Intersectional Stigma and Occupational Engagement Among Racialized Higher Education Students: A Qualitative Study.

Abstract

Importance: Intersectional stigma of mental illness and race/ethnicity is a persistent determinant of the growing mental health care disparities among students in the United States. It is also the foundation on which concerns of inclusion and belonging are experienced, warranting scholarship on intersectional stigma and occupational engagement.

Objective: To examine intersectional stigma and its relationship with occupational engagement among racialized higher education students.

Design: This study used a qualitative descriptive design with interview methodology, and thematic analysis was used for data analysis. Transcript checks, peer debriefings, and multiple analysts helped strengthen the rigor of the study. Theoretical frameworks included the principle of gradient rationality to examine stigma and the moral economics of occupations framework to examine occupational engagement.

Setting: Higher education institution. Participants Thirteen racialized students with mental illness were recruited via purposive sampling.

Results: Four themes emerged: identities and their negotiations, mental health journey, intersectional stigma of mental illness and race/ethnicity, and occupational engagement (mental health care and community participation).

Conclusions and relevance: Findings highlight that intersectional stigma and racial/ethnic identity construction are fluid processes instead of fixed attributes and guide occupational engagement. Future research will help occupational therapy practitioners and leaders in efforts to address the growing public mental health crisis. Plain-Language Summary: This study highlights that concerns related to belonging and inclusion among racialized students with mental illness are experienced through the intersectional stigma of mental illness and race/ethnicity. Understanding intersectional stigma also allows practitioners and scholars to better inform and implement culturally sensitive care within mental health care settings. Positionality Statement: This research was conducted by a team of interdisciplinary multiracial researchers. This research was initiated by Nikhil Tomar, an immigrant scholar of color with a professional background in occupational therapy. The team included researchers from clinical psychology, social work, and sociology. The team included a Black scholar with expertise in race/ethnic identity, a Biracial scholar with expertise in stigma and global mental health, and a White scholar with expertise in children and adolescent mental health. The interdisciplinary nature of this research allowed the authors to challenge conventional wisdom in their respective fields and conduct research in a critical manner. Tomar has expertise in interview methodology and mental health research, which helped him conduct interviews by balancing the needs for participant safety and data collection.