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2022

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Full-Text Articles in Clinical Psychology

Examining Gender Differences In A Forensic Sample Using The Personality Assessment Inventory, Rebecca Elliott Jan 2022

Examining Gender Differences In A Forensic Sample Using The Personality Assessment Inventory, Rebecca Elliott

Antioch University Dissertations & Theses

Rates of female criminality appear to be rising (The Sentencing Project, 2022), and thus more women are likely to present for evaluation in a forensic capacity. A majority of research in the field of criminal behavior has focused exclusively on male populations. A dearth of research examining risk factors among female offenders has led to a lack of empirically validated tools used to assess women. Additionally, research on gender differences within a forensic population representing a wide range of referral questions has not been conducted. Women offenders present with unique and different risk factors than men (Grimbos et al., 2016); …


Managing Expectations After Expecting: A Phenomenological Study Of Anger And Societal Expectations In New Motherhood, Jennifer Monahan Demella Jan 2022

Managing Expectations After Expecting: A Phenomenological Study Of Anger And Societal Expectations In New Motherhood, Jennifer Monahan Demella

Antioch University Dissertations & Theses

The literature on motherhood is dominated by topics on the roles of attachment, prenatal care, and childrearing. Research on the negative effects of motherhood is typically described in terms of postpartum depression (PPD) or postpartum mood disorder (PPMD). However, anger is a prominent component in motherhood, which may not be seen through the criteria of PPD or PPMD. Additionally, angry mothers conflict with the mythos of the Good Mother. In this phenomenological study, the thematic structure of mothers’ experience within the first year of their newborns’ life are examined. Data from interviews with seven women who were four to ten …


No Time For That: Graduate Psychology Student Perspectives On Self-Care Culture, Anthony Primavera Jan 2022

No Time For That: Graduate Psychology Student Perspectives On Self-Care Culture, Anthony Primavera

Antioch University Dissertations & Theses

Graduate psychology students face numerous stressors that can hinder their performance both academically and clinically as they move through their education and into the professional world (Pakenham & Stafford-Brown, 2012; Shen-Miller, 2011). Engagement with regular self-care not only can enhance a sense of well-being, but also plays a crucial role in shielding an individual from some of the most harmful effects of stress (Wise et al., 2012). Graduate level psychology programs are inherently positioned to teach graduate trainees about the importance of self-care practices and to help them develop self-care habits that they can take into future careers. It appears …


The Mechanism Of Reducing Anxiety Through Mindfulness Interventions: Digital Therapeutic Program, Maria Neizvestnaya Jan 2022

The Mechanism Of Reducing Anxiety Through Mindfulness Interventions: Digital Therapeutic Program, Maria Neizvestnaya

Antioch University Dissertations & Theses

The COVID-19 pandemic exacerbated the prevalence of anxiety disorders, making it a population health concern in the United States and worldwide. The growing need for effective prevention and treatment of anxiety coincides with a deficit of mental health providers and physicians. With the healthcare system currently overwhelmed and the slow training pipeline of new providers, the gap between patient demand and treatment providers will not be closed in the next decade. There is a growing need for evidence-based treatments for anxiety disorders that can increase access to care while addressing the underlying mechanisms of anxiety. Digital therapeutics is a fast-developing …


A Literature Resource For Those Supporting Patients With Autism Spectrum Disorder And Cancer, Kaylee James Jan 2022

A Literature Resource For Those Supporting Patients With Autism Spectrum Disorder And Cancer, Kaylee James

Psychology Doctoral Specialization Projects

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that impacts both social interaction and patterns of behavior. ASD is rooted in genetic, biological, and environmental causes. Cancer begins when cells grow out of control and there is also a genetic and biological cause of cancer. There is an overlap between the genetic and biological causes of ASD and cancer. As a result, evidence supports an increased risk of developing some types of cancer as well as protective factors for some times of cancer for individuals with ASD. Therefore, individuals with ASD may be at a heightened risk to develop cancer, …


Equine Assisted Psychotherapy: Implications For Treating Trauma, Kara L. Harrison Psy.D. Jan 2022

Equine Assisted Psychotherapy: Implications For Treating Trauma, Kara L. Harrison Psy.D.

Psychology Doctoral Specialization Projects

Trauma related symptoms and Posttraumatic Stress Disorder (PTSD) have been increasingly recognized for the key roles they occupy in mental health and overall individual well-being within both adult and childhood populations. They often represent significant barriers to the provision of mental healthcare within military populations and individuals diagnosed with serious mental illness (SMI). This original contribution to practice explores the significance of Equine Assisted Psychotherapy as a novel adjunctive approach to treating trauma. symptoms in adults and children. An extensive literature review examines current research and discussion on common definitions and nomenclature. It begins with discussion on the broader areas …


Stardust In Cedar Forest: Suicide Prevention Through Interactive Theatre For College Students, Ghina Fawaz Jan 2022

Stardust In Cedar Forest: Suicide Prevention Through Interactive Theatre For College Students, Ghina Fawaz

Honors Program Theses

Suicide can impact people from all walks of life, and for those who are vulnerable to circumstances that amplify suicidal ideation, prevention programs can be effective methods to provide relief and promote awareness to community members. The World Health Organization (2021) highlighted a global need for prevention programs targeted toward young people as suicide is the second leading cause of death for people aged 15-29. The objective of this study was to evaluate the impact of interactive theatre as a form of psychoeducation and suicide prevention for college students. This study found that interactive theatre had a positive impact as …


Online Disclosure Boundaries And Marital Quality Among Facebook Users, Dominique M. Jones-King Jan 2022

Online Disclosure Boundaries And Marital Quality Among Facebook Users, Dominique M. Jones-King

Walden Dissertations and Doctoral Studies

AbstractCurrent marital and social media research has revealed that married couples are often unsuspecting of the negative marital ramifications associated with impulsive disclosure to Facebook friends, poor disclosure boundaries, and inappropriate online emotional affairs until the affair has been revealed and the emotional detachment has already incited a legal divorce. The purpose of this study was to examine the correlation, if any, between online intimate disclosure with another sex, online disclosure boundaries, and marital quality among Facebook users. The theoretical framework for this study was the social penetration theory. A quantitative, nonexperimental correlational research design was used. A total of …


Are Narcissism And Entitlement Associated With Higher Rates Of Violence And Unsuccessful Treatment Completion?, Melissa Chipollini Jan 2022

Are Narcissism And Entitlement Associated With Higher Rates Of Violence And Unsuccessful Treatment Completion?, Melissa Chipollini

PCOM Psychology Dissertations

Following the dimensional-categorical model of personality functioning, this study used archival data to examine the degree to which narcissism and entitlement determined engagement in violent acts and treatment completion. The study reviewed MCMI-III/IV scores, discharge summaries, and violence histories for a sample of 105 individuals who were referred for forensic outpatient services by the court. One-way ANOVAs were used to assess all four of the hypotheses (a) individuals with more than one violent act (vs. one violent act) would have significantly higher mean scores on the MCMI-III/IV entitlement subscale, (b) individuals with more than one violent act would have significantly …


Do Law Enforcement Officers’ Attitudes And Knowledge Impact Their Likelihood Of Administering Naloxone?, Nicole Alexis Gulkis Jan 2022

Do Law Enforcement Officers’ Attitudes And Knowledge Impact Their Likelihood Of Administering Naloxone?, Nicole Alexis Gulkis

PCOM Psychology Dissertations

Law enforcement officers (LEOs) are integral public service providers who have been called upon by government personnel across state and local government bodies to aid in combating the opioid epidemic. As LEOs are often the primary front-line workers who encounter opioid overdose scenarios, more states across the nation are training LEOs to administer naloxone. The emergence of Coronavirus (COVID-19) has complicated LEOs’ involvement with naloxone administration because of shifts in policing strategies and occupational safety procedures. Given the current pandemic, concerns about contraction and transmission of COVID-19 must be considered for LEOs working in the frontlines of these concurrent public …


Characteristics Of Patient Encounters For Athletic Training Students During Clinical Education: A Report From The Aate Research Network, Cailee E. Welch Bacon, Julie M. Cavallario, Stacy E. Walker, R.Curtis Bay, Bonnie L. Van Lunen Jan 2022

Characteristics Of Patient Encounters For Athletic Training Students During Clinical Education: A Report From The Aate Research Network, Cailee E. Welch Bacon, Julie M. Cavallario, Stacy E. Walker, R.Curtis Bay, Bonnie L. Van Lunen

Rehabilitation Sciences Faculty Publications

Context: To enhance the quality of patient care, athletic training students (ATSs) should experience a wide variety of clinical practice settings, interact with diverse patient populations, and engage with patients that have a wide variety of conditions. It is unclear in what ways, if any, ATSs have diverse opportunities during clinical experiences.

Objective: To describe the characteristics of patient encounters (PEs) ATSs engage in during clinical experiences. Design: Multi-site, panel design.

Setting: 12 professional athletic training programs (ATPs; 5 Bachelor, 7 Master's).

Patients or Other Participants: 363 ATSs from the ATPs that used E*Value software to document PEs during clinical …


Expectations And Reality: Post Deployment Reintegration Through The Lived Experiences Of Military Spouses, Michele Marie Brown Jan 2022

Expectations And Reality: Post Deployment Reintegration Through The Lived Experiences Of Military Spouses, Michele Marie Brown

Walden Dissertations and Doctoral Studies

This phenomenological study aims to understand how post-deployment reintegration impacted the quality of life, functionality, adjustment, and levels of distress among military spouses. Additionally, this study analyzed data collected from 11 individual military spouse responses to gain firsthand insight into the challenges of post-deployment reintegration and the resiliency factors that influence stability. While extensive research existed on the challenges associated with the hardships of physical distance and absence, there was limited research on the impact of post-deployment reintegration on the overall quality of life of a military spouse. Three theories explored the extremely individualized experiences of military spouses’ post-deployment reintegration. …


The Minnesota Multiphasic Personality Inventory Pessimism–Optimism Scale As A Predictor In Depression Change After Medication Treatment And Placebo, Donna J. Winsor Jan 2022

The Minnesota Multiphasic Personality Inventory Pessimism–Optimism Scale As A Predictor In Depression Change After Medication Treatment And Placebo, Donna J. Winsor

Walden Dissertations and Doctoral Studies

The field of positive psychology has included research on the personality traits of optimism and pessimism and how they predict depression; however, there has been limited investigation on whether these characteristics can predict treatment outcomes. This study used a quantitative nonexperimental design with archived data provided by Summit Research Network, to evaluate whether pessimism or optimism, as measured by the Pessimism–Optimism (PSM) scale of the Minnesota Multiphasic Personality Inventory, had an effect on depression and somatic symptom change in 98 adults with depression who were randomized into imipramine, alprazolam, or placebo treatment. Seligman’s explanatory style theory was used to guide …


The Limits Of Healthy Habits: Exploring The Relationship Between Disordered Eating, Body Image, Mindfulness, Social Media, And Dysfunctional Exercise, Taylor A. Dinkel Jan 2022

The Limits Of Healthy Habits: Exploring The Relationship Between Disordered Eating, Body Image, Mindfulness, Social Media, And Dysfunctional Exercise, Taylor A. Dinkel

Master's Theses or Doctor of Nursing Practice

In recent decades, there has been an increase not only in full syndrome eating disorders, but also in subclinical presentations of disordered eating, many of which include dysfunctional relationships with exercise. Although not full diagnosable syndromes, disordered relationships with food and exercise, as well as a preoccupation with body image, can cause severe physical and psychological stress for individuals who present with these dysfunctional patterns. With the growth of fitness-related social media accounts, the increase in social media usage during the pandemic, and the increase in subclinical disordered eating presentations and dysfunctional relationships with exercise, it is important be aware …


The Association Between Neuroticism, Self-Esteem, And Peer Interactions And Disordered Eating And Body Checking Behavior In Female College Athletes, Alyssa Hertz Jan 2022

The Association Between Neuroticism, Self-Esteem, And Peer Interactions And Disordered Eating And Body Checking Behavior In Female College Athletes, Alyssa Hertz

PCOM Psychology Dissertations

Numerous studies have investigated whether participation in collegiate sports is a risk or protective factor for disordered eating attitudes and behaviors. The purpose of this study was to evaluate potential psychosocial factors (neuroticism, peer relations, and self-esteem) that may contribute to increased risk for disordered eating or maladaptive body checking behaviors in female college athletes. This anonymous, cross sectional, online study recruited 206 participants. Participants completed screening questions, a demographic questionnaire in addition to the Eating Attitudes Test-26, Rosenberg Self-Esteem Scale, Body Checking and Avoidance Questionnaire, Inventory of Peer Influence, and Ten Item Personality Inventory. There was no significant relationship …


Clinical Interventions For Developmental Trauma Disorder: How Evidence-Based Practice And Attachment Theory Can Inform Therapeutic Approach, Victoria Deveau Jan 2022

Clinical Interventions For Developmental Trauma Disorder: How Evidence-Based Practice And Attachment Theory Can Inform Therapeutic Approach, Victoria Deveau

DSW Capstone Projects

Approximately two-thirds of U.S. children and adolescents report having experienced a traumatic event. A posttraumatic stress disorder (PTSD) diagnosis requires that the youth has directly experienced a traumatic event, witnessed a traumatic event occur to others, or learned that a traumatic event has occurred to someone close. The clinician is in a diagnostic quandary, however, when the youth presents with the PTSD hallmarks of hyperarousal, avoidance, and emotional dysregulation, in absence of such life experiences. The answer to this quandary lies in an understanding of developmental trauma disorder (DTD). Clinical interventions for DTD are the focus of this capstone.

Product …


Cognitive Distortions, Partisan Strength, And Authoritarianism: Exploring Potential Factors Contributing To The Current Partisan Divide, Brooke C. Singer Jan 2022

Cognitive Distortions, Partisan Strength, And Authoritarianism: Exploring Potential Factors Contributing To The Current Partisan Divide, Brooke C. Singer

PCOM Psychology Dissertations

Over the past two decades, the number of Americans on the extremes of the political spectrum has more than doubled, and politically motivated aggression has increased. In addition, an unprecedented division has emerged between the left and right on fundamental political values and animosity continues to rise. The purpose of this study was to explore factors that potentially contribute to political polarization and animosity in the United States, including authoritarianism, strength of partisan commitment, and distorted thinking. The participants for this study comprised 513 individuals from the general population of the United States recruited from online platforms. Participants completed an …


The Relationship Between Cognitive Distortions, Humor Styles, Coping Humor, And Self-Confidence, Emma Dudones Jan 2022

The Relationship Between Cognitive Distortions, Humor Styles, Coping Humor, And Self-Confidence, Emma Dudones

Williams Honors College, Honors Research Projects

Cognitive distortion is an error in thinking believed to increase susceptibility to depression (Burns, 1980; Dozois & Beck, 2008). Research shows Affiliative and Self-Enhancing humor styles are associated with less cognitive distortion, while Aggressive and Self-Defeating humor styles are associated with greater cognitive distortion (Rnic et al., 2016). The current study examines those relationships and extends the research by examining whether coping humor and self-confidence relate to humor styles and cognitive distortion. 210 college students took the Humor Styles Questionnaire, the Cognitive Distortions Questionnaire, the Coping Humor Scale, and the Internal and External Self-Confidence Scales. The maladaptive humor styles were …


The Role Of Affective Heterogeneity On Treatment Effects For Youth With Conduct Problems, Pevitr Singh Bansal Jan 2022

The Role Of Affective Heterogeneity On Treatment Effects For Youth With Conduct Problems, Pevitr Singh Bansal

Theses and Dissertations--Psychology

Conduct problems (CP) are a class of disruptive and aggressive behaviors (e.g., aggression, vandalism) comprised of both oppositional defiant and conduct disorder. CP are highly heterogenous and one vital factor that parses out this heterogeneity is affect, specifically the affective traits of irritability (IRR) and limited prosocial emotions (LPE). The current study examined how IRR and LPE predict distinct aspects of treatment efficacy including (1) treatment response (i.e., magnitude of change from week 1 to week 5); (2) trajectories (i.e., shape of symptom change); and (3) time-out (i.e., behavioral and emotional reactions to time-out). Participants were 49 youth aged 7-12 …


Examining The Indirect Effect Of Trauma On Obsessive-Compulsive Symptoms Through Responsibility/Threat Beliefs, Emily E. Fenlon Jan 2022

Examining The Indirect Effect Of Trauma On Obsessive-Compulsive Symptoms Through Responsibility/Threat Beliefs, Emily E. Fenlon

Theses and Dissertations--Psychology

Inflated responsibility beliefs and threat estimations have been implicated in the etiology and maintenance of obsessive-compulsive (OC) symptoms. Research suggests that early life experiences that involve actual or perceived serious harm to oneself or others may lead to inflated responsibility/threat beliefs and OC symptoms. Research has yet to explore if traumatic experiences influence responsibility/threat beliefs or if the associations between trauma and OC symptoms are at all dependent on trauma’s influence on responsibility/threat beliefs. The present study aims to examine associations among exposure to potentially traumatic events (PTEs), responsibility/threat beliefs, and OC symptoms. A sample of 886 undergraduate students completed …


Pain Interference Across Chronic Pain Populations: Variability And Associated Psychosocial Processes, Stephanie Judge Jan 2022

Pain Interference Across Chronic Pain Populations: Variability And Associated Psychosocial Processes, Stephanie Judge

Theses and Dissertations--Psychology

Chronic pain is one of the most common health complaints, yet the limited effectiveness of existing treatment options suggests that chronic pain is still not fully understood. The goals of this study are to identify and organize well-established and emerging psychosocial factors associated with pain interference, clarify the nature of between- and within-diagnostic group differences in psychosocial and demographic factors associated with pain interference, and identify interactions among diagnostic and psychosocial factors associated with pain interference.

Community-dwelling participants (N = 284) completed a one-time survey which included demographic information, information about pain and diagnosis, and five existing measures that assess …


A Comparison Of Forensic Populations Using The Validity Scales On The Mmpi-3, Steven W. Steinert Jan 2022

A Comparison Of Forensic Populations Using The Validity Scales On The Mmpi-3, Steven W. Steinert

Master's Theses and Doctoral Dissertations

Examining the impact of different factors influencing the validity of an individual’s self-report during a psychological assessment is important in ensuring valid clinical findings and useful recommendations. These factors are often referred to as response biases. There are multiple types of response bias that can negatively influence the validity of self-reports in clinical assessment contexts. Specifically, individuals undergoing an assessment can be impacted by non-contentbased response bias, overreporting, and underreporting of psychological impairment and/or distress. Minnesota Multiphasic Personality Inventory (MMPI) instruments are amongst the leading tools within professional psychology used to identify response bias. The most recent iteration, the MMPI-3, …


Screening For Energy Restriction In Middle And Late Life, Kate Happel Krautbauer Jan 2022

Screening For Energy Restriction In Middle And Late Life, Kate Happel Krautbauer

Master's Theses and Doctoral Dissertations

The most commonly used screening tools for disordered eating, the Eating Attitudes Test (EAT-26) and Eating Disorders Examination–Questionnaire (EDE-Q), rely on the detection of shape and weight concerns to identify potentially dangerous caloric restriction among adolescent girls and young adult women. It is unclear how accurate these measures are at detecting restriction among adults 40 years and older. These adults may be vulnerable to developing or maintaining restrictive eating patterns when healthcare providers recommend weight loss as a preventative health measure or when acute or chronic illnesses (e.g., diabetes or cancers) impact eating. The present online study (a) evaluated the …


Primary Care Behavioral Health In The Time Of Covid-19, Michael Vriesman Jan 2022

Primary Care Behavioral Health In The Time Of Covid-19, Michael Vriesman

Master's Theses and Doctoral Dissertations

People are commonly receiving mental health treatment from primary care providers rather than from behavioral health providers. To address this issue, the healthcare system has begun to integrate behavioral health providers into primary care clinics, known as integrated primary care (IPC). Research suggests that IPC can lead to a number of benefits, including increased likelihood of patients receiving the appropriate standard of care, as well as reduction in healthcare costs due to medical cost offset. While IPC is a promising method of healthcare delivery, additional research is needed to optimize this system. Additionally, the onset of the COVID-19 pandemic has …


Five Spiritually Based Tools For Clinical Practice During Challenging, Stressful, And Apocalyptic Times, Thomas G. Plante Jan 2022

Five Spiritually Based Tools For Clinical Practice During Challenging, Stressful, And Apocalyptic Times, Thomas G. Plante

Psychology

Stress in America and across the globe is high with so many ongoing societal problems. The COVID-19 global pandemic along with accelerating climate change, increasing economic instability and inequality, divisive politics and an increase in authoritarianism, racism, and discrimination against those who are oppressed and marginalized are just a few current examples. Evidence suggests that mental health problems and demand for services have exploded as well. Psychotherapists who are well versed in spiritual and religious integration in their clinical work can help. While therapists cannot solve the country’s and world’s numerous problems, they can help their clientele better cope and …


Cross-Group Friendships And Skin Tone Perceptions, Jhenifa Parker Jan 2022

Cross-Group Friendships And Skin Tone Perceptions, Jhenifa Parker

EWU Masters Thesis Collection

George Allport (1954) coined the term contact hypothesis to explain the relationship between intragroup friendships/interactions and perceptions toward that group. Allport’s hypothesis had been scrutinized as an intervention for reducing prejudices and biases against groups who collectively experience discrimination. This theory was mainly tested in terms of cross-group friendships between individuals of a different ethnicity, racial group, physical ability, and so on; however, very little research has explored this hypothesis in the context of skin tone perceptions. Colorism has had an historical and pervasive impact on individuals categorized as racial/ethnic minorities. This study attempted to bridge the gaps in research …


The Role Of Coping Self-Efficacy, Coping Strategies, And Resiliency Following Sexual Assault, Lauren Hirsch Jan 2022

The Role Of Coping Self-Efficacy, Coping Strategies, And Resiliency Following Sexual Assault, Lauren Hirsch

Clinical Psychology Dissertations

Sexual assault is a pervasive problem in the United States that effects people of all genders and sexualities. Due to fears of negative consequences, many victims of sexual assault do not legally prosecute the perpetrator. Those who do risk experiencing secondary victimization. The use of legal advocates during prosecution can help to guide individuals through the legal process and add a layer of social support that can minimize feelings of secondary victimization and help increase resilience in the victims. In this dissertation I examined a model predicting resilience from coping self-efficacy, mediated by four coping strategies. Participants were at least …


Integrative Meaning, Mindfulness, And Traumatic Grief Among Bereaved Adults, Brandy Tidwell Jan 2022

Integrative Meaning, Mindfulness, And Traumatic Grief Among Bereaved Adults, Brandy Tidwell

Clinical Psychology Dissertations

Traumatic Grief (TG) entails clinically significant expressions of grief and posttraumatic stress following bereavement. TG experiences are more likely following violent, sudden, or accidental losses, which has been largely explained by integrative meaning-making processes. In this study, I aimed to explore relationships between integrative meaning, mindfulness, and TG among a sample of adults (N = 237) bereaved by various circumstances. First, I sought to contribute to findings regarding the negative association between integrative meaning and TG experiences by investigating whether this relationship persists among individuals bereaved by varied circumstances. Second, I sought to explore the role of mindfulness in …


The Relationship Between Social Media Use And Depression And Anxiety Symptoms During Covid-19, Tene'sha L. Crews, Christina Sheerin Jan 2022

The Relationship Between Social Media Use And Depression And Anxiety Symptoms During Covid-19, Tene'sha L. Crews, Christina Sheerin

Undergraduate Research Posters

The rise of the coronavirus (COVID-19) pandemic has caused a global surge in exposure to disaster and crisis-related media. Increases in poor mental health outcomes such as anxiety and depression, are associated with increased exposure to such media content (Abbas et al., 2021; Riehm et al., 2020; Zhao & Zhou, 2020). In recent years, social media has become one of the most widely used sources for news; approximately 48% of adult Americans receive their news from social media (Pew Research Center, 2021). During the COVID-19 pandemic, there has been an increase in social media use due to social distancing and …


Examining Perceived Stigma, Disclosure, Self-Compassion, And Health-Related Quality Of Life In College Students With Cystic Fibrosis, Anna R. Hangge Jan 2022

Examining Perceived Stigma, Disclosure, Self-Compassion, And Health-Related Quality Of Life In College Students With Cystic Fibrosis, Anna R. Hangge

Electronic Theses and Dissertations

Cystic Fibrosis (CF) is a life-limiting genetic disorder that affects the lungs, pancreas, and other organs. Recent advances in CF-related healthcare have improved the life expectancy of individuals with CF from childhood to approximately 50 years old (CFF, 2020). Therefore, more individuals with CF are attending college and facing challenges within this new stage of life. This study examined perceived stigma, disease disclosure, self-compassion, and health-related quality of life (HRQoL) in a sample of current and former college students with CF to understand their psychosocial experience of managing their illness while in college. Results indicated that perceived stigma and HRQoL …