Psychosocial Impact of COVID-19: Stigma and Xenophobia

The novel type of coronavirus (COVID-19) pandemic, which affected the whole world and resulted in the death of many people, caused problems in various fields in societies. The effects of the pandemic, especially on health and the economy, have reached important points and studies in these areas have intensified. It is also a known fact that the pandemic causes psychosocial problems in humans. Existing problems have also had negative effects on mental health. Measures, restrictions, and quarantine practices are taken to control the epidemic have caused psychological, social, and economic problems. The spread of the disease and changes in living conditions have led to an increase in negative attitudes among people. The pandemic has also caused discriminatory and stigmatizing attitudes among people. In addition, xenophobic attitudes, defined as fear, hatred, and prejudice against foreigners, have become widespread during the pandemic process. People exposed to stigma and xenophobic attitudes due to the pandemic have experienced social and economic inequalities. It is important to prevent stigmatizing and xenophobic attitudes during the pandemic process in order to ensure social cohesion in society. In this section, the psychosocial effects of stigma and xenophobia associated with COVID-19 will be discussed in light of literature.

The Long-Term Effectiveness of Interventions Addressing Mental Health Literacy and Stigma of Mental Illness in Children and Adolescents: Systematic Review and Meta-Analysis

Objectives: This study aims to provide a systematic review and meta-analysis of the literature on the long-term effects of interventions addressing children’s and adolescents’ mental health literacy and/or stigmatizing attitudes.Methods: Articles in English or German published between January 1997 and May 2020 were retrieved from five databases, leading to a total of 4,375 original articles identified.Results: 25 studies were included after applying exclusion criteria, 13 of which were eligible for meta-analysis. The overall average of the follow-up period was about 5 months. Long-term improvements were sustained for mental health literacy, d = 0.48, 95% CI = (0.34, 0.62), as well as for stigmatizing attitudes, d = 0.30, 95% CI = (0.24, 0.36), and social distance, d = 0.16, 95% CI = (0.03, 0.29). The combination of educational and contact components within interventions led to worse results for mental health literacy, but not stigmatizing attitudes or social distance.Conclusion: Interventions targeting children and adolescents generally have a brief follow-up period of an average of 5 months. They show a stable improvement in mental health literacy, but are to a lesser degree able to destigmatize mental illness or improve social distance.

HIV stigma reduction interventions among health care providers and students in different countries: a systematic review

Background: Health care providers’ stigmatizing attitudes are obstacles to patients’ well-being and quality of life. Dealing with HIV-related stigma and understanding the impact of feasible interventions on reducing stigmatizing attitudes among health care providers are considered important strategies to improve the quality of HIV care, patient-provider relationships, and provide supportive and safe care services. Objectives: The aim of this study was to systematically review interventions to reduce HIV-related stigma among health care providers. Methods: This systematic review was performed using Medline, CINAHL, ERIC, and APA PsycInfo, Health Source: Nursing/Academic Edition to search for quasi-experimental studies and randomized controlled trials (RCTs) designed to reduce HIV stigma among health care providers. The quality of eligible research studies was independently appraised by two reviewers. Results: A total of 774 studies were screened, 100 articles were assessed for the eligibility, and 10 studies met the inclusion criteria. All interventions effectively reduced HIV-related stigma. Elements of successful interventions including knowledge modules, peer education, patients’ testimonials, Photovoice-informed stigma reduction training, stigma-free space intervention, and popular opinion leaders. Interventions were assessed and compared in terms of contents, delivery modes, HIV stigma measurements, follow-up, and limitations. Conclusions: This systematic review supports the effectiveness of in-person educational interventions at reducing HIV-related stigma among health care providers across countries. Comparisons of delivery modes of interventions indicated that educational interventions delivered by patients’ testimonials and peer education strategies are more promising than lecture-based teaching methods. Further studies are needed to assess long-term effects of interventions on clinical behaviors and practices.

A Comparison of COVID-19 Stigma and AIDS Stigma During the COVID-19 Pandemic: A Cross-Sectional Study in China

Objective: To understand the current situation of stigmatizing attitudes toward Coronavirus Disease 2019 (COVID-19) in China and compare it with acquired immunodeficiency syndrome (AIDS).Methods: Convenient sampling and vignette-based methods were used to recruit participants on WeChat. A demographic form and adopted stigma scale were used to collect participants' demographic information and stigmatizing attitudes toward COVID-19 and AIDS.Results: A total of 13,994 questionnaires were included in this study. A high portion of participants tend to avoid contact with individuals affected with COVID-19 (74.3%) or AIDS (59.0%), as well as their family members (70.4% for COVID-19 and 47.9% for AIDS). About half of the participants agreed that affected persons could not only cause problems to their own family but also have adverse effects on others (59.6% and 55.6% for COVID-19, 56.9 and 47.0% for AIDS). The agreements with statements about perceived stigma were similar but slightly higher than those about personal stigma in both COVID-19 and AIDS. Participants' agreements with all statements regarding personal and perceived stigma attitudes between COVID-19 and AIDS were all statistically significant (p < 0.001). Participants obtained COVID-19-related information mainly from social media (91.3%) and newspaper or television (77.1%) during the epidemic, and 61.0% of them thought information from newspapers or television was the most reliable.Conclusion: Several similarities and differences of people's attitude toward COVID-19 and AIDS were found. Avoidance, blame, and secondary discrimination to diagnosed persons and their surrounding persons were the main representations of COVID-19-related stigma. Stigma of COVID-19 had less moral link but more public panic. Experience from HIV-related stigma reduction and prevention can be applied to reduce COVID-19-related stigma.

Stigma Attitudes Towards People with Mental Illness among Professionals Working in a Psychiatric Hospital

Introduction: Mental illness stigma studies demonstrate the presence of stigmatizing attitudes towards people with mental illness both by the public and health professionals. This study aimed to analyze the attitudes of professionals working at a Portuguese psychiatric hospital towards people with mental illness. Material and Methods: A cross‑sectional observational study was conducted to examine the attitudes of professionals through application of Mental Illness Clinician Attitude Scale (MICA) and collection of sociodemographic data. Results: Scores of MICA questionnaire were significantly lower than the cut‑off point for negative attitude in general and across professional categories suggesting that overall professionals seem to manifest a positive attitude towards people with mental illness. There was a trend of decrease in MICA scores throughout increasing years of professional experience although not statistically significant. Conclusion: Our results do not contradict the need to continue fighting stigma, but instead to better evaluate how these attitudes translate into practice, by including behavioral outcomes in future research.

Public Stigma of COVID-19 and Its Correlates in the General Population of China

This study aimed to examine the profile of COVID-19-related public stigma and its correlates in the general population of China. A cross-sectional online survey was conducted in China from 7 May to 25 May in 2020. A total of 1212 participants from the general population completed the survey measuring their stigmatizing attitudes towards COVID-19, as well as knowledge and causal attributions of COVID-19. Univariate and multivariate analyses were performed to examine the correlates of COVID-19-related public stigma. A total of 31.8% of participants endorsed stigmatization towards people with COVID-19. Those who were of older age (t = −3.97, p < 0.001), married (F = 3.04, p < 0.05), had a lower level of education (F = 8.11, p < 0.001), and a serious psychological response (F = 3.76, p < 0.05) reported significantly higher scores of public stigma. Dangerousness (B = 0.047, p < 0.001), fear (B = 0.059, p < 0.001), anger (B = 0.038, p < 0.01), and responsibility (B = 0.041, p < 0.001) were positively associated with public stigma. This study shows that public stigma related to COVID-19 is prevalent in the general population of China. Actions against public stigma need to contain the spread of misinformation about COVID-19, alter inappropriate attributions, alleviate unfavorable reactions, and provide psychosocial support for the public.

Stigma toward Wuhan people during the COVID-19 epidemic: an exploratory study based on social media

Background Stigma associated with infectious diseases is common and causes various negative effects on stigmatized people. With Wuhan as the center of the COVID-19 outbreak in China, its people were likely to be the target of stigmatization. To evaluate the severity of stigmatization toward Wuhan people and provide necessary information for stigma mitigation, this study aimed to identify the stigmatizing attitudes toward Wuhan people and trace their changes as COVID-19 progresses in China by analyzing related posts on social media. Methods We collected 19,780 Weibo posts containing the keyword ‘Wuhan people’ and performed a content analysis to identify stigmatizing attitudes in the posts. Then, we divided our observation time into three periods and performed repeated-measures ANOVA to compare the differences in attitudes during the three periods. Results The results showed that stigma was mild, with 2.46% of related posts being stigmatizing. The percentages of stigmatizing posts differed significantly during the three periods. The percentages of ‘Infectious’ posts and ‘Stupid’ posts were significantly different for the three periods. The percentage of ‘Irresponsible’ posts was not significantly different for the three periods. After government interventions, stigma did not decrease significantly, and stigma with the ‘Infectious’ attitude even increased. It was not until the government interventions took effect that stigma significantly reduced. Conclusions This study found that stigma toward Wuhan people included diverse attitudes and changed at different periods. After government interventions but before they took effect, stigma with the ‘Infectious’ attitude increased. After government interventions took effect, general stigma and stigmas with ‘Infectious’ and ‘Stupid’ attitudes decreased. This study constituted an important endeavor to understand the stigma toward Wuhan people in China during the COVID-19 epidemic. Implications for stigma reduction and improvement of the public’s perception during different periods of epidemic control are discussed.

HIV-Related Stigma and Discrimination (S&D) among Healthcare Workers (HCW) in Government Healthcare Facilities in Malaysia: Is It Real?

Stigma and discrimination (S&amp;D) undermine quality of life of people living with HIV (PLHIV) and their access to health services. In this context, an understanding of current stigmatizing attitudes among HCW towards PLHIV from the perspective of Malaysia healthcare setting is crucial to plan for service delivery improvement that is non-stigmatizing and non-discriminatory. The objective of this study was to examine and measure the level of S&amp;D towards PLHIV among HCW in selected government facilities. A cross-sectional study was undertaken from July to August 2020 in five government hospitals and six government health clinics in Malaysia. Two sets of a validated self-administered questionnaires, one for HCW and another one for PLHIV were used to assess HIV-related S&amp;D. This survey was conducted via web-based platform. Overall, 3880 HCW and 1173 PLHIV participated in this study. This study found significant proportion of HCW were having stigmatizing attitudes towards PLHIV. This includes fear of taking blood from PLHIV (87%) and double gloving when attending PLHIV (64%) probably due to fear of contracting HIV. In addition, 45% of HCW agreed that women living with HIV (WLHIV) should be prohibited from having children. Although HCW have fears for contracting HIV, their consciences and integrity allowed them to display some positive attitudes towards PLHIV with the majority of HCW 84% and 79% stated that they having observed others in their facility expressed willingness to care and providing good care to PLHIV. On PLHIV experience, only 12% of them reported that they had ever experienced stigma when accessing health services. The findings of this study shared a worrying magnitude of stigma towards PLHIV among HCW in Malaysia. Nevertheless, ethics and professionalism are upheld through giving good care and services to PLHIV. However, stigma reduction intervention programmes are still needed for HCW to ensure continuous excellent service delivery.

Comparison of the Effects of a Genetic, a Mild Encephalitis, and a Psychosocial Causal Explanation of Schizophrenia on Stigmatizing Attitudes – a Pilot Study With a Quasi-Experimental Design

Background: Previous research has shown that the endorsement of biogenetic causal explanations of schizophrenia is associated with stronger stigmatizing attitudes against people with schizophrenia than the endorsement of psychosocial explanations. However, little is known about whether different biogenetic causal explanation beliefs differentially affect stigmatizing attitudes. This is particularly valid for the endorsement of the mild encephalitis hypothesis of schizophrenia.Aim: To examine to what extent different causal explanations of schizophrenia influence the desire for social distance from persons with schizophrenia.Methods: A study with a prospective, quasi-experimental design was carried out with students in Germany (N = 333). A case vignette depicting a person with schizophrenia-typical symptoms was presented, and a social distance scale (SDS) was used to measure the stigmatizing attitude against the person described. Participants were randomly assigned to one of three groups receiving different causal explanations of schizophrenia (genetic, mild encephalitis hypothesis, or psychosocial) without treatment information.Results: A one-way ANOVA showed that the mean SDS was lowest in the group with the mild encephalitis hypothesis explanation, followed by the genetic explanation group, and highest in the psychosocial explanation group. However, the differences between the groups were small and not significant. A subanalysis revealed a significant interaction between gender and causal explanation. Women showed a significantly lower desire for social distance than men when receiving the mild encephalitis hypothesis. Neither the study discipline nor the number of semesters of study had significant effects on the mean SDS. The differences between the mean SDS scores for the different items were much bigger than the differences for the different causal explanations. Regardless of the causal explanation, the extent of the desired social distance depends strongly on social proximity.Conclusion: The present study fits into previous research, which has found that biogenetic beliefs were either associated with more social distance or did not yield a statistically significant association. Although we found a small gender-specific effect of the endorsement of the mild encephalitis hypothesis, we do not recommend gender-specific anti-stigmatization campaigns because they might rightly raise suspicions of dishonesty and manipulation. Rather we support recovery-oriented messages focusing on effective treatments.