02200nas a2200217   4500000000100000008004100001653003600042653001100078653001500089653001600104653003000120653002100150100001200171700001400183700001300197245011700210300001200327490000800339520162100347022001401968       2016                            d10aCommunity based rehabilitation 10aStigma10aDisability10aAfghanistan10aPersons with disabilities10aSocial exclusion1 aTrani J1 aBallard E1 aPeña JB00aStigma of persons with disabilities in Afghanistan: Examining the pathways from stereotyping to mental distress.  a258-2650 v1533 a<p>Despite evidence that stigma of disability is frequently reflected through stereotyping and often results in mental distress, very limited literature demonstrates the pathways through which stereotyping has an impact on mental health. Drawing from a large sample of 1449 participants interviewed between December 2012 and September 2013 from an Afghan community-based rehabilitation program, we examined the structure of stigma associated with disability in Afghanistan. Labeling and negative stereotypes, associated with a specific cause of disability, result in social exclusion that in turn impacts mental health. Using structural equation modeling with latent variables, we examined the mediation effect of stereotypes associated with disability on mental distress and anxiety. We found a mediating role of social exclusion between stereotypes and mental distress but only in the case of persons with disabilities from birth. Comparing the total effect of 'disabled at birth' and mental distress 0.195 (95% CI: 0.018-0.367) the effect size of this mediation effect was 0.293 (95% CI: 0.173-0.415). There was no significant direct effect between 'disabled at birth' and mental distress once mediation effect was accounted for in our model. These findings suggest that a multipronged policy approach that recognizes the driving forces of stigma and promotes social participation directly alongside psychosocial interventions on mental distress of persons with disabilities is necessary to achieve wellbeing for a group that has been historically and systematically excluded from development interventions.</p>
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