Graduation Year

2022

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Psychology

Major Professor

Kristin A. Kosyluk, Ph.D.

Committee Member

Jerome T. Galea, Ph.D.

Committee Member

Khary K. Rigg, Ph.D.

Committee Member

Arvind Singhal, Ph.D.

Keywords

LGBTQ+, Mental Illness, Stigma, Intersectionality, Entertainment-Education, Narratives

Abstract

The stigma process (i.e., stereotyping, prejudice, and discrimination) has profound and lasting effects on individuals within marginalized identities. Research has indicated that lesbian, gay, bisexual, trans*, queer, or questioning (LGBTQ+) individuals’ experiences of stigma have contributed to the development of mental illness. Therefore, LGBTQ+ individuals living with mental illness experience a unique and challenging type of stigma, intersectional stigma, due to identification within multiple marginalized communities. Populations most vulnerable to stigma include individuals who identify with more than one stigmatized identity, such as LGBTQ+ individuals living with mental illness. Therefore, there is a need to explore strategies to address intersectional stigma. Contact (interaction between individuals within a marginalized population (out-group) and individuals within the dominant population (in-group) is the most effective form of stigma reduction as compared to education and protest alone. However, education (providing facts to counteract stereotypes) is also an effective stigma change strategy. The communication strategy of Entertainment-Education (EE) encompasses both the use of contact and education to affect behavioral change.

Prior research has examined the use of Entertainment-Education stories to address the stigma experienced by racial/ethnic minority individuals living with a mental illness. However, there has not been any research to date to examine the use of Entertainment-Education stigma change strategies to address LGBTQ+- and mental illness-related intersectional stigma. This dissertation research explores and examines the use of stories from individuals who identify as LGBTQ+ living with a mental illness (a form of Entertainment-Education) to address intersectional stigma of LGBTQ+ and mental illness.

This dissertation begins with a systematic integrative review of the literature on contact-based interventions to address LGBTQ+-related stigma. Prior literature has already established the effectiveness of contact for reducing mental illness stigma. Therefore, this manuscript introduces and synthesizes the literature on contact-based interventions for reducing LGBTQ+-related stigma. In addition to the review, this manuscript proposes the use of contact-based interventions to address intersectional LGBTQ+ and mental illness stigma, setting the stage for the second article, which is the first to examine and evaluate the use of intersectional stories delivered through an Entertainment-Education communication framework, highlighting the lived experiences of LGBTQ+ individuals living with a mental illness.

An outcome of interest for this work is the reduction of intersectional LGBTQ+ and mental illness stigma. For this work, successful reduction of intersectional LGBTQ+ and mental illness stigma would mean reductions in both types of stigma among intervention participants. Using a randomized control trial, participants either viewed stories from LGBTQ+ individuals living with a mental illness, individuals living with a mental illness, or a control condition of TEDTalks. Results showed that stories of individuals living with mental illness effectively reduced mental illness-related stigma. However, intersectional stories of LGBTQ+ individuals living with a mental illness were only effective at reducing mental illness stigma and not LGBTQ+-related stigma. These results have implications for using specific culturally adapted Entertainment-Education interventions to reduce intersectional LGBTQ+ and mental illness stigma.

In a final article, a follow-up analysis of the randomized control trial, Entertainment-Education factors (perceived similarity to the storyteller, identification with the storyteller, and empathy with the storyteller) are examined to determine whether they might play a moderating role on the effect of stories of lived experience on stigma change. Results showed that EE factors did not moderate the impact of stories from LGBTQ+ individuals living with mental illness on mental illness-related stigma. However, identification with and perceived similarity to the storyteller did moderate the relationship of LGBTQ+ Mental Illness stories on genderism and transphobia from pre- to post-intersectional story condition. These results have implications for incorporating Entertainment-Education factors in developing contact-based interventions to address intersectional LGBTQ+ and mental illness stigma.

Overall, this dissertation makes novel contributions to the literature with preliminary data on the use of intersectional stories from LGBTQ+ individuals living with a mental illness to address intersectional LGBTQ+ and mental illness stigma. This is the first study to utilize Entertainment-Education to address LGBTQ+ and mental illness stigma and has implications for the widespread use of stories to address various forms of intersectional stigma that impact the LGBTQ+ communities, such as racial/ethnic minority LGBTQ+ individuals living with mental illness.

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