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 >165 peer-reviewed publications, including in journals such as 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 grant in Vietnam, and is co-investigator on 4 R01 grants and another R34 grant. 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 will yield a published book by MIT Press (anticipated 2023).
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 recently 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
Investigating the relationship between self-esteem and stigma among young adults with history of suicide attempts
AbstractLehmann, M., Hilimire, M. R., Yang, L. H., Link, B. G., & DeVylder, J. E. (n.d.).Publication year
2016Journal title
CrisisVolume
37Issue
4Page(s)
265-270AbstractBackground: Self-esteem is a major contributor to risk for repeated suicide attempts. Prior research has shown that awareness of stigma is associated with reduced self-esteem among people with mental illness. No prior studies have examined the association between self-esteem and stereotype awareness among individuals with past suicide attempts. Aims: To understand the relationship between stereotype awareness and self-esteem among young adults who have and have not attempted suicide. Method: Computerized surveys were administered to college students (N = 637). Linear regression analyses were used to test associations between self-esteem and stereotype awareness, attempt history, and their interaction. Results: There was a significant stereotype awareness by attempt interaction (β = -.74, p = .006) in the regression analysis. The interaction was explained by a stronger negative association between stereotype awareness and self-esteem among individuals with past suicide attempts (β = -.50, p = .013) compared with those without attempts (β = -.09, p = .037). Conclusion: Stigma is associated with lower self-esteem within this high-functioning sample of young adults with histories of suicide attempts. Alleviating the impact of stigma at the individual (clinical) or community (public health) levels may improve self-esteem among this high-risk population, which could potentially influence subsequent suicide risk.Principles
AbstractYang, L., Kleinman, A., & Morita, J. (n.d.). In International Encyclopedia of Public Health: Stigma (1–).Publication year
2016Page(s)
40-50AbstractStigma is a pervasive force that has powerful consequences and reduces the life opportunities of people with mental illness and other stigmatized conditions. Society also becomes burdened by the costs of people with mental illness who neglect adequate treatment and whose conditions worsen due to fears of stigma. The concept of stigma includes interior psychological processes within people with mental illness, interpersonal social processes between individuals and groups, and large-scale processes on the level of culture and politics. These models identify different mechanisms by which stigma exerts its negative effects on people with mental illness and other stigmatized conditions. Further, current antistigma interventions have drawn upon these conceptualizations to reduce stigma and its effects. Attitudes toward mental illness and other stigmatized conditions may continue to change as scientific understanding of these illnesses evolves.Stigma toward mental illness in Latin America and the caribbean: A systematic review
AbstractMascayano, F., Tapia, T., Schilling, S., Alvarado, R., Tapia, E., Lips, W., & Yang, L. H. (n.d.).Publication year
2016Journal title
Revista Brasileira de PsiquiatriaVolume
38Issue
1Page(s)
73-85AbstractObjective: Stigma toward individuals with mental disorders has been studied extensively. In the case of Latin America and the Caribbean, the past decade has been marked by a significant increase in information on stigma toward mental illness, but these findings have yet to be applied to mental health services in Latin America. The objective of this study was to conduct a systematic review of studies relating to stigma toward mental illness in Latin America and the Caribbean. The authors specifically considered differences in this region as compared with manifestations reported in Western European countries. Methods: A systematic search of scientific papers was conducted in the PubMed, MEDLINE, EBSCO, SciELO, LILACS, Imbiomed, and Bireme databases. The search included articles published from 2002 to 2014. Results: Twenty-six studies from seven countries in Latin America and the Caribbean were evaluated and arranged into the following categories: public stigma, consumer stigma, family stigma, and multiple stigmas. Conclusion: We identified some results similar to those reported in high-income settings. However, some noteworthy findings concerning public and family stigma differed from those reported in Western European countries. Interventions designed to reduce mental illness-related stigma in this region may benefit from considering cultural dynamics exhibited by the Latino population.#Schizophrenia: Use and misuse on Twitter
AbstractJoseph, A. J., Tandon, N., Yang, L. H., Duckworth, K., Torous, J., Seidman, L. J., & Keshavan, M. S. (n.d.).Publication year
2015Journal title
Schizophrenia ResearchVolume
165Issue
2Page(s)
111-115AbstractBackground: The role and prevention of stigma in mental illness is an area of evolving research. Aims: The present study is the first to examine the use and misuse of the word 'schizophrenia' on Twitter.com in comparison with another illness (diabetes) by analyzing Tweets that use the adjective and noun forms of schizophrenia and diabetes. Method: Tweets containing one of four search terms (#schizophrenia, #schizophrenic, #diabetes, #diabetic) were collected over a forty-day time period. After establishing inter-rater reliability, Tweets were rated along three dimensions: medical appropriateness, negativity, and sarcasm. Chi square tests were conducted to examine differences in the distributions of each parameter across illnesses and across each word form (noun versus adjective). Results: Significant differences were seen between the two illnesses (i.e., among "schizophrenia", "schizophrenic", "diabetes", and "diabetic") along each parameter. Tweets about schizophrenia were more likely to be negative, medically inappropriate, sarcastic, and used non-medically. The adjective ("schizophrenic") was more often negative, medically inappropriate, sarcastic, and used non-medically than the noun "schizophrenia." Schizophrenia tweets were more likely to be negative and sarcastic when used non-medically and in a medically inappropriate manner. Conclusions: Our findings confirm the presence of a great deal of misuse of the term schizophrenia on Twitter, and that this misuse is considerably more pronounced by the adjectival use of the illness. These findings have considerable implications for efforts to combat stigma, particularly for youth anti-stigma efforts.Addressing stigma relating to mental illness in low- and middle-income countries
Mascayano, F., Armijo, J. E., & Yang, L. H. (n.d.).Publication year
2015Journal title
Frontiers in PsychiatryVolume
6Analysis of psychometric properties of the Brazilian Portuguese version of the community attitudes towards the mentalii Ill (CAMI-BR)
Lima, L., Siqueira, S., Legay, L., Yang, L., Valencia, E., Sarucao, K., & Lovisi, G. (n.d.).Publication year
2015Journal title
Revista de la Facultad de Ciencias MedicasPage(s)
15-24Analysis of psychometric properties of the brazilian portuguese version of the community attitudes towards the mentally ill (CAMI-BR)
AbstractAbelha, L., Gonçalves Siqueira, S. R., Legay, L., Yang, L. H., Valencia, E., Rodrigues Sarução, K., & Lovisi, G. M. (n.d.).Publication year
2015Journal title
Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina)Volume
72Issue
4Page(s)
211-219AbstractOBJECTIVES: To perform an analysis of the psychometric properties of the Brazilian Portuguese version of the COMMUNITY ATTITUDES TOWARDS THE MENTALLY ILL (CAMI-BR), a 40-item scale divided into four sub-scales.METHODS: The study was conducted in a non-probability sample of 230 households located close to therapeutic residences in the west area of Rio de Janeiro. Reliability was assessed by test-retest and the Principal Component Analysis (PCA) was used to test the internal structure of the questionnaire.RESULTS: Most participants were women, married, with children aged 18 years or over. The overall score was 27.72 (SD = 3.31), showing attitudes ranging from neutral to positive stereotypes. The scale showed a high internal consistency (? = 0.842), consistent with other international studies. In the factor analysis, the sample was adequate (KMO = 0.800). The strength of the correlations among subscales and the factors of factor analysis were highly satisfactory. The version in Brazilian Portuguese suggests a better distinction among sub-scales through the lower correlation among them (between 0.336 and 0.441) as compared to higher values (between 0.630 and 0.770) found in the original scale. The community mental health ideology sub-scale showed a strong relation to factor 1 (? = 0.910). Benevolence had a strong relationship with factor 2 (? = 0.847); Authoritarianism and Social Restrictiveness had the highest correlation with factor 3 (? = 0.631 and 0.577 respectively).CONCLUSIONS: The scale psychometric properties were maintained after adjustment. Having registered a lower correlation between the scales the factor analysis further suggests that the Brazilian Portuguese version conveys more clearly the differences between the sub-scales.Development of an intervention to reduce self-stigma in outpatient mental health service users in Chile
AbstractSchilling, S., Bustamante, J. A., Sala, A., Acevedo, C., Tapia, E., Alvarado, R., Sapag, J. C., Yang, L. H., Lukens, E., Mascayano, F., Cid, P., & Tapia, T. (n.d.).Publication year
2015Journal title
Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina)Volume
72Issue
4Page(s)
284-294AbstractBACKGROUND: Latin America is characterized by a high prevalence of public stigma toward those with mental illness, and significant selfstigma among labeled individuals, leading to social exclusion, low treatment adherence, and diminished quality of life. However, there is no published evidence of an intervention designed to address stigma in the region. In light of this, a psychosocial intervention to reduce self-stigma among users with severe mental illness was developed and tested through an RCT in two regions of Chile.OBJECTIVES: To describe the development of the psychosocial intervention, assess its feasibility and acceptability, and evaluate its preliminary impact.METHODS: An intervention was designed and is being tested, with 80 users with severe mental illness attending two community mental health outpatient centers. To prepare the intervention, pertinent literature was reviewed, and experts and mental health services users were consulted. Feasibility and acceptability were assessed, and impact was analyzed, based on follow-up qualitative reports by the participants.RESULTS: The recovery-oriented, ten-session group intervention incorporates the Tree of Life narrative approach, along with other narrative practices, to promote a positive identity change in users, and constructivist psychoeducation, based on case studies and group discussions, to gather tools to confront self-stigma. The intervention was feasible to implement and well evaluated by participants, family members, and center professionals. Participants reported increased self-confidence, and the active use of anti-stigma strategies developed during the workshop.CONCLUSIONS: This group intervention promises an effective means to reduce stigma of mental illness within Chile and other Latin American countries and feasibility to scale up within mental health services.Effects of increased psychiatric treatment contact and acculturation on the causal beliefs of chinese immigrant relatives of individuals with psychosis
AbstractYang, L., Lo, G., Tu, M., Wu, O., Anglin, D., Saw, A., & Chen, F. P. (n.d.).Publication year
2015Journal title
Journal of Immigrant and Refugee StudiesVolume
13Issue
1Page(s)
19-39AbstractEncounters with Western psychiatric treatment and acculturation may influence causal beliefs of psychiatric illness endorsed by Chinese immigrant relatives, thus affecting help seeking. We examined causal beliefs held by 46 Chinese immigrant relatives and found that greater acculturation was associated with an increased number of causal beliefs. Further, as Western psychiatric treatment and acculturation increased, causal models expanded to incorporate biological/physical causes. However, frequency of Chinese immigrant relatives’ endorsing spiritual beliefs did not appear to change with acculturation. Clinicians might thus account for spiritual beliefs in treatment even after acculturation increases and biological causal models proliferate.Experiences of Social and Structural Forms of Stigma Among Chinese Immigrant Consumers with Psychosis
AbstractCheng, Z. H., Tu, M. C., Li, V. A., Chang, R. W., & Yang, L. H. (n.d.).Publication year
2015Journal title
Journal of Immigrant and Minority HealthVolume
17Issue
6Page(s)
1723-1731AbstractChinese immigrants tend to rely on family and close community for support given their vulnerable societal position. Yet stigma, especially from structural and familial sources, may have a particularly harmful impact upon Chinese immigrants with psychosis. Using a descriptive analysis based upon grounded theory, we examined stigma experiences of 50 Chinese immigrant consumers with psychosis, paying particular attention to frequency, sources, and themes of social and structural stigma. Although past research indicates that family is a recipient of stigma, we found instead that family members were common perpetuators of social forms of stigma. We also found that perceptions of work deficit underlie many forms of stigma, suggesting this is “what matters most” in this community. Lack of financial resources and language barriers comprised most frequent forms of structural stigma. Anti-stigma efforts should aim to improve consumer’s actual and perceived employability to target what is most meaningful in Chinese immigrant communities.Marriage outcome and relationship with urban versus rural context for individuals with psychosis in a population-based study in China
AbstractYang, L. H., Phillips, M. R., Li, X., Yu, G., Zhang, J., Shi, Q., Song, Z., Ding, Z., Pang, S., & Susser, E. (n.d.).Publication year
2015Journal title
Social psychiatry and psychiatric epidemiologyVolume
50Issue
10Page(s)
1501-1509AbstractPurpose: While social integration among individuals with psychosis differs by social context, this has rarely been investigated across urban vs. rural settings. For individuals with psychosis, marriage may be a key component of social integration. This study aims to compare marriage outcomes for individuals with psychosis in urban vs. rural settings in China, where marriage has been almost universal among individuals without psychosis. Methods: In a large community-based study in four provinces representing 12 % of China’s population, we identified 393 individuals with psychosis (112 never treated). We used adjusted Poisson regression models to compare marriage status for those living in urban (n = 96) vs. rural (n = 297) contexts. Results: While urban and rural residents had similar impairments due to symptoms, urban female residents were 2.72 times more likely to be unmarried than their rural counterparts (95 % CI 1.19–6.22, p < 0.0176). Stratified analyses indicated that this marital disadvantage occurred primarily among urban females with an earlier age of onset. No differences were found among males. Conclusions: Our findings indicate that urban contexts impeded opportunities for marriage for female individuals with psychosis. These data suggest that urban women with earlier age of onset have difficulty in marrying which may be related to economic expectations of women in urban areas. Research examining contextual mechanisms that affect marriage may further understanding of social integration in China and other contexts.Mental illness stigma research in Argentina
AbstractAgrest, M., Mascayano, F., Ardila-Gómez, S. E., Abeldaño, A., Fernandez, R., Geffner, N., Leiderman, E. A., Susser, E. S., Valencia, E., Yang, L. H., Zalazar, V., & Lipovetzky, G. (n.d.).Publication year
2015Journal title
BJPsych InternationalVolume
12Issue
4Page(s)
86-88AbstractStudies regarding stigma towards mental illness in Argentina blossomed after the first National Mental Health Law was passed in 2010. Methodological limitations and contradictory results regarding community perceptions of stigma hinder comparisons across domestic and international contexts but some lessons may still be gleaned. We examine this research and derive recommendations for future research and actions to reduce stigma. These include tackling culture-specific aspects of stigma, increasing education of the general population, making more community-based services available and exposing mental health professionals to people with mental illness who are on community paths to recovery.Racial and mental illness stereotypes and discrimination: An identity-based analysis of the virginia tech and columbine shootings
AbstractChen, C. Y., Purdie-Vaughns, V., Phelan, J. C., Yu, G., & Yang, L. H. (n.d.).Publication year
2015Journal title
Cultural Diversity and Ethnic Minority PsychologyVolume
21Issue
2Page(s)
279-287AbstractThe Virginia Tech and Columbine High shootings are 2 of the deadliest school massacres in the United States. The present study investigates in a nationally representative sample how White Americans' causal attributions of these shooting moderate their attitudes toward the shooter's race. White Americans shown a vignette based on the Virginia Tech shooting were more likely to espouse negative beliefs about Korean American men and distance themselves from this group the more they believed that the shooter's race caused the shooting. Among those who were shown a vignette based on the Columbine High shooting, believing that mental illness caused the shooting was associated with weaker negative beliefs about White American men. White Americans in a third condition who were given the Virginia Tech vignette and prompted to subtype the shooter according to his race were less likely to possess negative beliefs about Korean American men the more they believed that mental illness caused the shooting. There was no evidence for the ultimate attribution error. Theoretical accounts based on the stereotype and in-group-out-group bias literature are presented. The current findings have important implications for media depictions of minority group behavior and intergroup relations.Stigma related to labels and symptoms in individuals at clinical high-risk for psychosis
AbstractYang, L. H., Link, B. G., Ben-David, S., Gill, K. E., Girgis, R. R., Brucato, G., Wonpat-Borja, A. J., & Corcoran, C. M. (n.d.).Publication year
2015Journal title
Schizophrenia ResearchVolume
168Issue
1Page(s)
9-15AbstractBackground: Despite advances that the psychosis "clinical high-risk" (CHR) identification offers, risk of stigma exists. Awareness of and agreement with stereotypes has not yet been evaluated in CHR individuals. Furthermore, the relative stigma associated with symptoms, as opposed to the label of risk, is not known, which is critical because CHR identification may reduce symptom-related stigma. Methods: Thirty-eight CHR subjects were ascertained using standard measures from the Center of Prevention and Evaluation/New York State Psychiatric Institute/ Columbia University. Labeling-related measures adapted to the CHR group included "stereotype awareness and self-stigma" ("Stereotype awareness", "Stereotype Agreement", "Negative emotions [shame]"), and a parallel measure of "Negative emotions (shame)" for symptoms. These measures were examined in relation to symptoms of anxiety and depression, adjusting for core CHR symptoms (e.g. attenuated psychotic symptoms). Results: CHR participants endorsed awareness of mental illness stereotypes, but largely did not themselves agree with these stereotypes. Furthermore, CHR participants described more stigma associated with symptoms than they did with the risk-label itself. Shame related to symptoms was associated with depression, while shame related to the risk-label was associated with anxiety. Conclusion: Both stigma of the risk-label and of symptoms contribute to the experience of CHR individuals. Stereotype awareness was relatively high and labeling-related shame was associated with increased anxiety. Yet limited agreement with stereotypes indicated that labeling-related stigma had not fully permeated self-conceptions. Furthermore, symptom-related stigma appeared more salient overall and was linked with increased depression, suggesting that alleviating symptom-related shame via treating symptoms might provide major benefit.Suicide in Latin America: a growing public health issue
AbstractMascayano, F., Irrazabal, M., D. Emilia, W., Vaner, S. J., Sapag, J. C., Alvarado, R., Yang, L. H., & Sinah, B. (n.d.).Publication year
2015Journal title
Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina)Volume
72Issue
4Page(s)
295-303AbstractINTRODUCTION: Suicide has become an international public mental health challenge, resulting in a need for interventions to address it as an individual, family, and community levels. The current scope review assesses trends regarding suicide within Latin America and the Caribbean: risk factors, protective factors, and mediators of suicidal ideation and behavior. Body: Our review is split into three sections, as a way of addressing the complex topic of suicide in an organized, comprehensive manner: (i) epidemiology of suicide in Latin America and Caribbean; (ii) factors associated to suicide ideation and attempts; and (iii) cultural factors as a predictors and mediators of suicide. Further, proper evidence about the association between suicide and cultural dimensions such as Familismo, Machismo/Marianismo, Religion and Acculturation is provided.CONCLUSION: Upon analyzing trends of and factors associated with suicide, we offer recommendations regarding future studies and intervention programs. We conclude that interventions and research should be based on and in response to cultural values and norms related to suicide within each community, in order to make more culturally-specific programs.Understanding the Importance of "symbolic Interaction Stigma": How Expectations about the Reactions of Others Adds to the Burden of Mental Illness Stigma
AbstractLink, B. G., Wells, J., Phelan, J. C., & Yang, L. (n.d.).Publication year
2015Journal title
Psychiatric Rehabilitation JournalVolume
38Issue
2Page(s)
117-124AbstractObjective: Important components of stigma include imagining what others might think of a stigmatized status, anticipating what might transpire in an interaction with others, and rehearsing what one might do if something untoward occurs. These imagined relations are here called symbolic interaction stigma and can have an impact even if the internalization of negative stereotypes fails to occur. Concepts and measures that capture symbolic interaction stigma are introduced, and a preliminary assessment of their impact is provided. Method: Four self-report measures of symbolic interaction stigma (perceived devaluation discrimination, anticipation of rejection, stigma consciousness, and concern with staying in) were developed or adapted and administered to a sample of individuals who have experienced mental illness (N = 65). Regression analyses examined whether forms of symbolic interaction stigma were associated with withdrawal, self-esteem, and isolation from relatives independent of measures of internalization of stigma and rejection experiences. Results: As evidenced by scores on 4 distinct measures, symbolic interaction stigma was relatively common in the sample, somewhat more common than the internalization of stigma. In addition, measures of symbolic interaction stigma were significantly associated with withdrawal, self-esteem, and isolation from relatives even when a measure of the internalization of stigma was statistically controlled. Conclusion: The study suggests the potential importance of considering symbolic interaction forms of stigma in understanding and addressing stigma and its consequences. Being aware of symbolic interaction stigma could be useful in enhancing rehabilitation goals if an approach to counteracting the negative effects of these aspects of stigma can be developed.What matters most': stigma towards severe mental disorders in Chile, a theory-driven, qualitative approach
AbstractMascayano, F., Toso-Salman, J., Ruiz, B., Warman, K., Jofre Escalona, A., Alvarado Muñoz, R., Sia, K. J., & Yang, L. H. (n.d.).Publication year
2015Journal title
Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina)Volume
72Issue
4Page(s)
250-260AbstractBACKGROUND: Stigma towards severe mental illness manifests in different ways across cultures and only recently has a theoretical perspective emerged to understand such cultural differences. The 'What Matters Most' framework identifies culturally specific dimensions of stigma by identifying the interactions between cultural norms, roles, and values that impact personhood.OBJECTIVE: This study explores the cultural underpinnings that create and maintain stigmatizing attitudes towards severe mental illness in Chile.METHODS: In-depth interviews developed using the 'Scale of Perceived Discrimination and Devaluation', and the 'What Matters Most' framework were conducted with twenty people identified as having a severe mental illness. Interviews were coded and discussed until agreement was reached, then analyzed by an independent reviewer to determine inter-rater reliability.RESULTS: A key factor shaping stigma among women was the loss of capacity to accomplish family roles (i.e. take care of children).or men, cultural notions of 'Machismo' prevented them from disclosing their psychiatric diagnosis as a means to maintain status and ability to work. A protective factor against stigma for men was their ability to guide and provide for the family, thus fulfilling responsibilities attributable to 'Familismo'. Social appearances could play either a shaping or protecting role,contingent on the social status of the individual.DISCUSSION: In Chilean culture, stigma is rooted in gendered social characteristics and shared familial roles. Interventions should aim to address these norms and incorporate culturally salient protective factors to reduce stigma experienced by individuals with serious mental illness in Chile and other Latin American settings."What matters most:" A cultural mechanism moderating structural vulnerability and moral experience of mental illness stigma
AbstractYang, L. H., Chen, F. P., Sia, K. J., Lam, J., Lam, K., Ngo, H., Lee, S., Kleinman, A., & Good, B. (n.d.).Publication year
2014Journal title
Social Science and MedicineVolume
103Page(s)
84-93AbstractTo understand Chinese immigrants' experiences with mental illness stigma and mental health disparities, we integrate frameworks of 'structural vulnerability' and 'moral experience' to identify how interaction between structural discrimination and cultural engagements might shape stigma. Fifty Chinese immigrants, including 64% Fuzhounese immigrants who experienced particularly harsh socio-economical deprivation, from two Chinese bilingual psychiatric inpatient units in New York City were interviewed from 2006 to 2010 about their experiences of mental illness stigma. Interview questions were derived from 4 stigma measures, covering various life domains. Participants were asked to elaborate their rating of measure items, and thus provided open-ended, narrative data. Analysis of the narrative data followed a deductive approach, guided by frameworks of structural discrimination and "what matters most" - a cultural mechanism signifying meaningful participation in the community. After identifying initial coding classifications, analysis focused on the interface between the two main concepts. Results indicated that experiences with mental illness stigma were contingent on the degree to which immigrants were able to participate in work to achieve "what mattered most" in their cultural context, i.e., accumulation of financial resources. Structural vulnerability - being situated in an inferior position when facing structural discrimination - made access to affordable mental health services challenging. As such, structural discrimination increased healthcare spending and interfered with financial accumulation, often resulting in future treatment nonadherence and enforcing mental health disparities. Study participants' internalizing their structurally-vulnerable position further led to a depreciated sense of self, resulting in a reduced capacity to advocate for healthcare system changes. Paradoxically, the multi-layered structural marginalization experienced by Chinese immigrants with mental illness allowed those who maintained capacity to work to retain social status even while holding a mental illness status. Mental health providers may prioritize work participation to shift service users' positions within the hierarchy of structural vulnerability.A brief anti-stigma intervention for Chinese immigrant caregivers of individuals with psychosis: AdaptatioN and initial findings
AbstractYang, L. H., Lai, G. Y., Tu, M., Luo, M., Wonpat-Borja, A., Jackson, V. W., Lewis-Fernández, R., & Dixon, L. (n.d.).Publication year
2014Journal title
transcultural psychiatryVolume
51Issue
2Page(s)
139-157AbstractMental illness stigma has adverse effects on both the caregivers’ psychological well-being and the effectiveness of care that consumers receive. While anti-stigma interventions for family caregivers from Western settings have recently shown efficacy, these interventions may not be equally applicable across culturally diverse groups. Specifically, Chinese immigrant caregivers experience heightened internalized stigma, which predisposes the adoption of harmful coping strategies and reduced quality of social networks. We present an anti-stigma intervention based on a peer-family group format, co-led by a clinician and a trained family caregiver, to counter stigma among Chinese immigrants. Data are presented from a brief intervention administered to a pilot sample of 11 Chinese immigrant caregivers that provides: psychoeducation, strategies to counter experienced discrimination, and techniques to resist internalized stigma. Case vignettes illustrate implementation of this intervention, and how the peer-family format via interactive contact counteracts internalized stereotypes, encourages adaptive coping strategies, and reinvigorates social networks. Quantitative results further suggest preliminary efficacy in reducing internalized stigma for caregivers who evidenced at least some prior internalized stigma. This study constitutes an initial but important step towards reducing mental illness stigma among Asian Americans, for whom stigma has played a powerful role in the delay and underuse of treatment.Assessing depression in youth at clinical high risk for psychosis: A comparison of three measures
AbstractDeVylder, J. E., Yang, L. H., Harkavy-Friedman, J. M., Azimov, N., Walder, D. J., & Corcoran, C. M. (n.d.).Publication year
2014Journal title
Psychiatry ResearchVolume
215Issue
2Page(s)
323-328AbstractDepressive symptoms are prevalent among individuals at clinical high-risk (CHR) for psychosis. Prior studies have used the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), and the "dysphoric mood" item of the Scale of Prodromal Symptoms (SOPS) to assess depressive symptoms in CHR samples. We compared the psychometric properties of these instruments in a CHR cohort, to support the selection of appropriate depressive symptoms measures in future studies and in clinical settings. Internal consistency was assessed using Cronbach's alpha. Construct validity was assessed through correlations with SOPS items that were expected or not expected to be related to depressive symptoms. Criterion validity was assessed by comparing scores between patients with and without a major depressive disorder diagnosis. We hypothesized based on the schizophrenia literature that the BDI would have superior internal consistency and discriminant validity compared to the HDRS, and that all three measures would show convergent validity and criterion validity. The BDI demonstrated superior internal consistency and construct validity in this at-risk sample. The BDI and HDRS differentiated patients with major depressive disorder, but SOPS dysphoria did not. This has implications for the choice of depression measures in future CHR studies and for the interpretation of past findings.Authors' reply
Yang, L., Phillips, M., & Susser, E. (n.d.). In British Journal of Psychiatry (1–).Publication year
2014Volume
204Issue
5Page(s)
403-404Co-occurrence of psychotic experiences and common mental health conditions across four racially and ethnically diverse population samples
AbstractDeVylder, J. E., Burnette, D., & Yang, L. H. (n.d.).Publication year
2014Journal title
Psychological MedicineVolume
44Issue
16Page(s)
3503-3513AbstractBackground. Prior research with racially/ethnically homogeneous samples has demonstrated widespread co-occurrence of psychotic experiences (PEs) and common mental health conditions, particularly multi-morbidity, suggesting that psychosis may be related to the overall severity of psychiatric disorder rather than any specific subtype. In this study we aimed to examine whether PEs are associated with the presence of specific disorders or multi-morbidity of co-occurring disorders across four large racially/ethnically diverse samples of adults in the USA.Method. Data were drawn from the National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL) and separately from the Asian and Latino subsamples of the National Latino and Asian American Study (NLAAS). Logistic regression models were used to examine the relationship between PEs and individual subtypes of DSM-IV disorder, and to test for a linear dose-response relationship between the number of subtypes and PEs.Results. Prevalence of PEs was moderately greater among individuals with each subtype of disorder in each data set [odds ratios (ORs) 1.8-3.8], although associations were only variably significant when controlling for clinical and demographic variables. However, the sum of disorder subtypes was related to odds for PEs in a linear dose-response fashion across all four samples.Conclusions. PEs are related primarily to the extent or severity of psychiatric illness, as indicated by the presence of multiple psychiatric disorders, rather than to any particular subtype of disorder in these data. This relationship applies to the general population and across diverse racial/ethnic groups.Direct-to-Consumer Racial Admixture Tests and Beliefs About Essential Racial Differences
AbstractPhelan, J. C., Link, B. G., Zelner, S., & Yang, L. H. (n.d.).Publication year
2014Journal title
Social Psychology QuarterlyVolume
77Issue
3Page(s)
296-318AbstractAlthough at first relatively disinterested in race, modern genomic research has increasingly turned attention to racial variations. We examine a prominent example of this focus-direct-to-consumer racial admixture tests-and ask how information about the methods and results of these tests in news media may affect beliefs in racial differences. The reification hypothesis proposes that by emphasizing a genetic basis for race, thereby reifying race as a biological reality, the tests increase beliefs that whites and blacks are essentially different. The challenge hypothesis suggests that by describing differences between racial groups as continua rather than sharp demarcations, the results produced by admixture tests break down racial categories and reduce beliefs in racial differences. A nationally representative survey experiment (N = 526) provided clear support for the reification hypothesis. The results suggest that an unintended consequence of the genomic revolution may be to reinvigorate age-old beliefs in essential racial differences.Discrimination, arrest history, and major depressive disorder in the U.S. Black population
AbstractAnglin, D. M., Lighty, Q., Yang, L. H., Greenspoon, M., Miles, R. J., Slonim, T., Isaac, K., & Brown, M. J. (n.d.).Publication year
2014Journal title
Psychiatry ResearchVolume
219Issue
1Page(s)
114-121AbstractEveryday discrimination contributes negatively to depressive symptomatology among Blacks in the US and being arrested could add to this depression. Using data from the National Survey on American Life, the present study determined the association between an arrest history and major depressive disorder (MDD), while accounting for discrimination among African Americans, US-born Afro-Caribbeans and first-generation Black immigrants. Findings from logistic regression analyses adjusted for discrimination suggested an arrest history is associated with 12-month MDD (Adjusted OR=1.47; 95% CI=1.02-2.10) and lifetime MDD (Adjusted OR=1.56 CI=1.17-2.09). Accounting for drug and alcohol dependence attenuated the association between arrest history and 12-month MDD, but not lifetime MDD. The associations between arrest history and both 12-month and lifetime MDD, and discrimination and lifetime MDD varied by ethnic/immigrant group. Specifically, while the association between arrest history and MDD (both 12-month and lifetime) was strongest among US-born Afro-Caribbeans, evidence consistent with the immigrant paradox, the association between discrimination and lifetime MDD was particularly relevant for first-generation Black immigrants, suggesting discrimination may hinder the protection of first-generation status. Mental health prevention and treatment programs should target the stress associated with being arrested and experiencing discrimination among US Blacks.Examining the meaning of the rural advantage in employment for social integration
Yang, L., Phillips, M., & Susser, E. (n.d.). In British Journal of Psychiatry (1–).Publication year
2014Page(s)
403-404