Associate Professor of Social and Behavioral Sciences
If every public health researcher had a calling card indicator, Dr. Larry 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 the manifestation of stigma -- drove the GPH Associate Professor to develop a framework for how stigma acts to impede social recovery cross-culturally to improve the lives of countless people with mental illness and their families around the world.
"I was drawn by the global and applied perspective of GPH. I saw working at GPH as an incredible research opportunity to build mental health programs and the college's ties to NYU Shanghai as a unique opportunity to further establish research studies throughout China," said Larry regarding his new position on the GPH Social and Behavioral Sciences team. As part of the faculty, Larry will teach Psychometric Measurement and Analysis in the fall as well as a Social Behavioral Sciences course in the spring. In addition to teaching, Larry will continue several ongoing research studies on the forefront of public health and psychiatric epidemiology.
As PI of a five year study, R01-Stigma of Clinical High-Risk Psychosis (CHR) funded by the NIMH, Larry is examining the impact of stigma on identity among youth diagnosed with a Clinical High-Risk State for Psychosis (CHR). The research is being conducted in partnership with the medical schools of Harvard, Columbia and Maine. "People used to think that intervening with psychosis when a person first has a psychotic break was early intervention," said Larry. "Now, we understand that the first psychotic break is actually well into the development of the disorder." Using a diagnostic interview that identifies a Clinical High-Risk Psychosis state to look for clinical features and symptoms of psychosis, a mental health professional can detect the signs of psychosis and begin treatment. Early treatment can help delay onset of psychosis and possibly improve the course of the illness. Yet, only 30 percent of those with the earliest signs of psychosis will develop a full-psychotic disorder. "Early detection comes with a potential cost," said Larry. "There are all sorts of implications regarding how early diagnosis could negatively affect a young person's identity and the way the rest of the world views them." For the past four years, Larry has been examining the impact of psychological, social, and developmental outcomes among participants identified as CHR. The study is now in its 5th year and nearing completion. Additionally, Larry is conducting a supplemental study to examine the manifestation of stigma using neuroimaging and to determine whether and how stigma is expressed in the brain.
Larry's fascination with stigma was first sparked during his dissertation research in Shanghai with a leader in global mental health research, Michael Phillips. "I saw stigma in its most terrifying and ferocious form," said Larry describing his first experiences working with people with severe mental health in Shanghai. "For the family members and those with mental illness themselves, it's crippling and debilitating. What 'face' (a crucial Chinese concept) allows you to do is to plug into social networks and enables you to access social resources. Just imagine if you are cut off from any social resource? You have no power. You have no way to access the common things that most people do in their everyday lives. People call this being 'faceless' or 'social death'." From this experience, Larry became motivated to do something to empower people with mental illness and their families within their communities.
After receiving an NIMH K-award, Larry conducted a study in New York City of the psychological factors, including stigma, that shape the course of mental illness among Chinese immigrants. As a result of this study, Larry formulated theoretical work on how culture relates to stigma and implementing interventions to improve recovery for different stigmatizing conditions on which his future research is based. He learned that upholding face (or preserving honor and the community's respect) is important among Chinese immigrants, as it is for Asians in many countries. When someone develops signs of mental illness, that person loses face in many circumstances. Resulting from his K-Award, Larry used the study to formulate an anti-stigma intervention to help people with mental illness take a powerful step towards regaining face. "Arthur Kleinman and I call it "remobilization", Larry said. "We helped Chinese immigrants with psychosis move from a position where they were completely disempowered in society to a place where they could reengage with society. To work if they wish, to volunteer if they wish. We were able to help them re-engage in social interaction and reduce internalized stigma." Although his anti-stigma intervention has been based in the US, they have now conducted similar research in China and in other international settings such as Chile, Argentina, India and Botswana.
Larry returned to China as PI of an R01 study with co-PI's, Michael Phillips and Larry Seidman, Characterizing Cognition of Untreated Psychosis in China. Recently, China has been rolling out programs in detection of untreated psychosis around the country. As the program had not yet reached the poorest provinces in China, including Ningxia, Larry chose to propose a study there which has since become supported by the Ningxia Ministry of Health. The study includes 400 untreated psychosis participants, who are then matched with 400 treated psychosis participants and an additional 400 healthy control participants in Ningxia Province.
"If you've ever seen "A Beautiful Mind", you may have noted that there were points where the main character John Nash, Jr. maintained his brilliance and others where he was more dull and slowed down. Unfortunately, this slowing of cognition happens to a lot of people with psychosis. But we've never been able to disentangle how much of this is connected to the illness and how much is due to the medication. This study is a historic scientific opportunity to examine what cognition looks like in people who are completely untreated for psychosis."
Additionally, Larry's team will work with Michael Phillips and local psychiatrists in the province to scale up their capacity to treat first episode psychosis by providing more advanced clinical training.
While Larry has conducted several studies in China, his latest research has also taken him to South America (Argentina, Chile and Brazil). Currently, he is part of a study, the Collaborative Hub for International Research in Mental Health, an NIMH U-19, establishing a network of research hubs: two in South America (including his team's study in Chile, Argentina and Brazil), one in Asia and one in Africa. Following a scale up intervention conducted by his research partners, Larry co-leads a qualitative evaluation to measure the barriers and facilitators to scale-up social interventions for psychosis in Latin America and across all hub sites. His collaborating research partners on this study include the University of Chile (Santiago) and the University of Frederico (Rio). Larry's role is to harmonize interviews and the collection of data across all five global hub sites so that the research teams can collect uniform data to facilitate the scale up of interventions worldwide.
Larry holds a doctoral degree from Boston University in Clinical Psychology. He was awarded a clinical fellowship at Harvard Medical School to work at the Massachusetts Mental Health Center and has received 8 early career awards for his work on stigma, 6 of which are national. Larry is a member of two prestigious editorial boards: the Cultural Diversity and Ethnic Minority Psychology Board of the Journal of the American Psychological Association, and the Stigma and Health Board of the Journal of the American Psychological Association. He has also authored publications in The Lancet, British Journal of Psychiatry, and the Journal of Abnormal Psychology.
BA, High Honors and Phi Beta Kappa, Wesleyan University, Middletown, CTPhD, Boston University, Boston, MAClinical Fellowship, Harvard Medical School-Massachusetts Mental Health Center
Honors and awards
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)
Areas of research and study
Community HealthCultural Determinants of HealthEpidemiologyImmigrationMental HealthMinoritiesMinority HealthPsychologyStigma
Advances in the cultural assessment of stigma to promote global mental healthYang, L., Sia, K., & Yang, L.
Baseline demographics, clinical features and predictors of conversion among 200 individuals in a longitudinal prospective psychosis-risk cohortBrucato, G., Masucci, M.D., Arndt, L.Y., Ben-David, S., Colibazzi, T., Corcoran, C.M., … Girgis, R.R.
Journal titlePsychological Medicine
Background: DSM-5 proposes an Attenuated Psychosis Syndrome (APS) for further investigation, based upon the Attenuated Positive Symptom Syndrome (APSS) in the Structured Interview for Psychosis-Risk Syndromes (SIPS). SIPS Unusual Thought Content, Disorganized Communication and Total Disorganization scores predicted progression to psychosis in a 2015 NAPLS-2 Consortium report. We sought to independently replicate this in a large single-site high-risk cohort, and identify baseline demographic and clinical predictors beyond current APS/APSS criteria. Method: We prospectively studied 200 participants meeting criteria for both the SIPS APSS and DSM-5 APS. SIPS scores, demographics, family history of psychosis, DSM Axis-I diagnoses, schizotypy, and social and role functioning were assessed at baseline, with follow-up every 3 months for 2 years. Results: The conversion rate was 30% (n = 60), or 37.7% excluding participants who were followed under 2 years. This rate was stable across time. Conversion time averaged 7.97 months for 60% who developed schizophrenia and 15.68 for other psychoses. Mean conversion age was 20.3 for males and 23.5 for females. Attenuated odd ideas and thought disorder appear to be the positive symptoms which best predict psychosis in a logistic regression. Total negative symptom score, Asian/Pacific Islander and Black/African-American race were also predictive. As no Axis-I diagnosis or schizotypy predicted conversion, the APS is supported as a distinct syndrome. In addition, cannabis use disorder did not increase risk of conversion to psychosis. Conclusions: NAPLS SIPS findings were replicated while controlling for clinical and demographic factors, strongly supporting the validity of the SIPS APSS and DSM-5 APS diagnosis.
Impact of lifetime traumatic experiences on suicidality and likelihood of conversion in a cohort of individuals at clinical high-risk for psychosisGrivel, M.M., Leong, W., Masucci, M.D., Altschuler, R.A., Arndt, L.Y., Redman, S.L., … Girgis, R.R.
Journal titleSchizophrenia Research
Recent research suggests that trauma history (TH) is a strong socio-environmental risk factor for the development of psychosis. While reported rates of childhood trauma are higher among individuals at clinical high-risk (CHR) for psychosis than in the general population, little research has explored the effects of trauma upon the severity of attenuated positive symptoms. We aimed to explore the specific relationships between TH and baseline symptom severity; likelihood of conversion to full-blown psychosis; suicidal ideation (SI); and suicidal behavior (SB) in a cohort of 200 help-seeking CHR individuals. Participants were evaluated every three months for up to two years using the Structured Interview for Psychosis-Risk Syndromes (SIPS). More trauma history was reported by females and Hispanic/Latino participants, while age and race did not significantly distinguish those with and without TH. Individuals with TH reported higher rates of SI and SB than those without. While TH was positively associated with several SIPS subscales, including Unusual Thought Content, Perceptual Abnormalities/Hallucinations, Bizarre Thinking, Sleep Disturbances, and Dysphoric Mood, and negatively associated with Expressed Emotion, results indicated that TH was not significantly related to conversion to psychosis. Moreover, baseline SI was unrelated to conversion and baseline DSM diagnosis, with the exception of Post-Traumatic Stress Disorder (PTSD). These results suggest that traumatic experiences may significantly impact the severity of attenuated positive symptoms and suicidality in the CHR state, providing new windows for further research and potential intervention.
The family economic status and outcome of people with schizophrenia in Xinjin, Chengdu, China: 14-year follow-up studyRan, M.S., Yang, L., Liu, Y.J., Huang, D., Mao, W.J., Lin, F.R., … Chan, C.L.W.
Journal titleInternational Journal of Social Psychiatry
Background: Little is known about whether family economic status might influence the long-term (e.g. over 10 years) outcome of persons with schizophrenia in the community. Aim: To examine the differences in outcome at 14-year follow-up of persons with schizophrenia from high versus low family economic status backgrounds in a Chinese rural area. Method: A prospective 14-year follow-up study was conducted in six townships in Xinjin County, Chengdu, China. All participants with schizophrenia (n = 510) were identified in an epidemiological investigation of 123,572 people aged 15 years and older and followed up from 1994 to 2008. Results: Individuals from low family economic status (
The importance of symbolic interaction in mental illness stigmaHe, E., Yang, L., & Link, B.G.
The role of culture in population mental health: prevalence of mental disorders among Asian and Asian american populationsYang, L., & Benson, J.
Violating clan and kinship roles as risk factors for suicide and stigma among lao refugees: An application of the cultural model of suicide and “what matters most” frameworksMandavia, A., Huang, D., Wong, J., Ruiz, B., Crump, F., Shen, J., … Yang, L.
Journal titleIsrael Journal of Psychiatry and Related Sciences
Background: While Asian groups have immigrated worldwide, suicide risk models have neglected to integrate cultural components. This study incorporates how stigma associated with failure to uphold clan/kinship roles can increase suicide risk in highly-marginalized Lao-Americans. Methods: One focus group with five Lao participants and 21 individual semi-structured interviews with community family members were conducted. Transcripts were coded via directed content analysis using the “What Matters Most” and Cultural Theory of Suicide frameworks. Results: Violating role-expectations associated with youth, adults and older adults appears to be associated with risk for suicide. This suggests that the failure of adults to fulfill their roles might potentially threaten loss of “full personhood” and trigger stigma, thus potentially evoking greater suicide risk. Conclusion: Interventions would benefit from cultural considerations of fulfilling role-expectations and “personhood” to combat suicide and stigma within cultural communities.
attitudes toward judicial lenience and government assistance for individuals with mental illness: A comparison of Chinese and European AmericansHuang, D., Yang, L., Wonpat-Borja, A., Lam, J., Link, B.G., & Phelan, J.C.
Journal titleJournal of Community Psychology
Attitudes Towards the Mentally Ill: A Study with Health Workers at a University Hospital in Rio de JaneiroSiqueira, S.R.G., Abelha, L., Lovisi, G.M., Sarução, K.R., & Yang, L.
Journal titlePsychiatric Quarterly
As there are few studies about evaluation of attitudes of health care workers to people with mental disorders in Brazil, a cross-sectional study was carried out to assess the health professionals’ attitudes working in a university hospital in Rio de Janeiro and also examine the proportion of negative and positive attitudes endorsed by healthcare professionals in Brazil towards people with mental illness in comparison with other parts of the world. Data were collected using the Community Attitudes towards the Mentally Ill (CAMI) in a random sampling frame of health professionals (n = 246) working in a University Hospital in Rio de Janeiro between April 2013 and June 2013. The CAMI consists of four sub-scales: Authoritarianism, Benevolence, Social Restrictiveness and Community Mental Health Ideology. The results showed attitudes that range from neutral to positive, with the Benevolence and Social Restrictiveness sub-scales showing the least stigmatizing results. The following individual characteristics were associated with negative attitudes: lower levels of education and less clinical experience. In general, health workers attitudes towards service users are characterized as positive when compared with other international studies. However, educational programs for health workers should be reinforced to further promote pre-existing positive attitudes towards people with mental health and the implementation of Brazilian Mental Health Policies.
Experiences of Social Support Among Chinese Immigrant Mental Health Consumers with PsychosisCheng, Z.H., Tu, M.C., & Yang, L.
Journal titleCommunity Mental Health Journal
Limited research has investigated how culture impacts expressions of social support, which is crucial in developing culturally sensitive care. Using a classification based on theories of social support, we examined the social support experiences of 49 Chinese immigrant mental health consumers with psychosis, paying particular attention to frequency and sources. We found that the most common forms of social support were belonging and companionship, perceived emotional support, social control, and perceived instrumental support, while self-esteem and sense of mastery were the least common forms. Family and friends were the main sources of support. These results demonstrate the influence of Confucian values of renqing (or fulfillment of relational obligations) and guanxi (or social networks) and the negative effects of stigma in diminishing the social standing of these consumers by compromising ‘personhood.’ Clinical implications for increasing the cultural competency of clinicians and improving the mental health outcomes of Chinese immigrants are discussed.
Investigating the relationship between self-esteem and stigma among young adults with history of suicide attemptsLehmann, M., Hilimire, M.R., Yang, L., Link, B.G., & DeVylder, J.E.
Background: 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.
Measurement of attitudes, beliefs, and behaviors of mental health and mental illnessYang, L., & Link, B.G.
Stigma toward mental illness in Latin America and the caribbean: A systematic reviewMascayano, F., Tapia, T., Schilling, S., Alvarado, R., Tapia, E., Lips, W., & Yang, L.
Journal titleRevista Brasileira de Psiquiatria
Objective: 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 TwitterJoseph, A.J., Tandon, N., Yang, L., Duckworth, K., Torous, J., Seidman, L.J., & Keshavan, M.S.
Journal titleSchizophrenia Research
Background: 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 countriesMascayano, F., Armijo, J.E., & Yang, L.
Journal titleFrontiers in Psychiatry
Analysis 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.
Journal titleRevista de la Facultad de Ciencias Medicas
Analysis of psychometric properties of the brazilian portuguese version of the community attitudes towards the mentally ill (CAMI-BR)Abelha, L., Gonçalves Siqueira, S.R., Legay, L., Yang, L., Valencia, E., Rodrigues Sarução, K., & Lovisi, G.M.
Journal titleRevista de la Facultad de Ciencias Medicas (Cordoba, Argentina)
OBJECTIVES: 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 ChileSchilling, S., Bustamante, J.A., Sala, A., Acevedo, C., Tapia, E., Alvarado, R., … Tapia, T.
Journal titleRevista de la Facultad de Ciencias Medicas (Cordoba, Argentina)
BACKGROUND: 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 psychosisYang, L., Lo, G., Tu, M., Wu, O., Anglin, D., Saw, A., & Chen, F.P.
Journal titleJournal of Immigrant and Refugee Studies
Encounters 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 PsychosisCheng, Z.H., Tu, M.C., Li, V.A., Chang, R.W., & Yang, L.
Journal titleJournal of Immigrant and Minority Health
Chinese 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 ChinaYang, L., Phillips, M.R., Li, X., Yu, G., Zhang, J., Shi, Q., … Susser, E.
Journal titleSocial Psychiatry and Psychiatric Epidemiology
Purpose: 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 ArgentinaMartin Agrest, M., Mascayano, F., Ardilla-Gomez, S., Abeldano, A., Fernandez, R., Geffner, N., … Lipovetzky, G.
Journal titleBJPsych International
Racial and mental illness stereotypes and discrimination: An identity-based analysis of the virginia tech and columbine shootingsChen, C.Y., Purdie-Vaughns, V., Phelan, J.C., Yu, G., & Yang, L.
Journal titleCultural Diversity and Ethnic Minority Psychology
The 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 psychosisYang, L., Link, B.G., Ben-David, S., Gill, K.E., Girgis, R.R., Brucato, G., … Corcoran, C.M.
Journal titleSchizophrenia Research
Background: 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 issueMascayano, F., Irrazabal, M., D Emilia, W., Vaner, S.J., Sapag, J.C., Alvarado, R., … Sinah, B.
Journal titleRevista de la Facultad de Ciencias Medicas (Cordoba, Argentina)
INTRODUCTION: 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.