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
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)
Community HealthCultural Determinants of HealthEpidemiologyImmigrationMental HealthMinoritiesMinority HealthPsychologyStigma
A predictive model for conversion to psychosis in clinical high-risk patientsCiarleglio, A. J., Brucato, G., Masucci, M. D., Altschuler, R., Colibazzi, T., Corcoran, C. M., Crump, F. M., Horga, G., Lehembre-Shiah, E., Leong, W., Schobel, S. A., Wall, M. M., Yang, L. H., Lieberman, J. A., & Girgis, R. R.
Journal titlePsychological Medicine
Page(s)1-10Background: The authors developed a practical and clinically useful model to predict the risk of psychosis that utilizes clinical characteristics empirically demonstrated to be strong predictors of conversion to psychosis in clinical high-risk (CHR) individuals. The model is based upon the Structured Interview for Psychosis Risk Syndromes (SIPS) and accompanying clinical interview, and yields scores indicating one's risk of conversion. Methods: Baseline data, including demographic and clinical characteristics measured by the SIPS, were obtained on 199 CHR individuals seeking evaluation in the early detection and intervention for mental disorders program at the New York State Psychiatric Institute at Columbia University Medical Center. Each patient was followed for up to 2 years or until they developed a syndromal DSM-4 disorder. A LASSO logistic fitting procedure was used to construct a model for conversion specifically to a psychotic disorder. Results: At 2 years, 64 patients (32.2%) converted to a psychotic disorder. The top five variables with relatively large standardized effect sizes included SIPS subscales of visual perceptual abnormalities, dysphoric mood, unusual thought content, disorganized communication, and violent ideation. The concordance index (c-index) was 0.73, indicating a moderately strong ability to discriminate between converters and non-converters. Conclusions: The prediction model performed well in classifying converters and non-converters and revealed SIPS measures that are relatively strong predictors of conversion, comparable with the risk calculator published by NAPLS (c-index = 0.71), but requiring only a structured clinical interview. Future work will seek to externally validate the model and enhance its performance with the incorporation of relevant biomarkers.
Criminal victimization and psychotic experiences: Cross-sectional associations in 35 low- and middle-income countriesDevylder, J. E., Kelleher, I., Oh, H., Link, B. G., Yang, L. H., & Koyanagi, A.
Journal titleActa Psychiatrica ScandinavicaObjective: Criminal victimization has been associated with elevated risk for psychotic symptoms in the United Kingdom, but has not been studied in low- and middle-income countries (LMICs). Understanding whether crime exposure may play a role in the social etiology of psychosis could help guide prevention and intervention efforts. Method: We tested the hypothesis that criminal victimization would be associated with elevated odds of psychotic experiences in 35 LMICs (N = 146 999) using cross-sectional data from the World Health Organization World Health Survey. Multivariable logistic regression analyses were used to test for associations between criminal victimization and psychotic experiences. Results: Victimization was associated with greater odds of psychotic experiences, OR (95% CI) = 1.72 (1.50-1.98), and was significantly more strongly associated with psychotic experiences in non-urban, OR (95% CI) = 1.93 (1.60-2.33), compared to urban settings, OR (95% CI) = 1.48 (1.21-1.81). The association between victimization and psychosis did not change across countries with varying aggregated levels of criminal victimization. Conclusions: In the largest ever study of victimization and psychosis, the association between criminal victimization and psychosis appears to generalize across a range of LMICs and, therefore, across nations with a broad range of crime rates, degree of urban development, average per capita income, and racial/ethnic make-up.
Depressive symptoms and their association with social determinants and chronic diseases in middle-aged and elderly Chinese peopleLiu, Q., Cai, H., Yang, L. H., Xiang, Y. B., Yang, G., Li, H., Gao, Y. T., Zheng, W., Susser, E., & Shu, X. O.
Journal titleScientific Reports
Issue1Depression is one of the most prevalent mental disorders worldwide. Little information is available regarding association of depressive symptoms (DS) with cancer and chronic diseases among middle-aged and elderly Chinese in a population-based setting. In this study we evaluated the prevalence and examined correlates of DS in two population-based cohort studies. Included in the analyses were 103,595 people with a mean age of 61.8 years at the DS assessment. The prevalence of DS was 2.4% in men and 5.6% in women. We found elderly participants, those with lower BMI, or chronic diseases were more likely to experience DS. Having a history of stroke (odds ratio (OR) = 2.2 in men and 1.8 in women), cancer (OR = 3.3 in men and 1.9 in women), or Parkinson's disease (OR = 3.1 in men and 2.7 in women) was associated with high DS. In women, high income and high education levels were inversely related to DS. Being a single woman, long-term or heavy female smoker was associated with high prevalence of DS. High BMI was correlated with low prevalence of depression in men. Our data suggests a low prevalence of DS among middle-aged and elderly people in Shanghai, China. Age, education, income, marital status, smoking, BMI, and certain health conditions were associated with DS.
Factors Related to the Probable PTSD after the 9/11 World Trade Center Attack among Asian AmericansKung, W. W., Liu, X., Huang, D., Kim, P., Wang, X., & Yang, L. H.
Journal titleJournal of Urban Health
Page(s)255-266Despite the fact that Asians constituted a sizeable proportion of those exposed to the World Trade Center attack on September 11, 2001 due to its proximity to Chinatown and many South Asians working in the nearby buildings, no study had focused on examining the mental health impact of the attack in this group. Based on data collected by the World Trade Center Health Registry from a sample of 4721 Asians 2–3 years after the disaster, this study provides a baseline investigation for the prevalence and the risk and protective factors for PTSD among Asian Americans directly exposed to the attack and compared this population against 42,862 non-Hispanic Whites. We found that Asians had a higher prevalence of PTSD compared to Whites (14.6 vs 11.7%). “Race-specific factors” significantly associated to PTSD in the multivariate analyses were noted among sociodemographics: higher education was protective for Whites but a risk factor for Asians; being employed was protective for Whites but had no effect for Asians; and being an immigrant was a risk factor for Whites but had no effect for Asians. However, income was a protective factor for both races. Other “universal factors” significantly increased the odds of PTSD symptoms but showed no racial differences, including exposure to the disaster and the presence of lower respiratory symptoms which intensified odds of PTSD by the greatest magnitude (3.6–3.9 times). Targeted effort to reach out to Asians is essential for prevention and follow up treatment given this group’s striking history of underutilization of mental health services.
Measuring internalized stigma of mental illness among Chinese outpatients with mood disordersSmith, M. L., Yang, L. H., Huang, D., Pike, K. M., Yuan, C., & Wang, Z.
Journal titleInternational Journal of Culture and Mental Health
Page(s)1-14Internalized stigma is a barrier to mental health care in China, and stigma reduction is expected to promote treatment utilization, especially for mood disorders and schizophrenia. We aimed to identify the most common domains of internalized stigma of mental illness and to test the hypothesis that people with more severe mood disorders evidence more internalized stigma than those with less severe disorders. The Internalized Stigma of Mental Illness (ISMI) was administered to 366 outpatients with various mood disorders in Shanghai. Reliability statistics were calculated and frequently-endorsed items were identified. The magnitude of internalized stigma was compared among diagnostic categories and among sociodemographic groups. Except for stigma resistance, the ISMI and its subscales had good internal consistency. Across subgroups, stereotype endorsement was most commonly reported. Bipolar (versus depressive) disorders, male gender, and less education were associated with more internalized stigma, especially social withdrawal. Contrasting findings in Western countries, those with family history of mental illness trended toward more internalized stigma. We conclude that anti-stigma interventions should focus on reducing social withdrawal and stereotype endorsement, especially for those with more severe mood disorders, males, less educated individuals, and those with family history of mental illness.
Understanding stigma as a barrier to accessing cancer treatment in South Africa: Implications for public health campaignsOystacher, T., Blasco, D., He, E., Huang, D., Schear, R., McGoldrick, D., Link, B., & Yang, L. H.
Journal titlePan African Medical Journal
Volume29Introduction: Cancer contributes to significant illness burden in South Africa, with delayed diagnosis resulting from limited knowledge of cancer, lack of biomedical treatment and stigma. This study examines ways in which people are identified as having cancer through perspectives of traditional healing or the biomedical model. Additionally, we sought to understand the stigma associated with cancer, including stereotypes, anticipated discrimination and coping styles. Methods: Livestrong Foundation conducted 11 semi-structured focus groups with key community stakeholders in three South African townships. Interviews examined the negative consequences of being labeled with a cancer diagnosis as well as causes of, possible prevention of and barriers and methods to improve access to cancer treatment. Analyses were completed using directed content analysis. Results: Revealed three main labeling mechanisms: physical appearance of perceived signs/symptoms of cancer, diagnosis by a traditional healer, or a biomedical diagnosis by a Western physician. Being labeled led to anticipated discrimination in response to prevalent cancer stereotypes. This contributed to delayed treatment, use of traditional healers instead of biomedical treatment and secrecy of symptoms and/or diagnosis. Further, perceptions of cancer were commonly conflated with HIV/TB owing to prior educational campaigns. Conclusion: Our study deepens the understanding of the cancer labeling process in South Africa and the resulting negative effects of stigma. Future anti-stigma interventions should partner with traditional healers due to their respected community status and consider how previous health interventions may significantly impact current understandings of illness.
Using information and communication technologies to prevent suicide among secondary school students in two regions of Chile: A randomized controlled trialMascayano, F., Schilling, S., Tapia, E., Santander, F., Burrone, M. S., Yang, L. H., & Alvarado, R.
Journal titleFrontiers in Psychiatry
Volume9Background: There is an increasing concern for addressing suicide among adolescents in Latin America. Recent mental health policies encourage the development and implementation of preventive interventions for suicide. Such initiatives, however, have been scarcely developed, even in countries with solid mental health services such as Chile. The use of information and communications technology (ICT) might contribute to create accessible, engaging, and innovative platforms to promote well-being and support for adolescents with mental health needs and suicide risk. Objective: To evaluate a program based on ICT to prevent suicide and enhance mental health among adolescents in Chile. Method: A cluster randomized controlled trial (RCT) will be conducted including 428 high-school students aged 18-14 years in two regions of Chile. Study procedures will take place as follows: (1) design of the intervention model and creation of prototype; (2) selection and randomization of the participating public schools; (3) implementation of the 3-month intervention and evaluation at baseline, post-intervention period, and a 2-month follow-up. Suicidal ideation at the 2-month follow up is the primary outcome in this study. Secondary outcomes include negative psychological outcomes (e.g., stigma, depression, anxiety) as well as a number of protective psychological and social factors. Indicators regarding the study implementation will be also gathered. Discussion: Here we describe a novel program based on technological devices and aimed to target youth suicide in Chile. This is the first clinical trial of such a program in Latin America, and to our knowledge, the first of its kind in any middle income country.
Advances in the cultural assessment of stigma to promote global mental healthYang, L., Sia, K., & Yang, L. In Stigma Towards Mental Illness: a Public Health Challengs.
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., Crumbley, A. H., Crump, F. M., Gill, K. E., Kimhy, D., Lister, A., Schobel, S. A., Yang, L. H., Lieberman, J. A., & Girgis, R. R.
Journal titlePsychological Medicine
Page(s)1-13Background: 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., Yang, L. H., Brucato, G., & Girgis, R. R.
Journal titleSchizophrenia ResearchRecent 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. H., Liu, Y. J., Huang, D., Mao, W. J., Lin, F. R., Li, J., & Chan, C. L.
Journal titleInternational Journal of Social Psychiatry
Page(s)203-211Background: 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 (<mean) in 1994 had significantly higher rate of homelessness (9.9%) and lower rate of survival (63.8%) in 2008 than those from high family economic status (3/4mean; 3.2% and 76.6%, respectively). Individuals from low family economic status had significantly lower rates of marriage and complete remission, higher mean scores on Positive and Negative Syndrome Scale (PANSS) and lower mean score on Global Assessment of Functioning (GAF) than those from high family economic status in 2008. The predictors of low family economic status of individuals in 2008 encompassed the baseline low family economic status, poor families' attitude toward the patient, younger age, older age of first onset and longer duration of illness. Conclusion: Low family economic status is a predictive factor of poor long-term outcome of persons with schizophrenia in the rural community. Individuals' family economic status should be considered in making mental health policy and providing community-based mental health services.
The importance of symbolic interaction in mental illness stigmaHe, E., Yang, L., & Link, B. G. In Stigma Towards Mental Illness: A Public Health Challenge.
The role of culture in population mental health: prevalence of mental disorders among Asian and Asian american populationsYang, L., & Benson, J. In Handbook of Cultural Neuroscience.
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., Martinez, M., Botcheva, L., Vega, E., Chu, J., Lewis, S., & Yang, L. H.
Journal titleIsrael Journal of Psychiatry and Related Sciences
Page(s)39-49Background: 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. H., 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., Abelha, L., Lovisi, G. M., Sarução, K. R., & Yang, L.
Journal titlePsychiatric Quarterly
Page(s)1-14As 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. H.
Journal titleCommunity Mental Health Journal
Page(s)643-650Limited 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. H., Link, B. G., & DeVylder, J. E.
Page(s)265-270Background: 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.
PrinciplesYang, L., Kleinman, A., & Morita, J. In International Encyclopedia of Public Health: Stigma.
Page(s)40-50Stigma 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.
#Schizophrenia: Use and misuse on TwitterJoseph, A. J., Tandon, N., Yang, L. H., Duckworth, K., Torous, J., Seidman, L. J., & Keshavan, M. S.
Journal titleSchizophrenia Research
Page(s)111-115Background: 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. H.
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. H., Valencia, E., Rodrigues Sarução, K., & Lovisi, G. M.
Journal titleRevista de la Facultad de Ciencias Medicas (Cordoba, Argentina)
Page(s)211-219OBJECTIVES: 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., Sapag, J. C., Yang, L. H., Lukens, E., Mascayano, F., Cid, P., & Tapia, T.
Journal titleRevista de la Facultad de Ciencias Medicas (Cordoba, Argentina)
Page(s)284-294BACKGROUND: 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
Page(s)19-39Encounters 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.