The stigma of mental health, homelessness and intellectual disability, development of a national stigma survey with an intersectional gender perspective
Keywords:Women, Discrimination, Homelessness, Mental illness, Intellectual disability
Background: Social stigma towards people with mental health problems, homeless people or people with intellectual disabilities leads to a significant restriction of their human rights. Such stigma, which is associated with different conditions of vulnerability, has been assessed over time through surveys. However, intersectional stigma due to gender is often not assessed in these studies as they only analyse the data for this variable separately. Therefore, presented here is the first national survey in Spain on the social stigma associated with mental health problems, homelessness and intellectual disability. This proposal considers the importance of gender and intersectional stigma.
Methods: A qualitative-quantitative methodology is used by means of a computer assisted web interviewing survey. A gender perspective is proposed both in the development of the questions and in the measurement and analysis of the data. To this end, three versions of the questionnaire are developed: a neutral, a male and a female version.
Conclusions: The results are intended to have an impact on social and equality policies for people with mental disorders, homeless people and people with intellectual disabilities.
Trial Registration: The study has the approval of the deontological commission of the faculty of psychology and is registered in clinical trials.
Mental health action plan 2013–2020. 2013. Available at: http://apps.who.int/iris/ bitstream/10665/ 89966/1/9789241506021_eng.pdf. Accessed on 20 August 2021.
Intersectional discrimination in EU gender equality and non-discrimination law, Publications Office. Available at: https://data.europa.eu/doi/10.2838/ 241520. Accessed on 20 August 2021.
Castaño AM, Fontanil Y, García-Izquierdo AL. “Why can’t i become a manager? A systematic review of gender stereotypes and organizational discrimination. Int J Environ Res Public Health. 2019;16(10):23-9.
Trevillion K, Oram S, Feder G, Howard LM. Experiences of domestic violence and mental disorders: a systematic review and meta-analysis. PLoS One. 2012;7(12):12-8.
Oram S, Khalifeh H, Howard LM. Violence against women and mental health. The Lancet Psychiat. 2017; 4(2):159-70.
Thomas N, Menih H. Negotiating multiple stigmas: substance use in the lives of women experiencing homelessness. Int J Ment Health Addict. 2021;10:1-20.
Vázquez JJ, Panadero S. Meta-stereotypes among women living homeless: Content, uniformity, and differences based on gender in Madrid, Spain. J Community Psychol. 2020;48(5):1316-26.
Taggart L, McMillan R, Lawson A. Women with and without intellectual disability and psychiatric disorders: An examination of the literature. J Intellect Disabil. 2008;12(3):191-211.
Thornicroft G, Bakolis I, Evans-Lacko S, Gronholm PC, Henderson C, Kohrt BA, et al. Key lessons learned from the INDIGO global network on mental health related stigma and discrimination. World Psychiatr. 2019;18(2):229-30.
Seeman N, Tang S, Brown AD, Ing A. World survey of mental illness stigma. J Affect Disord. 2016;190: 115-21.
Ilic N, Henderson H, Henderson C, Evans-lacko S, Thornicroft G. Health Survey for England, Attitudes towards mental illness. J Affect Disord. 2014;1:1-15.
Leiderman EA, Vazquez G, Berizzo C, Bonifacio A, Bruscoli N, Capria JI, et al. Public knowledge, beliefs and attitudes towards patients with schizophrenia: Buenos Aires. Soc Psychiatry Psychiatr Epidemiol. 2011;46(4):281-90.
Tanaka G, Inadomi H, Kikuchi Y, Ohta Y. Evaluating stigma against mental disorder and related factors. Psychiatry Clin Neurosci. 2004;58(5):558-66.
Groot C, Imogen Rehm, Andrews C, Hobern B, Morgan R, Hannah Green, et al. Report on findings from the our turn to speak survey. J Affect Disord. 2020;34:78-80.
Högberg T, Magnusson A, Lützén K, Ewalds-Kvist B. Swedish attitudes towards persons with mental illness. Nord J Psychiatr. 2012;66(2):86-96.
Aznar-Lou I, Serrano-Blanco A, Fernández A, Luciano JV, Rubio-Valera M. Attitudes and intended behaviour to mental disorders and associated factors in catalan population, Spain: Cross-sectional population-based survey. BMC Public Health. 2016;16(1):1-12.
Brandon D, Khoo R, Maglajlic R, Abuel-Ealeh M. European snapshot homeless survey: Results of questions asked of passers-by in 11 European cities. Int J Nurs Pract. 2000;6(1):39-45.
Phelan J, Link BG, Moore RE, Stueve A. The stigma of homelessness: The impact of the label “homeless” on attitudes toward poor persons. Soc Psychol Q. 1997;60(4):323-37.
Petit J, Loubiere S, Tinland A, Vargas-Moniz M, Spinnewijn F, Manning R, et al. European public perceptions of homelessness: A knowledge, attitudes and practices survey. PLoS One. 2019;14(9): e0221896.
McConkey R, Slater P, Dubois L, Shellard A, Smith A. An international study of public contact with people who have an intellectual disability. J Intellect Disabil Res. 2021;65(3):272-82.
Akrami N, Ekehammar B, Claesson M, Sonnander K. Classical and modern prejudice: Attitudes toward people with intellectual disabilities. Res Dev Disabil. 2006;27(6):605-17.
Wilson MC, Scior K. Implicit attitudes towards people with intellectual disabilities: their relationship with explicit attitudes, social distance, emotions and contact. PLoS One. 2015;10(9):e0137902.
Creswell JW, Clark VLP. Designing and conducting mixed methods. Res Pub. 2020;6:12-8.
Evans-Lacko S, Rose D, Little K, Flach C, Rhydderch D, Henderson C, et al. Development and psychometric properties of the reported and intended behaviour scale (RIBS): A stigma-related behaviour measure. Epidemiol Psychiatr Sci. 2011;20(3):263-71.
Taylor SM, Dear MJ. Scaling community attitudes toward the mentally ill. Schizophr Bull. 1981;7(2):225-40.
Ochoa S, Martínez-Zambrano F, Vila-Badia R, Arenas O, Casas-Anguera E, García-Morales E, et al. Spanish validation of the social stigma scale: community attitudes towards mental illness. Rev Psiquiatr Salud Ment. 2016;9(3):150-7.
Corrigan PW, Powell KJ, Michaels PJ. Brief battery for measurement of stigmatizing versus affirming attitudes about mental illness. Psychiatry Res. 2014;215(2):466-70.
Corrigan P, Markowitz FE, Watson A, Rowan D, Kubiak MA. An Attribution Model of Public Discrimination Towards Persons with Mental Illness. J Health Soc Behav. 2003;44(2):162.
Power MJ, Green AM. The attitudes to disability scale (ADS): development and psychometric properties. J Intellect Disabil Res. 2010;54(9):860-74.
Snow-Hill N. The survey of attitudes toward homeless people: the validation of a new instrument assessing negative attitudes toward homeless people. Theses Dis. 2019;23:43-9.
Martín E, Ahaoual S. Proyecto estigmatismo: estigmatirmo. Madrid; 2019.
Muñoz M, Pérez-Santos E, Crespo M, Guillén AI. Estigma y enfermedad mental: Análisis del rechazo social que sufren las personas con enfermedad mental. Madrid: Editorial Complutense; 2009.
Takahashi LM. The socio-spatial stigmatization of homelessness and HIV/AIDS: Toward an explanation of the NIMBY syndrome. Soc Sci Med. 1997;45(6): 903-14.
Crenshaw KW, Bonis O. Cartographies des marges : intersectionnalité, politique de l’identité et violences contre les femmes de couleur. Cah du Genre. 2005 Nov 1;39(2):51-82.
Mora-Ríos J, Bautista N. Estigma estructural, género e interseccionalidad: Implicaciones en la atención a la salud mental. Salud Ment. 2014;37(4):303-12.
Paton J, Horsfall D, Carrington A. Sensitive Inquiry in mental health: a tripartite approach. Soc Sci Med. 2018;17(1):34-8.
Palmén R, Arroyo L, Müller J, Reidl S, Caprile M, Unger M. Integrating the gender dimension in teaching, research content & knowledge and technology transfer: Validating the EFFORTI evaluation framework through three case studies in Europe. Eval Program Plann. 2020;79:101751.
Fehrenbacher AE, Patel D. Translating the theory of intersectionality into quantitative and mixed methods for empirical gender transformative research on health. Soc Sci Med. 2019;22(1):145-60.
Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol. 2001;27:363-85.
Corrigan PW. Lessons learned from unintended consequences about erasing the stigma of mental illness. World Psychiatry. 2016;15(1):67-73.