Earnshaw Valerie A, Mousavi Mohammad, Qiu Xueli, Fox Annie B
Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA; email:
School of Healthcare Leadership, MGH Institute of Health Professions, Boston, Massachusetts, USA.
Annu Rev Clin Psychol. 2025 May;21(1):85-111. doi: 10.1146/annurev-clinpsy-081423-023228. Epub 2025 Jan 13.
Researchers, interventionists, and clinicians are increasingly recognizing the importance of structural stigma in elevating the risk of mental illnesses (MIs) and substance use disorders (SUDs) and in undermining MI/SUD treatment and recovery. Yet, the pathways through which structural stigma influences MI/SUD-related outcomes remain unclear. In this review, we aim to address this gap by summarizing scholarship on structural MI/SUD stigma and identifying pathways whereby structural stigma affects MI/SUD-related outcomes. We introduce a conceptual framework that describes how structural-level stigma mechanisms influence the MI/SUD treatment cascade via () interpersonal- and individual-level stigma mechanisms and () mediating processes among people with MI/SUD (i.e., access to resources, psychological responses, behavioral responses, social isolation). We consider intersections between MI/SUD stigma and stigma based on race/ethnicity, gender identity, and sexual orientation. Finally, we discuss the implications of this review for future research, interventions, and clinical practice.
研究人员、干预专家和临床医生越来越认识到结构性耻辱感在增加精神疾病（MIs）和物质使用障碍（SUDs）风险以及破坏MI/SUD治疗与康复方面的重要性。然而，结构性耻辱感影响MI/SUD相关结果的途径仍不明确。在本综述中，我们旨在通过总结关于结构性MI/SUD耻辱感的学术研究并确定结构性耻辱感影响MI/SUD相关结果的途径来填补这一空白。我们引入一个概念框架，该框架描述了结构性层面的耻辱感机制如何通过（1）人际和个体层面的耻辱感机制以及（2）MI/SUD患者之间的中介过程（即获得资源、心理反应、行为反应、社会隔离）来影响MI/SUD治疗过程。我们考虑了MI/SUD耻辱感与基于种族/族裔、性别认同和性取向的耻辱感之间的交叉点。最后，我们讨论了本综述对未来研究、干预措施和临床实践的意义。
