Stigma resistance and well-being in the context of the mental illness identity.
identity; mental illness; stigma; stigma resistance strategies; well-being
We use a perceptual control model of identity to examine the relationship between stigmatized appraisals (from self and other) and well-being among individuals with serious mental illness. We also examine the role of stigma resistance strategies in the identity process. Using in-depth interviews with active clients of a community mental health center (N = 156), we find that deflection, or distancing oneself from mental illness, is associated with greater self-esteem and fewer depressive symptoms. Challenging others through education is associated with higher self-esteem, and challenging stigma through activism is associated with fewer depressive symptoms. Activism also moderates the relationship between identity discrepancy (the difference between appraisals from self and other) and well-being; however, the extent to which activism is helpful or harmful depends on whether appraisals from others are more or less stigmatizing than self-views. We discuss the implications of these findings for identity and stigma research.
Marcussen K; Gallagher M; Ritter C
Journal of Health and Social Behavior
2021
2021-01-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1177/0022146520976624" target="_blank" rel="noreferrer noopener">10.1177/0022146520976624</a>
The rapid risk of violence screen (rrovs): A brief violence risk screening tool for people in a community behavioral health setting.
Outpatient behavioral health services; Violence risk assessment; Violence risk screen
The Rapid Risk of Violence Screen (RROVS) is a brief screening tool that is designed for use in community-based behavioral health service settings to identify people who may need comprehensive violence risk assessment. This study examined the association between the RROVS total score and future criminal justice involvement including violent offenses. Results from this study suggest that the RROVS screening tool has predictive validity as it is associated with later criminal justice involvement with a violent offense. The RROVS may be a helpful tool for community-based behavioral health providers to screen incoming clients for violence risk to inform whether additional assessment for violence potential is warranted.
Bonfine N;Donohue M;Walters B;Ritter C;Potts L;Baker RN
The Journal of Behavioral Health Services & Research
2020
2020-11-05
journalArticle
<a href="http://doi.org/10.1007/s11414-020-09736-y" target="_blank" rel="noreferrer noopener">10.1007/s11414-020-09736-y</a>
Depression Prevalence And Incidence Among Inner-city Pregnant And Postpartum Women
black; childbearing; disorders; families; life; poverty; psychological distress; Psychology; psychosocial predictors; social support; stress; white
A sample of 192 financially impoverished, inner-city women was assessed for clinical depression twice during pregnancy and once postpartum. At the first and second antepartum interviews, respectively, 77.6% and 24.5% of the women were depressed, controlling for pregnancy-related somatic symptoms. Postpartum depression was found among 23.4% of women. These rates are about double those found for middle-class samples. Particularly heightened risk for antepartum depression was found among single women who did not have a cohabiting partner. African American and European American women did not differ in rates of depression. Antepartum depression was a weak but significant risk factor for postpartum depression.
Hobfoll S E; Ritter C; Lavin J; Hulsizer M R; Cameron R P
Journal of Consulting and Clinical Psychology
1995
1995-06
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1037/0022-006x.63.3.445" target="_blank" rel="noreferrer noopener">10.1037/0022-006x.63.3.445</a>
The Effect Of Services And Stigma On Quality Of Life For Persons With Serious Mental Illnesses
consequences; Environmental & Occupational; Health; Health Care Sciences & Services; Psychiatry; Public; rejection; satisfaction; self-esteem
Marcussen K; Ritter C; Munetz M R
Psychiatric Services
2010
2010-05
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1176/ps.2010.61.5.489" target="_blank" rel="noreferrer noopener">10.1176/ps.2010.61.5.489</a>
Depression in family medicine faculty
stress; General & Internal Medicine; physicians; predictors; Mental Health; care; quality; Job satisfaction; general-practitioners
(B) under bar(a) under bar(c) under bar(k) under bar(g) under bar(r) under bar(o) under bar(u) under bar(n) under bar(d) under bar (a) under bar(n) under bar(d) under bar (O) under bar(b) under bar(j) under bar(e) under bar(c) under bar(t) under bar(i) under bar(v) under bar(e) under bar(s) under bar: Depression among family medicine faculty may contribute to decreased effectiveness in patient care, decreased effectiveness in teaching, and career changes. The present study determined the nationwide prevalence of depression and related risk factors among family medicine residency program faculty. (M) under bar(e) under bar(t) under bar(h) under bar(o) under bar(d) under bar(s) under bar: All full-time US family medicine faculty, program directors, and behavioral scientists listed as members of the Society of Teachers of Family Medicine in October 2000 were surveyed. The survey included demographics, clinical practice characteristics, the Beck Depression Inventory II, the Social Readjustment Rating Scale (SRRS), and a scale to measure stress within the residency program. (R) under bar(e) under bar(s) under bar(u) under bar(l) under bar(t) under bar(s) under bar: Surveys were completed by 1,418 faculty members. Seven percent of survey respondents scored mildly depressed, and 5% scored moderately to severely depressed. Seven percent Of respondents scored highly stressed on the SRRS. Significant predictors of depression scores included being single, being a member of an underrepresented minority group, having increased stress scores, and having a greater amount of time devoted to teaching. (C) under bar(o) under bar(n) under bar(c) under bar(l) under bar(u) under bar(s) under bar(i) under bar(o) under bar(n) under bar(s) under bar: Program directors and department chairs need to be aware of the prevalence of depression among faculty, since it may affect their performance of patient care and teaching responsibilities.
Costa A J; Schrop S L; McCord G; Ritter C
Family Medicine
2005
2005-04
Journal Article or Conference Abstract Publication
n/a
Weight, self-esteem, ethnicity, and depressive symptomatology during pregnancy among inner-city women
pregnancy; African Americans; depression; obesity; self-esteem; Psychology; weight; black-women; body-image; dysphoria; postpartum; white
The relationship of weight and self-esteem to depressive symptomatology was examined among 36 African American and 96 European American pregnant inner-city women. Lower self-esteem and higher deviations from medically ideal weight predicted increased dysphoria during the 3rd trimester for European American women, but only lower self-esteem predicted increased dysphoria for African American women. These results support the hypothesis that African Americans are less likely than European Americans to experience negative psychological repercussions of greater weight. Consistent with findings among nonpregnant middle-class samples, these results extend the association between heavier weight and increased risk for psychological distress to pregnant women of European American descent.
Cameron R P; Grabill C M; Hobfoll S E; Crowther J H; Ritter C; Lavin J
Health Psychology
1996
1996-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1037/0278-6133.15.4.293" target="_blank" rel="noreferrer noopener">10.1037/0278-6133.15.4.293</a>
Epidemiology of trauma: Childhood adversities, neighborhood problems, discrimination, chronic strains, life events, and daily hassles among people with a severe mental illness
1st-episode psychosis; adults; Childhood trauma; community; Health; national comorbidity survey; posttraumatic-stress-disorder; prevalence; Psychiatry; quality-of-life; schizophrenia; Serious mental illness; stress; symptoms; world-trade-center
Trauma during childhood and adolescence is a common event among people with a serious psychological disorder. Few studies assess a wide range of stressors for this population. This is surprising given that these stressful events are implicated in poorer outcomes related to course and treatment of mental health problems. This study of 214 people with serious mental illness examines the prevalence of childhood traumas, perceived neighborhood problems, discrimination, chronic strains, negative life events, and daily hassles. We use regression analyses to determine if these stressors are associated with quality of life. Results show that 95% of the sample report at least one childhood adversity. Perceived neighborhood problems, experiences of discrimination, chronic strains, life events, and daily hassles were also common. Examining the relationship between demographic factors and stressors suggests that older respondents, Whites, those who have never been married, and people diagnosed with Schizophrenia reported fewer stressors compared to those who are older, non-White, ever married, or suffering from other types of mental health problems. Finally, three of the six types of stressors were related to lower quality of life and depression. We discuss the implications of these findings for the treatment of severe psychological problems. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
Adams R E; Ritter C; Bonfine N
Psychiatry Research
2015
2015-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.psychres.2015.10.012" target="_blank" rel="noreferrer noopener">10.1016/j.psychres.2015.10.012</a>
Underserved Patients' Choice of Kiosk-based Preventive Health Information
General & Internal Medicine
Background and Objectives: Compliance with health promotion recommendations Ails short of expectations nearly every time it is studied. Some of the most successful programs, however, focus on the patient and incorporate computers. Methods: Interactive kiosks in waiting rooms of clinics for the medically underserved were used to educate patients about alcohol consumption, exercise, smoking cessation, and weight control. Results: Kiosks were accessed 11,401 times. Users averaged 40 years old, and most had at least a high school education and an average body mass index (BMI) of 29.8. Sixty percent were white, and 64% were women. Weight control garnered the most interest followed by smoking cessation. Those overweight and men with sleep disorders were more interested in weight control. Smokers and depressed women were most interested in smoking cessation. Men who were older, Latino, or had high blood pressure and women who were overweight were most interested in exercise. Those interested most in alcohol consumption were men who were white, drink alcohol, or married and women who were younger, single, black, Latino, or smoke. Conclusions: These results add to our understanding of underserved populations and individuals who might be more receptive to preventive health interventions so that educational efforts might be more likely to result in behavior change.
Pendleton B F; Schrop S L; Ritter C; Kinion E S; McCord G; Cray J J; Costa A J
Family Medicine
2010
2010-07
Journal Article
n/a
Crisis intervention team training for police officers responding to mental disturbance calls
Environmental & Occupational; Health; Health Care Sciences & Services; health emergencies; ill; Psychiatry; Public
Objectives: In recognition of the fact that police are often the first responders for individuals who are experiencing a mental illness crisis, police departments nationally are incorporating specialized training for officers in collaboration with local mental health systems. This study examined police dispatch data before and after implementation of a crisis intervention team (CIT) program to assess the effect of the training on officers' disposition of calls. Methods: The authors analyzed police dispatch logs for two years before and four years after implementation of the CIT program in Akron, Ohio, to determine monthly average rates of mental disturbance calls compared with the overall rate of calls to the police, disposition of mental disturbance calls by time and training, and the effects of techniques on voluntariness of disposition. Results: Since the training program was implemented, there has been an increase in the number and proportion of calls involving possible mental illness, an increased rate of transport by CIT-trained officers of persons experiencing mental illness crises to emergency treatment facilities, an increase in transport on a voluntary status, and no significant changes in the rate of arrests by time or training. Conclusions: The results of this study suggest that a CIT partnership between the police department, the mental health system, consumers of services, and their family members can help in efforts to assist persons who are experiencing a mental illness crisis to gain access to the treatment system, where such individuals most often are best served.
Teller J L S; Munetz M R; Gil K M; Ritter C
Psychiatric Services
2006
2006-02
Journal Article
<a href="http://doi.org/10.1176/appi.ps.57.2.232" target="_blank" rel="noreferrer noopener">10.1176/appi.ps.57.2.232</a>
Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women
birth outcomes; depression; differentials; Health; mortality; multivariate; nonpsychotic postpartum depression; prevalence; Psychology; psychosocial resources; satisfaction; self-esteem; social support; stress; weight
The authors examined the prospective influence of stress, self-esteem, and social support on the postpartum depressive symptoms of 191 inner-city women (139 European Americans and 52 African Americans) over 3 waves of data collection. Depressive symptomatology was measured by multiple indicators, including self-report and clinical scales. Women became less depressed as they move from prenatal to postpartum stages and adjusted to their pregnancy and its consequences. LISREL and regression analyses indicated that stress was related to increased depression, whereas greater income and social support were related to decreased depression. Self-esteem was related to lower depression at the prenatal and postpartum periods but not to change in depression from the prenatal to the postpartum period. The results also indicated that self-esteem and social support did not have additional stress-buffering effects over and above their direct effects on depression. Finally, African American women did not differ from European American women terms of depression or in terms of how they were impacted by stress or psychosocial resources.
Ritter C; Hobfoll S E; Lavin J; Cameron R P; Hulsizer M R
Health Psychology
2000
2000-11
Journal Article
<a href="http://doi.org/10.1037//0278-6133.19.6.576" target="_blank" rel="noreferrer noopener">10.1037//0278-6133.19.6.576</a>
Mental Health Court and Assisted Outpatient Treatment: Perceived Coercion, Procedural Justice, and Program Impact
adherence; civil commitment; community treatment; Environmental & Occupational; Health; Health Care Sciences & Services; hospital admission; new-york; north-carolina; outcomes; people; perceptions; Psychiatry; Public; state
Objective: Mandated community treatment has been proposed as a mechanism to engage people with severe and persistent mental disorders in treatment. Recently, two approaches to mandate treatment through the courts have been highlighted: assisted outpatient treatment (AOT) and mental health court programs. This study examined levels of perceived coercion, procedural justice, and the impact of the program (mental health court or AOT) among participants in a community treatment system. Methods: Data were analyzed from interviews with former AOT participants who were no longer under court supervision (N=17) and with graduates of a mental health court program (N=35). The Mac-Arthur Admission Experience Survey, created to measure perceived coercion, procedural justice, and program impact on hospital admission, was modified to include judges and case managers. Results: Mental health court graduates perceived significantly less coercion and more procedural justice in their interactions with the judge than did AOT participants. No significant difference was found between mental health court and AOT participants in perceptions of procedural justice in interactions with their case managers. Mental health court participants felt more respected and had more positive feelings about the program than did AOT participants. Conclusions: Both mental health courts and AOT programs have potentially coercive aspects. Findings suggest that judges and case managers can affect participants' perceptions of these programs by the degree to which they demonstrate procedural justice, a process that may affect the long-term effects of the programs on individuals.
Munetz M R; Ritter C; Teller J L S; Bonfme N
Psychiatric Services
2014
2014-03
Journal Article
<a href="http://doi.org/10.1176/appi.ps.002642012" target="_blank" rel="noreferrer noopener">10.1176/appi.ps.002642012</a>
Mental Illness as a Stigmatized Identity
appraisals; discrepancy; disorders; identity; internalized stigma; mental illness; modified labeling theory; people; reflected; self-esteem; Sociology; stigma
In this study, we examine the relationships among reflected appraisals, self-views, and well-being for individuals diagnosed with severe and persistent mental illness. We also test a perceptual control model of identity to determine whether discrepancies between stigmatized reflected appraisals and stigmatized self-views are associated with self-evaluation (self-esteem and self-efficacy) and psychological distress (depressive symptoms). We find that stigmatized self-views are significantly associated with lower self-esteem and self-efficacy and higher levels of depressive symptoms. Stigmatized reflected appraisals are also associated with lower self-efficacy and higher depressive symptoms but are not associated with self-esteem. As predicted, discrepancies between reflected appraisals and self-views are associated with lower levels of self-efficacy and higher levels of depressive symptoms; however, we do not find a relationship between identity discrepancy and self-esteem. We discuss the implications of our findings for identity and stigma research.
Marcussen K; Gallagher M; Ritter C
Society and Mental Health
2019
2019-07
<a href="http://doi.org/10.1177/2156869318810326" target="_blank" rel="noreferrer noopener">10.1177/2156869318810326</a>