UNASSIGNED: Mental disorders are often stigmatized in society. The stigma of mental illness affects people with a mental illness themselves as well as their family members-a phenomenon called stigma by association (SBA). Children of parents with a mental illness (COPMI) are a particular vulnerable group for SBA. In our systematic review, experienced SBA, anticipated SBA, affiliate SBA, and structural discrimination were identified as relevant stigma dimensions for children of parents with a mental illness. To assess SBA in adolescents who grow up with a parent with a mental illness, the COPMI-SQ was developed.
UNASSIGNED: N = 930 adolescents completed the study. Of those, N = 380 adolescents (sample 1; 72.6% female, mean age 17.12 (SD = 2.01) years) reported growing up with at least one parent with a mental illness. Using confirmatory (CFA) and exploratory factor analyses (EFA) as well as standard item and reliability analyses, we analyzed and revised the COPMI-SQ in the first sample. To validate the factorial structure of the revised COPMI-SQ, CFA was also conducted in the independent sample of the other N = 550 adolescents (sample 2; 80.0% female, mean age 16.36 (SD = 1.98) years) who reported not growing up with a parent with a mental illness. To test four measurement invariance, a multiple-group CFA was conducted in the combined sample of adolescents who reported growing up with and without a parent with a mental illness (sample 1 and sample 2).
UNASSIGNED: CFA in sample 1 resulted in an inadequate model fit for the theoretically assumed four-factor structure (CFI = .687; RMSEA = .064 (90% CI = .062-.066); SRMR = .092; AIC = 229 155.63). Following EFA and item and reliability analyses in sample 1, the COPMI-SQ was reduced to four scales (\"Experienced SBA,\" \"Affiliate SBA,\" \"Shame,\" and \"Anticipated SBA\") and two additional screening scales (\"Healthcare\" and \"Social support\"). To facilitate questionnaire use, only the three best items were retained in each scale, reducing the total item number to 12 plus five additional screener items. CFA in sample 2 also resulted in an inadequate model fit for the theoretically assumed four factor structure (CFI = .667; RMSEA = .065 (90% CI = .063-.066); SRMR = .101; AIC = 335 651.99). In comparison, the final version of the COPMI-SQ-r showed the best model fit (CFI = .945; RMSEA = .062 (90% CI = .052-.072); SRMR = .049; AIC = 60 008.05). In the multiple-group CFA (sample 1 and sample 2), metric invariance was established (χ2 (208) = 481.58, p < .001; CFI = .939; RMSEA = .053 (90% CI = .047-.059); SRMR = .056). In sample 2, internal consistency was found to be good for the total scale (α = .84) and almost acceptable to almost good for the subscales (α = .64 to.78).
UNASSIGNED: The revised version of the COPMI-SQ (COPMI-SQ-r) is a reliable and economic questionnaire to assess SBA in adolescents who grow up with a parent with a mental illness. The COPMI-SQ-r can be used to help develop and evaluate anti-stigma and general interventions for affected adolescents.

BACKGROUND: Steeped in Chinese culture which considers continuing the family lineage highly important, infertility stigma endorsed by others and oneself can both negatively impact psychological well-being in women with infertility in Taiwan. The aim of the present study was to find out whether family stigma attached to infertility has a direct effect on psychological well-being, or whether it is only when family stigma is internalized into self-stigma that psychological well-being is affected.
METHODS: The present study had a cross-sectional design, approved by an institutional review board in Taiwan. 245 female participants with infertility completed measures on infertility stigma, self-esteem, and positive and negative affect. The main question of this study was analyzed by conducting structural equation modeling.
RESULTS: The present study found that none of the direct effects of family stigma on self-esteem, negative affect, or positive affect were significant, while the indirect effects of family stigma on the three psychological well-being indexes through the mediator of self-stigma were significant.
CONCLUSIONS: Self-stigma fully mediates the effect of family stigma on self-esteem, positive affect, and negative affect in women with infertility. Collectively, stigma endorsed by others does not necessarily lead to negative psychological well-being. The negative influence comes from internalizing public/family stigma into self-stigma.

Although emerging adulthood is recognized as a pivotal time for relationship development, most studies concern heterosexual youth or older sexual minority partners. Using narratives from 40 college student emerging adults, we sought to understand the particularities and generalities of lesbian, gay, bisexual and other sexual minority (LGB+) relationship experiences. Positive experiences particular to being in a LGB+ relationship concerned partner support for coming and being out; support from family members for the relationship was rarely mentioned. Negative experiences were twice as likely to be mentioned as positive ones. They concerned how partners being at different levels of outness and problems with family support stressed the relationship. Generalities pertaining to positive relationship factors included meeting needs for support and using perspective taking to deal with conflict. Negative factors included unmet needs for companionship and intimacy and breakup anxiety about whether the relationship had a future. Our findings suggest the importance of developing strength-based LGB+ affirmative education for emerging adults to promote core relationship processes and strengthen skills to cope with stressors specific to sexual minority romantic partnerships.

Children of parents with a mental illness are a particularly vulnerable group as they have a high risk to develop a mental disorder themselves and those are associated with high stigma. Moreover, just like primary recipients of stigma, they are affected by the social taboo surrounding mental illness: they do not receive enough information, are often left alone with their problems, and are thus considered \"invisible children\". In previous research, family stigma has only been assessed through general questionnaires for all family members. What has not yet been adequately investigated is how stigma difficulties affect the children of parents with mental illness in particular. To address these limitations, we developed the Children of Parents with Mental Illness-Stigma-Questionnaire (COPMI-SQ), a self-report instrument for young people aged 12-19 years, designed to assess young people\'s stigma experiences in daily life. Based on a systematic review preceding the questionnaire, we identified relevant stigma dimensions for children of parents with a mental illness that resulted in 93 items that according to theory were assumed to load on four different scales: experienced stigma, anticipated stigma, self-stigma, and structural discrimination. An expert discussion, and a comprehensibility analysis with the target group followed. In this paper, we report on the development process and initial pilot data (N = 32) on the psychometric properties of the COPMI-SQ. Item analyses via an item difficulty index, discriminatory power, as well as internal consistency analysis resulted in a revised instrument reduced to 67 items. We observed very high internal consistencies (between α = 0.868 and α = 0.975) for the subscales. The approach taken to develop the COPMI-SQ followed scientifically accepted principles by ensuring different construction phases and is considered a solid basis for further reliability and validity studies. The study is ongoing and undergoing a further validation investigation; dimensionality and factor structure will also be examined.

Research has documented the stigma that individuals with degenerative neurological diseases experience, but caregivers also experience stigma by association (i.e., affiliate stigma). In order to shed light on the stigma of caregivers of people with degenerative neurological diseases, the current study aimed to explore cross-cultural differences in the prevalence of Parkinson\'s disease (PD) caregiver affiliate stigma, as well as the relationship between PD symptoms and caregiver affiliate stigma. Applications for Alzheimer\'s disease are discussed.
Survey data were collected in PD clinics at public, academic medical centers. Informal caregivers of an individual with PD from the US (n = 105) and from Mexico (n = 148) participated in the study. Caregivers completed a questionnaire that included the MDS Unified PD Rating Scale to describe the symptoms of the individual with PD, as well as the Affiliate Stigma Scale and demographic information.
A series of multiple regressions was run to examine whether PD symptoms were associated with affiliate stigma and if these differed by country. These regressions suggested that different patterns of PD symptoms predicted affiliate stigma in each country. Stigma was higher in the US compared to Mexico, and the relationship between bowel/bladder symptoms and affiliate stigma was significantly stronger in the US.
Symptoms of individuals with neurodegenerative diseases are related to affiliate stigma experienced by caregivers, and these relationships may differ cross-culturally. Negative public attitudes concerning bowl and bladder issues and the physical symptoms that accompany PD remain a source of stigma for caregivers and families, particularly in the US. Interventions for caregivers of individuals with neurodegenerative diseases should include strategies for coping with stigma concerning bladder and bowel problems, as well as other physical and mental health issues.

UNASSIGNED: Many studies have attempted to identify the factors that are associated with caregiver burden among family caregivers of people with Alzheimer\'s disease (AD), because of its plethora of negative consequences. One unique factor that has been investigated recently is family stigma. However, the path leading from family stigma to caregiver burden has not been thoroughly studied. Hence, this study had two main objectives. The first was to examine whether family stigma was a predictor of caregiver burden among Israeli Arab family caregivers of a person with AD. The second was to examine the interplay of family stigma and caregiver burden with coping strategies and social support.
UNASSIGNED: Structured face-to-face interviews were conducted with 175 Israeli Arab family caregivers (adult children and spouses) of elderly people with AD (87.4% female; 71.4% adult children; mean age = 54.28).
UNASSIGNED: Overall, the participants reported moderate levels of caregiver burden and family stigma. Additionally, as expected, family stigma made a unique - although modest - contribution to the explanation of caregiver burden. Whereas neither problem-focused coping nor emotion-focused coping played a significant role in mediating the relation between family stigma and caregiving burden, social support did mediate the relation between these variables.
UNASSIGNED: Our findings reveal how social support is important as a specific way to reduce the impact of family stigma on caregiver burden.

Providing care to people with Parkinson\'s disease (PD) poses challenges for family carers, including experiencing stigmatic beliefs -i.e., family stigma. However, to the best of our knowledge, there is no empirical study examining the stigmatic experiences of family members of people with PD. This was the aim of the present study. Three focus groups with 22 Israeli spouses of people with PD were conducted. Data were analyzed using theory-led thematic analysis. Overall, the spouses in our study shared mainly experiences of the stigma attached to the illness and/or to their loved ones, and not to themselves as carers. Three major themes emerged: the stereotypes that typify PD, stigmatizing behaviors towards the person with the disease, and structural stigma. Our findings highlight the profound stigma confronting carers of persons with PD, particularly when it comes to structural stigma.

BACKGROUND: Caregivers of patients with alcohol and opioid use disorder (OUD) have low quality of life (QoL) and suffer from family stigma. However, impact of family stigma on QoL has not been studied in this population.
METHODS: One hundred primary caregivers of male inpatients with severe alcohol use disorder (AUD) (n = 47) and OUD (n = 53) as per the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition were enrolled into the cross-sectional, descriptive study.Participants were assessed using sociodemographic and clinical proforma, World Health Organization QoL-BREF Hindi, and Hindi family stigma scale. Kolmogorov-Smirnov tests and Pearson\'s correlation were used for statistical analysis.
RESULTS: Majority of caregivers were females (64%), homemakers (48%), and married (80%). More than 50% of caregivers resided in rural areas and nuclear families. 46%, 30%, and 24% of caregivers were parents, wives, and siblings and children. Males, caregivers between 31 and 45 years of age, and married caregivers had significantly higher QoL. Parents had significantly lower QoL. Caregivers of patients with AUD had significantly lower overall QoL than that of OUD. Wives faced higher discrimination and overall stigma. Overall QoL, satisfaction with physical health, and environment were significantly negatively correlated with discrimination. Total stigma was negatively correlated with satisfaction with environment.
CONCLUSIONS: Stigma and discrimination have negative impact on QoL of caregivers. Stigma reduction and QoL enhancement should be integral part of psychosocial interventions for caregivers of patients with AUD and OUD.

BACKGROUND: Family members experience stigma via their connection with the affected member. Family stigma contains stereotypes of blame, shame and contamination.
OBJECTIVE: To establish the tendency towards stigmatization of family members of a person with autistic spectrum disorders (ASD) by a sample of the general public of Belgrade.
METHODS: The sample encompassed 181 participants, of various ages and levels of education, and of different, self-assessed levels of knowledge about autism. The structure of stigmatization of family members of a person with ASD was explored applying the Family Stigma Questionnaire (FSQ) and the Level of Familiarity Questionnaire (LFQ).
RESULTS: Analysis of the obtained results established that scores indicating the tendency towards stigmatization were most pronounced for variables connected to blame for deterioration of the condition of the person with autism, contamination of the individual family members by the condition, and to feeling pity for family members of a person with ASD. Statistically significant differences were established when the FSQ scores stigmatizing parents and siblings were compared. Significant differences in stigmatizing stereotypes were established according to gender and level of education, and according to the self-assessment of knowledge about autism and the level of previous contact to persons with mental disorders.
CONCLUSIONS: Anti-stigma programmes are important especially bearing in mind that participants who self-evaluated as having the least knowledge about ASD demonstrated the highest tendency towards stigmatizing the parents of a person suffering from ASD, and those of lower education demonstrated the highest tendency towards stigmatizing the family members.