Transcript Document

Perceptions of Mental Health
Stigma and Discrimination in a
Mexican American Sample
Presented: 11/09/2011
Latino Behavioral Health Conference
By Jeff D. Wright, Ph.D.
What is Stigma
• Word originally referred to the mark or brand
that was put on Greek slaves to separate
them from free men
• “An attribute that is deeply discrediting… A
sign of disgrace or discredit which sets a
person apart from others.” – Goffman, 1963
Examples of Stigma
Stigma of Physical Handicaps
• Physical disabilities have been found to be highly stigmatized
conditions.
• Saetermoe and colleagues (2001) found that the severity of a
disability, especially physical disabilities, have a strong impact on how
they are perceived by others.
• Murphy (1995) reported that individuals with physical disabilities
experienced significant stigma in the form of discrimination(i.e.
employment) and social rejection (i.e. limited social circle).
Examples of Stigma
Stigma of Obesity
• The negative attitudes that reinforce the stigmatization of obese
individuals are accepted, and even encouraged, in American society.
• Stigmatization of the obese is reinforced through the media, cultural
beliefs, and societal perspectives on individuals who are obese (Wang,
Brownwell, & Wadden, 2004).
• Research has consistently shown that stereotypes consistently view
obese individuals as lazy, undisciplined and unhappy (Hebl and
Turchin, 2005) .
• Obese individuals are discriminated against in professional and
employment arenas (Hebl & Kleck, 2002; Roehling, 1999).
Background
Link’s Theory of Stigma
• Stigma exists when the following interrelated components converge:
1. People distinguish and label human differences.
2. Dominant cultural beliefs link labeled persons to undesirable
characteristics and negative stereotypes
3. Labeled persons are placed in distinct categories so as to
accomplish some degree of separation of “us” from “them”
4. Labeled persons experience status loss and discrimination that
lead to unequal outcomes.
5. Thus, we apply the term stigma when elements of labeling,
stereotyping, separation, status loss, and discrimination co-occur
in a power situation that allows them to unfold (Link and Phelan,
2006).
Background
• At any given time 20% of the population of the United States has a
diagnosable mental disorder (DHHS, 1999).
• 66% of people with diagnosable mental disorders do not seek
treatment
o Stigma was one of the foremost barriers to not seeking treatment
(DHHS, 1999).
• Of treatment seekers, 74% prefer to receive treatment from their
primary care physician, as opposed to a mental health professional
(Ben-Porath, 2002; Regier, Hirschfeld, Goodwin, & Burke, 1988).
• Some evidence suggests that minorities are at increased risk for
experiencing mental health problems due to stress associated with
minority status.
• Minorities are underrepresented in mental health treatment.
• It is believed that this underutilization of services is, in part, due to
the stigma of mental health.
• Paucity of research on minority groups, such as Mexican Americans
and the stigma of mental health.
Brief Background
Ethnic Differences and the Stigma of Mental Health Problems
• There is a lack of studies in the literature focusing on racial
or ethnic differences
• In a study using college students it was found that AfricanAmericans and Latinos held more negative views of mental
health problems than their white counterparts (Silva de
Crane & Spielberger, 1981).
• Saetermoe and colleagues (2001) found Asian American
participants tended to be more stigmatizing toward
physical and mental disabilities than African American,
Latinos, or White non-Hispanic European Americans.
Brief Background
Ethnic Differences and the Stigma of Mental Health Problems
• Not all ethnic minority groups stigmatize mental health to
the same degree, such as some Native American cultures
•
•
View an individual’s disability as being minor
Tended to focus less on the disability and more on the contribution
the person makes to the overall society (Groce & Zola, 1993).
• Other data regarding the stigma of mental health problems
among ethnic groups has been found to be mixed.
•
•
One study found Hispanics who have a disabled child, either
physically or mentally, view themselves as chosen by God to raise
that child because they would be able to care for that child
(Mardiros, 1989).
Others have found that Hispanics tended to stigmatize mental
health more than severe physical disabilities, as compared to other
ethnic groups (Saetermoe et al., 2001).
Statement of the Problem
To what extent are mental health problems
stigmatized in Mexican American culture and what
factors are associated with the stigma of mental
health problems?
Justification of the Study
What is the need for this research?
•
Hispanics are the largest minority group in the U.S. and Mexican Americans constituted
63% of the Hispanic category.
•
Empirical data on Mexican Americans and their stigmatizing attitudes toward individuals
with mental health problems are limited.
•
Limited research has been conducted on gender differences among minorities and the
stigma of mental health.
•
Lack of research examining Mexican American acculturation level and the stigma of
mental health.
•
Lack of research targeting Spanish speaking Mexican Americans.
•
Understanding stigma aids in the quality and provision of care to ethnic minorities,
especially in the mental health arena.
Research Questions
• Research Question #1: Do Mexican Americans and White non-Hispanic European
Americans differ in the stigma of mental health.
• Research Question #2: Do Mexican American and White non-Hispanic European
American males and females differ in the stigma of mental health.
• Research Question #3: Is Mexican American acculturation level related to the stigma of
mental health.
• Research Question #4: Is Mexican American age, years of education, participation in
counseling and/or mental health services, and level of perceived ethnic discrimination
related to the stigma of mental health.
Methodology
Participants
• A total of 550 individuals completed the survey.
• 507 met the original criteria for the study:
18 years of age and older
self-identified as Mexican\Mexican American male or female
or self-identified as White non-Hispanic European American male or female
o Recruited from two cities in the southern part Idaho
o
o
Participants
Number of Participants by Ethnicity, Language and Gender
English
Ethnicity/Race
Spanish
Total
Female
Male
Female
Male
N
%
Asian American
4
2
-
-
6
1.1
African American
2
2
-
-
4
.8
Mexican American
84
39
57
46
226
41
White non-Hispanic European
American
171
89
-
-
260
47
6
1
-
-
7
1.2
267
133
57
46
503
91
Native American
Total
Participants
Number of Participants by Ethnicity and Generation Level
Generation Level
Ethnicity/Generation
1st
2nd
3rd
4th
5th
Unknown
Total
Asian American
1
-
3
1
-
1
6
African American
-
-
-
-
4
-
4
Mexican American
107
51
16
21
8
19
222
White non-Hispanic European American
7
5
25
48
151
16
252
Native American
-
-
3
1
2
1
7
115
56
47
71
165
37
491
Total
Participants
Number of Participants who have had Counseling and/or Mental Health Services
(MHS) by Ethnicity and Gender
Counseling
Ethnicity/Race
MHS
Female
Male
Total
Female
Male
Total
Asian American
4
2
6
1
1
2
African American
2
1
3
-
-
0
Mexican American
42
23
65
17
8
18
White non-Hispanic
European American
105
52
157
46
22
68
4
-
4
3
-
3
157
78
235
67
31
93
Native American
Total
Participants
Mean and Median for Age and Years of Education by Ethnic Group
Age
Ethnicity/Race
Education
Mean
Median
Mean
Asian American
41.2
35.5
13.6
13
African American
27.8
22.5
11.5
11.5
Mexican American
36.1
34
11.2
12
White non-Hispanic European American
41.6
40
15
16
Native American
31.9
30
13.3
12
39
37
13.2
13
Total
Median
Measures
Measure
# Items
Scale
Internal
Consistency
Reliability
Self-Stigma of Seeking Help scale
(SSOSH)
10
5-point Likert scale
1(strongly disagree) to 5 strongly agree)
0.86 – 0.90
Social Distance scale (SDS)
8
4-point Likert scale
0(definitely willing) to 3(definitely
unwilling)
0.92
Multigroup Ethnic Identity Measure
– Revised (MEIM-R)
6
5-point Likert scale
1(strongly disagree) to 5 (strongly agree)
.83
Brief Perceived Ethnic
Discrimination Questionnaire –
Community Version (Brief-PEDQCV)
17
5-point Likert scale
1(never) to 5(very often)
0.70 – 0.87
Language Proficiency Subscale
(LPS)
12
4-point Likert scale
1(very poorly) to 4(very well)
.97
Participants
Reliability Coefficients and Descriptive Statistics for Survey Measures with Mexican
Americans
# of Items
Cronbach’s Alpha
M (SD)
Min. – Max.
Self-Stigma of Seeking
Help scale a
10
.63
2.55(.26)
2.15 – 2.97
Social Distance Scale b
8
.82
1.28(.28)
.962 – 1.69
Brief Perceived Ethnic Discrimination
Questionnaire – Community Version c
17
.90
1.99(.38)
1.42 – 2.74
Language Proficiency Subscale d
12
.85
3.10(.25)
2.75 – 3.45
Multigroup Ethnic Identity Measure –
Revised e
6
.91
3.50(.18)
3.19 – 3.69
Measures
Participants
Reliability Coefficients and Descriptive Statistics for Survey Measures on the White
non-Hispanic European Americans
# of Items
Cronbach’s Alpha
M (SD)
Min. – Max.
Self-Stigma of Seeking Help scale a
10
.87
2.45(.25)
1.99 – 2.82
Social Distance Scale b
8
.85
1.22(.51)
.686 – 2.04
Brief Perceived Ethnic Discrimination
Questionnaire – Community Version c
17
.94
1.62(.28)
1.20 – 2.36
Language Proficiency Subscale d
12
.82
2.65(1.31)
1.32 – 3.93
Multigroup Ethnic Identity Measure –
Revised e
6
.90
3.20(.15)
3.07 – 3.48
Measures
Results
SSOSH Factor Analysis – White non-Hispanic
White non-Hispanic European Americans
Item
I would feel inadequate if I went to a therapist for
psychological help.
My self-confidence would NOT be threatened if I sought
professional help.
Seeking psychological help would make me feel less
intelligent.
My self-esteem would increase if I talked to a therapist.
My view of myself would not change just because I made the
choice to see a therapist.
It would make me feel inferior to ask a therapist for help.
I would feel okay about myself if I made the choice to seek
professional help.
If I went to a therapist, I would be less satisfied with myself.
My self-confidence would remain the same if I sought
professional help for a problem I could not solve.
I would feel worse about myself if I could not solve my own
problems.
Eigen values
% of Variance
Factor Loading
1
2
Communality
.75
-.40
.73
.66
.43
.62
.75
-
.68
-
.42
.26
.65
-
.55
.81
-
.72
.75
-
.71
.78
-
.67
.57
.53
.60
.74
-
.67
4.78
47.79
1.43
14.25
SSOSH Factor Analysis – Mexican Americans
Mexican Americans
Item
I would feel inadequate if I went to a therapist for
psychological help.
My self-confidence would NOT be threatened if I
sought professional help.
Seeking psychological help would make me feel less
intelligent.
My self-esteem would increase if I talked to a therapist.
My view of myself would not change just because I
made the choice to see a therapist.
It would make me feel inferior to ask a therapist for
help.
I would feel okay about myself if I made the choice to
seek professional help.
If I went to a therapist, I would be less satisfied with
myself.
My self-confidence would remain the same if I sought
professional help for a problem I could not solve.
I would feel worse about myself if I could not solve my
own problems.
Eigen values
% of Variance
1
Factor Loading
2
3
Communality
.43
-
-
.32
-
.57
.57
.73
.61
-
-
.54
-
.62
-
.51
-
.49
.46
.50
.78
-
-
.68
.59
.55
-
.69
.75
-
-
.65
-
.57
-.52
.65
.46
-
-
.43
2.56
25.57
2.11
21.07
1.03
10.29
Research Question #1:
• Do Mexican Americans and White non-Hispanic European
Americans differ in the stigma of mental health, as
measured by the SDS?
• Hypothesized that Mexican Americans and White nonHispanic European Americans would differ on SDS.
• Results for the main effect of ethnicity did not support the
hypothesis.
• Mexican Americans (M = 10.06, SD = 4.80)
• White non-Hispanic European Americans (M = 9.72, SD = 4.06)
• F (1,476) = .158, p = .692.
Research Question #2:
• Do Mexican American and White non-Hispanic European
American males and females differ in the stigma of mental
health, as measured by the SDS?
• Hypothesized that males and females would differ on the SDS.
•
•
•
Results for the main effect of gender did not support the hypothesis.
males (M = 9.87, SD = 4.73) - females (M = 9.88, SD = 4.42)
F (1,476) = .017, p = .896.
• Hypothesized a significant interaction between gender and
ethnicity with Mexican American males desiring significantly
more social distance than Mexican American females and
White non-Hispanic European American males and females.
Results did not support the hypothesis.
Mexican American males (M = 9.62, SD = 4.73) - Mexican American females
(M = 10.34, SD = 4.84),
o White non-Hispanic European American females (M = 9.51, SD = 4.03) White non-Hispanic European American males (M = 10.11, SD = 4.09).
o F (1,476) = 2.44, p = .119.
o
o
Research Question #2:
• Tested for gender differences on SSOSH within the White nonHispanic European American group.
Results of the statistical analysis supported the prediction that there would
be a gender difference.
o White non-Hispanic European males (M = 26.00, SD = 6.89) - females (M =
23.44, SD = 7.32)
o t (256) = 2.72, p = .007.
o
Research Question #3:
• Is Mexican American acculturation level related to the stigma
of mental health; as measured the SDS?
• Hypothesized that Mexican Americans’ language proficiency
would be associated with the SDS.
•
Results did not support the hypothesis. r (234) = -.04, p = .56.
• Hypothesized that Mexican Americans’ level of ethnic identity
would be related to the SDS.
•
Results did not support the hypothesis. r (182) = .07, p = .35.
• Hypothesized that Mexican Americans’ generation level
would be associated with the SDS.
•
Results did not support the hypothesis. tau-b (218) = -.06, p = .22.
Research Question #4: Is Mexican American age, years of education, participation in
counseling and/or mental health services, and level of perceived ethnic discrimination
related to the stigma of mental health, as measured by help-seeking attitudes and the
amount of social distance from individuals with mental health problems?
• There was a statistically significant correlation between age and the amount of social
distance desired from individuals with mental health problems for Mexican Americans,
r (219) = .17, p = .01.
• No statistically significant relationship between level of education and the amount of
social distance desired from individuals with mental health problems for Mexican
Americans, r (216) = -.04, p = .52.
• No statistically significant correlation between participation in counseling and the
amount of social distance from individuals with mental health problems for Mexican
Americans, rpb (232) = .03, p = .60.
• No statistically significant correlation between participation in mental health services
and the amount of social distance from individuals with mental health problems for
Mexican Americans, rpb (232) = .07, p = .32.
• No statistically significant correlation between perceived ethnic discrimination and the
amount of social distance desired from individuals with mental health problems for
Mexican Americans, r (219) = -.05, p = .55.
Discussion
Implications of the Study
• This study suggested that Mexican Americans do not stigmatize mental health
problems any more or less than White non-Hispanic European Americans.
• This argues against the stereotyped idea and some previous research that
Mexican Americans tend to be more reluctant to accept mental health
problems or interact with individuals with mental health issues.
• Furthermore, the assumption was that Mexican American males, in particular,
were the likeliest group to want the most distance between themselves and
individuals with mental health problems.
• Previous research had indicated that Mexican American males tended to
seek mental health treatment at a significantly lower rate than Mexican
American females and indicated greater distance from issues involving
mental health (Vega, Kolody, Aguilar-Gaxiola & Catalano, 1999).
• This study does not support that research; rather it indicated that Mexican
American males stigmatize mental health problems the same as White nonHispanic European American males and females as well as Mexican
American females.
Implications of the Study
• This study found a significant difference between White non-Hispanic
European American males and females in their attitudes toward seeking
help.
• Results indicated that females had significantly less self-stigma and were
more likely to seek help for psychological problems than males.
• Mexican Americans’ age was significantly correlated with the amount of
social distance from individuals with mental health problems.
As age increased the desired amount of social distance increased.
Reflect more of a generational shift in attitudes and beliefs regarding mental
health problems.
• Conversely, younger Mexican Americans appeared to be more tolerant and
may have different beliefs.
• This finding was consistent with Parra (1983) which found that younger
Mexican Americans tended to be more reluctant to label individuals’
behaviors as representing a mental health problem.
•
•
Implications of the Study
• Additionally, this study supported previous studies regarding Mexican
Americans underutilization of mental health and counseling services.
• A recent study by Vega et al., (1999) found that Mexican Americans, in
general, underutilize healthcare across the board.
• Furthermore, Mexican American females were more likely to access mental
healthcare significantly more than Mexican American males, but both
genders utilized mental healthcare significantly less than White nonHispanic European American males and females (Vega et al., 1999).
• Results of this study indicated that the Mexican American sample accessed
counseling and mental health services at approximately half the rate of
White non-Hispanic European Americans.
• This study utilized existing stigma measures and found that some
measures (SSOSH) may not be appropriate for studying stigma with
Mexican Americans in its current form.
Stigma
Strategies for Change
Interventions
• Protest
Corrigan, River et al., 2001
Corrigan & Gelb, B, 2006
Rűsch et al., 2005
Interventions
• Protest
• Education
Corrigan, River et al., 2001
Corrigan & Gelb, B, 2006
Rűsch et al., 2005
Interventions
• Protest
• Education
• Contact
Corrigan, River et al., 2001
Corrigan & Gelb, B, 2006
Rűsch et al., 2005
Anti-stigma Intervention Results
• Protest →
– No measurable effect on attitudes
Anti-stigma Intervention Results
• Protest → no effect
• Education →
– Positive effect on knowledge
– Minimal effect on attitudes, perhaps
greater in school children
– Less effect on social distance
– Longer interventions → more effective
Anti-stigma Intervention Trials
Results
• Protest → no effect
• Education → modest, limited effects
• Contact →
Greater impact on social distance than
education alone.
Impact still very small.
Contact →
Significant changes in some attitudes:
• The depressed patient
was held less
responsible for being depressed.
• Depression can improve with treatment.
• Psychosis can improve with treatment.
__________________________________
But not others:
• The psychotic patient was held no less responsible
for having psychosis.
Corrigan, River, et al., 2001
Protest Revisited
• Grassroots efforts directed at the media
• Reduce the presentation of negative images
about mental illness in the media
• Increase the presentation of positive images
about mental illness in the media
NZ National Plan 2007 - 2013
www.likeminds.org.nz
Ministry of Health. 2007. Like Minds, Like Mine National Plan 2007-2013:
Program to Counter Stigma and Discrimination Associated with Mental Illness.
Wellington: Ministry of Health.
Sponsors of U.S. Anti-Stigma Efforts
• National Alliance on Mental Illness (www.nami.org)
• SAMHSA: (www.adscenter.org)
– Address Discrimination & Stigma (ADS) Center
– Elimination of Barriers Initiative (EBI)
• Active Minds on Campus (www.activeminds.org)
• National Mental Health Awareness Campaign
– (www.nostigma.org)
• Mental Health America
• Chicago Consortium for Stigma Research
– (www.stigmaresearch.org)
• Open the Doors World Psychiatric Association
– (www.openthedoors.com/english)