Stigma and its impact on the families of former soldiers of the German Armed Forces: An exploratory study
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摘要
Background: Military families who have a family member with a mental illness see themselves confronted with many demands. Stigmatization is one of these challenges. Stigmatization affects not only the individual who suffers from a mental illness but also other family members via stigma by association and vicarious stigma. Stigma by association occurs when mental illness stigma spills over to individuals associated with an individual with a mental illness. Vicarious stigma describes the suffering of family members when they note the impact of stigma on their relative with mental illness. As a societal phenomenon, stigma plays out in social interactions and might therefore influence the social networks of families. It is also associated with healthcare utilization.Methods: Narrative interviews were conducted with 15 family members(partners, spouses, parents and children) of former soldiers of the German Armed Forces with a service-induced mental illness. The transcribed interview data were analyzed using a thematic analysis approach, in which codes were formed and emerging themes were systemized. Relationships between stigma, the families' reactions to it, its effects on their social relationships and its interference with their healthcare utilization were analyzed.Results: This study provides a detailed description of how relatives of former German soldiers with mental health problems experience stigma by association and vicarious stigma. Their perceptions are shown in a model that describes stigma-related attitudes, reactions to them and their effects on the social relationships of former soldiers' families. These families felt stigmatized because of the former soldiers' mental illness(mental illness stigma) and the military context in which it occurred(former soldier stigma). They reacted with nondisclosure, anger, acceptance and self-blame. Stigma was associated with smaller and weaker social networks that were characterized by social exclusion, self-segregation and conflicts with extended family, friends and colleagues. Stigma also affected the families' healthcare utilization.Conclusions: Urgently needed anti-stigma campaigns, particularly in the civilian context, should address the stigmatization of both mental illness and the military participation of the families affected. They should consider the needs of both former soldiers with a mental illness and their families.
Background: Military families who have a family member with a mental illness see themselves confronted with many demands. Stigmatization is one of these challenges. Stigmatization affects not only the individual who suffers from a mental illness but also other family members via stigma by association and vicarious stigma. Stigma by association occurs when mental illness stigma spills over to individuals associated with an individual with a mental illness. Vicarious stigma describes the suffering of family members when they note the impact of stigma on their relative with mental illness. As a societal phenomenon, stigma plays out in social interactions and might therefore influence the social networks of families. It is also associated with healthcare utilization.Methods: Narrative interviews were conducted with 15 family members(partners, spouses, parents and children) of former soldiers of the German Armed Forces with a service-induced mental illness. The transcribed interview data were analyzed using a thematic analysis approach, in which codes were formed and emerging themes were systemized. Relationships between stigma, the families' reactions to it, its effects on their social relationships and its interference with their healthcare utilization were analyzed.Results: This study provides a detailed description of how relatives of former German soldiers with mental health problems experience stigma by association and vicarious stigma. Their perceptions are shown in a model that describes stigma-related attitudes, reactions to them and their effects on the social relationships of former soldiers' families. These families felt stigmatized because of the former soldiers' mental illness(mental illness stigma) and the military context in which it occurred(former soldier stigma). They reacted with nondisclosure, anger, acceptance and self-blame. Stigma was associated with smaller and weaker social networks that were characterized by social exclusion, self-segregation and conflicts with extended family, friends and colleagues. Stigma also affected the families' healthcare utilization.Conclusions: Urgently needed anti-stigma campaigns, particularly in the civilian context, should address the stigmatization of both mental illness and the military participation of the families affected. They should consider the needs of both former soldiers with a mental illness and their families.
Background: Military families who have a family member with a mental illness see themselves confronted with many demands. Stigmatization is one of these challenges. Stigmatization affects not only the individual who suffers from a mental illness but also other family members via stigma by association and vicarious stigma. Stigma by association occurs when mental illness stigma spills over to individuals associated with an individual with a mental illness. Vicarious stigma describes the suffering of family members when they note the impact of stigma on their relative with mental illness. As a societal phenomenon, stigma plays out in social interactions and might therefore influence the social networks of families. It is also associated with healthcare utilization.Methods: Narrative interviews were conducted with 15 family members(partners, spouses, parents and children) of former soldiers of the German Armed Forces with a service-induced mental illness. The transcribed interview data were analyzed using a thematic analysis approach, in which codes were formed and emerging themes were systemized. Relationships between stigma, the families' reactions to it, its effects on their social relationships and its interference with their healthcare utilization were analyzed.Results: This study provides a detailed description of how relatives of former German soldiers with mental health problems experience stigma by association and vicarious stigma. Their perceptions are shown in a model that describes stigma-related attitudes, reactions to them and their effects on the social relationships of former soldiers' families. These families felt stigmatized because of the former soldiers' mental illness(mental illness stigma) and the military context in which it occurred(former soldier stigma). They reacted with nondisclosure, anger, acceptance and self-blame. Stigma was associated with smaller and weaker social networks that were characterized by social exclusion, self-segregation and conflicts with extended family, friends and colleagues. Stigma also affected the families' healthcare utilization.Conclusions: Urgently needed anti-stigma campaigns, particularly in the civilian context, should address the stigmatization of both mental illness and the military participation of the families affected. They should consider the needs of both former soldiers with a mental illness and their families.
引文
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7.Thompson EH Jr,Doll W.The burden of families coping with the mentallyⅢ:an invisible crisis.Fam Relat.1982;31(3):379-88.
8.van der Sanden RLM,Stutterheim SE,Pryor JB,Kok G,Bos AER.Coping with stigma by association and family burden amongfamily members of people with mental illness.J Nerv Ment Dis.2014;202(10):710-7.
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10.van der Sanden RL,Pryor JB,Stutterheim SE,Kok G,Bos AE.Stigma by association and fa mily burden among family members of people with mental illness:the mediating role of coping.Soc Psychiatry Psychiatr Epidemiol.2016;51(9):1 233-45.
11.Corrigan PW,Watson AC,Barr L.The self-stigma of mental illness:implications for self-esteem and self-efficacy.J Soc Clin Psychol.2006;25(8):875-84.
12.Link BG,Struening EL,Neese-Todd S,Asmussen S,Phelan JC.Stigma as a barrier to recovery:the conseq uences of stigma for the self-esteem of people with mental illnesses.Psychiatr Serv.2001;52(12):1621-6.
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14.Stjernsward S,Ostman M.Whose life am I living?Relatives living in the shadow of depression.Int J Soc Psychiatry.2008;54(4):358-69.
15.Link BG,Phelan JC.Conceptualizing stigma.Annu Rev Sociol.2001;27:363-85.
16.Pryor JB, Reeder GD,Monroe AE.The infection of bad company:stigma by association.J Pers Soc Psychol.201 2;102(2):224-41.
17.Angermeyer MC,Schulze B, Dietrich S.Courtesy stigma-a focus group study of relatives of schizophrenia patients.Soc Psychiatry Psychiatr Epidemiol.2003;38(1 0):593-602.
18.Corrigan PW,Miller FE.Shame,blame,and contamination:a review of the impact of mental illness stigma on family members.J Ment Health.2004;13(6):537-48.
19.van der Sanden RL,Bos AE,Stutterheim SE,Pryor JB,Kok G.Experiences of stigma by association among family members of people with mental illness.Rehabil Psychol.2013;58(1):73-80.
20.Link BG,Phelan JC,Bresnahan M,Stueve A,Pescosolido BA.Public conceptions of mental illness:labels,causes,dangerousness,and social distance.Am J Public Health.1999;89(9):1 328-33.
21.Struening EL,Perlick DA,Link BG,Hellman F,Herman D,Sirey JA.Stigma as a barrier to recovery:the extent to which caregivers believe most people devalue consumers and their families.Psychiatr Serv.2001;52(12):1 633-8.
22.de Boer HM,Mula M,Sander JW.The global burden and stigma of epilepsy.Epilepsy Behav.2008;12(4):540-6.
23.Werner P,Mittelman MS,Goldstein D,Heinik J.Family stigma and caregiver burden in Alzheimer's disease.Gerontologist.2012;52(1):89-97.
24.Bos AER,Pryor JB,Reeder GD,Stutterheim SE.Stigma:advances in theory and research.Basic Appl Soc Psychol.2013;35(1):1-9.
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26.Rusch N,Corrigan PW,Powell K,Rajah A,Olschewski M,Wilkniss S,et al.A stress-coping model of mental illness stigma:Ⅱ.Emotional stress responses,coping behavior and outcome.Schizophr Res.2009;110(1-3):65-71.
27.Werner S,Shulman C.Subjective well-being among familycaregivers of individuals with developmental disabilities:the role of affiliate stigma and psychosocial moderating variables.Res Dev Disabil.2013;34(11):41 03-14.
28.Phelan JC,Bromet EJ,Link BG.Psychiatric illness and family stigma.Schizophr Bull.1998;24(1):11 5-26.
29.Ostman M,Kjellin L.Stigma by association.Br J Psychiatry.2002;181:494-8.
30.Larson JE,Corrigan P.The stigma of families with mental illness.Acad Psychiatry.2008;32(2):87-91.
31.Tsang HW,Tam PK,Chan F,Chang WM.Sources of burdens on families of individuals with mental illness.Int J Rehabil Res.2003;26(2):123-30.
32.Chronister J,Chou C-C,Kwan K-LK,Lawton M,Silver K.The meaning of social support fo r persons with serious mental illness.Rehabil Psychol.2015;60(3):232-45.
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