Top

International Journal of Mental Health and Addiction

Published in:

03-06-2022 | Schizophrenia | Original Article

Effects of Recovery Measures on Internalized Stigma in Patients Diagnosed with Schizophrenia

Authors: Alejandra Caqueo-Urízar, Felipe Ponce-Correa, Alfonso Urzúa

Published in: International Journal of Mental Health and Addiction | Issue 6/2022

Abstract

The research aimed to establish important predictors for addressing internalized stigma from a series of clinical measures relevant to recovery such as symptomatology, functionality, and psychological recovery of patients diagnosed with schizophrenia. This cross-sectional study analyzed the information obtained through interviews and surveys of 165 patients diagnosed with schizophrenia of the Public Mental Health Centers in the city of Arica, Chile. The results show that regression models composed of different measures of recovery such as symptomatology, functionality, and subjective recovery are significant predictors of internalized stigma. Of all measures, subjective psychological aspects such as hope most strongly predict dimensions of internalized stigma. The implications of this study emphasize that for the treatment of internalized stigma, aspects such as hope or general optimism about the possibility of achieving personal goals and aspirations may contribute significantly to addressing internalized stigma in patients diagnosed with schizophrenia.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. Author.

Andreasen, N. C., Carpenter, W. T., Jr., Kane, J. M., Lasser, R. A., Marder, S. R., & Weinberger, D. R. (2005). Remission in schizophrenia: Proposed criteria and rationale for consensus. The American Journal of Psychiatry, 162(3), 441–449. https://doi.org/10.1176/appi.ajp.162.3.441CrossRefPubMed

Angermeyer, M. C., & Dietrich, S. (2006). Public beliefs about and attitudes towards people with mental illness: A review of population studies. Acta Psychiatrica Scandinavica, 113(3), 163–179. https://doi.org/10.1111/j.1600-0447.2005.00699.xCrossRefPubMed

Aukst-Margetić, B., Jakšić, N., BoričevićMaršanić, V., & Jakovljević, M. (2014). Harm avoidance moderates the relationship between internalized stigma and depressive symptoms in patients with schizophrenia. Psychiatry Research, 219(1), 92–94. https://doi.org/10.1016/j.psychres.2014.05.009CrossRefPubMed

Barlati, S., Morena, D., Nibbio, G., Cacciani, P., Corsini, P., Mosca, A., Deste, G., Accardo, V., Turrina, C., Valsecchi, P., & Vita, A. (2021). Internalized stigma among people with schizophrenia: Relationship with socio-demographic, clinical and medication-related features. Schizophrenia Research. Published. https://doi.org/10.1016/j.schres.2021.06.007

Bos, A. E. R., Pryor, J. B., Reeder, G. D., & Stutterheim, S. E. (2013). Stigma: Advances in theory and research. Basic and Applied Social Psychology, 35(1), 1–9. https://doi.org/10.1080/01973533.2012.746147CrossRef

Çapar, M., & Kavak, F. (2019). Effect of internalized stigma on functional recovery in patients with schizophrenia. Perspectives in Psychiatric Care, 55(1), 103–111. https://doi.org/10.1111/ppc.12309CrossRefPubMed

Caqueo-Urízar, A., Urzúa, A., Habib, J., Loundou, A., Boucekine, M., Boyer, L., & Fond, G. (2019). Relationships between social stigma, stigma experience and self-stigma and impaired quality of life in schizophrenia across three Latin-American countries. European Archives of Psychiatry and Clinical Neuroscience, 270(5), 513–520. https://doi.org/10.1007/s00406-019-01035-8CrossRefPubMed

Carrara, B. S., & Ventura, C. (2018). Self-stigma, mentally ill persons and health services: An integrative review of literature. Archives of Psychiatric Nursing, 32(2), 317–324. https://doi.org/10.1016/j.apnu.2017.11.001CrossRefPubMed

Catalano, L. T., Brown, C. H., Lucksted, A., Hack, S. M., & Drapalski, A. L. (2021). Support for the social-cognitive model of internalized stigma in serious mental illness. Journal of Psychiatric Research, 137, 41–47. https://doi.org/10.1016/j.jpsychires.2021.02.014CrossRefPubMedCentralPubMed

Chaimowitz, G. A., Upfold, C., Géa, L. P., Qureshi, A., Moulden, H. M., Mamak, M., & Bradford, J. M. W. (2021). Stigmatization of psychiatric and justice-involved populations during the COVID-19 pandemic. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 106, 110150. https://doi.org/10.1016/j.pnpbp.2020.110150CrossRefPubMed

Chan, K. K. S., & Mak, W. W. S. (2014). The mediating role of self-stigma and unmet needs on the recovery of people with schizophrenia living in the community. Quality of Life Research, 23(9), 2559–2568. https://doi.org/10.1007/s11136-014-0695-7CrossRefPubMed

Ciudad, A., Bobes, J., Álvarez, E., San, L., Novick, D., & Gilaberte, I. (2011). Resultados clínicos relevantes en Esquizofrenia: Remisión y recuperación. Revista De Psiquiatría y Salud Mental, 4(1), 53–65. https://doi.org/10.1016/j.rpsm.2010.12.002CrossRefPubMed

Corrigan, P. W., Rafacz, J., & Rüsch, N. (2011). Examining a progressive model of self-stigma and its impact on people with serious mental illness. Psychiatry Research, 189(3), 339–343. https://doi.org/10.1016/j.psychres.2011.05.024CrossRefPubMedCentralPubMed

Cureton, E. E. (1956). Rank-biserial correlation. Psychometrika, 21(3), 287–290. https://doi.org/10.1007/bf02289138CrossRef

Degnan, A., Berry, K., Humphrey, C., & Bucci, S. (2021). The relationship between stigma and subjective quality of life in psychosis: A systematic review and meta-analysis. Clinical Psychology Review, 85, 102003. https://doi.org/10.1016/j.cpr.2021.102003CrossRefPubMed

Díaz-Mandado, O., & Periáñez, J. A. (2021). An effective psychological intervention in reducing internalized stigma and improving recovery outcomes in people with severe mental illness. Psychiatry Research, 295, 113635. https://doi.org/10.1016/j.psychres.2020.113635CrossRefPubMed

El-Monshed, A., & Amr, M. (2020). Association between perceived social support and recovery among patients with schizophrenia. International Journal of Africa Nursing Sciences, 13, 100236. https://doi.org/10.1016/j.ijans.2020.100236CrossRef

Fay, M. P., & Proschan, M. A. (2010). Wilcoxon-Mann-Whitney or t-test? On assumptions for hypothesis tests and multiple interpretations of decision rules. Statistics Surveys, 4, 1–39. https://doi.org/10.1214/09-SS051CrossRefPubMedCentralPubMed

Grandón, P., Aguilera, A. V., Bustos, C., Alzate, E. C., & Saldivia, S. (2018). Evaluation of the stigma towards people with a diagnosis of schizophrenia using a knowledge scale. Revista Colombiana De Psiquiatría (english Ed.), 47(2), 72–81. https://doi.org/10.1016/j.rcpeng.2018.03.002CrossRefPubMed

Grandón-Fernández, P., Cárcamo Guzmán, K., Cofré Lira, I., Flores Oyarzo, G., Lagos Arriagada, D., & Oñate Vidal, N. (2019). Atención en salud mental de las personas con diagnóstico psiquiátrico grave y su recuperación. Psicoperspectivas. Individuo y Sociedad, 18(2), 1–11. https://doi.org/10.5027/psicoperspectivas-vol18-issue2-fulltext-1582CrossRef

Haro, J. M., Altamura, C., Corral, R., Elkis, H., Evans, J., Krebs, M. O., Zink, M., Malla, A., Méndez, J. I., Bernasconi, C., Lalonde, J., & Nordstroem, A. L. (2018). Understanding the course of persistent symptoms in schizophrenia: Longitudinal findings from the pattern study. Psychiatry Research, 267, 56–62. https://doi.org/10.1016/j.psychres.2018.04.005CrossRefPubMed

Hinshaw, S. P. (2007). The mark of shame: Stigma of mental illness and an agenda for change. Oxford University Press.

Hofer, A., Mizuno, Y., Frajo-Apor, B., Kemmler, G., Suzuki, T., Pardeller, S., Welte, A. S., Sondermann, C., Mimura, M., Wartelsteiner, F., Fleischhacker, W. W., & Uchida, H. (2016). Resilience, internalized stigma, self-esteem, and hopelessness among people with schizophrenia: Cultural comparison in Austria and Japan. Schizophrenia Research, 171(1–3), 86–91. https://doi.org/10.1016/j.schres.2016.01.027CrossRefPubMed

Hofer, A., Post, F., Pardeller, S., Frajo-Apor, B., Hoertnagl, C. M., Kemmler, G., & Fleischhacker, W. W. (2019). Self-stigma versus stigma resistance in schizophrenia: Associations with resilience, premorbid adjustment, and clinical symptoms. Psychiatry Research, 271, 396–401. https://doi.org/10.1016/j.psychres.2018.12.029CrossRefPubMed

Hosseini, S. H., & Karkhaneh Yousefi, M. (2011). Quality of life and GAF in schizophrenia correlation between quality of life and global functioning in schizophrenia. Iranian Journal of Psychiatry and Behavioral Sciences, 5(2), 120–125.PubMedCentralPubMed

İpçi, K., Yildiz, M., İNcedere, A., Kiras, F., Esen, D., & Gürcan, M. B. (2020). Subjective recovery in patients with schizophrenia and related factors. Community Mental Health Journal, 56(6), 1180–1187. https://doi.org/10.1007/s10597-020-00616-5CrossRefPubMed

Ivezić, S. Š, Sesar, M. A., & Mužinić, L. (2017). Effects of a group psychoeducation program on self-stigma, empowerment and experiences of discrimination of persons with schizophrenia. Psychiatria Danubina, 29(1), 66–73.CrossRefPubMed

Karakaş, S. A., Okanlı, A., & Yılmaz, E. (2016). The effect of internalized stigma on the self esteem in patients with schizophrenia. Archives of Psychiatric Nursing, 30(6), 648–652. https://doi.org/10.1016/j.apnu.2016.02.006CrossRefPubMed

Kvrgic, S., Cavelti, M., Beck, E. M., Rüsch, N., & Vauth, R. (2013). Therapeutic alliance in schizophrenia: The role of recovery orientation, self-stigma, and insight. Psychiatry Research, 209(1), 15–20. https://doi.org/10.1016/j.psychres.2012.10.009CrossRefPubMed

Kylmä, J., Juvakka, T., Nikkonen, M., Korhonen, T., & Isohanni, M. (2006). Hope and schizophrenia: An integrative review. Journal of Psychiatric and Mental Health Nursing, 13(6), 651–664. https://doi.org/10.1111/j.1365-2850.2006.01012CrossRefPubMed

Lançon, C., Aghababian, V., Llorca, P. M., & Auquier, P. (1998). Factorial structure of the Positive and Negative Syndrome Scale (PANSS): A forced five-dimensional factor analysis. Acta Psychiatrica Scandinavica, 98(5), 369–376. https://doi.org/10.1111/j.1600-0447.1998.tb10101.xCrossRefPubMed

Libman-Sokołowska, M., & Nasierowski, T. (2013). Rola nadziei w zmaganiach ze schizofrenia [The importance of hope in coping with schizophrenia]. Psychiatria Polska, 47(5), 933–943.CrossRefPubMed

Link, B., & Phelan, J. (2001). Conceptualizing stigma. Annual Review of Sociology, 27(1), 363–385.CrossRef

Livingston, J. D., & Boyd, J. E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Social Science & Medicine, 71(12), 2150–2161. https://doi.org/10.1016/j.socscimed.2010.09.030CrossRef

Mak, W. W. S., & Cheung, R. Y. M. (2010). Self-stigma among concealable minorities in Hong Kong: Conceptualization and unified measurement. American Journal of Orthopsychiatry, 80(2), 267–281. https://doi.org/10.1111/j.1939-0025.2010.01030.xCrossRefPubMed

Mann, H. B., & Whitney, D. R. (1947). On a test of whether one of two random variables is stochastically larger than the other. The Annals of Mathematical Statistics, 18(1), 50–60. http://www.jstor.org/stable/2236101.CrossRef

Mathew, S., Nirmala, B., Kommu, J. V., & Sagar. (2018). Meaning of recovery among persons with schizophrenia: A literature review. Journal of Psychosocial Rehabilitation and Mental Health. https://doi.org/10.1007/s40737-018-0111-7CrossRef

Morgades-Bamba, C. I., Fuster-Ruizdeapodaca, M. J., & Molero, F. (2019). Internalized stigma and its impact on schizophrenia quality of life. Psychology, Health & Medicine, 24(8), 992–1004. https://doi.org/10.1080/13548506.2019.1612076CrossRef

Morgan, A. J., Reavley, N. J., Ross, A., Too, L. S., & Jorm, A. F. (2018). Interventions to reduce stigma towards people with severe mental illness: Systematic review and meta-analysis. Journal of Psychiatric Research, 103, 120–133. https://doi.org/10.1016/j.jpsychires.2018.05.017CrossRefPubMed

Nowak, I., Waszkiewicz, J., Świtaj, P., Sokół-Szawłowska, M., & Anczewska, M. (2017). A qualitative study of the subjective appraisal of recovery among people with lived experience of schizophrenia in Poland. The Psychiatric Quarterly, 88(3), 435–446. https://doi.org/10.1007/s11126-016-9459-6CrossRefPubMed

Oexle, N., Müller, M., Kawohl, W., Xu, Z., Viering, S., Wyss, C., Vetter, S., & Rüsch, N. (2017). Self-stigma as a barrier to recovery: A longitudinal study. European Archives of Psychiatry and Clinical Neuroscience, 268(2), 209–212. https://doi.org/10.1007/s00406-017-0773-2CrossRefPubMed

Oexle, N., Rüsch, N., Viering, S., Wyss, C., Seifritz, E., Xu, Z., & Kawohl, W. (2016). Self-stigma and suicidality: A longitudinal study. European Archives of Psychiatry and Clinical Neuroscience, 267(4), 359–361. https://doi.org/10.1007/s00406-016-0698-1CrossRefPubMed

Öztürk, Z., Şahi, N., & Altun, Ö. (2022). The effect of nursing interventions to instill hope on the internalized stigma, hope, and quality of life levels in patients with schizophrenia. Perspectives in Psychiatric Care, 58(1), 364–373. https://doi.org/10.1111/ppc.12800CrossRefPubMed

Pellet, J., Golay, P., Nguyen, A., Suter, C., Ismailaj, A., Bonsack, C., & Favrod, J. (2019). The relationship between self-stigma and depression among people with schizophrenia-spectrum disorders: A longitudinal study. Psychiatry Research, 275, 115–119. https://doi.org/10.1016/j.psychres.2019.03.022CrossRefPubMed

Reneses, B., Sevilla Llewellyn-Jones, J., Vila-Badia, R., Palomo, T., Lopez-Micó, C., Pereira, M., José Regatero, M., & Ochoa, S. (2020). The relationships between sociodemographic, psychosocial and clinical variables with personal-stigma in patients diagnosed with schizophrenia. Actas Espanolas De Psiquiatria, 48(3), 116–125.PubMed

A Rossi M Amore S Galderisi P Rocca A Bertolino E Aguglia G Amodeo A Bellomo P Bucci A Buzzanca B Carpiniello A Comparelli L DellOsso M Giannantonio di M Mancini C Marchesi P Monteleone C Montemagni L Oldani R Roncone … Italian Network for Research on Psychoses 2018 The complex relationship between self-reported ‘personal recovery’ and clinical recovery in schizophrenia Schizophrenia research 192 108 112 https://doi.org/10.1016/j.schres.2017.04.040

Rossi, A., Galderisi, S., Rocca, P., Bertolino, A., Rucci, P., Gibertoni, D., Stratta, P., Bucci, P., Mucci, A., Aguglia, E., Amodeo, G., Amore, M., Bellomo, A., Brugnoli, R., Caforio, G., Carpiniello, B., Dell'Osso, L., di Fabio, F., di Giannantonio, M., Marchesi, C., … Italian Network for Research on Psychoses (2017). Personal resources and depression in schizophrenia: The role of self-esteem, resilience and internalized stigma. Psychiatry research, 256:359–364. https://doi.org/10.1016/j.psychres.2017.06.079

Schwarzbold, M. L., Kern, R. S., Novacek, D. M., McGovern, J. E., Catalano, L. T., & Green, M. F. (2021). Self-stigma in psychotic disorders: Clinical, cognitive, and functional correlates in a diverse sample. Schizophrenia Research, 228, 145–150. https://doi.org/10.1016/j.schres.2020.12.003CrossRefPubMed

Singh, A., Mattoo, S. K., & Grover, S. (2016). Stigma and its correlates in patients with schizophrenia attending a general hospital psychiatric unit. Indian Journal of Psychiatry, 58(3), 291–300. https://doi.org/10.4103/0019-5545.192024CrossRefPubMedCentralPubMed

Singla, N., Avasthi, A., & Grover, S. (2020). Recovery and its correlates in patients with schizophrenia. Asian Journal of Psychiatry, 52, 102162. https://doi.org/10.1016/j.ajp.2020.102162CrossRefPubMed

Slade, M., Leamy, M., Bacon, F., Janosik, M., Le Boutillier, C., Williams, J., & Bird, V. (2012). International differences in understanding recovery: Systematic review. Epidemiology and Psychiatric Sciences, 21(4), 353–364. https://doi.org/10.1017/S2045796012000133CrossRefPubMedCentralPubMed

Switaj, P., Wciórka, J., Smolarska-Switaj, J., & Grygiel, P. (2009). Extent and predictors of stigma experienced by patients with schizophrenia. European Psychiatry : The Journal of the Association of European Psychiatrists, 24(8), 513–520. https://doi.org/10.1016/j.eurpsy.2009.06.003CrossRefPubMed

The jamovi project (2021). jamovi. (Version 1.8) [Computer Software]. Retrieved from https://www.jamovi.org.

Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., Koschorke, M., Shidhaye, R., O’Reilly, C., & Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet (london, England), 387(10023), 1123–1132. https://doi.org/10.1016/S0140-6736(15)00298-6CrossRefPubMed

Tooth, B., Kalyanasundaram, V., Glover, H., & Momenzadah, S. (2003). Factors consumers identify as important to recovery from schizophrenia. Australasian Psychiatry, 11(Suppl1), S70–S77. https://doi.org/10.1046/j.1440-1665.11.s1.1.xCrossRef

Tsang, H. W., Ching, S. C., Tang, K. H., Lam, H. T., Law, P. Y., & Wan, C. N. (2016). Therapeutic intervention for internalized stigma of severe mental illness: A systematic review and meta-analysis. Schizophrenia Research, 173(1–2), 45–53. https://doi.org/10.1016/j.schres.2016.02.013CrossRefPubMed

Tse, S., Davidson, L., Chung, K. F., Ng, K. L., & Yu, C. H. (2014). Differences and similarities between functional and personal recovery in an Asian population: A cluster analytic approach. Psychiatry, 77(1), 41–56. https://doi.org/10.1521/psyc.2014.77.1.41CrossRefPubMed

Valencia, M., Fresán, A., Barak, Y., Juárez, F., Escamilla, R., & Saracco, R. (2015). Predicting functional remission in patients with schizophrenia: A cross-sectional study of symptomatic remission, psychosocial remission, functioning, and clinical outcome. Neuropsychiatric Disease and Treatment, 11, 2339–2348. https://doi.org/10.2147/NDT.S87335CrossRefPubMedCentralPubMed

Valery, K. M., & Prouteau, A. (2020). Schizophrenia stigma in mental health professionals and associated factors: A systematic review. Psychiatry Research, 290, 113068. https://doi.org/10.1016/j.psychres.2020.113068CrossRefPubMed

Vass, V., Morrison, A. P., Law, H., Dudley, J., Taylor, P., Bennett, K. M., & Bentall, R. P. (2015). How stigma impacts on people with psychosis: The mediating effect of self-esteem and hopelessness on subjective recovery and psychotic experiences. Psychiatry Research, 230(2), 487–495. https://doi.org/10.1016/j.psychres.2015.09.042CrossRefPubMed

Verdoux, H., Quiles, C., Bon, L., Chéreau-Boudet, I., Dubreucq, J., Legros-Lafarge, E., Guillard-Bouhet, N., Massoubre, C., Plasse, J., & Franck, N. (2020). Characteristics associated with self-reported medication adherence in persons with psychosis referred to psychosocial rehabilitation centers. European Archives of Psychiatry and Clinical Neuroscience. Published. https://doi.org/10.1007/s00406-020-01207-x

Wade, M., Tai, S., Awenat, Y., & Haddock, G. (2017). A systematic review of service-user reasons for adherence and nonadherence to neuroleptic medication in psychosis. Clinical Psychology Review, 51, 75–95. https://doi.org/10.1016/j.cpr.2016.10.009CrossRefPubMed

Wood, L., Byrne, R., Varese, F., & Morrison, A. P. (2016). Psychosocial interventions for internalised stigma in people with a schizophrenia-spectrum diagnosis: A systematic narrative synthesis and meta-analysis. Schizophrenia Research, 176(2–3), 291–303.CrossRefPubMed

Yanos, P. T., Lysaker, P. H., Silverstein, S. M., Vayshenker, B., Gonzales, L., West, M. L., & Roe, D. (2019). A randomized-controlled trial of treatment for self-stigma among persons diagnosed with schizophrenia-spectrum disorders. Social Psychiatry and Psychiatric Epidemiology, 54(11), 1363–1378. https://doi.org/10.1007/s00127-019-01702-0CrossRefPubMedCentralPubMed

Yanos, P. T., Roe, D., Markus, K., & Lysaker, P. H. (2008). Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psychiatric services (Washington, D.C.), 59(12), 1437–1442. https://doi.org/10.1176/appi.ps.59.12.1437CrossRefPubMed

Yılmaz, E., & Okanlı, A. (2015). The effect of internalized stigma on the adherence to treatment in patients with schizophrenia. Archives of Psychiatric Nursing, 29(5), 297–301. https://doi.org/10.1016/j.apnu.2015.05.006CrossRefPubMed

Young, D. K. W., Ng, P. Y. N., & Cheng, D. (2019). Destigmatized group intervention on promoting hope of recovery: A quasi-experiment study. Research on Social Work Practice, 30(1), 54–64. https://doi.org/10.1177/1049731519841432CrossRef

Yu, B. C., Chio, F. H., Mak, W. W., Corrigan, P. W., & Chan, K. K. (2021). Internalization process of stigma of people with mental illness across cultures: A meta-analytic structural equation modeling approach. Clinical Psychology Review, 87, 102029. https://doi.org/10.1016/j.cpr.2021.102029CrossRefPubMed

Zhang, T. M., Wong, I. Y. L., Yu, Y. H., Ni, S. G., He, X. S., Bacon-Shone, J., Gong, K., Huang, C. H., Hu, Y., Tang, M. M., Cao, W., Chan, C. L. W., & Ran, M. S. (2018). An integrative model of internalized stigma and recovery-related outcomes among people diagnosed with schizophrenia in rural China. Social Psychiatry and Psychiatric Epidemiology, 54(8), 911–918. https://doi.org/10.1007/s00127-018-1646-3CrossRefPubMed

Title: Effects of Recovery Measures on Internalized Stigma in Patients Diagnosed with Schizophrenia
Authors: Alejandra Caqueo-Urízar
Felipe Ponce-Correa
Alfonso Urzúa
Publication date: 03-06-2022
Publisher: Springer US
Keyword: Schizophrenia
Published in: International Journal of Mental Health and Addiction / Issue 6/2022
Print ISSN: 1557-1874
Electronic ISSN: 1557-1882
DOI: https://doi.org/10.1007/s11469-022-00847-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Effects of Recovery Measures on Internalized Stigma in Patients Diagnosed with Schizophrenia

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2022

Blended-eLearning Impact on Health Worker Stigma Toward Alcohol, Tobacco, and Other Psychoactive Substance Users

Measuring Stigma Towards People with Opioid Use Problems: Exploratory and Confirmatory Factor Analysis of the Opening Minds Provider Attitudes Towards Opioid-Use Scale (OM-PATOS)

To Blame or Not to Blame: the Role of Belief in Free Will in Substance Use and Suicide Stigma

Stigma and Medication for Opioid Use Disorder (MOUD) Among Women

Individuals to Systems: Methodological and Conceptual Considerations for Addressing Mental Illness Stigma Holistically

Combination of a Serious Game Application and Direct Contact with Mental Health Patients