Abstract
Stigma has been documented to act as a significant barrier to healthcare access and healthcare-seeking behavior. Traditional frameworks of stigma and discrimination have been used in the past to explain the stigma associated with diseases such as tuberculosis, leprosy, and HIV. However, increasing globalization and unprecedented access to information via social media and the internet have altered infectious disease dynamics and have forced a rethink on mechanisms which propagate stigma. SARS, MERS, Ebola, and more recently COVID-19 have been associated with fear in communities across the globe due to the inherent uncertainties associated with emerging infectious diseases and a concurrent spread of misinformation—an infodemic. The authors present a theoretical framework to explain the evolution of COVID-19 associated stigma by exploring the complex interplay of various international and national mechanisms. It is anticipated that a conceptual framework which explains the evolution of stigma in fast-spreading global pandemics such as COVID-19 may also prove to be useful as a starting point for furthering the discussion on the progenitors, pathways, and manifestations of COVID-19-related stigma. This should be of practical use to researchers who are interested in exploring, validating, and identifying interventions for informing other frameworks for similar diseases.
The members in the GRID COVID-19 Study Group are the co-authors of this chapter. Dr Anirban and Dr Balaji are representing the GRID COVID-19 Study Group in the author byline as the corresponding author.
Generating Research Insights for Development (GRID) COVID-19 Study Group has members located across institutions in 21 of 28 states and 3 of 8 union territories (UTs) in India. These include teaching faculty, residents in medical schools, and public health experts in academic research organizations. The members were identified based on their engagement in COVID-19 pandemic containment in various capacities (as program advisors, implementers, members of rapid response teams, treating physicians, and researchers) in respective states/UTs and at the national level. The group keeps track of developments in the COVID-19 in India.
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Background
Stigma influences population health outcomes by worsening, undermining, and impeding social processes. It impacts social relationships, resource availability, and access (including care-seeking behavior), and triggers psychological and behavioral responses [1, 2]. The coronavirus disease 2019 (COVID-19) incited stigma as a prominent individual and societal reaction. Still, amidst the more tangible and observable dimensions of the pandemic (e.g., health and economic outcomes), the role stigma plays in influencing health outcomes is likely to remain under-assessed.
Stigma related to COVID-19 was maximally reported in India during the first wave of the pandemic (2020). Even though the fatality rate was 3–5%, people were afraid of adverse outcomes if they tested positive. Dead bodies were left unclaimed, pregnant women who had tested positive for SARS-CoV-2 found it difficult to get a hospital bed, patients’ families refused to help them, and people were refused entry into their homes by family members and relatives even after they had recovered from COVID-19. Incidents were reported where family members of COVID-19 patients were discriminated against though they had tested negative. Cured persons and their families also suffered discrimination. Even healthcare workers faced stigma and discrimination.
Documented real-life experiences of patients admitted in COVID-19 wards underscored how internalized stigma, feelings of guilt of infecting near and dear ones, the shame of infecting others, and anger directed towards self, led to a vicious cycle of stigma and psychological distress among patients during and after their hospital stay [3].
It was also reported that stigma impeded care-seeking for COVID-19 which led to adverse outcomes. Many people avoided getting tested for SARS-CoV-2 even if they had symptoms of COVID-19. Incidents are reported of people quarantining inside a car instead of going home to their families. Stigma related to COVID-19, on occasion, resulted in arguments, conflicts, and feuds among individuals. Suicides were also reported due to COVID-related anxiety [3].
In the initial days of the pandemic in India, there seems to have been a lack of effective stigma mitigation and behavior change management strategy based on evidence that could translate into public education and community engagement and instill trust in the healthcare system and government initiatives.
Unlike stigma associated with other health conditions (e.g., HIV/AIDS, tuberculosis, and mental health), the stigma associated with COVID-19 is unique in several aspects. Its evolution was speedy despite (and sometimes partially due to) the society having better access to information that was regulated, accultured, and more cohesive than before. This was the case because even though a hitherto unprecedented number of people could access and potentially consume information from a multitude of legitimate sources, there was a concurrent mushrooming of sources of misinformation on various platforms at a rate that rivaled the rate of the spread of COVID-19. This epidemic of misinformation, aptly named infodemic, was responsible for fostering stigma directed at those purported to be afflicted with COVID-19 and their caregivers [4]. Secondly, medical stigma is usually preceded by labelling followed by stereotyping. Another unique trait of COVID-19-related stigma is that although initially there were indications of the generation of stereotypes, the rapid progression and spread of the disease left little space for any enduring stereotype. Stigmatization seemed to be happening directly based on labelling [5,6,7]. Although unique, it seems that similar patterns of stigma can be theorized for earlier infectious disease pandemics in recent history [8, 9].
In this chapter, we review the existing definitions for stigma and the literature from India on stigma related to COVID-19 to propose a theoretical framework for the characterization of COVID-19-related stigma in India.
Existing Frameworks of Stigma
In the sociological context, stigma has been studied from as long back as the nineteenth century and is generally understood to be the process by which persons having a particular attribute are first labelled and then stereotyped. This stereotyping subsequently gives rise to stigma. Many theories have been proposed to define stigma and its operators in society (Table 1). Traditional stigma frameworks developed for medical conditions (HIV, obesity, or mental illnesses) have relied on the conventional progression from labelling to stereotyping and from stereotyping to stigmatizing. Unique socio-cultural backgrounds that foster stigma directed at various health conditions have necessitated the development of multiple stigma frameworks. Of late, there have been efforts to condense them into a broader more encompassing framework [2, 10]. For example, in the context of HIV/AIDS, stigma was seen to evolve through three phases. Firstly, those infected with HIV were labelled. This led to the evolution of group-based beliefs which were applied to all individuals with HIV. This was followed by their being stigmatized [11]. Such stigmatization usually followed the cycle of social stigma, internalized stigma, and anticipated stigma [11, 12]. Similarly, mental health stigma frameworks also envisage the process of labelling followed by stereotyping which ultimately culminates into stigma which again cycles through social stigma, internalized stigma, and anticipated stigma [13,14,15]. Stigma frameworks have also been developed for obesity, tuberculosis, leprosy, and more recently, Ebola and severe acute respiratory syndrome (SARS) [9, 16,17,18,19,20,21].
Most stigma frameworks have focused on individualistic approaches to the development of stigma with either perspective from the victims or the perpetrators and the victims [9, 11, 15,16,17,18, 20, 22]. Very few stigma frameworks focus on the social and/or systemic and structural pathways engendering, emboldening, and perpetuating stigma [2]. Although most frameworks distinguish between the stigmatized and stigmatizer, frameworks such as the Health Stigma and Discrimination Framework proposed in 2019 do away with the differentiation between the victim and the perpetrator(s) of stigma, to discourage the process of ‘othering’, but also retain the baseline process of labelling, stereotyping, and stigmatization [2].
Literature Review
We conducted a scoping literature search to summarize published primary research on stigma and COVID-19 in India. Two searches of peer-reviewed manuscripts till August 2021 were conducted in July and in August 2021 using the PubMed and Scopus databases. Searches included terms related to [1] ‘stigma’ or other associated terms such as ‘social stigma’; [2] ‘COVID-19’ and [3] ‘India’. An initial title and abstract review were performed, followed by a full-text review of articles included during the first phase. For charting, data were extracted according to authors and year of publication, study design, sample size, objectives, and type of stigma measured (i.e., perceived, anticipated, internalized, experienced/enacted). The studies included in the chapter are listed below (Table 2).
Proposed Framework of COVID-19 Stigma
Our COVID-19 stigma framework is based on previously developed frameworks for other medical and health conditions. It is informed by prevalent theories of stigma and contemporary literature (Fig. 1) [9, 14, 16,17,18,19,20,21,22,23,24,25,26,27,28,29]. We observed that the stigma associated with COVID-19 had its inception in ‘labelling’ as soon as the person tested positive for SARS-CoV-2. Stereotyping was not universally obvious, though, at times, it was associated with health workers and other frontline personnel engaged in combating COVID-19.
There is considerable overlap between the various terminologies used in the context of stigma. As noted elsewhere, the term internalized stigma has been used to have the same contextual meaning as experienced stigma or perceived stigma. The terms internalized stigma and self-stigma have been used interchangeably. Anticipated stigma has been conflated with stigma concerns, stigma apprehension, and stigma consciousness. In the framework proposed by us, we have used the following definitions:
Social Stigma
The term social stigma is used to define people’s reaction to someone who is assumed/confirmed to be having the stigmatized condition. It was first described by Goffman and later by Farina et al. [24, 25, 29]. Recent insights into stigma acknowledge the role that structural factors play in the persistence of stigma in the community, provisionally defined as “societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and wellbeing of the stigmatized” [27, 42]. Structural factors range from governmental and systemic policies which discriminate against the stigmatized (such as against ‘undocumented’ immigrants and gender and sexual minorities) to prevalent cultural norms which stigmatize certain identities and conditions (such as mental illness or sexual identities) [43,44,45,46]. In addition, it is postulated that power differentials may play a formative role in the production of stigma. For example, studies on schizophrenia patients report that greater social power was associated with less internalized stigma and negative symptoms as well as more stigma resistance. Studies define social power as “the perception of one’s ability to influence another person or other people” [12, 47].
Policies based on the premise of social stigma in existing literature define social stigma “as the process by which the victim is labelled and subsequently discriminated against by society based on the suspicion/confirmation of harboring SARS-CoV-2”. Early evidence from India showed that patients who recovered from COVID-19 experienced social stigma and prohibition from essential services due to social stigma [30, 36, 39]. They were restricted from dining in public spaces, using public bathrooms in hostels, grocery shopping, and procuring water from public tap facilities. One study reported stigmatization at the health facilities; patients reported that they were almost abandoned and overlooked by health providers in the hospitals. Few patients reported that after being admitted to the hospital, the doctors asked them to measure their blood pressure and oxygen saturation level [30]. Health professionals, who are on the frontline in the COVID-19 pandemic also experienced social stigma. Health professionals reported that the people in their locality considered them to be carriers of infection and avoided them [31, 38, 40]. We hypothesize that this stigma is fueled by the fear of contracting COVID-19 from the victim.
Self-stigma
The term self-stigma has been used to describe the process by which victims internalize the labels applied to them and eventually end up believing those ascribed labels to be true [48]. Furthermore, self-stigma may be enacted alongside anticipated stigma, especially in cases where the stigmatized identity is not visible. The fear of being discovered, along with the negative connotations of the stigmatizing label, collectively act as a source of psychological distress [49].
We base our definition of self-stigma on previous definitions provided in the Encyclopedia of Critical Psychology by Corrigan, Pattyn et al., and Mak and Cheung [50,51,52,53]. We define self-stigma “as the process by which victims become aware of social stigma, agree with and internalize the label applied to them”. Similar evidence emerged from a study conducted on lived experiences of individuals. In addition to the anticipated stigma, because of being traced as the source of infection within the household and community, individuals started blaming themselves for their carelessness and felt ashamed and guilty [35]. Self or internalized stigma was reported to be high in a study conducted on COVID-19 survivors in Kashmir, India [39].
Anticipated Stigma
Anticipated stigma is an essential component of our framework because, in the case of COVID-19, the stigmatized label may not be visible. We hypothesize that anticipated stigma would influence the healthcare-seeking behavior of the victims as they would try and avoid enactment of the anticipated stigma into social stigma [46]. We base our definition of anticipated stigma on definitions provided by Scambler and Hopkins, Quinn and Chaudoir, and Earnshaw and define anticipated stigma “as the degree to which individuals expect that others will stigmatize them if they know about their concealed stigmatized identity” [54,55,56]. In one study participants on being discharged from the isolation ward, were concerned about the likelihood of facing stigma from the community and the neighborhood after going back home [30]. Similar findings were reported by another study, wherein on being discharged from the hospital, the participants reported a high level of anticipated societal stigma as compared to self-stigma and apprehension of being stigmatized by their family members [37]. Additionally, patients who were still in the hospital and undergoing treatment for COVID-19 reported their concerns about being stigmatized on their return to the community. Another study on stigma in COVID-19 inpatients reported that 7.1% of the respondents had significantly higher stigma scores, especially in the domain of concern about public attitudes [33]. In a study from Kerala, a southern state of India, the investigators discovered high anticipated stigma scores among doctors on COVID duty [34].
Associated Stigma
It is observed that in the case of medical stigma, conditions as disparate as mental illness, leprosy, and HIV have the potential to affect, not only the patients, but also the family, friends, and caretakers by association [57,58,59]. Such stigma has been called ‘courtesy’ stigma by Goffman and was first described by Mehta and Farina as a stigma by association [22, 24]. Further work on stigma by association or associative stigma has been done by Lefley, Phelan et al., and Byrne, Struening and Kjellin [60,61,62,63,64]. There is also evidence of associative stigma affecting medical professionals associated with caring for the stigmatized such as among mental health professionals [65, 66]. We define associative stigma as “stigma felt by family members and caregivers of the stigmatized victim who is, in this case, a person suspected/confirmed of harboring SARS-CoV-2, simply due to their association with the stigmatized”. We hypothesize that in the case of COVID-19, associative stigma may arise due to suspicion of the care-giver(s) acting as ‘vectors’ of the disease. Other studies report that there is ostracized behavioral and social monitoring of the infected and their family members by the neighborhood [31, 41].
Currently, evidence related to stigma and its manifestation has been reported widely, however, limited studies have also reported the intervention to deal with the stigma and its outcome. Video-based interventions reported reductions in COVID-19-related fear and stigma [67].
Conclusion
It must be understood that the realization and perception of stigmas are contextual and are influenced by the victims’ understanding and perspective of how they conceptualize and realize the stigma directed towards them. This is more so for stigma directed towards identities not visible in the victim. Therefore, while constructing the stigma framework for COVID-19, we recognize that stigma would have differential impacts depending, not only on how victims are stigmatized, but also on how they perceive they are being stigmatized. Stigma related to COVID-19 has a temporal trend and is subject to individual awareness, population behavior change management interventions, and public information. The framework proposed by us is generic. We suggest that by using available evidence, the conceptual framework that we have proposed be used as an initial model for future improvisation and validation— a starting point to study and develop interventions to address stigma during similar pandemics in future.
Change history
26 September 2023
A correction has been published.
References
Kane JC, Elafros MA, Murray SM, Mitchell EMH, Augustinavicius JL, Causevic S, Baral SD (2019) A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC Med 17(17). https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1250-8
Stangl AL, Earnshaw VA, Logie CH, Brakel W Van, Simbayi LC, Barré I, Dovidio JF (2019) The health stigma and discrimination framework : a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med 17(31). https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1271-3
Bhanot D, Singh T, Verma SK, Sharad S (2021) Stigma and discrimination during COVID-19 pandemic. Front Public Health 8:577018. PMID: 33585379; PMCID: PMC7874150. https://www.frontiersin.org/articles/10.3389/fpubh.2020.577018/full
Zarocostas J (2020) How to fight an infodemic. The Lancet 395(10225):676. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30461-X/fulltext
Bird JDP, Voisin DR (2013) “You’re an open target to be abused”: a qualitative study of stigma and HIV self-disclosure among black men who have sex with men. Am J Public Health 103(12):2193–2199. https://www.researchwithrutgers.com/en/publications/youre-an-open-target-to-be-abused-a-qualitative-study-of-stigma-a
Budhwani H, Sun R (2020) Creating COVID-19 stigma by referencing the novel coronavirus as the “ Chinese virus ” on Twitter : quantitative analysis of social media data corresponding author. J Med Internet Res 22(5):e19301. https://www.jmir.org/2020/5/e19301/
Lin CY (2020) Social reaction toward the 2019 novel coronavirus (COVID - 19). Social Health Behav 3:1–2. https://www.shbonweb.com/article.asp?issn=2589-9767;year=2020;volume=3;issue=1;spage=1;epage=2;aulast=Lin
Person B, Sy F, Holton K, Govert B, Liang A, the NCID, SARS Community Outreach Team, Garza B, Gould D, Hickson M, McDonald M, Meijer C, Smith J, Veto L, Williams W, Zauderer L (2004) Fear and stigma: the epidemic within the SARS outbreak. Emerg Infect Dis 10(2):358–363. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322940/
Davtyan M, Brown B, Folayan MO (2014) Addressing Ebola-related stigma : lessons learned from HIV/AIDS. Global Health Action 7(1):26058. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225220/
Pryor JB, Reeder GD (2011) Chapter 34: HIV-related stigma. In: Hall JC, Hall BJ, Cockerell CJ (eds) HIV/AIDS in the Post-HAART Era: manifestations, treatment, and epidemiology. Connecticut: People’s Medical Publishing House-USA, pp 790–807. https://www.researchgate.net/publication/302944473_HIV-related_stigma
Earnshaw VA, Chaudoir SR (2009) From conceptualizing to measuring HIV stigma : a review of HIV stigma mechanism measures. AIDS Behav 13(6):1160–1177. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511707/
Parker R, Aggleton P (2003) HIV and AIDS-related stigma and discrimination : a conceptual framework and implications for action. Soc Sci Med 57(1):13–24. http://bibliobase.sermais.pt:8008/BiblioNET/Upload/PDF6/004754_Social%20Science%20&%20Medicine.pdf
BG, Phelan JC (2001) Conceptualizing stigma. Ann Rev Sociol 27(1):363–385. https://doi.org/10.1146/annurev.soc.27.1.363
Mukolo A, Heflinger CA, Wallston KA (2010) The stigma of childhood mental disorders: a conceptual framework. J Am Acad Child Adolesc Psychiatry 49(2): 92–128. https://www.jaacap.org/article/S0890-8567(09)00025-2/fulltext
Martin JK, Lang A, Olafsdottir S (2008) Rethinking theoretical approaches to stigma: a framework integrating normative influences on stigma (FINIS). Soc Sci Med 67(3):431–440. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2587424/
Ratcliffe D, Ellison N (2015) Obesity and internalized weight stigma : a formulation model for an emerging psychological problem. Behav Cogn Psychother 43(2):239–252. https://www.cambridge.org/core/journals/behavioural-and-cognitive-psychotherapy/article/abs/obesity-and-internalized-weight-stigma-a-formulation-model-for-an-emerging-psychological-problem/1EC1419B01092DA657EC45601AFE61F4
Sikorski C, Luppa M, Luck T, Riedel-Heller SG (2015) Weight stigma “gets under the skin”—evidence for an adapted psychological mediation framework: a systematic review. Obesity (Silver Spring) 23(2):266–276. https://pubmed.ncbi.nlm.nih.gov/25627624/
Himmelstein MS, Puhl RM, Quinn DM (2017) Intersectionality: an understudied framework for addressing weight stigma. Am J Prevent Med 53(4):421–431. https://media.ruddcenter.uconn.edu/PDFs/pdf%20Intersectionality%20and%20weight%20stigma.pdf
Craig GM, Daftary A, Engel N, Driscoll SO, Ioannaki A (2017) Tuberculosis stigma as a social determinant of health : a systematic mapping review of research in low incidence countries. Int J Infect Dis 56:90–100. https://www.sciencedirect.com/science/article/pii/S120197121631195X
Ebenso B, Newell J, Emmel N, Adeyemi G, Ola B (2019) Changing stigmatisation of leprosy : an exploratory , qualitative life course study in Western Nigeria. Br Med J Global Health 4(2). https://gh.bmj.com/content/bmjgh/4/2/e001250.full.pdf
Mak WWS, Cheung F, Woo J, Lee D, Li P, Chan KS, Tam CM (2009) A comparative study of the stigma associated with infectious diseases ( SARS, AIDS, TB ). Hong Kong Med J 15(8). https://www.hkmj.org/abstracts/v15n6s8/34.htm
Mehta SI, Farina A (1988) Associative stigma : perceptions of the difficulties of college-aged children of stigmatized fathers. J Soc Clin Psychol 7(2/3):192–202. https://psycnet.apa.org/record/1989-25878-001
Durkheim E (1895) Introduction to sociology: the rules of sociological method. Ediciones Akal Sa. Madrid. September. https://durkheim.uchicago.edu/Summaries/rules.html
Goffman E (1963) Stigma: notes on the management of spoiled identity. Penguin Books. https://scirp.org/reference/referencespapers.aspx?referenceid=2205344
Jones EF, Farina A, Hastorf AH, Markus H, Miller DT, Scott RA (1984) Social stigma: the psychology of marked relationships. W.H. Freeman & Co Ltd, 347. https://www.worldcat.org/title/social-stigma-the-psychology-of-marked-relationships/oclc/10230869
Stafford MC, Scott RR (1986) Stigma, deviance, and social control. In: Ainlay SC, Becker G, Coleman LM (eds) The dilemma of difference. Springer, pp 77–91. https://springerlink.fh-diploma.de/chapter/10.1007/978-1-4684-7568-5_5
Link BG, Phelan JC (2001) Conceptualizing stigma. Ann Rev Sociol 27:363–385. https://www.annualreviews.org/doi/abs/10.1146/annurev.soc.27.1.363
Falk G (2001) Stigma: how we treat outsiders, 1st edn. Prometheus Books, Amherst, New York, 376. https://onesearch.library.rice.edu/discovery/fulldisplay/alma991010063949705251/01RICE_INST:RICE
Deacon H (2008) Towards a sustainable theory of health-related stigma: lessons from the HIV/AIDS literature. J Commun Appl Soc Psychol 16(6):418–425. https://onlinelibrary.wiley.com/doi/abs/10.1002/casp.900
Gopichandran V, Subramaniam S (2021) A qualitative inquiry into stigma among patients with COVID-19 in Chennai, India. Indian J Med Ethics VI(3):1–21. https://ijme.in/articles/a-qualitative-inquiry-into-stigma-among-patients-with-covid-19-in-chennai-india/
George CE, Inbaraj LR, Rajukutty S, De Witte LP (2020) Challenges, experience and coping of health professionals in delivering healthcare in an urban slum in India during the first 40 days of COVID-19 crisis: a mixed method study. Br Med J 10(11). https://bmjopen.bmj.com/content/10/11/e042171.long
Sumesh SS, Gogoi N (2021) Collecting the ‘Thick Descriptions’: a pandemic ethnography of the lived experiences of COVID-19 induced stigma and social discrimination in India. J Loss Trauma. https://www.tandfonline.com/doi/abs/10.1080/15325024.2021.1947019?journalCode=upil20
Moideen S, Uvais NA, Rajagopal S, Maheshwari V, Gafoor TA, Sherief SH (2021) COVID-19-related stigma among inpatients with COVID-19 infection: a cross-sectional study from India. The Primary care companion CNS Disorders 23(1). https://www.psychiatrist.com/pcc/covid-19/stigma-among-inpatients-with-covid-19/
Uvais NA, Aziz F, Hafeeq B (2020) COVID-19-related stigma and perceived stress among dialysis staff. J Nephrol 33(6):1121–1122. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429935/
Sahoo S, Mehra A, Suri V, Malhotra P, Yaddanapudi LN, Dutt Puri G, Grover S (2020) Lived experiences of the corona survivors (patients admitted in COVID wards): a narrative real-life documented summaries of internalized guilt, shame, stigma, anger. Asian J Psychiatry 53. https://www.sciencedirect.com/science/article/pii/S1876201820302999?via%3Dihub
Singh K, Kaushik A, Johnson L, Jaganathan S, Jarhyan P, Deepa M, Kong S, Venkateshmurthy NS, kondal D, mohan S, Anjana RM, Ali MK, Tandon N, Narayan KMV, Mohan V, Eggleston K, Prabhakaran D (2021) Patient experiences and perceptions of chronic disease care during the COVID-19 pandemic in India: a qualitative study. Br Med J 11(6):1–10. https://pesquisa.bvsalud.org/global-literature-on-novel-coronavirus-2019-ncov/resource/en/covidwho-1276965
Sahoo S, Mehra A, Dua D, Suri V, Malhotra P, Yaddanapudi LN, Puri GD, Grover S (2020) Psychological experience of patients admitted with SARS-CoV-2 infection. Asian J Psychiatry 54. https://www.sciencedirect.com/science/article/pii/S1876201820304688?via%3Dihub
Banerjee D, Sathyanarayana Rao TS, Kallivayalil RA, Javed A (2021) Psychosocial framework of resilience: Navigating needs and adversities during the pandemic, a qualitative exploration in the Indian ffrontline physicians. Front Psychol 1–10. https://www.frontiersin.org/articles/10.3389/fpsyg.2021.622132/full
Dar SA, Khurshid SQ, Wani ZA, Khanam A, Haq I, Shah NN, Shahnawaz M, Mustafa H (2020) Stigma in coronavirus disease-19 survivors in Kashmir, India: a cross-sectional exploratory study. PLoS One 1–13. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240152
Radhakrishnan RV, Jain M, Mohanty CR, Jacob J, Shetty AP, Stephen S, Vijay VR, Issac A (2021) The perceived social stigma, self-esteem, and its determinants among the health care professionals working in India during COVID 19 pandemic. Med J, Armed Forces India 77(2):450–458. https://pesquisa.bvsalud.org/global-literature-on-novel-coronavirus-2019-ncov/resource/pt/covidwho-1525888
Kumar K, Jha S, Sharma MP, Sharma R, Singh SM (2020) The experiential impact of isolation and quarantine on patients during the initial phase of the COVID-19 pandemic in India. Ind Psychiatry J 29(2):310–316. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188911/
Hatzenbuehler ML, Bellatore A, Lee Y, Finch B, Muennig P, Fiscella K (2014) Structural stigma and all-cause mortality in sexual minority populations. Soc Sci Med 103: 33–41. https://www.sciencedirect.com/science/article/pii/S0277953613003353?via%3Dihub
Rhodes SD, Mann L, Simán FM, Song E, Alonzo J, Downs M, Lawlor E, Martinez O, Sun CJ, O'Brien MC, Reboussin BA, Hall MA (2015) The impact of local immigration enforcement policies on the health of immigrant Hispanics/Latinos in the United States. Am J Public Health 105(2):329–337. https://ajph.aphapublications.org/doi/10.2105/AJPH.2014.302218?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed
Magno L, da Silva LAV, Veras MA, Pereira-Santos M, Dourado I (2019) Stigma and discrimination related to gender identity and vulnerability to HIV/AIDS among transgender women: a systematic review. Cadernos De Saude Publica 35(4). https://www.scielo.br/j/csp/a/8rxk9ZKGG9GWhCTXW7QBsKh/?lang=en
Corrigan PW, Morris SB, Michaels PJ, Rafacz JD, Rusch N. Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatr Serv 63(10):963–973. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201100529?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
Herek GM (2007) Confronting sexual stigma and prejudice : theory and practice. J Soc Issues 63(4):905–925. https://spssi.onlinelibrary.wiley.com/doi/10.1111/j.1540-4560.2007.00544.x
Campellone TR, Caponigro JM, Kring AM (2014) The power to resist: the relationship between power, stigma and negative symptoms in schizophrenia. Psychiatry Res 215(2):280–285. https://www.sciencedirect.com/science/article/abs/pii/S016517811300752X?via%3Dihub
Rusch N, Corrigan PW, Todd AR, Bodenhausen GV (2010) Automatic stereotyping against people with schizophrenia, schizoaffective and affective disorders. Psychiatry Res 186(1):34–39. https://www.sciencedirect.com/science/article/abs/pii/S0165178110005329?via%3Dihub
Pachankis JE (2007) The psychological implications of concealing a stigma : a cognitive—affective—behavioral model. Psychol Bull 133(2):328–345. https://psycnet.apa.org/record/2007-02367-008
Bathje GJ, Marston HN (2014) Self-stigmatization. In: Teo T (ed) Encyclopedia of critical psychology. Springer, New York, US. https://springerlink.fh-diploma.de/referenceworkentry/10.1007/978-1-4614-5583-7_395
Corrigan PW (2002) Empowerment and serious mental illness: treatment partnerships and community opportunities. Psychiatr Q 73(3):217–228. https://ur.booksc.me/book/11156178/704073
Pattyn E, Verhaeghe M, Sercu C, Bracke P (2014) Public stigma and self-stigma: Differential association with attitudes toward formal and informal help seeking. Psychiatr Serv 65(2):232–238. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201200561?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
Mak WWS, Cheung RYM (2008) Affiliate stigma among caregivers of people with intellectual disability or mental illness. J Appl Res Intellect Disabil 21:532–545. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1468-3148.2008.00426.x
Scambler G, Hopkins A (1986) Being epileptic : coming to terms with stigma. Sociol Health Illness 8(1):26–43. https://onlinelibrary.wiley.com/doi/10.1111/1467-9566.ep11346455
Quinn DM, Chaudoir SR (2009) Living with a concealable stigmatized identity: the impact of anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health. J Personal Soc Psychol 97(4):634–651. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511710/
Earnshaw VA, Quinn DM, Park CL (2012) Anticipated stigma and quality of life among people living with chronic illnesses. Chronic Illn 8(2):79–88. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644808/
Sanden RLM Van Der, Pryor JB, Stutterheim SE, Kok G, Bos AER (2016) Stigma by association and family burden among family members of people with mental illness : the mediating role of coping. Soc Psychiatry Psychiatr Epidemiol 51(9):1233–1245. https://psycnet.apa.org/record/2016-32613-001
Dako-gyeke M (2018) Courtesy stigma : a concealed consternation among caregivers of people affected by leprosy. Soc Sci Med 196:190–196. https://www.sciencedirect.com/science/article/abs/pii/S0277953617306950
Mo PKH, Lau JTF, Yu X, Gu J (2015) A model of associative stigma on depression and anxiety among children of HIV-infected parents in China. AIDS Behav 19(1):50–59. https://springerlink.fh-diploma.de/article/10.1007/s10461-014-0809-9
Lefley HP (1987) Impact of mental illness in families of mental health professionals. J Nerv Mental Dis 175(10):613–619. https://pubmed.ncbi.nlm.nih.gov/3655769/
Phelan JC, Bromet EJ, Link BG (1998) Psychiatric illness and family stigma. Schizophrenia Bull 24(1):115–126. https://psycnet.apa.org/record/1998-00339-015
Byrne P (2018) Psychiatric stigma. Br J Psychiatry 178(3):281–284. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/psychiatric-stigma/D56AC9BCEFA868283A424E07394CD9BB
Struening EL, Perlick DA, Link BG, Hellman F, Herman D, Sirey JA (2001) Stigma as a barrier to recovery: The extent to which caregivers believe most people devalue consumers and their families. Psychiatr Serv 52(12):1633–1638. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.52.12.1633?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
Kjellin L, Margareta O (2002) Stigma by association: psychological factors in relatives of people with mental illness. Br J Psychiatry 181:494–498. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/stigma-by-association/2DBF3FC5A25A3DEF13C1097BEAB2D3B4
Picco L, Chang S, Abdin E, Chua BY, Yuan Q, Vaingankar JA, Ong S, Yow KL, Chua HC, Chong SA, Subramaniam M (2019) Associative stigma among mental health professionals in Singapore : a cross- sectional study. Br Med J. https://bmjopen.bmj.com/content/9/7/e028179.long
Waddell C, Graham JM, Pachkowski K, Waddell C, Friesen H (2020) Battling associative stigma in psychiatric nursing. Issues Ment Health Nurs 41(8):1–7. https://www.researchgate.net/publication/341094268_Battling_Associative_Stigma_in_Psychiatric_Nursing
Valeri L, Amsalem D, Jankowski S, Susser E, Dixon L (2021) Effectiveness of a video-based intervention on reducing perceptions of fear, loneliness, and public stigma related to COVID-19: a randomized controlled trial. Int J Public Health 66:1604164. https://doi.org/10.3389/ijph.2021.1604164. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8407346/
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Appendix I
Appendix I
Members of the GRID COVID-19 Study Group who drafted/ critically reviewed and approved the final draft (Names arranged alphabetically; views expressed are personal and may not represent that of the organization they are affiliated to):
-
1.
Abhimanyu Singh Chauhan, Generating Research Insights for Development (GRID) Council, Delhi NCR - 201301, India
-
2.
Abhishek Jaiswal, Assistant Professor, Department of Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana. Email: jaiswal.aiims@gmail.com
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3.
Abhishek Pathak, Department of Psychiatry, Hind Institute of Medical Sciences, Sitapur, Uttar Pradesh, India. Email: drpathak7@gmail.com
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4.
Ahmed Shammas, Generating Research Insights for Development (GRID) Council, Delhi NCR - 201301, India
-
5.
Akhil Dhanesh Goel, Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan - 342005, India
-
6.
Anil Koparkar, Department of Community and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh - 273008, India
-
7.
Anirban Chatterjee, Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh - 462020, India
-
8.
Antony Stanley, Achutha Menon Centre for Health Science Studies, Thiruvananthapuram, Kerala - 695011, India
-
9.
Anubhuti Kujur, Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh - 492099, India
-
10.
Anuj Mundra, Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra - 442102, India
-
11.
Archisman Mohapatra, Generating Research Insights for Development (GRID) Council, Delhi NCR - 201301, India
-
12.
Arvind Kumar Singh, Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha - 751019, India
-
13.
Ashish Srivastava, Independent Researcher, New Delhi - 110020, India
-
14.
Balaji Ramraj, Formerly Professor, Community Medicine, SRM Medical College Hospital & Research Centre, Chennai; Currently Scientist E (Medical), Indian Council of Medical Research (ICMR)—National Institute of Research in Tuberculosis, Chennai, Tamil Nadu - 600 031, India
-
15.
Bharti Mehta, Assistant Professor, Community Medicine, Shri Atal Bihari Vajpayee Government Medical College, Chhainsa, Faridabad, Haryana - 121004 India. Email: drbhartimehta9585@gmail.com
-
16.
Dewesh Kumar, Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand - 834009, India
-
17.
Dinesh P Sahu, Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha - 751019, India
-
18.
Gaihemlung Pamei, Department of Community Medicine, Government Medical College, Haldwani, Uttarakhand - 263139, India
-
19.
Gitismita Naik, Department of Community and Family Medicine, All India Institute of Medical Sciences, Kalyani, Nadia - 741245, India
-
20.
Hariom Kumar Solanki, Department of Community Medicine, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh - 201310, India
-
21.
Harshal Ramesh Salve, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi - 110029, India
-
22.
Hemant Kumar, Department of Psychiatry, Government Medical College, Bettiah, Bihar - 845438, India. Email: drhemant21@gmail.com
-
23.
Jasmin Nilima Panda, Senior Resident, Department of Community Medicine, Maharaja Krushna Chandra Gajapati Medical College and Hospital, Berhampur Odisha - 76004, India. Email: jasminnilimapanda5@gmail.com
-
24.
Jaya Singh Kshatri, Indian Council of Medical Research—Regional Medical Research Centre, Bhubaneswar, Odisha - 751023, India
-
25.
Jigyansa Ipsita Pattnaik, Assistant Professor, Department of Psychiatry, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, Odisha - 751024. Email: drjigyansaipsita@gmail.com
-
26.
Kajal Davara, Department of Community Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College, Vadodara, Gujarat - 390021, India
-
27.
Kamla Kant, Department of Medical Microbiology, All India Institute of Medical Sciences, Bathinda, Punjab - 151001, India
-
28.
Kaushik Sarkar, Director, Institute for health Modeling and Climate Solutions (IMACS), New Delhi, India. Email: kaushik198706@gmail.com
-
29.
Kavita Rajesh, Generating Research Insights for Development (GRID) Council, Delhi NCR - 201301, India
-
30.
Kedar G Mehta, Department of Community Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College, Vadodara, Gujarat - 390021, India
-
31.
Kumari Rina, Assistant Professor, Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, West Bengal. Email: drkumaririna@gmail.com
-
32.
Madan Mohan Majhi, Assistant Professor, Department of Community Medicine, SCB Medical college, Cuttack,Odisha, India - 753007. Email: mad.an.doc82@gmail.com
-
33.
Madhur Verma, Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab - 151001, India
-
34.
Malatesh Undi, Department of Community Medicine, Karwar Institute of Medical Sciences, Karwar, Karnataka - 581301, India
-
35.
Manish Kumar Singh, Department of Community Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh - 226010, India
-
36.
Manoj Kumar Gupta, Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan - 342005, India
-
37.
Md Mahbub Hossain, Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A and M University, Texas - TX 77843, USA
-
38.
Mihir P Rupani, Formerly Department of Community Medicine, Government Medical College, Bhavnagar, Gujarat - 364001; Currently Division of Clinical Epidemiology, Indian Council of Medical Research (ICMR)—National Institute of Occupational Health, Ahmedabad, Gujarat - 380016, India
-
39.
Mohan Bairwa, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi - 110029, India
-
40.
Mohan Kumar, Assistant Professor, Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India.Email: kumar.mohan324@gmail.com
-
41.
Neeraj Sharma, SD Gupta School of Public Health, IIHMR University,Jaipur. Email: neerajsharma4450@gmail.com
-
42.
Nikita Savani, Community Medicine Department, Shantabaa Medical College, Amreli, Gujarat - 365601, India
-
43.
Nilanjana Ghosh, Department of Community Medicine, North Bengal Medical College and Hospital, Darjeeling, West Bengal - 734101, India
-
44.
Nilima D Shah, Department of Psychiatry, Sardar Vallabhbhai Patel Institute of Medical Sciences and Research, Ahmedabad, Gujarat - 380007, India
-
45.
Niravkumar B Joshi, Community Medicine Department, Pandit Dindayal Upadhyay Medical College, Rajkot, Gujarat - 360001, India
-
46.
Nitika Sharma, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi - 110029, India
-
47.
Pallavi Shukla, Preventive Oncology, Baba Rao Ambedkar—Institute Rotary Cancer Hospital (BRA-IRCH), All India Institute of Medical Sciences, New Delhi - 110029, India
-
48.
Paragkumar D Chavda, Department of Community Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College, Vadodara, Gujarat - 390021, India
-
49.
Pradnya Chandanshive, Assistant Professor (Contractual), Department of Community Medicine, T.N. Medical College and B.Y.L. Nair Charitable Hospital, Mumbai -400008. Email: drpradnya0201@gmail.com
-
50.
Pragyan Paramita Parija, Assistant Professor, Department of Community Medicine, All India Institute of Medical Sciences, Vijaypur, Jammu, India. Email: pragyanparija@gmail.com
-
51.
Praveen Kulkarni, Department of Community Medicine, Jagadguru Sri Shivarathreeshwara (JSS) Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka - 570015, India
-
52.
Pritam Roy, Public Health Expert and Independent Researcher, Kolkata, West Bengal - 700064, India
-
53.
Priyamadhaba Behera, Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha - 751019, India
-
54.
Priyanka J Pawar, Generating Research Insights for Development (GRID) Council, Delhi NCR - 201301, India
-
55.
Rabbanie Tariq Wani, Department of Community Medicine, Sher-i-Kashmir Institute of Medical Sciences, Soura,Srinagar, Kashmir - 190011, India. Email: rabbanietariq@gmail.com
-
56.
Rachana R Annadani, Department of Community Medicine, Karwar Institute of Medical Sciences, Karwar, Karnataka - 581301, India
-
57.
Rachit Sharma, Department of Environmental and Occupational Health, Dornsife School of Public Health, Philadelphia,Pennsylvania, United States. Email: drrachitsharma09@gmail.com
-
58.
Rakesh N Pillai, Generating Research Insights for Development (GRID) Council, Delhi NCR - 201301, India
-
59.
Ramadass Sathiyamoorthy, Assistant Professor, Department of Community and Family Medicine, All India Institute of Medical Sciences, Madurai (Tamilnadu), India. Email: ramadassdoctor@gmail.com
-
60.
Rashmi Agarwalla, Department of Community and Family Medicine, All India Institute of Medical Sciences, Guwahati, Assam - 781030, India
-
61.
Ravi Rohilla, Department of Community Medicine, Government Medical College and Hospital, Chandigarh - 160030, India
-
62.
Ritika Mukherjee, Generating Research Insights for Development (GRID) Council, Delhi NCR - 201301, India
-
63.
Roopam Kumari, Department of Psychiatry, Nalanda Medical College, Patna, Bihar - 800026, India
-
64.
Sakhi Roy, Amity School of Economics, Amity University Kolkata Campus, Kolkata, West Bengal - 700135, India
-
65.
Santosh K Yatnatti, Department of Community Medicine, Dr Chandramma Dayanand Sagar Institute of Medical Education and Research, Ramanagara, Karnataka - 562112, India
-
66.
Satyanarayana Konda, Professor, Department of Community Medicine, Malla Reddy Medical College for Women, Hyderabad - 500 055, India. Email: satya4ster@gmail.com
-
67.
Shamshad Ahmad, Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar - 801507, India
-
68.
Shankar R Dudala, Department of Community Medicine, Government Medical College, Kadapa, Andhra Pradesh - 516002, India
-
69.
Shib Sekhar Datta, Department of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura - 799014, India
-
70.
Shikha Nargotra, Program Coordinator, Public Health Foundation of India, Gurugram, Haryana, India. Email: drs.nargotra@gmail.com
-
71.
Shilpa Karir, Assistant Professor, Department of Community Medicine, Malabar Medical College and Research Centre, Ulliyeri, Kozhikode, Kerala - 673323, India. Email: drshilpa011@gmail.com
-
72.
Shubhashri Jahagirdar, Department of Community Medicine, Mahavir Institute of Medical Sciences, Vikarabad,Telangana - 501102, India. shubha. Email: jahagirdar@gmail.com
-
73.
Siddharudha Shivalli, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK - WC 1E 7HT
-
74.
Sithun K Patro, Department of Community Medicine, Maharaja Krushna Chandra Gajapati Medical College and Hospital, Berhampur, Odisha - 760004, India
-
75.
Smrutiranjan Nayak, Department of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha - 751024, India
-
76.
Soumya S Sahoo, Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab - 151001, India
-
77.
Srikanta Kanungo, Indian Council of Medical Research—Regional Medical Research Centre, Bhubaneswar, Odisha - 751023, India
-
78.
Subhra R Balabantaray, Department of Economics and International Business, School of Business, University of Petroleum and Energy Studies, Dehradun, Uttarakhand - 248007, India
-
79.
Sudhir Chawla, Independent Researcher, New Delhi - 110024, India
-
80.
Sudhir P Haladi, Department of Community Medicine, Father Muller Medical College, Mangalore, Karnataka - 575002, India
-
81.
Sumit Chawla, Associate Professor, Community Medicine, Shri Atal Bihari Vajpayee Govt Medical College, Chhainsa, Faridabad, Haryana-121004, India. Email: drschawla86@gmail.com
-
82.
Susanta K Padhy, Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha - 751019, India
-
83.
Tapas S Nair, Independent Researcher, Geneva - 1218, Switzerland
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Chatterjee, A., Ramraj, B. (2023). Stigma Mechanisms in a Globalized Pandemic in India: A Theoretical Framework for Stigma. In: Pachauri, S., Pachauri, A. (eds) Global Perspectives of COVID-19 Pandemic on Health, Education, and Role of Media. Springer, Singapore. https://doi.org/10.1007/978-981-99-1106-6_18
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