title: Interlocking oppressions: the effect of a comorbid physical disability on perceived stigma and discrimination among mental health consumers in Canada.
abstract: People living with mental health problems often face stigma and discrimination; however, there is a lack of research that examines how comorbid conditions affect this perceived stigma. This study sought to determine whether people who have a comorbid physical and psychiatric disability experience more stigma than those with only a psychiatric disability. It also looked at how perceived stigma and discrimination affect physical and mental health. A secondary analysis on data from interviews with 336 former and current clients of the mental health system in a mid-size Canadian city in 2005 was performed. Of these, 203 (60.4%) reported they had a psychiatric disability, 112 (33.0%) reported that they had a physical disability, with 74 reporting both a psychiatric and a physical disability. People with a self-reported psychiatric disability and a self-reported comorbid physical disability faced more overall perceived discrimination/stigma (P = 0.04), than those with a psychiatric disability alone. Perceived discrimination/stigma was positively correlated with psychiatric problem severity (P = 0.02), and negatively correlated with self-rated general health (P < 0.001), physical condition (P < 0.001), emotional well-being (P < 0.001) and life satisfaction (P < 0.001). These results bring to light the aggravating effect of a physical disability on the perceived stigma for those living with a mental illness, and also strengthen the knowledge that stigma and discrimination have a negative impact on health. Healthcare providers should recognise this negative impact and screen for these comorbid conditions. Policy-makers should take measures such as improving access to housing and employment services to help reduce stigma and discrimination against this particularly vulnerable group.
authors.affiliation: Schulich School of Medicine and Dentistry, The University of Western Ontario, Canada. abahm2009@meds.uwo.ca
authors.forename: Allison
authors.initials: A
authors.lastname: Bahm
authors.forename: Cheryl
authors.initials: C
authors.lastname: Forchuk
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology; D008605:Mental Health Services / Q000706:statistics & numerical data; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010549:Personal Satisfaction; D011287:Prejudice; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D012059:Rejection, Psychology; D012938:Social Perception; D013240:Stereotyping; D011795:Surveys and Questionnaires; D055815:Young Adult