Chih Chin Chou

Bio: Chih Chin Chou is an academic researcher from University of Arizona. The author has contributed to research in topics: Social support & Mental health. The author has an hindex of 7, co-authored 14 publications receiving 241 citations. Previous affiliations of Chih Chin Chou include National Institute of Education & San Francisco State University.

The role of stigma coping and social support in mediating the effect of societal stigma on internalized stigma, mental health recovery, and quality of life among people with serious mental illness

Abstract: This study investigated the mediating properties of stigma coping and social support on the relationship between societal stigma, internalized stigma, mental health recovery, and quality of life among people with serious mental illness (SMI). Participants were 101 adults with SMI living in New York City and Boston. We used 11 measures to assess the study variables. Descriptive statistics, correlational analyses, and structural equation modeling were used to analyze the data. Results showed that secrecy and withdrawal coping and emotional and tangible support mediate the effect of societal stigma on internalized stigma and recovery. Challenging and educating others coping were frequently used and positively linked to recovery. The sample reported low levels of social support and social support was linked to higher levels of societal and internalized stigma and lower levels of recovery and quality of life. Social support and coping should be incorporated into treatment to reduce the negative effects of stigma.

The meaning of social support for persons with serious mental illness.

Abstract: “Serious mental illness” (SMI) is defined by federal regulations as any diagnosable mental, behavioral, or emotional disorder experienced by persons age 18 and older that is characterized by episodic, recurrent or persistent features and substantially interferes with or limits the ability to participate in one or more major life activities (U. S. Department of Health and Human Services, 1992). Five percent of the U.S. population experiences SMI and it is a leading cause of disability (National Institute of Mental Health, 2014). The SMI population experiences significant stressors such as illness management, isolation, homelessness and stigma – long understood to be barriers to functioning and societal participation – which elevate the risk of morbidity and mortality (Madianos, 2010; Narrow, Regier, Norquist et al., 2000). In fact, the life expectancy of persons with SMI is an alarmingly 25-30 years less than that of the general population (Colton & Manderscheid, 2006). Studies showing that these stressors cannot be alleviated solely through psychopharmacological and/or behavioral interventions have led to recommendations that psychosocial approaches such as social support interventions be added to the SMI treatment toolkit (Corrigan & Phelan, 2004; Madianos, 2010; Narrow et al., 2000; Whitley, Harris, Fallot, & Berley, 2008). Social support has been demonstrated to buffer the negative impact of stress among the general population (Cohen, 2001; Cohen, Doyle, Turner, Alper & Skoner, 2003; Feldman, Cohen, Hamrick & Lepore, 2004) and has achieved national attention as a key component of the mental health recovery paradigm for persons with SMI defined as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential” (U. S. Department of Health and Human Services, 2011). Specifically, Community, or the relationships and social networks that provide support, friendship, love, and hope is identified as a major dimension of the recovery model, and three out of the ten major principles guiding the recovery model address social support in some way. For example, recovery is described to include support from peers and allies, through relationships and social networks, and involving individuals, family, community strengths and weaknesses (U. S. Department of Health and Human Services, 2014). In addition, clinical practice guidelines for healthcare settings now include social support assessment as an essential part of psychiatric evaluation (Lehman & Steinwachs, 2010). To date, little is known about how social support buffers the negative impact of stress among those with SMI. The limited body of research that exists suggests that social support is positively linked to quality of life (Bengtsson-Tops & Hansson, 2001; Sharir, Tanasescu, Turbow & Mamam, 2007), yet, the findings in aggregate reveal small to moderate effect sizes, and some studies show no effect (Anonymous & Anonymous, 2012). We believe these mixed findings are due, in part, to the use of non-population specific measures that do not capture the unique types of support relevant for persons with SMI. These studies are based on measures of social support designed for the general population who experience “typical” life stressors (e.g., divorce, death, loss of job), whereas the SMI population experiences an additional distinctive set of chronic and often debilitating stressors related to stigma, isolation, homelessness and illness management (Madianos, 2010; Narrow et al., 2000). Moreover, researchers who investigate social support with distinct clinical populations point out that general population measures are not sufficient in and of themselves (Broadhead & Kaplan, 1991; Wortman, 1984) and that population-specific support measures are necessary in order to help interpret the existing “morass of positive and negative studies [which are] of little value in the aggregate” (Broadhead & Kaplan, p.67). Recently-developed measures of social support for individuals with diabetes, cancer, and other specific health conditions have made important contributions in this area (e.g., McCormack, Williams-Piehota, Bann, Burton, Kamerow et al., 2008; Taskila, Lindbohm, Martikainen, Lehto, Hakanen et al., 2006; Yanover & Sacco, 2008). For example, the diabetes-specific support scale Resources and Support for Self-Management (McCormack et al., 2008) measures five domains of functional support unique to persons with diabetes and has been found to be both psychometrically sound and clinically useful. A limited number of studies have explored SMI-specific types of social support. Breier and Strauss (1984) conducted a qualitative study that identified SMI types of supports such as symptom monitoring, role modeling and reality testing. In addition, Walsh and Connelly (1996) observed that emotional support was more common than material and instrumental support among this population. To date, research paralleling the scientific advancement made with other clinical populations has not occurred with the SMI population; indeed, the types of social support relevant to persons with SMI differ from those of the general population and requires systematic investigation. Therefore, this study sought to better understand the population-specific types of social support relevant to adults living with SMI. Our study was exploratory and used a qualitative approach that centered on uncovering the types of social support meaningful and relevant to persons with SMI. Despite the phenomenological nature of our inquiry, the premise of our study was based on a broad conceptualization of social support defined as the emotional and tangible provisions by others that are perceived to be helpful by the receiver (Cohen & Syme, 1985). Our investigation was also guided by two overarching typologies of social support that have been consistently identified as the most salient and encompassing types of support: emotional support and instrumental support (Declercq, Vanheule, Markey & Willemsen, 2007; Shakespeare-Finch & Obst, 2011). Emotional support involves the provision of caring, empathy, love and trust (House, 1981; Krause, 1986), an affective transaction which imparts liking, admiration, respect and love (Kahn & Antonucci, 1980), or support that leads to the information that one is cared for and loved, is esteemed and valued, and belongs to a network of mutual obligation (Cobb, 1976). Instrumental support is the provision of tangible goods, aid, services, or concrete assistance that is intended to solve a problem or accomplish a task (Barrera, 1986; Cohen & McKay, 1984; Cutrona & Russell, 1990; Krause, 1986; Langford, Bowsher, Maloney, & Lillis, 1997).

The relationship between social support and rehabilitation related outcomes: A meta-analysis

Abstract: An abundance of social support research has accumulated over the past several decades (e.g., Barrera, 1986; Cohen & Willis, 1985; House, Umberson, & Landis, 1988; Sarason, Sarason, & Shearin, 1986; Schwarzer & Leppin, 1992; Vaux, 1988). The emergence of this research has been traced to the early work of Cassel (1976), Caplan (1974), and Cobb (1976), which identified social support as an important factor in the prevention of and susceptibility to illness and disease. Since this time, various disciplines have contributed to this body of literature including social psychology, health psychology, rehabilitation psychology, behavior medicine, and nursing. The fundamental premise driving these studies has been the widespread consensus that social support has a positive relationship to health and wellbeing. Specifically, researchers from an array of disciplines have found positive relationships between social support and a variety of outcomes typically associated with health, well-being, and coping (Auslander & Litwin, 1992; Pierce, Lakey, Sarason & Sarason, 1997; Schwarzer & Leppin, 1992). Further, social support has been found to be negatively related to stress (Russell & Cutrona, 1991), emotional distress (Dilworth-Anderson, Williams & Cooper, 1999), and mortality (Berkman & Syme, 1979), and shown to predispose persons to engage in health-promoting or in self-care behaviors (Hubbard, Muhlen, & Brown, 1984; Muhlenkamp & Sayles, 1986; Riffle, Yoho, & Sams, 1989). Contemporary social support research has extended to a variety of health conditions (e.g., cancer, cardiovascular disorders, multiple sclerosis, AIDS), psychological disorders (e.g., depression, anxiety, severe mental illness, addiction), and other life stressors (e.g., divorce, caregiving), and has been studied with an array of health and mental health related outcomes (i.e., recovery time, improved condition, health maintenance, and relapse). Of particular interest are the studies investigating social support within the rehabilitation context. For years, scholars have consistently stressed the importance of familial and peer support in the rehabilitation process (Brady, Koch, & Griffith, 2003; Bray, 1978; Cook & Ferritor, 1984; Kelly & Lambert, 1992; McKenna & Power, 2000; Power & Dell Orto, 1986; Safilios-Rothschild, 1970; Story & Certo, 1996; Sutton, 1985; Wright, 1960). And, there is growing evidence of a relationship between social support and rehabilitation related outcomes. For example, research suggests that social support is related to adjustment to disability, quality of life, psychological well-being, employment, treatment compliance, and survival rates among persons with disabilities and chronic illness (Belgrave & Walker, 1991; Dunbar, Ford, & Hunt, 1998; Elliot, Herrick, Patti, Witty, Godshall, & Spruell, 1991; Elliott, Herrick, Witty, Godshall, & Spruell, 1992; Evers, Kraaimaat, Geenen, Jacobs, & Bijlsma, 2002; Hatchett, Friend, Symister, & Wadhwa, 1997; Herrick, Elliott, & Crow, 1994; Holosko, Huege, 1998; Kaplan, 1990; Kaplan & Hartwell, 1987; Leach, Frank, Bouman, & Farmer, 1994; McColl & Rosenthal, 1994; McShane & Karp, 1993; Orr & Aronson, 1990; Rintala, Young, Hart, Clearman, & Fuhrer, 1992; Schulz & Decker, 1985; Symister & Friend, 2003; Zea, Belgrave, Townsend, Jarama, & Banks, 1996). While a number of studies have been conducted in the area of social support and rehabilitation, the evidence is ambiguous. The varied evidence base for social support is not unique to rehabilitation however; it is pervasive across a wide array of health related disciplines and contributes to the universal myth that social support is a unidimensional, global, positive force that works in some inexplicable way (Heller & Rook, 2001). Nonetheless, this area is of particular importance to our field as social support is integral to the ecological approach of rehabilitation, wherein characteristics of the individual and the environment are integrated to achieve optimal functioning and quality of life (Chronister, Johnson, & Berven, in press). …

Social Tie Characteristics and Psychiatric Rehabilitation Outcomes Among Adults With Serious Mental Illness

Abstract: Social support has achieved national attention as a key component of the mental health recovery paradigm for persons with serious mental illness (SMI). The aim of this study was to investigate the ...

The Self-medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications

Abstract: The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.

Medical and psychosocial aspects of chronic illness and disability : Donna R. Falvo

Abstract: Falvo (rehabilitation counselor training, Southern Illinois U.) provides the basic medical information about chronic conditions which she believes will be of valuable use to nonmedical rehabilitation professionals and students. Introductory chapters discuss psychosocial aspects of chronic illness an

The buffering effect of resilience on depression among individuals with spinal cord injury: A structural equation model.

Abstract: OBJECTIVE To translate the theoretical constructs from a model of resilience into a structural equation model and evaluate relationships among the model's theoretical constructs associated with resilience and the occurrence of depressive symptoms. DESIGN Quantitative descriptive research design using structural equation modeling (SEM). PARTICIPANTS Two-hundred and fifty-five individuals with SCI recruited from the Canadian Paraplegic Association (CPA). OUTCOME MEASURES Outcome was measured by the Center for Epidemiologic Studies-Depression Scale. RESULTS The resilience model fit the data relatively well: χ² (200, N = 255) = 451.57, p < .001; χ²/df = 2.26; CFI = .92, RMSEA = 0.070 (90% CI: 0.062-0.079), explaining 77% of the variance in depressive symptomatology. Severity of SCI-related stressors significantly influenced perceived stress (β = .60) and perceived stress, in turn, affected depressive symptoms (β = .66), characteristics of resilience (β = -.43), and social support (β = -.26). The resilience characteristics had an inverse relationship with depressive symptoms (β = -.29). No direct relationship was found between severity of SCI-related stressors and depressive symptoms. CONCLUSIONS Findings provide support for the resilience model and suggests characteristics of resilience "buffer" the perceptions of stress on depressive symptoms. The resilience model may be useful to guide clinical interventions designed to improve the mental health of individuals with SCI.

Randomized controlled trial of the self-stigma reduction program among individuals with schizophrenia.

Abstract: Research evidence suggests that individuals with schizophrenia are prone to self-stigmatization, which reduces their psychosocial treatment adherence. A self-stigma reduction program was developed based on a theoretical framework proposed by our team. The effectiveness of such program to reduce self-stigma, enhance readiness for change, and promote adherent behaviors among individuals with schizophrenia was investigated. This program consisted of 12 group and four individual follow-up sessions. An integrative approach including psychoeductaion, cognitive behavioral therapy, motivational interviewing, social skills training, and goal attainment program was adopted. Sixty-six self-stigmatized individuals with schizophrenia were recruited. They were randomly allocated to the self-stigma reduction program ( N =34; experimental protocol) or the newspaper reading group ( N =32; comparison protocol). Measures on participants' level of self-stigma, readiness for change, insight, general self-efficacy, and treatment adherence were taken for six assessment intervals. The findings suggested that the self-stigma reduction program has potential to reduce self-esteem decrement, promote readiness for changing own problematic behaviors, and enhance psychosocial treatment adherence among the self-stigmatized individuals with schizophrenia during the active interventional stage. However, there was a lack of therapeutic maintenance effects during the 6-month follow-up period. Recommendations for further improving the effectiveness of self-stigma reduction program are suggested.

The role of stigma coping and social support in mediating the effect of societal stigma on internalized stigma, mental health recovery, and quality of life among people with serious mental illness

Abstract: This study investigated the mediating properties of stigma coping and social support on the relationship between societal stigma, internalized stigma, mental health recovery, and quality of life among people with serious mental illness (SMI). Participants were 101 adults with SMI living in New York City and Boston. We used 11 measures to assess the study variables. Descriptive statistics, correlational analyses, and structural equation modeling were used to analyze the data. Results showed that secrecy and withdrawal coping and emotional and tangible support mediate the effect of societal stigma on internalized stigma and recovery. Challenging and educating others coping were frequently used and positively linked to recovery. The sample reported low levels of social support and social support was linked to higher levels of societal and internalized stigma and lower levels of recovery and quality of life. Social support and coping should be incorporated into treatment to reduce the negative effects of stigma.