stigma of Treatment Stages for First-Episode Psychosis: A Conceptual Framework for Early Intervention Services
AbstractYang, L. H., Blasco, D., Lieff, S. A., Le, P. T. D., Li, Y. P., Broeker, M., Mascayano, F., Bello, I., Nossel, I., & Dixon, L. (n.d.).Publication year
2021Journal title
Harvard Review of PsychiatryVolume
29Issue
2Page(s)
131-141AbstractEarly intervention services (EIS; in the United States, Coordinated Specialty Care) can lead to substantial improvements in psychiatric symptoms and social functioning for individuals with first-episode psychosis who engage in treatment. Nevertheless, stigma associated with early intervention services can limit their full potential benefits by preventing or reducing participation. Drawing from Corrigan's "why try"model positing relationships between public and self-stigma, engagement in treatment services, and the EIS treatment model, this article proposes a framework that delineates how distinct forms of stigma are linked to given stages of treatment engagement in first-episode psychosis. We identify three phases of engagement: (1) community outreach, which has associations with public stigma; (2) the referral and evaluation process, which primarily has associations with self-stigma; and (3) EIS, which have associations with self-stigma and its psychosocial consequences. For each phase, we describe evidence-based strategies typically provided by EIS programs, using OnTrackNY as an exemplary model, to illustrate potential linkages in our conceptual framework. By specifying how distinct forms of stigma are associated with EIS treatment stages, this framework is intended to guide EIS programs in explicitly addressing stigma to optimize recovery of individuals with first-episode psychosis.Stigma, Structural Vulnerability, and "what Matters Most" among Women Living with HIV in Botswana, 2017
AbstractYang, L. H., Poku, O. B., Misra, S., Mehta, H. T., Rampa, S., Eisenberg, M. M., Yang, L. S., Cao, T. X. D., Blank, L. I., Becker, T. D., Link, B. G., Entaile, P., Opondo, P. R., Arscott-Mills, T., Ho-Foster, A. R., & Blank, M. B. (n.d.).Publication year
2021Journal title
American journal of public healthVolume
111Issue
7Page(s)
1309-1317AbstractObjectives. To explore whether beneficial health care policies, when implemented in the context of gender inequality, yield unintended structural consequences that stigmatize and ostracize women with HIV from "what matters most" in local culture. Methods. We conducted 46 in-depth interviews and 5 focus groups (38 individuals) with men and women living with and without HIV in Gaborone, Botswana, in 2017. Results. Cultural imperatives to bear children bring pregnant women into contact with free antenatal services including routine HIV testing, where their HIV status is discovered before their male partners'. National HIV policies have therefore unintentionally reinforced disadvantage amongwomen with HIV,wherebymen delay or avoid testing by using their partner's status as a proxy for their own, thus facilitating blame toward women diagnosed with HIV. Gossip then defines these women as "promiscuous" and as violating the essence of womanhood. We identified cultural and structural ways to resist stigma for these women. Conclusions. Necessary HIV testing during antenatal care has inadvertently perpetuated a structural vulnerability that propagates stigma toward women. Individual- and structural-level interventions can address stigma unintentionally reinforced by health care policies.Sustained Effect of a Brief Video in Reducing Public Stigma Toward Individuals With Psychosis: A Randomized Controlled Trial of Young Adults
AbstractAmsalem, D., Markowitz, J. C., Jankowski, S. E., Yang, L. H., Valeri, L., Lieff, S. A., Neria, Y., & Dixon, L. B. (n.d.).Publication year
2021Journal title
American Journal of PsychiatryVolume
178Issue
7Page(s)
635-642AbstractObjective: Public stigma is a barrier to care and increases the duration of untreated psychosis among individuals with first-episode psychosis. The authors recently demonstrated the efficacy of a 90-second social contact–based video intervention in reducing such stigma. That proof-of-concept study was the first to employ so brief an antistigma intervention in a sample of young adults. The authors now present a randomized controlled replication study with baseline, postintervention, and 30-day follow-up assessments. The authors aimed to replicate their previous findings and to show a persisting benefit for the video intervention. Methods: Using a crowdsourcing platform (Amazon Mechanical Turk), the authors recruited and assigned 1,055 participants ages 18–30 years to a brief video-based intervention, to a written vignette intervention containing the same material, or to a nonintervention control condition. In the 90-second video, a 22-year-old African American woman with schizophrenia humanized the illness through her emotional description of living a meaningful and productive life. Results: A three-by-three group-by-time multivariate analysis of variance showed a significant group-by-time interaction for the total scores of all five stigma-related domains: social distance, stereotyping, separateness, social restriction, and perceived recovery. Post hoc pairwise tests showed greater reductions in the video group compared with the vignette and control groups at the postintervention and 30-day follow-up assessments, while the vignette group differed from the control group at the postintervention assessment but not at the 30-day assessment. Conclusions: This randomized controlled study replicated and strengthened the authors’ earlier findings, further showing month-long sustained stigma reduction in the social contact–based video intervention arm. A 90-second video sufficed to humanize schizophrenia and reduce stigma. Further research should examine longer-term sustainability, assess changes in behavior, and determine optimal effective video length.Systematic Review of Cultural Aspects of Stigma and Mental Illness among Racial and Ethnic Minority Groups in the United States: Implications for Interventions
AbstractMisra, S., Jackson, V. W., Chong, J., Choe, K., Tay, C., Wong, J., & Yang, L. H. (n.d.).Publication year
2021Journal title
American journal of community psychologyVolume
68Issue
3Page(s)
486-512AbstractStigma is integral to understanding mental health disparities among racial and ethnic minority groups in the United States. We conducted a systematic review to identify empirical studies on cultural aspects of mental illness stigma (public, structural, affiliative, self) among three racial and ethnic minority groups (Asian Americans, Black Americans, Latinx Americans) from 1990 to 2019, yielding 97 articles. In comparison studies (N = 25), racial and ethnic minority groups often expressed greater public and/or self-stigma than White American groups. In within-group studies (N = 65; Asian American, n = 21; Black American, n = 18; Latinx American; n = 26), which were primarily qualitative (73%), four major cultural themes emerged: 1) service barriers including access and quality (structural stigma); 2) family experiences including concealment for family’s sake, fear of being a burden, and stigma extending to family (affiliative stigma); 3) lack of knowledge about mental illness and specific cultural beliefs (public stigma); and 4) negative emotional responses and coping (self-stigma). These findings confirmed stigma has both similar and unique cultural aspects across groups. Despite this, few studies tested stigma reduction interventions (N = 7). These cultural insights can inform contextual change at the health systems and community levels to reduce stigma, and empowerment at the interpersonal and individual levels to resist stigma.A Narrative Review of Alzheimer's Disease Stigma
AbstractRosin, E. R., Blasco, D., Pilozzi, A. R., Yang, L. H., & Huang, X. (n.d.).Publication year
2020Journal title
Journal of Alzheimer's DiseaseVolume
78Issue
2Page(s)
515-528AbstractAs the most common form of senile dementia, Alzheimer's disease (AD) is accompanied by a great deal of uncertainty which can lead to fear and stigma for those identified with this devastating disease. As the AD definition evolves from a syndromal to a biological construct, and early diagnoses becomes more commonplace, more confusion and stigma may result. We conducted a narrative review of the literature on AD stigma to consolidate information on this body of research. From the perspective of several stigma theories, we identified relevant studies to inform our understanding of the way in which implementation of the new framework for a biological based AD diagnosis may have resulted in new and emerging stigma. Herein, we discuss the emergence of new AD stigma as our understanding of the definition of the disease changes. We further propose recommendations for future research to reduce the stigma associated with AD.Advancing study of cognitive impairments for antipsychotic-naïve psychosis comparing high-income versus low- and middle-income countries with a focus on urban China: Systematic review of cognition and study methodology
AbstractYang, L. H., Ruiz, B., Mandavia, A. D., Grivel, M. M., Wong, L. Y., Phillips, M. R., Keshavan, M. S., Li, H., Lieberman, J. A., Susser, E., Seidman, L. J., & Stone, W. S. (n.d.).Publication year
2020Journal title
Schizophrenia ResearchVolume
220Page(s)
1-15AbstractBackground: Comparing the course of antipsychotic-naïve psychosis in low- and middle-income countries (LMIC) may help to illuminate core pathophysiologies associated with this condition. Previous reviews-primarily from high-income countries (HIC)-identified cognitive deficits in antipsychotic-naïve, first-episode psychosis, but did not examine whether individuals with psychosis with longer duration of untreated psychosis (DUP > 5 years) were included, nor whether LMIC were broadly represented. Method: A comprehensive search of PUBMED from January 2002-August 2018 identified 36 studies that compared cognitive functioning in antipsychotic-naïve individuals with psychosis (IWP) and healthy controls, 20 from HIC and 16 from LMIC. Results: A key gap was identified in that LMIC study samples were primarily shorter DUP (<5 years) and were primarily conducted in urban China. Most studies matched cases and controls for age and gender but only 9 (24%) had sufficient statistical power for cognitive comparisons. Compared with healthy controls, performance of antipsychotic-naïve IWP was significantly worse in 81.3% (230/283) of different tests of cognitive domains assessed (90.1% in LMIC [118/131] and 73.7% [112/152] in HIC). Conclusions: Most LMIC studies of cognition in antipsychotic-naïve IWP adopted standardized procedures and, like HIC studies, found broad-based impairments in cognitive functioning. However, these LMIC studies were often underpowered and primarily included samples typical of HIC: primarily male, young-adult, high-school educated IWP, in their first episode of illness with relatively short DUP (<5 years). To enhance understanding of the long-term natural course of cognitive impairments in untreated psychosis, future studies from LMIC should recruit community-dwelling IWP from rural areas where DUP may be longer.Association between the Duration of Untreated Psychosis and Selective Cognitive Performance in Community-Dwelling Individuals with Chronic Untreated Schizophrenia in Rural China
AbstractStone, W. S., Phillips, M. R., Cai, B., Liu, X., Grivel, M. M., Yu, G., Xu, Y., Ouyang, X., Chen, H., Deng, F., Xue, F., Li, H., Lieberman, J. A., Keshavan, M. S., Susser, E. S., & Yang, L. H. (n.d.).Publication year
2020Journal title
JAMA PsychiatryVolume
77Issue
11Page(s)
1116-1126AbstractImportance: Cognitive deficits constitute core features of schizophrenia, but the trajectories of cognitive difficulties in chronic untreated schizophrenia remain unclear.Objective: To assess the association of neuropsychological deficits with duration of untreated psychosis in individuals with chronic untreated schizophrenia.Design, Setting, and Participants: Community-dwelling individuals with chronic untreated schizophrenia (untreated patient group) and individuals without mental illness (control group) were recruited from predominantly rural communities in Ningxia, China between June 20, 2016, and August 6, 2019, and administered the Structured Clinical Interview for DSM-IV, the Mini-Mental State Examination, an 8-test version of the MATRICS Consensus Cognition Battery adapted for use in individuals with low levels of education, and a measure of social cognition.Main Outcomes and Measures: Comparison of cognitive test scores between the two groups and association of cognitive test scores with duration of untreated schizophrenia.Results: The patient group included 197 individuals with chronic untreated schizophrenia (101 men [51.3%]; mean [SD] age, 52.1 [11.8] years; median [interquartile range] years of schooling, 3 [0-6] years; median [interquartile range] years of untreated psychosis, 22.9 [14.9-32.8] years). The control group included 220 individuals (118 men [53.6%]; mean [SD] age, 52.1 [11.2] years; median [interquartile range] years of schooling, 4 [0-6] years). The untreated patient group performed significantly worse than the control group on all cognitive measures (adjusted partial Spearman correlation coefficient [Spearman ρ] ranged from -0.35 for the revised Chinese version of the Reading the Mind in the Eyes Test to -0.60 for the Brief Visuospatial Memory Test-Revised; P < .001 for all comparisons). Longer durations of untreated psychosis were associated with lower performance in 3 MATRICS Consensus Cognition Battery measures assessing different aspects of executive functioning (Brief Visuospatial Memory Test-Revised [ρ = -0.20; P = .04]; Brief Assessment of Cognition in Schizophrenia, Symbol Coding subtest [ρ = -0.35; P < .001]; and Neuropsychological Assessment Battery, Mazes subtest [ρ = -0.24; P = .01]). The median duration of untreated psychosis (22.9 years) was associated with estimated score reductions in the 3 measures of 34% (95% CI, 10%-52%), 43% (95% CI, 28%-55%), and 57% (95% CI, 31%-73%), respectively.Conclusions and Relevance: The findings of this study suggest that long-term untreated schizophrenia was associated with decreases in selective cognitive abilities; both neurodegenerative pathology and neurodevelopmental dysfunction may be factors in cognition in persistent psychosis. Expanding research to include cohorts of patients from underserved rural communities in low- and middle-income countries may provide new insights about the etiological factors, disease course, and management of schizophrenia.