OBJECTIVE:Reducing social isolation is a public health priority. The implementation of COVID-19 stay-at-home orders increased social isolation and had detrimental psychiatric health impacts. The study's objective was to examine whether the COVID-19 stay-at-home orders impacted suicide attempts among U.S. adolescents. STUDY DESIGN:Comparative interrupted time series. METHODS:We calculated predicted probabilities and marginal effects of the COVID-19 stay-at-home orders on suicide attempts among adolescents. National claims data from the COVID-19 Research Database produced a study cohort of 374,524 unique adolescents in both the pre- (March 2019-January 2020) and post-pandemic periods (March-June 2020). The outcome of interest was suicide attempts, including intentional poisoning. Separate analyses compared states with shorter duration COVID-19 stay-at-home orders (March-May) and states with longer duration COVID-19 stay-at-home orders (three sub-groups were created for COVID-19 stay-at-home orders lasting March-June, March-May, and April-June). RESULTS:Among the states with longer-duration COVID-19 stay-at-home orders lasting from March-June and April-June, post-stay-at-home orders slopes increased more than comparison states without COVID-19 stay-at-home orders (March-June: 0.00016; 95 % CI: 0.00001, 0.00031; April-June: 0.00067, 95 % CI: 0.00022, 0.00112). States with shorter-duration COVID-19 stay-at-home orders did not yield significant results. CONCLUSIONS:Longer-duration COVID-19 stay-at-home orders were associated with a small but significant increase in suicide attempts among adolescents. Mitigation strategies such as stakeholders creating and implementing school-based youth suicide prevention programs, and allocating more funding to text-based lines for those in suicidal crisis need to be implemented.

Stigma surrounding mental illness is shaped by emotional reactions such as pity and empathy. While pity can involve condescension and reinforce hierarchies, empathy fosters understanding and connection. This study tested how different mental health conditions elicit these emotions and mediate stigmatizing attitudes. A nationally representative U.S. sample ( N = 5,264) read vignettes describing a character with subclinical distress, major depression, alcohol use disorder, opioid use disorder, or schizophrenia. Vignettes varied by diagnosis and symptoms, causal explanation (none, trauma, genetics, both), and treatment recommendation (none, psychotherapy, medication). Structural equation modeling showed that empathy reduced social distance more consistently than pity. Schizophrenia and substance use disorders evoked less empathy and more pity, while environmental attributions to a traumatic event increased pity and empathy. Treatment recommendations enhanced empathy but not pity. Findings highlight that targeting empathy over pity may lead to stigma reduction, suggesting that interventions might benefit from emphasizing relatable experiences and trauma while balancing treatment messaging.

The purpose of this study was to test the association between frequency of exposure to discriminatory police practices and poor mental health among Black Americans and to explore potential moderators of that association. Survey data were collected from 227 Black Americans. The survey measured exposure to negative police behaviors, two dimensions of Black Americans' identity, psychological distress, somatic symptoms, and demographic covariates. The data were analyzed with OLS regression to test the direct effects of police discrimination exposure on distress and somatic symptoms and the potential for moderator effects of two dimensions of racial identity: public and private regard. The analysis found that frequency of exposure to police discrimination was not significantly associated with distress, but it was significantly associated with somatic symptoms, suggesting that Black Americans respond to police discrimination via expressions of physical pain, rather than psychological discontent. Neither dimension of racial identity was directly associated with somatic symptoms, but they both predicted less psychological distress. Private regard did not moderate the association between police discrimination and either outcome, but higher public regard amplified the association between police discrimination and both distress and somatic symptoms. These moderator effects suggest that Black Americans who believe the public holds them in high regard are more sensitive to the negative health effects of police discrimination, perhaps because they are less prepared and more taken aback when treated poorly by the police.

Moral values play an important role in understanding stigma toward people with opioid use disorder (OUD) and attitudes toward related treatment modalities, given the moralized nature of substance use disorders in the United States. This study explored how moral values, attributions about OUD, and demographic factors influence stigma and attitudes toward methadone clinics. Using structural equation modeling (SEM), this study analyzed data from a 2 x 2 between-subjects factorial survey design (n = 248). Participants, recruited via the online survey platform Prolific, were demographically diverse but predominantly White. Measures included the Moral Foundations Questionnaire and scales assessing attributions, stigma, and attitudes toward a hypothetical methadone clinic. Endorsement of care and fairness values was generally associated with reduced stigma and favorable attitudes toward the methadone clinic, both directly and mediated by making less attributions of OUD to irreligiosity and character flaws. In contrast, values of purity, loyalty, and authority were generally linked to heightened stigma indirectly through more attributions of OUD to irreligiosity and character flaws. Methadone clinic proximity effects revealed stronger negative attitudes among middle- to upper class participants when the clinic was described as closer to home compared to lower class participants. Recognizing the influence of moral values and demographic characteristics in advocacy and education efforts, potentially reframing perceptions of OUD and its treatments.

The COVID-19 pandemic accelerated a trend toward working remotely and by 2023, a majority of employees preferred to work from home at least part-time. Despite the documented benefits of schedule flexibility to employees and employers, employer support for it is variable. Considering this context, we examined whether there are systematic biases against supporting remote work options for employees who have lower occupational status, who disclose a mental illness, or who are women. Using an experimental design, we exposed a probability sample of the U.S. adult population to a vignette character (VC) employed by a law firm who requested a hybrid schedule. We compared reactions to the VC's request based on the VC's occupational status (data entry clerk or lawyer), mental health (bipolar or no mention), and gender (woman or man). We found that the public tends to be more supportive of remote work arrangements for women than for men, and for lawyers than for data entry clerks, except if the lawyer has bipolar disorder. However, the public tends to support remote work for people with bipolar provided they believe it will improve their job performance. We conclude by recommending how to mitigate employer discrimination when evaluating remote work requests.

Researchers have sought to explain Black Americans' lower rates of common mental illnesses than White Americans, despite greater stress exposure, yet few explanations of this paradox are supported empirically. We examined the extent to which the paradox is owing to: Black Americans' racial identity and religiosity resources offsetting the ill-effects of stressors, limited empirical attention to externalizing mental health outcomes, and the homogenization of both racial groups by disregarding within-group gender differences. Data came from the 25,454 Black and White men and women of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. We used structural equation modeling to test for indirect effects of race on mental health via stressors, racial identity, and religiosity, and tested multigroup models by gender. Results indicated that the paradox could reflect the failure to account for Black Americans' increased risk of substance-use disorders and greater symptoms of poor mental health. Racial identity did not explain variations in mental disorder by race overall, but it protected against all mental disorders for Black women. Findings also indicated complex effects of Black Americans' greater religiosity. Greater religious importance exacerbated some mental health problems, whereas religious service attendance had protective effects, especially among women. Future research on explanations of the paradox should continue to incorporate multiple mental health outcomes and investigate intersectional identities.

Most medical researchers and social scientists concur that mental illness is caused by “nature” and “nurture,” yet efforts to reduce stigma tend to focus on biomedical causes. This study analyzed original survey data collected from 1,849 respondents in 2021–2022 who were randomly assigned to 16 experimental vignette conditions. Each vignette portrayed a man and varied according to which psychiatric diagnosis his situation resembled (alcohol dependence, depression, or schizophrenia) and what caused it: genetics (nature), environmental stress (nurture), or both. Control conditions included subclinical distress and no explanation. Exposure to the environmental explanation (vs. no explanation) predicted identifying mental illness, reduced expectation of violence toward others, increased willingness to socially interact, and optimism for recovery with treatment. Exposure to the nature and nurture explanation (vs. no explanation) predicted reduced desire for social distance. Implications of these findings for future research and for contact-based anti-stigma efforts are presented.

Stigma toward bipolar disorder (BIP) and borderline personality disorder (BOR) were compared by experimentally manipulating the symptoms and diagnosis of a vignette character (VC) and measuring people's responses to them. The purported cause, the recommended treatment of their condition, the VC's race, and their gender were manipulated. Following exposure to the vignette, a sample of 1,168 survey participants on Prolific Academia reported their reactions to the VC. The data were analyzed with structural equation modeling to test whether the experimental conditions indirectly increased stigma and reduced prognostic optimism via negative feelings, stereotypes, and perceptions of controllability and responsibility. The results suggest that public stigma toward individuals with BOR is greater than BIP because people judge them as more able to control their condition and more likely to inflict self-harm and be aggressive to others. Attributing mental illness to child abuse or to genetics indirectly reduces stigma because these explanations lead people to hold individuals as less responsible for their condition. When a psychiatrist recommends medication rather than psychotherapy as the preferred treatment, people tend to rate the VC as more likely to hurt themselves and less likely to recover, suggesting that psychotropic drug treatment connotes greater severity and hopelessness than does talk therapy. Finally, being of the same race (White vs. Black) or gender (male vs. female), as the vignette character has no bearing on stigma, whereas felt similarity and lived experience both reduce it. Suggestions for future research and antistigma interventions are explored based on these findings.

Objective: The purpose of this study was to test the effects of causal explanations, information about treatability, and type of psychiatric diagnosis on how the public reacts to an individual described as having a specific mental illness versus subclinical distress. Methods: A 5 (mental health condition) × 2 (treatability) × 4 (causal explanation) vignette experiment was embedded in an online survey, followed by assessments of prognostic optimism and desire to maintain social distance from the vignette character. Data were collected, in late 2022, from a probability sample (N=1,607) representative of the U.S. adult population. Ordinary least-squares regression was used to estimate the effects of the experimental conditions, covariates, and interactions on respondents' desire for social distance and their prognostic optimism. Results: Attribution of mental illness to a genetic predisposition (vs. no attribution) significantly (p<0.001) predicted unwillingness to socially interact with the vignette character, regardless of the character's psychiatric diagnosis. Describing the illness as treatable with medication or psychotherapy (vs. no treatability information) also reduced willingness to socially interact, yet it also increased optimism for recovery. Desire for social distance and prognostic pessimism were greater for alcohol use disorder, opioid use disorder, or schizophrenia compared with major depression or subclinical distress. Conclusions: Attributing mental illness solely to genetics predicts social rejection of people diagnosed as having psychiatric disorders. Efforts to reduce stigma, increase social acceptance, and protect the mental health of individuals diagnosed as having a mental illness should include not framing mental illness exclusively in genetic terms.

BACKGROUND:People diagnosed with mental illness develop a variety of explanatory models of their conditions in the face of uncertainty. Explanatory models matter because they are associated with internalized stigma and illness behaviors such as treatment preferences.AIMS:This paper explores how working professionals in the United States draw on biological and/or environmental factors to explain the cause(s) of their diagnoses of bipolar or depression.METHOD:Findings are derived from an analysis of transcripts of in-depth interviews with 52 individuals from across the United States who were invited to participate in a study of working professionals diagnosed with mental illness. About 25 self-identified as having bipolar disorder and 27 as having major depression. Transcript data were analyzed following the principles of flexible coding with the goal of establishing a typology of explanatory models of self-identified bipolar versus depression.RESULTS:Six types of explanatory models emerged from the analysis. One was exclusively biological, a second was exclusively environmental, and the remaining four combined biological and environmental factors in different ways. Quotations from the interviews are provided to illustrate each type, and comparisons between types are made based on primary diagnosis (bipolar vs. depression), and self-reports of trauma and stressful experiences.CONCLUSION:Implications for the future research on explanatory models and how they may impact people who are diagnosed with a mental illness across multiple dimensions of their lives are presented.

This study examined relationships between acculturation, acculturative stress, and symptoms of eating disorders among Latina university students in the US. We hypothesized that acculturative stress would be associated with increased symptoms, and acculturation would indirectly be associated with fewer symptoms via acculturative stress. Survey data from 567 Latinas age 18 to 54 at a public Western university were collected online. Participants provided data on acculturation, acculturative stress, demographics, and eating disorders symptoms. The results indicated that acculturation was indirectly and negatively related to desire for thinness, binge eating, and bulimia via its negative association with acculturative stress, which in turn was positively associated with eating disorder symptoms. However, acculturation had a direct positive association with binge eating and bulimia after considering its indirect negative associations via acculturative stress. The unique contributions of this study and its implications for mental health professionals, the media, and higher education are discussed.

The visible nature of stigmatized identities may shape processes related to stress, coping, and health outcomes. This study explored how stigma visiblility may explain health disparities among gay men and lesbians, specifically. Participants were recruited from advocacy organizations and online resources (N = 1,627 gay men; N = 848 lesbians) and completed an online survey. Stigma visibility primarily operated through experiences of discrimination to affect mental and physical health, albeit in both negative and positive ways. Experiences of discrimination predicted increases in the internalization of stigma and lowered sense of control, harming health outcomes. Experiences of discrimination also increased social identification with similarly stigmatized others, which improved health outcomes. Research identifying factors that put certain minority group members at risk for worse health outcomes relative to other members is vital to addressing health disparities; the visibility of a stigmatized identity appears to be one such risk factor.

Stigma toward opioid addiction is a barrier to reversing the opioid epidemic. This study examined stigma, preferred consequences, and attributions of the cause(s) of addiction based on responses to a character portrayed as recently laid off and addicted to opioids. This study employed a 2 (race: Black vs. White) x 2 (status: janitor vs. computer scientist) x 2 (source of opioids: from a doctor vs. on the street) vignette between-subjects experimental design in an online survey. Equal numbers of political conservatives and liberals (n = 513) were recruited. The sample was mostly White with equal proportions of males and females. Stigma was measured with four scales and two items, and causal attributions and preferred consequences were each measured with three scales. Stigma was greater toward the janitor than the computer scientist and toward obtaining opioids on the street versus from a doctor. Respondent political conservatism predicted greater stigma including social distance (b = .29, p < .001). Bad character attributions predicted greater stigma including more negative feelings (b = .23, p < .001). Attributing addiction to being laid off predicted less stigma such as negative stereotypes (b = -.11, p < .001) and support for economic relief (b = .24, p < .001), whereas attributing it to biology predicted negative stereotypes (b = .07, p < .001). Political conservatism and attributing addiction to bad character predict stigma and unwillingness to help people with opioid addiction, whereas attributing it to being laid off and struggling financially predicts the opposite.

The purpose of this study is to explore how professional employment impacts mental health among people with mental illness, and how having a mental illness impacts job performance, both positively and negatively. The research is based on in-depth interview data from 56 professionals diagnosed with mental illness, and the interview transcripts are analyzed in accordance with the flexible coding model of qualitative data analysis. We find that working conditions of professional jobs pose challenges to managing symptoms of mental illness, including the pressures of responsibility and exposure to secondary trauma. However, professional employment also provides benefits such as social connections and feeling accountable. Similarly, symptoms cause problems at work like having angry outbursts, yet experience with mental illness informs job performance such as by increasing empathy with others. We use these findings to recommend new directions for research and argue for inclusion of people with mental illness in the workplace.

Millions of men in the US experience substance abuse and impulse control disorders, which is well researched. Far fewer scholars have studied the millions of men that also experience depression (which is traditionally associated with women). Drawing upon literature on fragile masculinity and masculinity threat, we evaluate the role of endorsing hegemonic masculinity ideals (e.g., men should be strong, unemotional, and financially secure) in both internalizing (depression) and externalizing (anger) mental health problems, focusing on older White men aged 70–74 in the Wisconsin Longitudinal Survey (N = 1,794). In addition to predicting mental health among older men according to their agreement with hegemonic masculinity ideals, we examine the impact of two potential threats to masculinity: health and wealth decline. We find that endorsement of hegemonic masculinity ideals is positively associated with externalizing and internalizing symptoms and that the association between hegemonic masculinity ideals and depressive symptoms is even stronger for men who perceive their health to be declining and those who have lost wealth. We conclude that endorsement of rigid hegemonic masculinity ideals negatively impacts older men’s mental health, especially when they experience challenges to their self-perception as strong, independent, and self-reliant. We provide suggestions as to how improving our understanding of the association between masculinity beliefs and mental health can inform clinical practice as well as public health and public policy.

Black Americans have lower rates of depression and anxiety than Whites, despite greater exposure to stressors known to negatively impact mental health, characterized as the Black-White mental health paradox. This study revisited the paradox during the coronavirus pandemic. Drawing on stress process theory, minority stress theory, and the rejection-identification model of discrimination, in-group identity, and well-being, we analyzed original survey data from a quota sample of African American and White adults ( N = 594). The survey included a range of stressors and coping resources, including those relevant to the pandemic (e.g., COVID-19 illness) and race (e.g., witnessing anti-Black police violence). Results indicate that despite African Americans’ greater exposure and vulnerability to racial discrimination, the Black-White mental health paradox holds, owing in part to protective effects of African American’s higher self-esteem. Directions for future exploration of the paradox are presented based on this study’s findings.

This paper presents a qualitative analysis of in-depth interviews with eleven student veterans about transitioning from the U.S. military to civilian life and to a midsized, public university. The U.S. military and American institutions of higher education are significantly different, and these differences make adaptation for student veterans more difficult. The purpose of this research was to understand what this transition was like for student veterans and the factors that affected how they negotiated the move back home. Using framework analysis (Ritchie & Spencer, 1994), we noted five themes of student veterans’ military service that impacted their transition: (a) task cohesion; (b) military structure; (c) military responsibilities and release anxiety; (d) combat experience; and (e) social cohesion in combat units. We describe each of these themes and explain how they influenced student veterans’ experiences in school. We conclude with suggested policy implications for institutions of higher education.

This chapter presents the results of an analysis of in-depth interviews with a snowball sample of 45 people who identified as working professionals diagnosed with bipolar disorder or major depression. It explores three dimensions of their experience: disclosure versus concealment of their diagnosis on the job, exposure to discrimination in the workplace based on their mental illness diagnosis, and identity strategies they used to manage the status inconsistency between being a professional and having a mental illness diagnosis. The findings reveal how people learn to calculate when it is safe to disclose their diagnosis on the job, especially after experiencing discriminatory treatment such as being fired or demoted. They also indicate that applying for workplace modifications to accommodate symptoms of mental illness may be met with unprofessional and unsupportive reactions on the part of managers, Human Resources professionals, and coworkers, which could explain in part why so few participants in this sample sought them. When it comes to balancing inconsistent statuses, the findings demonstrate how people distance themselves from their mental illness identity in favor of the more prized status of working professional as a means of self-preservation. The chapter concludes with a call for sweeping changes in workplace culture to minimize fear and shame and maximize inclusion of people diagnosed with mental illness, allowing them to flourish in careers in which they may realize their full potential.