Predicting Psychological Distress for People with Concealable Stigmatized Identit

描述（由申请人提供）：数十年的耻辱感研究表明，具有耻辱感身份的人是否会经历更多的心理困扰存在巨大的可变性。当前应用程序的目标是测试一个模型，该模型可以检查具有可隐藏的耻辱身份的人的脆弱性因素。我们的样本将包括5种可隐藏的耻辱身份：精神疾病、童年虐待（身体、情感、性）、强奸、药物滥用和关系暴力。之所以选择这五种身份，是因为它们很常见，被污名化，并且与不断增加的心理困扰有关。参与者将从不同的社区样本中抽取，包括目前正在寻求心理治疗和未接受治疗的人。有三个具体目标：我们的第一个具体目标是测试具有可隐藏的耻辱身份的人的心理困扰的脆弱性因素模型。基于耻辱感理论和研究，我们预测了耻辱感目标的四个内部因素（预期的耻辱感、身份的中心性、身份的突出性和负面刻板印象的内化）和耻辱感目标的一个外部因素（身份附加的文化耻辱感水平）可以解释痛苦。使用结构方程模型，我们还将研究一个中介模型，其中预期的柱头对痛苦的影响是通过增加中心性和显著性来中介的。我们假设，由于一个人的身份被污名化，预期更多的贬值将导致身份中心性和突出性的增加，这反过来又会导致痛苦的增加。据预测，文化污名的程度对痛苦只有直接影响。我们的第二个具体目标是检查我们模型中的脆弱性因素是否能预测总体健康功能，如果是这样，这种影响是否通过心理困扰来调节。我们的第三个具体目标是比较不同种族的模型拟合。研究表明，美国少数族裔和多数族裔之间的生理和心理健康存在差异。我们假设，与欧洲裔美国人相比，非洲裔美国人和拉丁裔美国人会表现出更严重的隐性耻辱效应，这些效应可以通过之前的歧视经历来预测。公共卫生相关性：这项研究将提供一个风险因素模型，以预测谁可能容易受到心理困扰和健康功能下降，因为隐藏耻辱的身份。最终，通过增加治疗干预措施的获取、利用和治疗效果，以及减少与未经治疗的隐性耻辱相关的沉重残疾负担，这种模式可能对改善治疗结果产生最大影响。

DESCRIPTION (provided by applicant): Decades of stigma research show that an enormous amount of variability exists in whether people with stigmatized identities experience increased psychological distress. The goal of the current application is to test a model that examines vulnerability factors for people with concealable stigmatized identities. Our sample will include 5 concealable stigmatized identities: mental illness, childhood abuse (physical, emotional, sexual), rape, substance abuse, and relationship violence. These five identities were chosen because they are common, stigmatized, and related to increased psychological distress. Participants will be drawn from a diverse community sample, composed of people both currently seeking psychological treatment and those not in treatment. There are three specific aims: Our first specific aim is to test a model of vulnerability factors for psychological distress for people with concealable stigmatized identities. Based on stigma theory and research, four factors internal to the stigma target (anticipated stigma, centrality of the identity, salience of the identity, and internalization of negative stereotypes) and one factor external to the stigma target (level of cultural stigma attached to the identity) are predicted to explain distress. Using structural equation modeling, we will also examine a mediated model in which the effect of anticipated stigma on distress is mediated through increased centrality and salience. We hypothesize that anticipating more devaluation due to one's stigmatized identity will lead to increased identity centrality and salience, which in turn result in increased distress. Level of cultural stigma is predicted to have only a direct effect on distress. Our second specific aim is to examine whether the vulnerability factors in our model predict general health functioning, and if so, whether this effect is mediated through psychological distress. Our third specific aim is to compare model fit across ethnicity. Research has shown both physical and mental health disparities between minority and majority Americans. We hypothesize that, compared to European Americans, African Americans and Latinos will show exacerbated concealed stigma effects and these effects will be predicted by previous experiences with discrimination. PUBLIC HEALTH RELEVANCE: This research will provide a model of risk factors to predict who is likely to be vulnerable to psychological distress and decreased health functioning due to concealable stigmatized identities. Ultimately, such a model may have its greatest impact on the enhancement of treatment outcomes by increasing access, utilization, and treatment effectiveness of therapeutic interventions as well as reducing the heavy disability burden associated with untreated concealed stigmas.