Reference List: Examples of Stigmas Related to Social Identities and Health Conditions 

For the Chief Public Health Officer's Report on the State of Public Health in Canada 2019

Table of contents

Background

This reference list supports the Chief Public Officer’s Report on the State of Public Health in Canada 2019: Addressing Stigma – Towards a More Inclusive Health System (2019 CPHO Annual Report). This list will be of value to those who are interested in learning more about key stigmas related to social identities and health conditions in the context of the health system.

The references relate directly to Table 1 in the 2019 CPHO Annual Report, which outlines the stigma pathways of 7 different stigmas. They are organized by stigma type and according to pathways component (stigma drivers, stigma practices, experiences of stigma, and outcomes and impacts):

  1. racism experienced by First Nations, Inuit, and Métis peoples
  2. racism experienced by African, Caribbean, and Black Canadians
  3. sexual stigma and gender identity stigma as experienced by LGBTQ2+ people
  4. mental illness stigma
  5. HIV stigma
  6. substance use stigma
  7. obesity stigma

The references are meant to serve as a starting point for those interested in exploring these stigmas further. The list is not exhaustive and does not capture all relevant literature for each category.

Methodology

These references were compiled from a rapid review conducted by the Office of the Chief Public Health Officer in the Public Health Agency of Canada (PHAC). The objectives of the review were to:

  1. clarify the definition of stigma
  2. describe the impacts of stigma on health outcomes
  3. assess the effectiveness of interventions to reduce stigma in the health system and to improve health outcomes
  4. analyze the policy landscape to address stigma in Canada

A literature search strategy was developed in conjunction with the PHAC Health Library. The search was performed in February 2019 using the following databases: Medline, Embase, ProQuest Public Health, and Scopus. Studies published after January 1, 2009, were included for initial screening. However, a time limit was not applied to publications that explored stigma concepts, drivers, frameworks, and models. Search filters were applied to identify articles focused on stigma related to key health conditions and social identities. Only studies from Canada, the United Kingdom, Australia, New Zealand, and the United States were included.

The search yielded 3,500 articles after removal of duplicates. Two independent reviewers screened 80% of the articles at the title and abstract level. Data was organized into 3 main stigma categories:

  1. concepts and methods
  2. research related to the selected health conditions and social identities
  3. intervention research addressing stigma and health

Reviewers assessed full text articles for relevance and quality.  A total number of 516 studies were included for full text review. Additional targeted searches were completed after February 2019, including bibliographic searches, reviewing grey literature, and ancestry searching. A final search was also completed in August 2019 to identify any new publications in this field. Systematic reviews, narrative reviews, and critical reviews were prioritized for the reference list. High-quality primary studies and other literature were also included. The strongest evidence found through the review was included.

Limitations

Scope

The scope of the 2019 CPHO Annual Report was limited to stigma and the health system. Consequently, literature that addresses broader factors that drive and fuel stigma and discrimination, including other social determinants of health and social drivers such as political movements, were not the focus of the rapid review.

Literature search

The searches conducted were not exhaustive and may not have captured all relevant literature. Only literature published in English and French was reviewed, and some literature may have been excluded on this basis. A detailed review of study quality and risk of bias was not assessed in this review. Finally, the review predominantly focused on articles published after January 1, 2009.

Table 1. Racism experienced by First Nations, Inuit, and Métis peoples

  • Drivers of stigma
    • Allan, B. & Smylie, J. First Peoples, Second Class Treatment: The role of racism in the health and well-being of Indigenous peoples in Canada. (The Wellesley Institute, 2015).
    • Bombay, A., Matheson, K. A. & Anisman, H. Intergenerational Trauma: Convergence of Multiple Processes among First Nations peoples in Canada. Journal of Aboriginal Health 5, 6-47 (2009).
    • Hunt, S. An Introduction to the Health of Two-Spirit People: Historical, contemporary and emergent issues. (National Collaborating Centre for Aboriginal Health, 2016).
    • Inuit Tapiriit Kanatami. Social Determinants of Inuit Health in Canada. (Inuit Tapiriit Kanatami, 2014).
    • Loppie, S., Reading, C. & de Leeuw, S. Aboriginal Experiences with Racism and its Impacts. (National Collaborating Centre for Aboriginal Health, 2014).
    • Nelson, S. E. & Wilson, K. Understanding barriers to health care access through cultural safety and ethical space: Indigenous people’s experiences in Prince George, Canada. Soc. Sci. Med. 218, 21-27 (2018).
    • Reading, C. & Wien, F. Health Inequalities and Social Determinants of Aboriginal Peoples' Health. (National Collaborating Centre for Aboriginal Health, 2013).
    • Wilk, P., Maltby, A. & Cooke, M. Residential schools and the effects on Indigenous health and well-being in Canada—a scoping review. Public Health Reviews 38, (2017).
  • Stigma practices
    • Allan, B. & Smylie, J. First Peoples, Second Class Treatment: The role of racism in the health and well-being of Indigenous peoples in Canada. (The Wellesley Institute, 2015).
    • Goodman, A. et al. “They treated me like crap and I know it was because I was Native”: The healthcare experiences of Aboriginal peoples living in Vancouver’s inner city. Social Sciences and Medicine 178, 87-94 (2017).
    • Hunt, S. An Introduction to the Health of Two-Spirit People: Historical, contemporary and emergent issues. (National Collaborating Centre for Aboriginal Health, 2016).
    • Inuit Tapiriit Kanatami. Social Determinants of Inuit Health in Canada. (Inuit Tapiriit Kanatami, 2014).
    • Loppie, S., Reading, C. & de Leeuw, S. Aboriginal Experiences with Racism and its Impacts. (National Collaborating Centre for Aboriginal Health, 2014).
    • Nelson, S. E. & Wilson, K. Understanding barriers to health care access through cultural safety and ethical space: Indigenous people’s experiences in Prince George, Canada. Soc. Sci. Med. 218, 21-27 (2018).
    • Reading, C. & Wien, F. Health Inequalities and Social Determinants of Aboriginal Peoples' Health. (National Collaborating Centre for Aboriginal Health, 2013).
  • Experiences of stigma
    • Allan, B. & Smylie, J. First Peoples, Second Class Treatment: The role of racism in the health and well-being of Indigenous peoples in Canada. (The Wellesley Institute, 2015).
    • Goodman, A. et al. “They treated me like crap and I know it was because I was Native”: The healthcare experiences of Aboriginal peoples living in Vancouver’s inner city. Social Sciences and Medicine 178, 87-94 (2017).
    • Loppie, S., Reading, C. & de Leeuw, S. Aboriginal Experiences with Racism and its Impacts. (National Collaborating Centre for Aboriginal Health, 2014).
    • Nelson, S. E. & Wilson, K. Understanding barriers to health care access through cultural safety and ethical space: Indigenous peoples’ experiences in Prince George, Canada. Soc. Sci. Med. 218, 21-27 (2018).
    • Reading, C. & Wien, F. Health Inequalities and Social Determinants of Aboriginal Peoples' Health. (National Collaborating Centre for Aboriginal Health, 2013).
  • Outcomes and impacts

    • Allan, B. & Smylie, J. First Peoples, Second Class Treatment: The role of racism in the health and well-being of Indigenous peoples in Canada. (The Wellesley Institute, 2015).
    • Bombay, A., Matheson, K. A. & Anisman, H. Intergenerational Trauma: Convergence of Multiple Processes among First Nations peoples in Canada. Journal of Aboriginal Health 5, 6-47 (2009).
    • Goodman, A. et al. “They treated me like crap and I know it was because I was Native”: The healthcare experiences of Aboriginal peoples living in Vancouver’s inner city. Social Sciences and Medicine 178, 87-94 (2017).
    • Inuit Tapiriit Kanatami. Social Determinants of Inuit Health in Canada. (Inuit Tapiriit Kanatami, 2014).
    • Loppie, S., Reading, C. & de Leeuw, S. Aboriginal Experiences with Racism and its Impacts. (National Collaborating Centre for Aboriginal Health, 2014).
    • Nelson, S. E. & Wilson, K. Understanding barriers to health care access through cultural safety and ethical space: Indigenous people’s experiences in Prince George, Canada. Soc. Sci. Med. 218, 21-27 (2018).
    • Paine, S., Harris, R., Cormack, D. & Stanley, J. Racial Discrimination and Ethnic Disparities in Sleep Disturbance: the 2002/03 New Zealand Health Survey. Sleep 39, 477-485 (2016).
    • Reading, C. & Wien, F. Health Inequalities and Social Determinants of Aboriginal Peoples' Health. (National Collaborating Centre for Aboriginal Health, 2013).
    • Shepherd, C., Li, J., Cooper, M., Hopkins, K. & Farrant, B. The impact of racial discrimination on the health of Australian Indigenous children aged 5–10 years: analysis of national longitudinal data. International Journal for Equity in Health 16, 1-12 (2017).
    • Wilk, P., Maltby, A. & Cooke, M. Residential schools and the effects on Indigenous health and well-being in Canada—a scoping review. Public Health Reviews 38, 1-23 (2017).

Table 2. Racism experienced by African, Caribbean, and Black Canadians

  • Drivers of stigma
    • Bailey, Z. D. et al. Structural racism and health inequities in the USA: evidence and interventions. Lancet 389, 1453-1463 (2017).
    • Feagin, J. & Bennefield, Z. Systemic racism and U.S. health care. Soc. Sci. Med. 103, 7-14 (2014).
    • James, C. et al. Race & Well-being: The Lives, Hopes, and Activism of African Canadians (Brunswick Books, 2010).
    • Krieger, N. Discrimination and health inequities. Int. J. Health Serv. 44, 643-710 (2014).
    • Prather, C. et al. Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity. Health Equity 2, 249-259 (2018).
  • Stigma practices
    • Bailey, Z. D. et al. Structural racism and health inequities in the USA: evidence and interventions. Lancet 389, 1453-1463 (2017).
    • Feagin, J. & Bennefield, Z. Systemic racism and U.S. health care. Soc. Sci. Med. 103, 7-14 (2014).
    • James, C. et al. Race & Well-being: The Lives, Hopes, and Activism of African Canadians (Brunswick Books, 2010).
    • Krieger, N. Discrimination and health inequities. Int. J. Health Serv. 44, 643-710 (2014).
    • Paradies, Y. et al. Racism as a Determinant of Health: A Systematic Review and Meta-Analysis. PLoS ONE 10, e0138511 (2015).
    • Prather, C. et al. Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity. Health Equity 2, 249-259 (2018).
    • Williams, D. R., Lawrence, J. A. & Davis, B. A. Racism and Health: Evidence and Needed Research. Annu. Rev. Public Health 40, 105-125 (2019).
  • Experiences of stigma
    • Bailey, Z. D. et al. Structural racism and health inequities in the USA: evidence and interventions. Lancet 389, 1453-1463 (2017).
    • Bécares, L., Nazroo, J., & Kelly, Y. A longitudinal examination of maternal, family, and area-level experiences of racism on children’s socioemotional development: Patterns and possible explanations. Social Science and Medicine 142, 128-135 (2015).
    • Cozier, Y., Yu, J., Coogan, P. F., Bethea, T. N., Rosenberg, L. & Palmer, J. R. Racism, segregation, and risk of obesity in the Black Women’s Health Study. American Journal of Epidemiology 179, 875-883 (2014).
    • Feagin, J. & Bennefield, Z. Systemic racism and U.S. health care. Soc. Sci. Med. 103, 7-14 (2014).
    • James, C. et al. Race & Well-being: The Lives, Hopes, and Activism of African Canadians (Brunswick Books, 2010).
    • Thorpe, R. J. Jr., Parker, L. J., Cobb, R. J., Dillard, F., & Bowie, J. Association between discrimination and obesity in African-American men. Biodemography Soc Biol. 63, 253-261 (2017).
    • Williams, D. R., Lawrence, J. A. & Davis, B. A. Racism and Health: Evidence and Needed Research. Annu. Rev. Public Health 40, 105-125 (2019).
  • Outcomes and impacts
    • Bailey, Z. D. et al. Structural racism and health inequities in the USA: evidence and interventions. Lancet 389, 1453-1463 (2017).
    • Bécares, L., Nazroo, J., & Kelly, Y. A longitudinal examination of maternal, family, and area-level experiences of racism on children’s socioemotional development: Patterns and possible explanations. Social Science and Medicine 142, 128-135 (2015).
    • Cozier, Y., Yu, J., Coogan, P. F., Bethea, T. N., Rosenberg, L. & Palmer, J. R. Racism, segregation, and risk of obesity in the Black Women’s Health Study. American Journal of Epidemiology 179, 875-883 (2014).
    • Feagin, J. & Bennefield, Z. Systemic racism and U.S. health care. Soc. Sci. Med. 103, 7-14 (2014).
    • James, C. et al. Race & Well-being: The Lives, Hopes, and Activism of African Canadians (Brunswick Books, 2010).
    • Lukachko, A., Hatzenbuehler, M. L. & Keyes, K. M. Structural racism and myocardial infarction in the United States. Soc. Sci. Med. 103, 42-50 (2014).
    • Paradies, Y. et al. Racism as a Determinant of Health: A Systematic Review and Meta-Analysis. PLoS ONE 10, e0138511 (2015).
    • Prather, C. et al. Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity. Health Equity 2, 249-259 (2018).
    • Thorpe, R. J. Jr., Parker, L. J., Cobb, R. J., Dillard, F., & Bowie, J. Association between discrimination and obesity in African-American men. Biodemography Soc Biol. 63, 253-261 (2017).
    • Wallace, M., Crear-Perry, J., Richardson, L., Tarver, M. & Theall, K. Separate and unequal: Structural racism and infant mortality in the US. Health Place 45, 140–144 (2017).
    • Williams, D. R., Lawrence, J. A. & Davis, B. A. Racism and Health: Evidence and Needed Research. Annu. Rev. Public Health 40, 105-125 (2019).

Table 3. Sexual stigma and gender identity stigma as experienced by LGBTQ2+ people

  • Drivers of stigma
    • Alencar Albuquerque, G. et al. Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review. BMC International Health and Human Rights 16, 1-10 (2016).
    • Hunt, S. An Introduction to the Health of Two-Spirit People: Historical, contemporary and emergent issues. (National Collaborating Centre for Aboriginal Health, 2016).
    • Jaffee, K. D., Shires, D. A., & Stroumsa, D. Discrimination and delayed health care among transgender women and men. Medical Care 54, 1010-1016 (2016).
    • Logie, C. et al. “Automatic assumption of your gender, sexuality and sexual practices is also discrimination”: Exploring sexual healthcare experiences and recommendations among sexually and gender diverse persons in Arctic Canada. Health & Social Care in the Community 27, 1204-1213 (2019).
    • McCann, E. & Brown, M. Homelessness among youth who identify as LGBTQ+: A systematic review. Journal of Clinical Nursing 28, 2061-2072 (2019).
    • Miller, L. & Grollman, E. The Social Costs of Gender Nonconformity for Transgender Adults: Implications for Discrimination and Health. Sociological Forum 30, 809-831 (2015).
    • White Hughto, J., Reisner, S. & Pachankis, J. Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Social Science & Medicine 147, 222-231 (2015).
    • Whitehead, J., Shaver, J. & Stephenson, R. Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations. PLOS ONE 11, e0146139 (2016).
  • Stigma practices
    • Alencar Albuquerque, G. et al. Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review. BMC International Health and Human Rights 16, 1-10 (2016).
    • Casey, B. et al. The Health of LGBTQIA2 Communities in Canada: Report of the Standing Committee on Health. (House of Commons, 2019).
    • Doan Van, E., Mereish, E., Woulfe, J. & Katz-Wise, S. Perceived Discrimination, Coping Mechanisms, and Effects on Health in Bisexual and Other Non-Monosexual Adults. Archives of Sexual Behavior 48, 159-174 (2019).
    • Hunt, S. An Introduction to the Health of Two-Spirit People: Historical, contemporary and emergent issues. (National Collaborating Centre for Aboriginal Health, 2016).
    • Jaffee, K. D., Shires, D. A., & Stroumsa, D. Discrimination and delayed health care among transgender women and men. Medical Care 54, 1010-1016 (2016).
    • Lyons, T. et al. A qualitative study of transgender individuals’ experiences in residential addiction treatment settings: stigma and inclusivity. Substance Abuse Treatment, Prevention, and Policy 10, (2015).
    • Lyons, T. et al. Experiences of Trans Women and Two-Spirit Persons Accessing Women-Specific Health and Housing Services in a Downtown Neighborhood of Vancouver, Canada. LGBT Health 3, 373-378 (2016).
    • McCann, E. & Brown, M. Homelessness among youth who identify as LGBTQ+: A systematic review. Journal of Clinical Nursing 28, 2061-2072 (2019).
    • Reisner, S. et al. Substance Use to Cope with Stigma in Healthcare Among U.S. Female-to-Male Trans Masculine Adults. LGBT Health 2, 324-332 (2015).
    • Saewyc, E. et al. Hazards of stigma: the sexual and physical abuse of gay, lesbian, and bisexual adolescents in the U.S. and Canada. Child Welfare 85, 195-213 (2006).
    • White Hughto, J., Reisner, S. & Pachankis, J. Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Social Science & Medicine 147, 222-231 (2015).
    • Whitehead, J., Shaver, J. & Stephenson, R. Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations. PLOS ONE 11, e0146139 (2016).
    • Ylioja, T. & Craig, S. Exclusionary Health Policy: Responding to the Risk of Poor Health among Sexual Minority Youth in Canada. Social Work in Public Health 29, 81-86 (2014).
  • Experiences of stigma
    • Alencar Albuquerque, G. et al. Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review. BMC International Health and Human Rights 16, 1-10 (2016).
    • Casey, B. et al. The Health of LGBTQIA2 Communities in Canada: Report of the Standing Committee on Health. (House of Commons, 2019).
    • Colledge, L., Hickson, F., Reid, D. & Weatherburn, P. Poorer mental health in UK bisexual women than lesbians: evidence from the UK 2007 Stonewall Women's Health Survey. Journal of Public Health 37, 427-437 (2015).
    • Doan Van, E., Mereish, E., Woulfe, J. & Katz-Wise, S. Perceived Discrimination, Coping Mechanisms, and Effects on Health in Bisexual and Other Non-Monosexual Adults. Archives of Sexual Behavior 48, 159-174 (2019).
    • Jaffee, K. D., Shires, D. A., & Stroumsa, D. Discrimination and delayed health care among transgender women and men. Medical Care 54, 1010-1016 (2016).
    • Knight, K. W.  et al. The kids are OK: it is discrimination, not same-sex parents, that harms children. MJA 207, (2017).
    • Logie, C. et al. “Automatic assumption of your gender, sexuality and sexual practices is also discrimination”: Exploring sexual healthcare experiences and recommendations among sexually and gender diverse persons in Arctic Canada. Health & Social Care in the Community 27, 1204-1213 (2019).
    • Lyons, T. et al. A qualitative study of transgender individuals’ experiences in residential addiction treatment settings: stigma and inclusivity. Substance Abuse Treatment, Prevention, and Policy 10, (2015).
    • Lyons, T. et al. Experiences of Trans Women and Two-Spirit Persons Accessing Women-Specific Health and Housing Services in a Downtown Neighborhood of Vancouver, Canada. LGBT Health 3, 373-378 (2016).
    • Reisner, S. et al. Substance Use to Cope with Stigma in Healthcare Among U.S. Female-to-Male Trans Masculine Adults. LGBT Health 2, 324-332 (2015).
    • White Hughto, J., Reisner, S. & Pachankis, J. Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Social Science & Medicine 147, 222-231 (2015).
  • Outcomes and impacts
    • Alencar Albuquerque, G. et al. Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review. BMC International Health and Human Rights 16, 1-10 (2016).
    • Casey, B. et al. The Health of LGBTQIA2 Communities in Canada: Report of the Standing Committee on Health. (House of Commons, 2019).
    • Colledge, L., Hickson, F., Reid, D. & Weatherburn, P. Poorer mental health in UK bisexual women than lesbians: evidence from the UK 2007 Stonewall Women's Health Survey. Journal of Public Health 37, 427-437 (2015).
    • Jaffee, K. D., Shires, D. A., & Stroumsa, D. Discrimination and delayed health care among transgender women and men. Medical Care 54, 1010-1016 (2016).
    • Logie, C. et al. “Automatic assumption of your gender, sexuality and sexual practices is also discrimination”: Exploring sexual healthcare experiences and recommendations among sexually and gender diverse persons in Arctic Canada. Health & Social Care in the Community 27, 1204-1213 (2019).
    • McCann, E. & Brown, M. Homelessness among youth who identify as LGBTQ+: A systematic review. Journal of Clinical Nursing 28, 2061-2072 (2019).
    • Miller, L. & Grollman, E. The Social Costs of Gender Nonconformity for Transgender Adults: Implications for Discrimination and Health. Sociological Forum 30, 809-831 (2015).
    • Reisner, S. et al. Substance Use to Cope with Stigma in Healthcare Among U.S. Female-to-Male Trans Masculine Adults. LGBT Health 2, 324-332 (2015).
    • Scheim, A., Bauer, G. & Shokoohi, M. Drug use among transgender people in Ontario, Canada: Disparities and associations with social exclusion. Addictive Behaviors 72, 151-158 (2017).
    • White Hughto, J., Reisner, S. & Pachankis, J. Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Social Science & Medicine 147, 222-231 (2015).
    • Whitehead, J., Shaver, J. & Stephenson, R. Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations. PLOS ONE 11, e0146139 (2016).
    • Ylioja, T. & Craig, S. Exclusionary Health Policy: Responding to the Risk of Poor Health among Sexual Minority Youth in Canada. Social Work in Public Health 29, 81-86 (2014).

Table 4. Mental illness stigma

  • Drivers of stigma
    • Abdullah, T. & Brown, T. L. Mental illness stigma and ethnocultural beliefs, values, and norms: an integrative review. Clin. Psychol. Rev. 31, 934-948 (2011).
    • Boksa, P., Joober, R. & Kirmayer, L. J. Mental wellness in Canada's Aboriginal communities: striving toward reconciliation. Journal of psychiatry & neuroscience: JPN 40, 363-365 (2015).
    • Henderson, C. et al. Mental health-related stigma in health care and mental health-care settings. The Lancet Psychiatry 1, 467-482 (2014).
    • Kirmayer, L. J. & Valaskakis, G. G. Healing traditions: The mental health of Aboriginal peoples in Canada. (UBC Press, 2009).
    • Knaak, S., Mantler, E. & Szeto, A. Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare management forum 30, 111-116 (2017).
    • Koschorke, M., Evans-Lacko, S., Sartorius, N. & Thornicroft, G. Stigma in different cultures in The stigma of mental illness — End of the story? 67-82 (Springer International Publishing, Cham, 2017).
    • Larkings, J. S. & Brown, P. M. Do biogenetic causal beliefs reduce mental illness stigma in people with mental illness and in mental health professionals? A systematic review. International journal of mental health nursing 27, 928-941 (2018).
    • Leaune, E. et al. Ethnic minority position and migrant status as risk factors for psychotic symptoms in the general population: a meta-analysis. Psychol. Med. 49, 1-14 (2018).
    • Sharp, M. et al. Stigma as a barrier to seeking health care among military personnel with mental health problems. Epidemiol. Rev. 37, 144-162 (2015).
    • Young, C., Hanson, C., Craig, J. C., Clapham, K. & Williamson, A. Psychosocial factors associated with the mental health of Indigenous children living in high income countries: a systematic review. International Journal for Equity in Health 16, 153 (2017).
  • Stigma practices
    • Coleman, S. J., Stevelink, S. A., Hatch, S. L., Denny, J. A. & Greenberg, N. Stigma-related barriers and facilitators to help seeking for mental health issues in the armed forces: a systematic review and thematic synthesis of qualitative literature. Psychol. Med. 47, 1-13 (2017).
    • Donnelly, L. R. et al. Stigma Experiences in Marginalized People Living With HIV Seeking Health Services and Resources in Canada. Journal of the Association of Nurses in AIDS Care 27, 768-783 (2016).
    • Haugen, P. T., McCrillis, A. M., Smid, G. E. & Nijdam, M. J. Mental health stigma and barriers to mental health care for first responders: A systematic review and meta-analysis. J. Psychiatr. Res. 94, 218-229 (2017).
    • Jackson-Best, F. & Edwards, N. Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health 18, 919 (2018).
    • Kaushik A., Kostaki E., Fewings S., Thomas G. & Kyriakopoulos M. The stigma of mental illness in children and adolescents: A systematic review. European Psychiatry, S130 (2016).
    • Pantelic, M., Sprague, L. & Stangl, A. L. It's not "all in your head": critical knowledge gaps on internalized HIV stigma and a call for integrating social and structural conceptualizations. BMC infectious diseases 19, 210 (2019).
    • Ross, A. M., Morgan, A. J., Jorm, A. F. & Reavley, N. J. A systematic review of the impact of media reports of severe mental illness on stigma and discrimination, and interventions that aim to mitigate any adverse impact. Soc. Psychiatry Psychiatr. Epidemiol. 54, 11-31 (2019).
    • Young, C., Hanson, C., Craig, J. C., Clapham, K. & Williamson, A. Psychosocial factors associated with the mental health of indigenous children living in high income countries: a systematic review. International Journal for Equity in Health 16, 153 (2017).
  • Experiences of stigma
    • Chambers, L. A. et al. Evidence informing the intersection of HIV, aging and health: A scoping review. AIDS and Behavior 18, 661-675 (2014).
    • Coleman, S. J., Stevelink, S. A., Hatch, S. L., Denny, J. A. & Greenberg, N. Stigma-related barriers and facilitators to help seeking for mental health issues in the armed forces: a systematic review and thematic synthesis of qualitative literature. Psychol. Med. 47, 1-13 (2017).
    • Donnelly, L. R. et al. Stigma Experiences in Marginalized People Living With HIV Seeking Health Services and Resources in Canada. Journal of the Association of Nurses in AIDS Care 27, 768-783 (2016).
    • Furlotte, C. & Schwartz, K. Mental Health Experiences of Older Adults Living with HIV: Uncertainty, Stigma, and Approaches to Resilience. Canadian Journal on Aging 36, 125-140 (2017).
    • Jackson-Best, F. & Edwards, N. Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health 18, 919 (2018).
    • Kaushik A., Kostaki E., Fewings S., Thomas G. & Kyriakopoulos M. The stigma of mental illness in children and adolescents: A systematic review. European Psychiatry, S130 (2016).
    • Shi, Y. et al. Correlates of affiliate stigma among family caregivers of people with mental illness: A systematic review and meta-analysis. J. Psychiatr. Ment. Health Nurs. 26, 49-61 (2019).
  • Outcomes and impacts
    • Coleman, S. J., Stevelink, S. A., Hatch, S. L., Denny, J. A. & Greenberg, N. Stigma-related barriers and facilitators to help seeking for mental health issues in the armed forces: a systematic review and thematic synthesis of qualitative literature. Psychol. Med. 47, 1-13 (2017).
    • Donnelly, L. R. et al. Stigma Experiences in Marginalized People Living With HIV Seeking Health Services and Resources in Canada. Journal of the Association of Nurses in AIDS Care 27, 768-783 (2016).
    • Evans-Lacko S. et al. How much does mental health discrimination cost: Valuing experienced discrimination in relation to healthcare care costs and community participation. Epidemiology and Psychiatric Sciences 24, 423-434 (2014).
    • Jackson-Best, F. & Edwards, N. Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health 18, 919 (2018).
    • Kaushik A., Kostaki E., Fewings S., Thomas G. & Kyriakopoulos M. The stigma of mental illness in children and adolescents: A systematic review. European Psychiatry, S130 (2016).
    • Leaune, E. et al. Ethnic minority position and migrant status as risk factors for psychotic symptoms in the general population: a meta-analysis. Psychol. Med. 49, 545-559 (2018).
    • Ross, A. M., Morgan, A. J., Jorm, A. F. & Reavley, N. J. A systematic review of the impact of media reports of severe mental illness on stigma and discrimination, and interventions that aim to mitigate any adverse impact. Soc. Psychiatry Psychiatr. Epidemiol. 54, 11-31 (2019).
    • Schnyder, N., Panczak, R., Groth, N. & Schultze-Lutter, F. Association between mental health-related stigma and active help-seeking: systematic review and meta-analysis. The British journal of psychiatry: the journal of mental science 210, 261-268 (2017).
    • Shi, Y. et al. Correlates of affiliate stigma among family caregivers of people with mental illness: A systematic review and meta-analysis. J. Psychiatr. Ment. Health Nurs. 26, 49-61 (2019).

Table 5. HIV Stigma

  • Drivers of stigma
    • Auerbach, J. D., Parkhurst, J. O. & Cáceres, C. F. Addressing social drivers of HIV/AIDS for the long-term response: Conceptual and methodological considerations. Global Public Health 6, S293-S309 (2011).
    • Chambers, L. A. et al. Stigma, HIV and health: a qualitative synthesis. BMC Public Health 15, 848 (2015).
    • Jackson-Best, F. & Edwards, N. Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health 18, 919 (2018).
    • Jaworsky, D. et al. Geographic differences in the experiences of HIV-related stigma for women living with HIV in northern and rural communities of Ontario, Canada. Rural & Remote Health 18, 4522 (2018).
    • Logie, C. H., Jenkinson, J. I. R., Earnshaw, V., Tharao, W. & Loutfy, M. R. A Structural Equation Model of HIV-Related Stigma, Racial Discrimination, Housing Insecurity and Wellbeing among African and Caribbean Black Women Living with HIV in Ontario, Canada. PLoS ONE 11, e0162826 (2016).
    • Mahajan, A. P. et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS 22, S67-S79 (2008).
    • Mason, S. & Sultzman, V. O. Stigma as experienced by children of HIV-positive parents: a narrative review. AIDS Care 31, 1049-1060 (2019).
    • Monteiro, S. S., Villela, W. V. & Soares, P. S. The interaction between axes of inequality in studies on discrimination, stigma and HIV/AIDS: contributions to the recent international literature. Global public health 8, 519-533 (2013).
    • Pantelic, M., Sprague, L. & Stangl, A. L. It's not "all in your head": critical knowledge gaps on internalized HIV stigma and a call for integrating social and structural conceptualizations. BMC infectious diseases 19, 210 (2019).
  • Stigma practices
    • Alexandra Marshall, S., Brewington, K. M., Kathryn Allison, M., Haynes, T. F. & Zaller, N. D. Measuring HIV-related stigma among healthcare providers: a systematic review. AIDS Care 29, 1337-1345 (2017).
    • Baugher, A. R. et al. Discrimination in healthcare settings among adults with recent HIV diagnoses. AIDS Care 31, 1-6 (2018).
    • Forni J., Nicholson S. & Ford-Young W. HIV stigma and discrimination in primary care. HIV Medicine 17, 4 (2016).
    • Geter, A., Herron, A. R. & Sutton, M. Y. HIV-Related Stigma by Healthcare Providers in the United States: A Systematic Review. AIDS Patient Care & Stds 32, 418-424 (2018).
    • Jackson-Best, F. & Edwards, N. Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health 18, 919 (2018).
    • Katz, I. T. et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. Journal of the International AIDS Society 16, 18640 (2013).
    • Mason, S. & Sultzman, V. O. Stigma as experienced by children of HIV-positive parents: a narrative review. AIDS Care 31, 1049-1060 (2019).
    • Rueda, S. et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open 6, e011453 (2016).
    • Saewyc, E., Clark, T., Barney, L., Brunanski, D. & Homma, Y. Enacted Stigma and HIV Risk Behaviours among Sexual Minority Indigenous Youth in Canada, New Zealand, and the United States. Pimatisiwin 11, 411-420 (2014).
  • Experiences of stigma
    • Baugher, A. R. et al. Discrimination in healthcare settings among adults with recent HIV diagnoses. AIDS Care 31, 1-6 (2018).
    • Chambers, L. A. et al. Evidence informing the intersection of HIV, aging and health: A scoping review. AIDS and Behavior 18, 661-675 (2014).
    • Forni J., Nicholson S. & Ford-Young W. HIV stigma and discrimination in primary care. HIV Medicine 17, 4 (2016).
    • Geter, A., Herron, A. R. & Sutton, M. Y. HIV-Related Stigma by Healthcare Providers in the United States: A Systematic Review. AIDS Patient Care & Stds 32, 418-424 (2018).
    • Jackson-Best, F. & Edwards, N. Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health 18, 919 (2018).
    • Katz, I. T. et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. Journal of the International AIDS Society 16, 18640 (2013).
    • Mason, S. & Sultzman, V. O. Stigma as experienced by children of HIV-positive parents: a narrative review. AIDS Care 31, 1-12 (2019).
    • Rueda, S. et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open 6, e011453 (2016).
    • Saewyc, E., Clark, T., Barney, L., Brunanski, D. & Homma, Y. Enacted Stigma and HIV Risk Behaviours among Sexual Minority Indigenous Youth in Canada, New Zealand, and the United States. Pimatisiwin 11, 411-420 (2014).
  • Outcomes and impacts
    • Forni J., Nicholson S. & Ford-Young W. HIV stigma and discrimination in primary care. HIV Medicine 17, 4 (2016).
    • Furlotte, C. & Schwartz, K. Mental Health Experiences of Older Adults Living with HIV: Uncertainty, Stigma, and Approaches to Resilience. Canadian Journal on Aging 36, 125-140 (2017).
    • Geter, A., Herron, A. R. & Sutton, M. Y. HIV-Related Stigma by Healthcare Providers in the United States: A Systematic Review. AIDS Patient Care & Stds 32, 418-424 (2018).
    • Jackson-Best, F. & Edwards, N. Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health 18, 919 (2018).
    • Katz, I. T. et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. Journal of the International AIDS Society 16, 18640 (2013).
    • Mason, S. & Sultzman, V. O. Stigma as experienced by children of HIV-positive parents: a narrative review. AIDS Care 31, 1-12 (2019).
    • Patterson, S. E. et al. The impact of criminalization of HIV non-disclosure on the healthcare engagement of women living with HIV in Canada: a comprehensive review of the evidence. Journal of the International AIDS Society 18, 20572 (2015).
    • Rueda, S. et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open 6, e011453 (2016).
    • Stockton, M. A., Giger, K. & Nyblade, L. A scoping review of the role of HIV-related stigma and discrimination in noncommunicable disease care. PloS one 13, e0199602 (2018).

Table 6. Substance use stigma

  • Drivers of stigma
    • Corrigan, P. W. & Nieweglowski, K. Stigma and the public health agenda for the opioid crisis in America. International Journal of Drug Policy 59, 44-49 (2018).
    • Kennedy-Hendricks, A. et al. Social Stigma toward Persons With Prescription Opioid Use Disorder: Associations With Public Support for Punitive and Public Health-Oriented Policies. Psychiatric Services 68, 462-469 (2017).
    • Kulesza, M., Larimer, M. E. & Rao, D. Substance Use Related Stigma: What we Know and the Way Forward. Journal of addictive behaviors, therapy & rehabilitation 2 (2013).
    • Reisner, S. L. et al. Substance Use to Cope with Stigma in Healthcare Among U.S. Female-to-Male Trans Masculine Adults. Lgbt Health 2, 324-332 (2015).
    • Scheim, A. I., Bauer, G. R. & Shokoohi, M. Drug use among transgender people in Ontario, Canada: Disparities and associations with social exclusion. Addict. Behav. 72, 151-158 (2017).
    • Yang, L. H., Wong, L. Y., Grivel, M. M. & Hasin, D. S. Stigma and substance use disorders: an international phenomenon. Current Opinion in Psychiatry 30, 378-388 (2017).
  • Stigma practices
    • Cooper, S. & Nielsen, S. Stigma and Social Support in Pharmaceutical Opioid Treatment Populations: a Scoping Review. International Journal of Mental Health and Addiction 15, 452-469 (2017).
    • Kelly J.F., Saitz R. & Wakeman S. Language, Substance Use Disorders, and Policy: The Need to Reach Consensus on an "addiction-ary". Alcoholism Treatment Quarterly 34, 116-123 (2016).
    • Kennedy-Hendricks, A. et al. Social Stigma toward Persons With Prescription Opioid Use Disorder: Associations With Public Support for Punitive and Public Health-Oriented Policies. Psychiatric Services 68, 462-469 (2017).
    • van Boekel, L. C., Brouwers, E. P., van Weeghel, J. & Garretsen, H. F. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug Alcohol Depend. 131, 23-35 (2013).
    • Vayr, F., Herin, F., Jullian, B., Soulat, J. M. & Franchitto, N. Barriers to seeking help for physicians with substance use disorder: A review. Drug Alcohol Depend. 199, 116-121 (2019).
  • Experiences of stigma
    • Cooper, S. & Nielsen, S. Stigma and Social Support in Pharmaceutical Opioid Treatment Populations: a Scoping Review. International Journal of Mental Health and Addiction 15, 452-469 (2017).
    • Kelly J.F., Saitz R. & Wakeman S. Language, Substance Use Disorders, and Policy: The Need to Reach Consensus on an "addiction-ary". Alcoholism Treatment Quarterly 34, 116-123 (2016).
    • van Boekel, L. C., Brouwers, E. P., van Weeghel, J. & Garretsen, H. F. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug Alcohol Depend. 131, 23-35 (2013).
    • Vayr, F., Herin, F., Jullian, B., Soulat, J. M. & Franchitto, N. Barriers to seeking help for physicians with substance use disorder: A review. Drug Alcohol Depend. 199, 116-121 (2019).
  • Outcomes and impacts
    • Kennedy-Hendricks, A. et al. Social Stigma toward Persons With Prescription Opioid Use Disorder: Associations With Public Support for Punitive and Public Health-Oriented Policies. Psychiatric Services 68, 462-469 (2017).
    • Reisner, S. L. et al. Substance Use to Cope with Stigma in Healthcare Among U.S. Female-to-Male Trans Masculine Adults. Lgbt Health 2, 324-332 (2015).
    • van Boekel, L. C., Brouwers, E. P., van Weeghel, J. & Garretsen, H. F. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug Alcohol Depend. 131, 23-35 (2013).
    • Vayr, F., Herin, F., Jullian, B., Soulat, J. M. & Franchitto, N. Barriers to seeking help for physicians with substance use disorder: A review. Drug Alcohol Depend. 199, 116-121 (2019).

Table 7. Obesity stigma

  • Drivers of stigma
    • Alberga, A. S., McLaren, L., Russell-Mayhew, S. & Von Ranson, K. M. Canadian Senate Report on Obesity: Focusing on Individual Behaviours versus Social Determinants of Health May Promote Weight Stigma. Journal of Obesity 2018 (2018).
    • Puhl, R. M. & Brownell, K. D. Confronting and Coping with Weight Stigma: An Investigation of Overweight and Obese Adults. Obesity 14, 1802-1815 (2006).
    • Puhl, R. M. & Heuer, C. A. The Stigma of Obesity: A Review and Update. Obesity 17, 941-964 (2009).
    • Puhl, R. M. et al. A multinational examination of weight bias: predictors of anti-fat attitudes across four countries. Int. J. Obes. (Lond) 39, 1166-1173 (2015).
  • Stigma practices
    • Alberga, A.S., Russell-Mayhew, S., von Ranson, K.M., & McLaren, L. Weight bias: a call to action. J.Eat.Disord. 4, 016-0112-4 (2016).
    • Nutter, S. et al. Weight Bias in Educational Settings: a Systematic Review. Curr. Obes. Rep. 8, 185-200 (2019).
  • Experiences of stigma
    • Alberga, A.S., Russell-Mayhew, S., von Ranson, K.M., & McLaren, L. Weight bias: a call to action. J.Eat.Disord. 4, 016-0112-4 (2016).
    • Hebl, M. R. & Xu, J. Weighing the care: physicians' reactions to the size of a patient. International Journal of Obesity & Related Metabolic Disorders 25, 1246-1252 (2001).
    • Nutter, S. et al. Weight Bias in Educational Settings: a Systematic Review. Curr. Obes. Rep. 8, 185-200 (2019).
    • Puhl, R. M. & Brownell, K. D. Confronting and Coping with Weight Stigma: An Investigation of Overweight and Obese Adults. Obesity 14, 1802-1815 (2006).
    • Puhl, R. M. et al. A multinational examination of weight bias: predictors of anti-fat attitudes across four countries. Int. J. Obes. (Lond) 39, 1166-1173 (2015).
    • Ramos, S. X., Forhan, M., Caulfield T., Sharma, A.M., & Raine, K. Addressing Internalized Weight Bias and Changing Damaged Social Identities for People Living With Obesity. Front Psych 10, (2019).
  • Outcomes and impacts
    • Alberga, A. S., McLaren, L., Russell-Mayhew, S. & Von Ranson, K. M. Canadian Senate Report on Obesity: Focusing on Individual Behaviours versus Social Determinants of Health May Promote Weight Stigma. Journal of Obesity 2018 (2018).
    • Alberga, A.S., Russell-Mayhew, S., von Ranson, K.M., & McLaren, L. Weight bias: a call to action. J.Eat.Disord. 4, 016-0112-4 (2016).
    • Amy, N. K., Aalborg, A. F., Lyons, P. F. & Keranen, L. Barriers to routine gynecological cancer screening for White and African-American obese women. International Journal of Obesity 30, 147-155 (2005).
    • Chu, F. & Ohinmaa, A. The obesity penalty in the labor market using longitudinal Canadian data. Econ. Hum. Biol. 23, 10-17 (2016).
    • Hebl, M. R. & Xu, J. Weighing the care: physicians' reactions to the size of a patient. International Journal of Obesity & Related Metabolic Disorders 25, 1246-1252 (2001).
    • Hunger, J. M., Major, B., Blodorn, A. & Miller, C. T. Weighed Down by Stigma: How Weight-Based Social Identity Threat Contributes to Weight Gain and Poor Health. Social & Personality Psychology Compass 9, 255-268 (2015).
    • Nutter, S. et al. Weight Bias in Educational Settings: a Systematic Review. Curr. Obes. Rep. 8, 185-200 (2019).
    • Puhl, R. M. & Brownell, K. D. Confronting and Coping with Weight Stigma: An Investigation of Overweight and Obese Adults. Obesity 14, 1802-1815 (2006).
    • Puhl, R. M. & Heuer, C. A. The Stigma of Obesity: A Review and Update. Obesity 17, 941-964 (2009).
    • Puhl, R. M. et al. A multinational examination of weight bias: predictors of anti-fat attitudes across four countries. Int. J. Obes. (Lond) 39, 1166-1173 (2015).
    • Ramos, S. X., Forhan, M., Caulfield T., Sharma, A.M., & Raine K. Addressing Internalized Weight Bias and Changing Damaged Social Identities for People Living With Obesity. Front Psych 10, (2019).
    • Sutin, A. R., Stephan, Y. & Terracciano, A. Weight Discrimination and Risk of Mortality. Psychological science 26, 1803-1811 (2015).
    • Tomiyama, A. J. Weight stigma is stressful. A review of evidence for the Cyclic Obesity/Weight-Based Stigma model. Appetite 82, 8-15 (2014).
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