title: Stigma related to labels and symptoms in individuals at clinical high-risk for psychosis.
abstract: BACKGROUND
  Despite advances that the psychosis "clinical high-risk" (CHR) identification offers, risk of stigma exists. Awareness of and agreement with stereotypes has not yet been evaluated in CHR individuals. Furthermore, the relative stigma associated with symptoms, as opposed to the label of risk, is not known, which is critical because CHR identification may reduce symptom-related stigma.
  
  
  METHODS
  Thirty-eight CHR subjects were ascertained using standard measures from the Center of Prevention and Evaluation/New York State Psychiatric Institute/ Columbia University. Labeling-related measures adapted to the CHR group included "stereotype awareness and self-stigma" ("Stereotype awareness", "Stereotype Agreement", "Negative emotions [shame]"), and a parallel measure of "Negative emotions (shame)" for symptoms. These measures were examined in relation to symptoms of anxiety and depression, adjusting for core CHR symptoms (e.g. attenuated psychotic symptoms).
  
  
  RESULTS
  CHR participants endorsed awareness of mental illness stereotypes, but largely did not themselves agree with these stereotypes. Furthermore, CHR participants described more stigma associated with symptoms than they did with the risk-label itself. Shame related to symptoms was associated with depression, while shame related to the risk-label was associated with anxiety.
  
  
  CONCLUSIONS
  Both stigma of the risk-label and of symptoms contribute to the experience of CHR individuals. Stereotype awareness was relatively high and labeling-related shame was associated with increased anxiety. Yet limited agreement with stereotypes indicated that labeling-related stigma had not fully permeated self-conceptions. Furthermore, symptom-related stigma appeared more salient overall and was linked with increased depression, suggesting that alleviating symptom-related shame via treating symptoms might provide major benefit.
authors: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. Electronic address: lhy2001@cumc.columbia.edu.
authors: Lawrence H
authors: LH
authors: Yang
authors: University of California Riverside, 900 University Avenue, Riverside, CA 92521, USA. Electronic address: bruce.link@ucr.edu.
authors: Bruce G
authors: BG
authors: Link
authors: New York University Silver School of Social Work, 1 Washington Square North, New York, NY 10003, USA. Electronic address: sbd268@nyu.edu.
authors: Shelly
authors: S
authors: Ben-David
authors: The Catholic University of America, 620 Michigan Ave. NE, Washington, DC 20064, USA. Electronic address: kegill13@gmail.com.
authors: Kelly E
authors: KE
authors: Gill
authors: New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY 10032, USA. Electronic address: ragygir@nyspi.columbia.edu.
authors: Ragy R
authors: RR
authors: Girgis
authors: New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY 10032, USA. Electronic address: gb2428@cumc.columbia.edu.
authors: Gary
authors: G
authors: Brucato
authors: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. Electronic address: aw258@columbia.edu.
authors: Ahtoy J
authors: AJ
authors: Wonpat-Borja
authors: New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY 10032, USA. Electronic address: Corcora@nyspi.columbia.edu.
authors: Cheryl M
authors: CM
authors: Corcoran
mesh_terms: D000293:Adolescent; D001364:Awareness; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D062706:Prodromal Symptoms; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000523:psychology*; D018570:Risk Assessment; D012649:Self Concept; D057545:Social Stigma; D013240:Stereotyping; D055815:Young Adult
keywords: Adolescents; At risk; Clinical high risk state for psychosis; Discrimination; Early psychosis; Prodrome; Stigma