Large language models (LLMs) have been shown to exhibit social bias, however, bias towards non-protected stigmatized identities remain understudied. Furthermore, what social features of stigmas are associated with bias in LLM outputs is unknown. From psychology literature, it has been shown that stigmas contain six shared social features: aesthetics, concealability, course, disruptiveness, origin, and peril. In this study, we investigate if human and LLM ratings of the features of stigmas, along with prompt style and type of stigma, have effect on bias towards stigmatized groups in LLM outputs. We measure bias against 93 stigmatized groups across three widely used LLMs (Granite 3.0-8B, Llama-3.1-8B, Mistral-7B) using SocialStigmaQA, a benchmark that includes 37 social scenarios about stigmatized identities; for example deciding wether to recommend them for an internship. We find that stigmas rated by humans to be highly perilous (e.g., being a gang member or having HIV) have the most biased outputs from SocialStigmaQA prompts (60% of outputs from all models) while sociodemographic stigmas (e.g. Asian-American or old age) have the least amount of biased outputs (11%). We test if the
Simulating patients with large language models (LLMs) is a promising tool for mental health training, but existing approaches fail to capture a key clinical reality: self-stigma. Patients experiencing self-stigma, the internalization of negative stereotypes, often exhibit context-sensitive resistance, such as avoidance, denial, or self-blame, which current models render as static or uniformly compliant behavior. To address this, we introduce a novel simulation framework grounded in the psychological 3A1H model of self-stigmatization. Our core innovation is the creation of a \textbf{Stigmatized Self-Reflection} (\textbf{SSR}) dataset, where we augment mental health dialogues with internal monologues that reflect stigma-aware reasoning. By fine-tuning LLMs with this data using a chain-of-thought approach, we train patient agents to dynamically adjust their level and expression of stigma based on conversational triggers. Evaluations demonstrate that our approach significantly outperforms specialized baselines, generating more authentic and situationally appropriate patient responses. This work provides a crucial step towards realistic stigma simulation for clinical training and empath
While large language models (LLMs) are increasingly being explored for mental health applications, recent studies reveal that they can exhibit stigma toward individuals with psychological conditions. Existing evaluations of this stigma primarily rely on multiple-choice questions (MCQs), which fail to capture the biases embedded within the models' underlying logic. In this paper, we analyze the intermediate reasoning steps of LLMs to uncover hidden stigmatizing language and the internal rationales driving it. We leverage clinical expertise to categorize common patterns of stigmatizing language directed at individuals with psychological conditions and use this framework to identify and tag problematic statements in LLM reasoning. Furthermore, we rate the severity of these statements, distinguishing between overt prejudice and more subtle, less immediately harmful biases. To broaden the reasoning domain and capture a wider array of patterns, we also extend an existing mental health stigma benchmark by incorporating additional psychological conditions. Our findings demonstrate that evaluating model reasoning not only exposes substantially more stigma than traditional MCQ-based methods
The government's effort to alleviate HIV stigma has been justified by the suppression effect of stigma on the HIV testing rate. Nevertheless, the deterrence effect of stigma on undesirable sexual behaviours has long been overlooked. This study adapts the existing framework on HIV stigma with an additional stage that formally models people's choices on whether to take preventive measures in sex. The model shows that, when sex is explicitly modelled, the suppression and deterrence effects coexist, which makes the net societal impact of HIV stigma ambiguous. A utilitarian welfare analysis concludes that the welfare-maximizing stigma level can be higher than its natural level, implying that the government's effort to reduce stigma is not always welfare-improving. Instead, the study provides a rationale for maintaining a certain level of HIV stigma to maximize social welfare.
Robots are becoming more prominent in assisting persons with disabilities (PwD). Whilst there is broad consensus that robots can assist in mitigating physical impairments, the extent to which they can facilitate social inclusion remains equivocal. In fact, the exposed status of assisted workers could likewise lead to reduced or increased perceived stigma by other workers. We present a vignette study on the perceived cognitive and behavioral stigma toward PwD in the workplace. We designed four experimental conditions depicting a coworker with an impairment in work scenarios: overburdened work, suitable work, and robot-assisted work only for the coworker, and an offer of robot-assisted work for everyone. Our results show that cognitive stigma is significantly reduced when the work task is adapted to the person's abilities or augmented by an assistive robot. In addition, offering robot-assisted work for everyone, in the sense of universal design, further reduces perceived cognitive stigma. Thus, we conclude that assistive robots reduce perceived cognitive stigma, thereby supporting the use of collaborative robots in work scenarios involving PwDs.
Human immunodeficiency virus (HIV)-related stigma is a critical psychosocial determinant of health for people living with HIV (PLWH), influencing mental health, engagement in care, and treatment outcomes. Although stigma-related experiences are documented in clinical narratives, there is a lack of off-the-shelf tools to extract and categorize them. This study aims to develop a large language model (LLM)-based tool for identifying HIV stigma from clinical notes. We identified clinical notes from PLWH receiving care at the University of Florida (UF) Health between 2012 and 2022. Candidate sentences were identified using expert-curated stigma-related keywords and iteratively expanded via clinical word embeddings. A total of 1,332 sentences were manually annotated across four stigma subscales: Concern with Public Attitudes, Disclosure Concerns, Negative Self-Image, and Personalized Stigma. We compared GatorTron-large and BERT as encoder-based baselines, and GPT-OSS-20B, LLaMA-8B, and MedGemma-27B as generative LLMs, under zero-shot and few-shot prompting. GatorTron-large achieved the best overall performance (Micro F1 = 0.62). Few-shot prompting substantially improved generative model
Reproductive well-being education remains widely stigmatized across diverse cultural contexts, constraining how individuals access and interpret reproductive health knowledge. We designed and evaluated OpenBloom, a stigma-sensitive, AI-mediated system that uses LLMs to transform reproductive health articles into reflective, question-based learning prompts. We employed OpenBloom as a design probe, aiming to explore the emerging challenges of reproductive well-being stigma through LLMs. Through surveys, semi-structured interviews, and focus group discussions, we examine how sociocultural stigma shapes participants' engagements with AI-generated questions and the opportunities of inquiry-based reproductive health education. Our findings identify key design considerations for stigma-sensitive LLM, including empathetic framing, inclusive language, values-based reflection, and explicit representation of marginalized identities. However, while current LLM outputs largely meet expectations for cultural sensitivity and non-offensiveness, they default to superficial rephrasing and factual recall rather than critical reflection. This guides well-being HCI design in sensitive health domains to
Stigma is a barrier to treatment for individuals struggling with substance use disorders (SUD), which leads to significantly lower treatment engagement rates. With only 7% of those affected receiving any form of help, societal stigma not only discourages individuals with SUD from seeking help but isolates them, hindering their recovery journey and perpetuating a cycle of shame and self-doubt. This study investigates how stigma manifests on social media, particularly Reddit, where anonymity can exacerbate discriminatory behaviors. We analyzed over 1.2 million posts, identifying 3,207 that exhibited stigmatizing language towards people who use substances (PWUS). Using Informed and Stylized LLMs, we develop a model for de-stigmatization of these expressions into empathetic language, resulting in 1,649 reformed phrase pairs. Our paper contributes to the field by proposing a computational framework for analyzing stigma and destigmatizing online content, and delving into the linguistic features that propagate stigma towards PWUS. Our work not only enhances understanding of stigma's manifestations online but also provides practical tools for fostering a more supportive digital environment
As Large Language Models (LLMs) increasingly mediate stigmatized health decisions, their capacity to understand complex psychological phenomena remains inadequately assessed. Can LLMs understand what we cannot say? We investigate whether LLMs coherently represent abortion stigma across cognitive, interpersonal, and structural levels. We systematically tested 627 demographically diverse personas across five leading LLMs using the validated Individual Level Abortion Stigma Scale (ILAS), examining representation at cognitive (self-judgment), interpersonal (worries about judgment and isolation), and structural (community condemnation and disclosure patterns) levels. Models fail tests of genuine understanding across all dimensions. They underestimate cognitive stigma while overestimating interpersonal stigma, introduce demographic biases assigning higher stigma to younger, less educated, and non-White personas, and treat secrecy as universal despite 36% of humans reporting openness. Most critically, models produce internal contradictions: they overestimate isolation yet predict isolated individuals are less secretive, revealing incoherent representations. These patterns show current ali
Text-to-image generators (T2Is) are liable to produce images that perpetuate social stereotypes, especially in regards to race or skin tone. We use a comprehensive set of 93 stigmatized identities to determine that three versions of Stable Diffusion (v1.5, v2.1, and XL) systematically associate stigmatized identities with certain skin tones in generated images. We find that SD XL produces skin tones that are 13.53% darker and 23.76% less red (both of which indicate higher likelihood of societal discrimination) than previous models and perpetuate societal stereotypes associating people of color with stigmatized identities. SD XL also shows approximately 30% less variability in skin tones when compared to previous models and 18.89-56.06% compared to human face datasets. Measuring variability through metrics which directly correspond to human perception suggest a similar pattern, where SD XL shows the least amount of variability in skin tones of people with stigmatized identities and depicts most (60.29%) stigmatized identities as being less diverse than non-stigmatized identities. Finally, SD shows more homogenization of skin tones of racial and ethnic identities compared to other st
Mental-health stigma remains a pervasive social problem that hampers treatment-seeking and recovery. Existing resources for training neural models to finely classify such stigma are limited, relying primarily on social-media or synthetic data without theoretical underpinnings. To remedy this gap, we present an expert-annotated, theory-informed corpus of human-chatbot interviews, comprising 4,141 snippets from 684 participants with documented socio-cultural backgrounds. Our experiments benchmark state-of-the-art neural models and empirically unpack the challenges of stigma detection. This dataset can facilitate research on computationally detecting, neutralizing, and counteracting mental-health stigma. Our corpus is openly available at https://github.com/HanMeng2004/Mental-Health-Stigma-Interview-Corpus.
Background: Many people who could benefit from therapy do not receive it. Conversational AI is increasingly used for mental health support, yet it is unclear which barriers AI helps mitigate. We examined whether evaluation-sensitive (shame/stigma) and structural barriers (cost/coverage/access) to psychotherapy predict perceived helpfulness of an AI mental health conversational tool (Ash), and whether effects differ by prior therapy experience or user engagement. Methods: Participants (n=395) rated Ash's helpfulness (1-5) and described barriers to therapy. Open-text responses were coded for shame/stigma, access, and cost/coverage themes. Linear regressions examined associations between barriers and perceived helpfulness, adjusting for demographics and mental health, with moderation by therapy experience. Results: Shame/stigma (B=.45, p<.001) and access barriers (B=.31, p=.020) predicted higher perceived helpfulness but cost/coverage did not (B=.13, p=.262). Prior therapy experience moderated the shame effect (interaction B=.56, p=.036): shame predicted higher helpfulness among therapy-experienced users ($Δ$=.62, p<.001) but not therapy-naive users ($Δ$=.03, p=.877). Among ther
Widespread stigma, both in the offline and online spaces, acts as a barrier to harm reduction efforts in the context of opioid use disorder (OUD). This stigma is prominently directed towards clinically approved medications for addiction treatment (MAT), people with the condition, and the condition itself. Given the potential of artificial intelligence based technologies in promoting health equity, and facilitating empathic conversations, this work examines whether large language models (LLMs) can help abate OUD-related stigma in online communities. To answer this, we conducted a series of pre-registered randomized controlled experiments, where participants read LLM-generated, human-written, or no responses to help seeking OUD-related content in online communities. The experiment was conducted under two setups, i.e., participants read the responses either once (N = 2,141), or repeatedly for 14 days (N = 107). We found that participants reported the least stigmatized attitudes toward MAT after consuming LLM-generated responses under both the setups. This study offers insights into strategies that can foster inclusive online discourse on OUD, e.g., based on our findings LLMs can be us
AI conversational agents have demonstrated efficacy in social contact interventions for stigma reduction at a low cost. However, the underlying mechanisms of how interaction designs contribute to these effects remain unclear. This study investigates how participating in three human-chatbot interactions affects attitudes toward mental illness. We developed three chatbots capable of engaging in either one-way information dissemination from chatbot to a human or two-way cooperation where the chatbot and a human exchange thoughts and work together on a cooperation task. We then conducted a two-week mixed-methods study to investigate variations over time and across different group memberships. The results indicate that human-AI cooperation can effectively reduce stigma toward individuals with mental illness by fostering relationships between humans and AI through social contact. Additionally, compared to a one-way chatbot, interacting with a cooperative chatbot led participants to perceive it as more competent and likable, promoting greater empathy during the conversation. However, despite the success in reducing stigma, inconsistencies between the chatbot's role and the mental health c
Menstrual health education (MHE) in Pakistan is constrained by cultural taboos and inadequate formal curricula, leaving women with few trusted resources to lean on. In response to these challenges, we introduce a WhatsApp-based chatbot powered by a large language model (LLM) and Retrieval Augmented Generation (RAG), co-designed with Pakistani college women. Workshops (N=30) revealed key design requirements -- support for Roman Urdu, use of subsidized platforms, and an expert -- curated knowledge base. We then deployed the chatbot with 13 participants for two weeks (403 messages and interviews). Women used it to challenge cultural taboos, legitimize health concerns often dismissed as normal, and build reproductive health knowledge through iterative questioning. Yet, interactions also exposed tensions: reliance on cultural explanatory models, questions of trust and validation, and gendered persona of the chatbot itself. We contribute empirical insights, a stigma-aware design framework for culturally sensitive conversational AI, and a methodological lens foregrounding expert validation in intimate health domains.
Stigma toward people who use substances (PWUS) is a leading barrier to seeking treatment.Further, those in treatment are more likely to drop out if they experience higher levels of stigmatization. While related concepts of hate speech and toxicity, including those targeted toward vulnerable populations, have been the focus of automatic content moderation research, stigma and, in particular, people who use substances have not. This paper explores stigma toward PWUS using a data set of roughly 5,000 public Reddit posts. We performed a crowd-sourced annotation task where workers are asked to annotate each post for the presence of stigma toward PWUS and answer a series of questions related to their experiences with substance use. Results show that workers who use substances or know someone with a substance use disorder are more likely to rate a post as stigmatizing. Building on this, we use a supervised machine learning framework that centers workers with lived substance use experience to label each Reddit post as stigmatizing. Modeling person-level demographics in addition to comment-level language results in a classification accuracy (as measured by AUC) of 0.69 -- a 17% increase ove
We study an overlapping-generations model of community enforcement where each agent interacts once as young and once as old across two groups. After each match a minimal, directed record assigns a public "stigma" only when a player defects against a cooperator; the label is observed solely by the defector's next partner. A known fraction of agents are honest (cooperate unless the opponent is stigmatized); the rest are strategic and privately heterogeneous in the cost of being exploited. We characterize symmetric cutoff equilibria for strategic young players. When the one-shot gain from defection is moderate, the equilibrium exists and is unique; when it is large, multiple equilibria arise. In that region, increasing the share of honest types can reduce cooperation by shifting selection toward a lower cutoff - an "honesty backfires" effect. We further show that probabilistic record-clearing weakly lowers cutoffs and never expands the cooperation region. The results yield design lessons for reputation systems: target clear opportunism and avoid mechanically forgiving records, as persistence of credible negative signals disciplines behavior across cohorts.
Stigma, a recognized global barrier to effective disease management, impacts social interactions, resource access, and psychological well-being. In this study, we developed a patient-centered framework for deriving design requirements and interventions for health conditions subject to social stigma. This study introduces a patient-centered framework, grounded in sociotechnical systems theory, to create tailored interventions and design requirements for health conditions influenced by social stigma. We tested this framework through a mixed-method study on chronic pelvic pain patients. Our approach led to the identification of ten design requirements that encompass behavioral and psychological support and strategies for day-to-day living. The findings reveal a preference among CPP patients for priming and social support interventions. This study underscores the value of a systems-based perspective in healthcare, advocating for a nuanced, patient-centered approach that addresses the complex nature of health conditions affected by social stigma. It contributes to the ongoing discourse on integrating STS theory into healthcare frameworks, highlighting the need for targeted strategies to
Occupations referred to as "dirty work" often face entrenched social stigma, which adversely affects the mental health of workers in these fields and impedes occupational equity. In this study, we propose a novel Interactive Fiction (IF) framework powered by Large Language Models (LLMs) to encourage perspective-taking and reduce biases against these stigmatized yet essential roles. Through an experiment with participants (n = 100) across four such occupations, we observed a significant increase in participants' understanding of these occupations, as well as a high level of empathy and a strong sense of connection to individuals in these roles. Additionally, qualitative interviews with participants (n = 15) revealed that the LLM-based perspective-taking IF enhanced immersion, deepened emotional resonance and empathy toward "dirty work," and allowed participants to experience a sense of professional fulfillment in these occupations. However, participants also highlighted ongoing challenges, such as limited contextual details generated by the LLM and the unintentional reinforcement of existing stereotypes. Overall, our findings underscore that an LLM-based perspective-taking IF framew
This study investigates whether large language models (LLMs) exhibit cross-linguistic differences in mental health evaluations. Focusing on Chinese and English, we examine two widely used models, GPT-4o and Qwen3, to assess whether prompt language systematically shifts mental health-related evaluations and downstream decision outcomes. First, we assess models' evaluative orientation toward mental health stigma using multiple validated measurement scales capturing social stigma, self-stigma, and professional stigma. Across all measures, both models produce higher stigma-related responses when prompted in Chinese than in English. Second, we examine whether these differences also manifest in two common downstream decision tasks in mental health. In a binary mental health stigma detection task, sensitivity to stigmatizing content varies across language prompts, with lower sensitivity observed under Chinese prompts. In a depression severity classification task, predicted severity also differs by prompt language, with Chinese prompts associated with more underestimation errors, indicating a systematic downward shift in predicted severity relative to English prompts. Together, these findi