The demographics of the stigmatized can influence perceived stigma in two ways (Chen X. et al., 2020; Duan et al., 2020; He et al., 2020; Alsawalqa, 2021; Fan et al., 2021; Litam and Oh, 2021): (1) some demographics (e.g., Hubei residence, and Hubei hukou, which refers to households registered in Hubei province) increase Chinese/Asian people's relevance to the pandemic, leading to increased perceived stigma, and (2) Chinese/Asian people with certain demographics [e.g., male, young age, and low socioeconomic status (SES)] are more sensitive to stigma and/or less capable of coping with stigma, resulting in higher perceived stigma.

First, Chinese/Asian people with certain demographics (e.g., Hubei residence, and Hubei hukou) are seen as more relevant to the pandemic, resulting in more stigma toward these people. For example, one study found that because Hubei had a large proportion of cases in the early stage of the COVID-19 pandemic and Hubei people were accused of moral transgressions (e.g., eating wild animals), people who lived in Hubei during China's first COVID-19 outbreak and Hubei hukou holders faced higher discrimination (Fan et al., 2021). Similarly, one study found that compared to students from other East and Southeast Asian countries (e.g., Korea and Singapore), Chinese students have suffered significantly more cyberbullying (Alsawalqa, 2021).

Second, Chinese/Asian people with certain demographics (e.g., male, young age, and low SES) are more sensitive to others' stigmatizing behavior and/or less capable of coping with stigma, so they perceive higher levels of stigma. For example, Chinese/Asian men are more likely to report stigma experiences (Chen X. et al., 2020; Litam and Oh, 2021) because they tended to experience less stigma before the pandemic, making their experiences of COVID-19-related stigma more salient. Chinese/Asian women, on the other hand, may attribute stigma to their gender and thus tend to report less COVID-19-related stigma (Litam and Oh, 2021). Young Chinese/Asian people, who are less capable of coping with stigma compared to older people, tend to report higher stigma (Chen X. et al., 2020; He et al., 2020; Wang et al., 2020). Similarly, Hubei residents with low SES have fewer resources to protect their social image and have been found to report more stigma (Duan et al., 2020). However, the results on education are rather mixed. While one study found that education is positively related to stigma (Duan et al., 2020), one study found a null relationship (Chen X. et al., 2020) and another study found a negative relationship (He et al., 2020).

Two cognition-related aspects can influence Chinese/Asian people's perceived stigma: general and COVID-19-related cognition. Specifically, general cognition [e.g., perceived relevance of the stigmatized (Chen X. et al., 2021)] affects Chinese/Asian people's perceived stigma mainly because Chinese/Asian people's perceived relevance of the stigmatized increases their identification with a stigmatized group and their sensitivity to stigma posed by external groups, which increases their perceived stigma. COVID-19-related cognition [e.g., perceived higher susceptibility/severity of COVID-19 (Duan et al., 2020)] affects Chinese/Asian people's perceived stigma mainly via aggravating their anticipated stigma.

For general cognition, Chinese/Asian people who perceive higher relevance of the stigmatized group tend to identify more strongly with the group and are more sensitive to the stigma from external groups, which is related to increased perceived stigma. Indeed, one study found that perceived higher relevance of the stigmatized group is associated with higher levels of perceived stigma (Chen X. et al., 2021).

For COVID-19-related cognition, Chinese/Asian people who feel amplified perceived threats of COVID-19 may anticipate more stigma toward themselves, which is associated with increased stigma perceptions. For example, one study found that Chinese people who perceive higher susceptibility or severity of COVID-19 tend to report higher levels of perceived stigma (Duan et al., 2020).

Two health-related aspects can influence Chinese/Asian people's perceived stigma: general and COVID-19-related health. Specifically, general health (e.g., anxiety disorder symptoms) may influence Chinese/Asian people's perceived stigma because it may indicate amplified risk perceptions. COVID-19-related health (e.g., being suspected or confirmed of having COVID-19) increases Chinese/Asian people's stigma perceptions because being a suspected or confirmed COVID-19 patient brings additional stigma [i.e., stigma toward (suspected) patients].

For general health, Chinese/Asian people's anxiety symptoms may indicate that they have amplified risk perceptions of themselves transmitting the disease, resulting in higher stigma perceptions. For example, one study found that Chinese people who report more anxiety disorder symptoms (rather than self-reported general health) are more likely to report higher levels of perceived stigma (Duan et al., 2020).

For COVID-19-related health, Chinese/Asian people who are confirmed or suspected COVID-19 patients perceive more stigma due to having two stigmatized identities (i.e., being Chinese/Asian and being COVID-19 patients). For example, in a sample of 7,942 Chinese people, one study found that being confirmed or suspected of having COVID-19 is significantly related to perceived discrimination regardless of whether control variables, such as gender, age, education, income etc., are included or excluded (Fan et al., 2021).

Chinese/Asian people's use of coping strategies, such as face mask wearing (Rzymski and Nowicki, 2020), increases their stigma perceptions because of public misassumptions that wearing masks means there is a threat of COVID-19. For example, one study found that Asian medical students who wear face masks more frequently experience prejudice related to the COVID-19 outbreak in Poland compared to Asians who do not wear masks (Rzymski and Nowicki, 2020).

Stigmatizers' demographics (e.g., occupation, and workplace characteristics) influence their stigma attitudes toward Chinese/Asian people because certain demographics reflect stigmatizers' low knowledge and/or high perceived risk of COVID-19 (Yufika et al., 2021). For example, one study found that compared with doctors, nurses are more likely to display stigma toward Chinese/Asian people because they have lower knowledge and perceive higher risk of COVID-19 (Yufika et al., 2021). As another example, HCWs who work in private sub-rural hospitals and hospitals with no protocols for triage and isolation for patients may perceive higher risk and have lower knowledge about COVID-19, and they have been found to have more stigmatizing attitudes toward Chinese/Asian people (Yufika et al., 2021). However, no significant relationships have been found between stigma and stigmatizers' other demographics (e.g., gender, age, and marital status).

Stigmatizers' cognition, both general and COVID-19 related, affects their stigmatizing attitudes and behavior. Specifically, stigmatizers' general cognition affects stigmatizing attitudes and behavior in two ways: (1) stigmatizers' sense of efficacy and trust toward the collective and institutions (e.g., social/political trust, and collective efficacy) enhance their positive appraisals of resources to cope with COVID-19, which mitigates stigmatizing behavior, and (2) positive attitudes toward Trump's government [e.g., trust in Trump (Dhanani and Franz, 2020)] are associated with stigmatizing attitudes toward Chinese/Asian people following former President Trump's stigmatizing behavior (e.g., repeatedly using “Chinese virus” to refer to COVID-19). COVID-19-related cognition affects stigmatizers' stigmatizing behavior mainly because individuals with correct knowledge and perceptions about COVID-19 engage in less stigmatizing behavior.

For general cognition, first, people who perceive the collective or institutions as credible and efficacious (e.g., social/political trust, and collective efficacy) have more positive appraisals of their resources to cope with COVID-19; therefore, they are less likely to stigmatize Chinese/Asian people. For example, one study found that Singaporean citizens with higher trust in the government and people in society are less likely to adopt stereotypes and prejudice against Chinese immigrants (Ahmed et al., 2021). Another study found that collective efficacy, but not self-efficacy, is negatively related to stigmatizing attitudes toward Chinese/Asian people (Cho et al., 2021).

Second, given former President Trump's frequent stigmatizing behavior toward Chinese people (e.g., using “Chinese virus” to refer to COVID-19), stigmatizers who have more positive attitudes toward him and his government are more likely to engage in stigmatizing behavior toward Chinese/Asian people. For example, one study found that trust in Trump is significantly related to negative attitudes toward Asian Americans in response to COVID-19 (Dhanani and Franz, 2020). Another study found that perceived institutional efficacy (in Trump's government) during COVID-19 is positively related to stigmatizing attitudes toward Chinese/Asian people (Cho et al., 2021). In addition, Christian nationalism, “one of the leading factors driving continued support for Donald Trump and his policies” (Perry et al., 2021, p. 760), is significantly associated with supporting stigmatizing opinions about Chinese/Asian people (Perry et al., 2021).

For COVID-19-related cognition, individuals with high levels of knowledge and correct perceptions about COVID-19 are more likely to have low levels of stigmatizing attitudes and behavior. For example, one study found that HCWs with higher knowledge about COVID-19 are less likely to have stigmatizing attitudes toward Chinese/Asian people (Yufika et al., 2021). One study conducted a qualitative study in South Africa and found that misconceptions about COVID-19 are prevalent and contributes to stigmatizing attitudes and behavior toward people of Asian descent (Schmidt et al., 2020). Another study found that the perceived magnitude of harm of COVID-19 is positively associated with stigmatizing attitudes toward Chinese/Asian people (Cho et al., 2021).

Stigmatizers' negative emotions, both general and COVID-19 related, affect their stigmatizing behavior. Specifically, general emotions [e.g., racial envy (Cho et al., 2021)] signal prejudice of Chinese/Asian people, which is positively related to stigmatizing attitudes toward this group. COVID-19-related emotions [e.g., fear of infection (Xu et al., 2021)] are also positively related to stigmatizing attitudes toward Chinese/Asian people because stigmatization is used as a coping mechanism for negative emotions arising from the pandemic.

For general emotions, racial envy signals prejudice against Chinese/Asian people and perceived ineligibility of their advantages over other races, which may promote harm and stigma toward Chinese/Asian people. For example, one study found that American adults' racial envy is positively related to stigmatizing attitudes toward Chinese/Asian people (Cho et al., 2021).

For COVID-19-related emotions, negative emotions are positively related to stigmatizing attitudes toward Chinses/Asian people as many use stigmatization as a coping mechanism against negative emotions arising from the pandemic (e.g., fear). For example, one study found that COVID-19 creates public panic due to uncertainty about COVID-19 infections, resulting in avoidance and stigmatization of people believed to be at high risk of spreading the virus, which were mainly Chinese people at the onset of the pandemic (Xu et al., 2021). In addition, one study found that fear, rather than anger and anxiety, is positively related to stigmatizing attitudes toward Chinese/Asian people (Cho et al., 2021).

Stigmatizers' social interaction with the stigmatized group [e.g., social interaction with Asian friends (Cho et al., 2021), and intergroup contacts (Tsai et al., 2020)] could influence their stigmatizing attitudes in two contrasting ways: (1) interacting with Chinese/Asian people heightens the risk of infection, which is associated with more stigmatizing attitudes, (2) interacting with Chinese/Asian people can enhance understanding of this group and thus reduce stigma.

First, social interaction with Chinese/Asian people activates the threat and risk of COVID-19 infection, which is associated with more stigmatizing attitudes. For example, one study found that the frequency of direct intergroup contact is positively associated with prejudicial attitudes toward Asian people because of higher perceived threats (Tsai et al., 2020).

Second, interaction with Chinese/Asian people can enhance understanding of this group, thus stigmatizers are more likely to change their beliefs and stigmatizing attitudes toward Chinese/Asian people after interacting with them. For example, one study found that parasocial interaction with foreigners (i.e., watching foreign language movies) is negatively related to stigmatizing attitudes toward Chinese/Asian people (Cho et al., 2021). However, direct social interaction (i.e., number of close Asian friends) is not significantly related to stigmatizing attitudes.

Culture [e.g., food culture, mask culture, and racism (Xu et al., 2021)] influences stigma toward Chinese/Asian people in two primary ways: (1) food/mask culture contributes to stigmatizing behavior toward Chinese/Asian people because Westerners vs. Chinese/Asian people interpret food/mask wearing differently, and (2) deeply rooted racism toward Chinese/Asian people and political tension between mainland China and Hong Kong/Taiwan have been revived and intensified during the COVID-19 pandemic, which has also increased stigma toward Chinese/Asian people.

First, food/mask culture contributes to stigma toward Chinese/Asian people because Westerners vs. Chinese/Asians have different interpretations of food and mask wearing. Many people from Western countries consider eating wild animals uncivilized and dirty and believe that Wuhan people's consumption of wild animals caused the virus (Xu et al., 2021). Additionally, while overseas Chinese people wear masks for self-protection, people from Western countries may mistake this practice as spreading COVID-19 or creating terror and panic. For example, one study summarized that differences in food/mask culture comprise one of the factors contributing to stigma toward Wuhan residents and overseas Chinese/Asian people (Xu et al., 2021).

Second, racism against Chinese/Asian people has a long history in United States (Tessler et al., 2020), and political tension between mainland China and Hong Kong/Taiwan has been a longstanding issue (Xu et al., 2021). Both of these issues have been revived and intensified during the COVID-19 pandemic and contribute to stigma toward Chinese/Asian people. For example, one study found that racism and hate crimes toward Chinese/Asian people have been widely reported in multiple media outlets (e.g., CNN, New York Times) and that former US President Trump's use of stigmatizing words (e.g., “Chinese virus”) fueled racial discrimination (Xu et al., 2021). In addition, mainland China and Hong Kong/Taiwan have different political ideologies and have handled COVID-19 differently. As such, COVID-19 has heightened the political tension between the two regions and has fueled discrimination and stigma toward mainland Chinese people (Xu et al., 2021). In contrast, country-level openness to trade and immigration (measured by the value of trade flow relative to national GDP, and immigration flow relative to population, respectively), promote interaction between people of different races and nationalities, which has increased mutual understanding and decreased stigma toward Chinese/Asian people. For example, a multi-country study found that more openness to trade and immigration with China was related to reduced reported discrimination (He et al., 2021).

Media factors [e.g., (social) media use (Croucher et al., 2020; Dhanani and Franz, 2020; Duan et al., 2020; Tsai et al., 2020; Yu et al., 2020; Ahmed et al., 2021; Cho et al., 2021; Haft and Zhou, 2021), media sources (Tsai et al., 2020), framing (Dhanani and Franz, 2021)] have been extensively investigated in the literature. Three major points highlight the media's influence on stigma toward Chinese/Asian people: (1) people who use certain types of media (e.g., right-leaning media, and social media) are more likely to stigmatize Chinese/Asian people because biased and fake information is prevalent on these media platforms, (2) Chinese/Asian people who use media more frequently are more likely to perceive stigma toward themselves due to exposure to the biased and negative information in social and traditional media, and (3) the algorithms of media platforms may reinforce biased information and beliefs.

First, according to cultivation theory, right-leaning traditional media outlets politicize COVID-19 and blame China for the pandemic, aggravating the use of stigmatizing words, such as “China virus” and “Wuhan virus” (Tsai et al., 2020). Additionally, due to the lack of supervision of social media, users can freely publish information, resulting in substantial biased and false information spreading rapidly and widely on the Internet (Dhanani and Franz, 2020; Cho et al., 2021). Therefore, when individuals use right-leaning and social media more frequently, they tend to receive more biased and inaccurate information and form prejudicial and stereotypical attitudes, resulting in more stigma toward Chinese/Asian people. For example, one study found that use of traditional media and trust in social media are positively associated with prejudicial attitudes toward Asian people and relying on left-leaning and neutral media is negatively related to prejudicial attitudes toward Asian people (Tsai et al., 2020). Trust in social media also reinforces the effect of social media use on prejudice against Asian people such that frequent users of social media are more likely to have prejudicial attitudes toward Asian people when they have more trust in social media. In addition, how media outlets frame COVID-19 affects users' stigmatizing attitudes. For example, one study conducted an experiment and found that using Chinese framing (vs. neural framing) when describing the origin of COVID-19 significantly contributes to stigmatizing attitudes toward Asian people (Dhanani and Franz, 2021).

Second, Chinese/Asian people who use media more frequently are more likely to be exposed to biased information, which may result in higher perceived stigma toward themselves. For example, one study found that Hubei people who use media more frequently are more likely to report stigma (Duan et al., 2020). One study found that exposure to negative media portrayals of Chinese people mediates the relationship between COVID-19 period (i.e., pre- vs. post-COVID-19) and perceived discrimination among Chinese American college students (Haft and Zhou, 2021). Another study also found that use of social media is positively related to both experiences of everyday discrimination and concerns about future discrimination in a sample of Asians and Asian Americans (Yu et al., 2020).

Third, the algorithms of social media platforms can make individuals receive information they tend to agree with, which would create an echo chamber effect, leading to selective attention and polarization of opinions (Croucher et al., 2020; Ahmed et al., 2021). As such, social media may further worsen the problem of stigma toward Chinese/Asian people. For example, one study found that participants who use Facebook, a social media platform that uses algorithms to create a newsfeed (Bucher, 2017), score significantly higher on prejudice against Asian people (Dhanani and Franz, 2020). To mitigate the echo chamber effect created by algorithms, one study suggested increasing network size and heterogeneity, as they found that large network size and discussion network heterogeneity are negatively related to stereotypes and prejudice against Chinese immigrants (Ahmed et al., 2021).

The COVID-19 situation [e.g., number of infected individuals in a country (He et al., 2020)] has been investigated as an influence on stigma behavior toward Chinese/Asian people because when COVID-19 is more prevalent in a country, people may perceive less health risk and are less likely to engage in stigmatizing behavior (Robinson and Daly, 2021). Indeed, one study found that overseas Chinese people living in countries with more confirmed cases are less likely to experience discrimination and violent overaction (He et al., 2020).

The demographics of (suspected) patients and survivors have been investigated in the literature (Dar et al., 2020; Al-Zamel et al., 2021; Lin et al., 2021; Miconi et al., 2021b; Yuan et al., 2021). The influence of (suspected) patients and survivors' demographics can be interpreted in two main ways: (1) (suspected) patients and survivors whose demographics indicate a lack of resources are more vulnerable (e.g., economic loss) and tend to report higher stigma, and (2) (suspected) patients and survivors with certain demographics (e.g., men) tend to perceive higher stigma because they experienced less stigma before the pandemic and are more sensitive than their counterparts.

First, (suspected) patients and survivors whose demographics indicate a lack of resources (e.g., economic loss) are more vulnerable and more susceptible to the negative influence of stigma. Thus, they may perceive higher stigma. For example, one study found that COVID-19 survivors who have faced higher economic losses perceive higher levels of stigma (Yuan et al., 2021).

Second, (suspected) patients and survivors with certain demographics (e.g., men) had fewer stigmatizing experiences before the pandemic and are more sensitive to stigma toward them, so they tend to report higher stigma perceptions than female (suspected) patients and survivors. Indeed, two studies found that male (suspected) patients and survivors had higher perceived stigma (Dar et al., 2020; Miconi et al., 2021b).

(Suspected) patients and survivors' COVID-19-related cognition impacts their perceived stigma in two ways: (1) (suspected) patients and survivors who blame themselves or perceive being blamed for contracting COVID-19 may anticipate more stigma, which contributes to their stigma perceptions, and (2) (suspected) patients and survivors who are uncertain about their COVID-19 status may feel negative about themselves, contributing to self-stigma.

First, (suspected) patients and survivors who blame themselves or perceive being blamed for contracting COVID-19 may anticipate more stigma toward themselves, resulting in increased stigma perceptions. For example, a qualitative study in Finland showed that one of the drivers of COVID-19 patients' perceived stigma is being blamed for contracting the virus (Lohiniva et al., 2021). In addition, a review paper suggested that self-blame could be an important contributor of stigma perceptions (Ransing et al., 2020).

Second, (suspected) patients and survivors who are uncertain about their COVID-19 status may have negative feelings toward themselves, resulting in self-stigma. For example, one study found that uncertainty about their COVID-19 status and their immunity contributes to suspected and confirmed patients' self-stigma during and even after quarantine (Lohiniva et al., 2021).

(Suspected) patients and survivors' health conditions [e.g., severity of disease (Lin et al., 2021), time since hospital discharge (Dar et al., 2020)] influence their stigma perceptions because their poor health conditions may imply higher risk of transmitting the disease, resulting in more perceived stigma. For example, one study found that compared with patients with mild symptoms, COVID-19 patients whose condition was more severe perceive higher stigma (Lin et al., 2021). In addition, one study found that with increasing time since hospital discharge, survivors' self-reported stigma decreases (Dar et al., 2020). However, another study found that the presence of comorbidities is not related to perceived stigma (Al-Zamel et al., 2021).

(Suspected) patients and survivors' use of coping strategies [e.g., wearing a face mask and other personal protective equipment (Liu Y. et al., 2020; Nursalam et al., 2020), being quarantined (Nursalam et al., 2020; Xin et al., 2020; Jassim et al., 2021)] signals heightened risk of transmitting COVID-19, resulting in more perceived stigma. Specifically, quarantine and mask wearing send a risk signal that people who are quarantined or wear face masks are more likely to carry the virus (Liu Y. et al., 2020; Xin et al., 2020; Jassim et al., 2021). Thus, (suspected) patients and survivors using these coping strategies are more likely to be stigmatized. For example, one study found that being quarantined positively predicts perceived discrimination because of presumed COVID-19 infection (Xin et al., 2020). One study also found that individuals who wear face masks experience more stigma because of suspected COVID-19 status than those who do not (Liu Y. et al., 2020). Furthermore, the study found that mask wearing interacts with working status to predict experienced stigma such that those working outside and wearing masks experience more stigma compared with those who do not wear masks and those who wear masks and work partially or fully from home (Liu Y. et al., 2020).

(Suspected) patients and survivors' social interaction [e.g., social activities (Liu Y. et al., 2020)] influences their stigma perceptions. One paper showed that only passive forms of social activities (e.g., having visitors at one's residence) contributed to perceived stigma toward suspected patients, while more proactive forms of social interaction did not [e.g., going to the grocery store or the pharmacy, and going to a friend's residence (Liu Y. et al., 2020)].

Stigmatizers' demographics have been investigated in the literature (Abuhammad et al., 2021; Cassiani-Miranda et al., 2021; Hossain et al., 2021; Jiang et al., 2021; Li et al., 2021; Singh et al., 2021; Zhang et al., 2021). We identified two aspects highlighting the influence of stigmatizers' demographics: (1) certain demographics of stigmatizers are associated with less stigmatizing attitudes toward (suspected) patients and survivors because they reflect higher knowledge about COVID-19 (e.g., higher education and healthcare occupations vs. general public), and (2) certain demographics of stigmatizers are associated with more stigmatizing attitudes toward (suspected) patients and survivors because they reflect lower resources (e.g., rural vs. urban residence) and higher risk of COVID-19 infection (e.g., regions close to the origin location of COVID-19 and old age).

First, certain demographics of stigmatizers are associated with less stigmatizing attitudes toward (suspected) patients and survivors because they reflect higher knowledge about COVID-19 (e.g., higher education). For example, one study (Cassiani-Miranda et al., 2021) found that HCWs generally hold fewer stigmatizing attitudes toward COVID-19 patients compared with the general population. Another study (Hossain et al., 2021) found that individuals in Bangladesh with lower education backgrounds have higher levels of stigmatizing attitudes toward COVID-19 patients. Studies in Jordan (Abuhammad et al., 2021) and China (Zhang et al., 2021) also support this conclusion.

Second, certain demographics of stigmatizers are associated with more stigmatizing attitudes because they indicate lower resources to cope with COVID-19 (e.g., rural vs. urban residence) and higher COVID-19 risk (e.g., regions close to the origin location of COVID-19). For example, one study (Hossain et al., 2021) found that participants living in the rural and urban [excluding city corporation, i.e., “highly urbanized areas mostly in divisional headquarters” (Hossain et al., 2021, p. 3)] areas of Bangladesh tend to report higher stigmatizing attitudes toward people who tested positive for COVID-19 compared with participants living in city corporation areas. One study (Li et al., 2021) found that living in central China, which is close to the early epicenter of the pandemic, is associated with higher levels of discrimination against COVID-19 survivors. However, the results of age are rather mixed. While age has generally been found to be positively associated with stigma attitudes in studies conducted in China (Jiang et al., 2021; Li et al., 2021; Zhang et al., 2021), a study in Jordan (Abuhammad et al., 2021) found opposite results.

Both stigmatizers' general cognition [e.g., feeling of resource scarcity, and trust in public officials (Chen et al., 2021a)] and COVID-19-related cognition [e.g., perceived risk/harm of COVID-19 (Hossain et al., 2021; Li et al., 2021), and vaccine attitudes (Li et al., 2021)] affect their stigmatizing attitudes toward (suspected) patients and survivors. Stigmatizers' general cognition influences their stigmatizing attitudes because stigmatizers who perceive low sense of control (e.g., feeling of resource scarcity, and low trust in public officials) tend to stigmatize (suspected) patients and survivors to restore their sense of control. COVID-19-related cognition influences stigmatizers' attitudes in two ways: (1) correct knowledge and perceptions about COVID-19 mitigate stigmatizing attitudes, and (2) stigmatizers who attribute more blame to (suspected) patients and survivors are more likely to stigmatize them.

For general cognition, stigmatizers whose cognition reflects a low sense of control (e.g., feeling of resource scarcity, and low trust in public officials) are more likely to stigmatize (suspected) patients and survivors as a way to restore their sense of control. For example, one study found that the feeling of resource scarcity is positively related to stigmatizing attitudes toward suspected patients [e.g., people from major outbreak sites, and people discharged from quarantine sites (Chen et al., 2021a)]. In addition, trust in public officials, which can be seen as a sense of security and control, is negatively associated with stigmatizing attitudes toward suspected patients (Chen et al., 2021a).

For COVID-19-related cognition, first, stigmatizers who have high levels of knowledge and correct perceptions about COVID-19 are less likely to stigmatize (suspected) patients and survivors. For example, one study found that Chinese people with a higher knowledge score about COVID-19 are less likely to hold stigmatizing attitudes toward COVID-19 survivors (Li et al., 2021). Misbeliefs and misconceptions about COVID-19 are generally found to contribute to stigmatizing attitudes (Ransing et al., 2020; Hossain et al., 2021; Zhang et al., 2021). One study found that the perceived magnitude of risk of COVID-19 is positively related to stigmatizing attitudes toward COVID-19 patients (Hossain et al., 2021). A study on vaccination and stigmatization found that both vaccine effectiveness and vaccination intention reduce stigmatizing attitudes (Li et al., 2021).

Second, stigmatizers who attribute more blame to (suspected) patients and survivors are more likely to stigmatize them. For example, one study found that Chinese people who attribute more personal responsibility to COVID-19 patients are more likely to adopt stigmatizing attitudes toward them (Zhang et al., 2021). In addition, a qualitative study suggests that blaming others for contracting the COVID-19 virus contributes to stigmatizing attitudes and behavior toward patients (Ransing et al., 2020).

Stigmatizers' COVID-19-related emotions [e.g., fear (Ransing et al., 2020; Sorokin et al., 2020; Cassiani-Miranda et al., 2021; Chen et al., 2021a; Gopichandran and Subramaniam, 2021; Haddad et al., 2021; Zhang et al., 2021), and anxiety (Haddad et al., 2021)] influence their stigmatizing attitudes because stigmatization is used as a coping mechanism for negative emotions arising from the pandemic.

COVID-19 induces a lot of negative emotions (e.g., fear, anxiety, and anger), and individuals use stigmatization as a coping strategy to deal with these negative emotions (Chen et al., 2021b). For example, research has generally found that fear is positively associated with stigmatizing attitudes toward (suspected) patients and survivors (Sorokin et al., 2020; Cassiani-Miranda et al., 2021; Chen et al., 2021a; Gopichandran and Subramaniam, 2021; Haddad et al., 2021; Zhang et al., 2021). One study also found that feeling dangerous and angry toward COVID-19 patients is positively related to stigmatizing attitudes toward them (Zhang et al., 2021). However, another study found that other emotions (e.g., worry and optimism) are not related to stigmatization against suspected patients (Chen et al., 2021a).

Stigmatizers' health may influence stigma because people in poor health may be more prone to be affected with COVID-19 (Chen N. et al., 2020) and may be more likely to stigmatize (suspected) patients and survivors. However, empirical studies did not find a significant relationship between stigmatizers' health and stigma. Specifically, one study found that self-rated health is not related to discrimination (Li et al., 2021). Another study also found that stigmatizers' own COVID-19 status is not related to stigmatizing attitudes toward COVID-19 patients (Hossain et al., 2021).

Stigmatizers' social interaction with (suspected) patients and survivors [e.g., infections of relatives and friends (Li et al., 2021), and direct or indirect contact with a (suspected) COVID-19 patient/survivor (Haddad et al., 2021)] influence their stigmatizing attitudes in two ways: (1) for stigmatizers who must interact with (suspected) patients and survivors (e.g., frontline workers), social interaction with the stigmatized group (e.g., serving patients) reduces their stigmatizing attitudes because they change their attitudes to resolve cognitive dissonance, and (2) social interaction with (suspected) patients and survivors reduces stigmatizing attitudes because stigmatizers gain more knowledge about COVID-19 and perceive less risk of the disease by interacting with the stigmatized group.

First, stigmatizers who must interact with (suspected) patients and survivors (e.g., frontline workers) may change their stigmatizing attitudes to resolve cognitive dissonance (Chen et al., 2021a). For example, one study found that the epidemic proximity of one's role, ranging from peripheral (e.g., general public) to intermediate (e.g., family members of COVID-19 patients) to center (e.g., HCWs, police), negatively predicts stigmatization and discrimination toward suspected patients (Chen et al., 2021a). A web-based cross-sectional study among HCWs also found that having served COVID-19 patients positively predicts acceptance of COVID-19 patients and negatively predicts fear of COVID-19 patients—two dimensions of stigma toward COVID-19 patients (Singh et al., 2021).

Second, having contact with (suspected) patients and survivors can increase stigmatizers' knowledge and correct perceptions of COVD-19, leading to decreased stigmatizing attitudes. For example, one study found that a history of COVID-19 in one's family and direct contact with a (suspected) COVID-19 patient/survivor are negatively related to stigmatizing attitudes toward patients (Haddad et al., 2021). However, one study found that knowing COVID-19 patients within their immediate social environment is not related to stigmatizing attitudes toward COVID-19 patients (Hossain et al., 2021). Another study also found that relatives' and friends' infections are not related to discrimination against COVID-19 survivors (Li et al., 2021).

Media factors [e.g., (social) media use (Liu Y. et al., 2020; Yu et al., 2020), lack of public health information (Nursalam et al., 2020), and fake news (Sahoo and Patel, 2021)] can influence stigma toward (suspected) patients and survivors in two ways: (1) low-quality and poorly regulated messages in the media (e.g., misinformation, and irresponsible reporting) may create misconceptions about COVID-19, aggravating stigma toward (suspected) patients and survivors, and (2) (suspected) patients and survivors' frequent use of media may increase their stigma perceptions due to exposure to misinformation and stigmatizing messages in the media.

First, low-quality and poorly regulated messages (e.g., misinformation, and irresponsible reporting) contribute to stigma toward (suspected) patients and survivors by creating misconceptions about COVID-19. One qualitative study (Gopichandran and Subramaniam, 2021) and one review (Nursalam et al., 2020) showed that lack of COVID-19 information in the media creates fear and uncertainty, which aggravate stigma toward (suspected) patients and survivors. Misinformation and fake news in the media also create misconceptions about COVID-19, which also contribute to stigma toward (suspected) patients and survivors (Ransing et al., 2020; Gopichandran and Subramaniam, 2021; Sahoo and Patel, 2021). In addition, a qualitative study showed that patients tend to blame irresponsible media reporting (e.g., disclosure of personal information, and false allegation) as the main driver of stigma toward them (Jayakody et al., 2021).

Second, (suspected) patients and survivors' frequent social media use may be associated with increased perceived stigma due to increased exposure to misinformation and stigmatizing messages in the media. One study found that residents who spend more than 2 h per day on average on social media report higher levels of stigma experiences because of their suspected COVID-19 status compared with residents who use social media less often (Liu Y. et al., 2020). However, another study did not find a significant relationship between social media use and perceived stigma from COVID-19 (Yuan et al., 2021).

Policy-related factors [e.g., involvement of police (Gopichandran and Subramaniam, 2021), different and conflicting information about COVID-19 and quarantine procedures (Lohiniva et al., 2021)] influence stigma toward (suspected) patients and survivors. The influence of policy-related factors can be understood in two ways: (1) conflicting and inconsistent COVID-19 policies may create uncertainty for (suspected) patients and survivors of their health risks, resulting in higher self-stigma, and (2) inappropriate implementation of health policies may aggravate negative perceptions of COVID-19, which leads (suspect) patients to perceive more stigma.

First, conflicting and inconsistent COVID-19 policies increase (suspected) patients' and survivors' uncertainty about their health risks, leading to self-stigma (Lohiniva et al., 2021). For example, one study found that different and conflicting information about quarantine procedures positively predicts (suspected) patients' self-stigma during quarantine and isolation (Lohiniva et al., 2021).

Second, inappropriate implementation of health policies may aggravate negative perceptions of (suspected) patients and survivors, resulting in more stigma perceptions in these individuals. For example, a qualitative study showed that police involvement in the enforcement of COVID-19 health policies “made people associate COVID-19 with crime” (Gopichandran and Subramaniam, 2021, p. 196), leading to more stigma perceptions. In addition, forced isolation policies also contribute to stigma perceptions among (suspected) patients and survivors (Gopichandran and Subramaniam, 2021).

The COVID-19 situation (i.e., number of confirmed COVID-19 cases in a province) influences stigmatizing attitudes toward (suspected) patients and survivors. One study found that living in a province with more confirmed cases is associated with more stigma toward (suspected) COVID-19 patients and survivors probably because having more confirmed cases heightens infection risk, especially in China, where most provinces are categorized as low to medium risk (Jiang et al., 2021).

HCWs' demographics (Yadav et al., 2020; Zandifar et al., 2020; Adhikari et al., 2021; Radhakrishnan et al., 2021; Uvais et al., 2021; Khan et al., 2022) have been investigated in the literature. The main logic is that HCWs' demographics that reflect higher health risks (e.g., staying at the hospital) are associated with increased perceived stigma. For example, one study (Yadav et al., 2020) found that HCWs who stay in a hostel or accommodations provided by a hospital report higher perceived stigma than those who stay at home. Another study (Adhikari et al., 2021) found that HCWs living with the elderly, who are more prone to infection (Mueller et al., 2020), report higher perceived stigma. However, two studies found no difference in perceived stigma between living with family or not (Radhakrishnan et al., 2021; Uvais et al., 2021).

It is noteworthy that though some scholars suggest that female HCWs may be more vulnerable to stressful environments and more prone to feeling stigmatized (Zandifar et al., 2020), other studies found a null association between gender and perceived stigma (Yadav et al., 2020; Adhikari et al., 2021; Radhakrishnan et al., 2021; Uvais et al., 2021; Khan et al., 2022).

HCWs' work characteristics [e.g., frontline worker (Adhikari et al., 2021; Khan et al., 2022), and work area (Radhakrishnan et al., 2021)] have been investigated in the literature. HCWs' work characteristics that indicate high risk of infection (e.g., frontline HCWs, and clinical vs. non-clinical areas) are associated with higher perceived stigma. For example, two studies found that HCWs working on the front lines report higher perceived stigma (Zandifar et al., 2020; Adhikari et al., 2021). Another study found that HCWs who work in clinical areas (vs. non-clinical areas) report more perceived stigma (Radhakrishnan et al., 2021). Designations reflecting potential contact with the COVID-19 virus, such as resident doctors (vs. faculty/medical officers, Yadav et al., 2020) and surgical department (vs. medicine and critical care, Yadav et al., 2020), have been found to be associated with higher levels of perceived stigma. However, one study found that HCWs working in high-risk vs. low-risk areas do not differ in perceived stigma (Yadav et al., 2020). Moreover, the findings on occupations are rather mixed. For example, one study found that compared with doctors, nurses are more likely to experience stigma (Radhakrishnan et al., 2021), while another found opposite results (Zandifar et al., 2020).

HCWs' health conditions [e.g., being diagnosed with COVID-19 (Adhikari et al., 2021)] can influence perceived stigma because poor health may increase HCWs' fear of infection and anticipated stigma. One study found that only being diagnosed with COVID-19, rather than other health conditions (e.g., being admitted to the hospital due to COVID-19, and chronic diseases), is positively related to perceived stigma among HCWs (Adhikari et al., 2021).

HCWs' use of coping strategies [e.g., precautionary measures (Adhikari et al., 2021), and quarantine (Uvais et al., 2021; Khan et al., 2022)] influence perceived stigma for two reasons: (1) HCWs who take sufficient precautionary measures may feel safer and less concerned about potential stigma from patients, leading to decreased perceived stigma, and (2) HCWs who are quarantined may perceive themselves as being at high risk of transmitting the disease, resulting in more perceived stigma.

First, sufficient precautionary measures may decrease HCWs' concerns about and fear of infection and stigma from patients, leading to decreased perceived stigma. For example, one study found that HCWs who believe the precautionary measures they are taking are sufficient (vs. insufficient) tend to perceive less stigma (Adhikari et al., 2021).

Second, quarantine signals health risks, which may make HCWs perceive more stigma toward themselves. For example, one study found that being in quarantine is positively related to perceived stigma among physicians in Bangladesh (Khan et al., 2022). However, another study found that a history of quarantine is not related to doctors' perceived stigma (Uvais et al., 2021).

Stigmatizers' demographics have been examined in the literature (Cassiani-Miranda et al., 2021). Stigmatizers' demographics that indicate higher knowledge of COVID-19 (e.g., HCW occupation vs. general public) are associated with less stigmatizing attitudes. Indeed, one study found that compared with HCWs, individuals in the general population are more likely to adopt stigmatizing attitudes toward HCWs (Cassiani-Miranda et al., 2021).

Stigmatizers' cognition, both general and COVID-19 related, affects stigmatizing attitudes and behavior. Specifically, general cognition that reflects a low sense of control (e.g., feeling of resource scarcity, and low trust in public officials, Chen et al., 2021a) is positively related to stigma toward HCWs as some individuals use stigmatization as a coping mechanism to restore their sense of control. COVID-19-related cognition that reflects dehumanization (e.g., objectification of people returning from Hubei, Chen et al., 2021a) is associated with indifference and instrumental orientation toward affected people, which contributes to stigma toward HCWs.

For general cognition, stigmatizers whose cognition reflects a low sense of control are more likely to stigmatize HCWs as a way to restore their sense of control. For example, one study found that the feeling of resource scarcity and the need to belong are positively related to stigmatization and discrimination toward HCWs (Chen et al., 2021a). At the same time, trust in health experts, but not trust in public officials or the general public, is negatively associated with stigmatization and discrimination toward HCWs.

For COVID-19-related cognition, stigmatizers' objectification cognition denies individuals' humanity and leads to perceptions of people as “possible sources of infection” (Chen et al., 2021a, p 8), which contributes to stigma toward HCWs. Indeed, one study found that the objectification of people returning to Hubei is a powerful predictor for stigmatization and discrimination toward HCWs (Chen et al., 2021a).

Research on stigmatizers' emotions has focused on COVID-19-related emotions, such as fear (Taylor et al., 2020; Cassiani-Miranda et al., 2021; Chen et al., 2021a) and stress (Taylor et al., 2020) toward COVID-19. These emotions affect stigma because stigmatization is used as a coping mechanism for negative emotions arising from the pandemic. For example, research has found that fear (Taylor et al., 2020; Cassiani-Miranda et al., 2021; Chen et al., 2021a) and stress (Taylor et al., 2020) toward COVID-19 are positively associated with stigma toward HCWs. However, other studies did not find a significant relationship between other emotions (e.g., optimism, Chen et al., 2021a) and stigma¹.

Empirical studies have investigated the influence of stigma on Chinese/Asian people's mental health, such as depression, anxiety, and mental disorders. Stigma negatively influences Chinese/Asian people's mental health because stigma communicates hostility and diminishes the value of stigmatized groups, which threatens their sense of identity, control, and self-worth. Indeed, findings generally show that stigma toward Chinese/Asian people is associated with depression (Cheah et al., 2020; Litam and Oh, 2020, 2021; Hahm et al., 2021a,b; Lee and Waters, 2021), anxiety (Cheah et al., 2020; Yang and Wong, 2020; Adhikari et al., 2021; Chen X. et al., 2021; Haft and Zhou, 2021; Hahm et al., 2021a,b; Lee and Waters, 2021), fear (Hahm et al., 2021b), mental disorders (Wu C. et al., 2021), psychological distress (Chen et al., 2021b; Fan et al., 2021; Maglalang et al., 2021), anger (Chen X. et al., 2021), grief (Chen X. et al., 2021), internalizing and externalizing problems (Cheah et al., 2020), post-traumatic stress disorder (PTSD) (Hahm et al., 2021a), and decreased psychological well-being (Cheah et al., 2020), life satisfaction (Litam and Oh, 2020, 2021), and self-esteem (Alsawalqa, 2021). For example, one study found that COVID-19-related racial discrimination, especially the in-person direct form, is negatively associated with multiple adverse mental health indices for both Chinese American parents and youth, such as depressive symptoms, anxiety symptoms, and poor psychological wellbeing (Cheah et al., 2020).

Research found that stigma affects Chinese/Asian people's physical health (e.g., sleep difficulties and self-rated health) because poor mental health resulting from stigma perceptions may further negatively impact their physical health. Indeed, one study found that racial discrimination during the COVID-19 pandemic is positively related to sleep difficulties and physical symptoms (e.g., headaches) in a sample of Asians and Asian Americans (Lee and Waters, 2021). They further found that social support buffers against the negative impact of discrimination on physical symptoms but not on sleep difficulties.

Studies have found that perceived stigma affects Chinese/Asian people's social activities and social life (e.g., avoidance of social activities). Two mechanisms explain the social impacts of perceived stigma on Chinese/Asian people: (1) Chinese/Asian people who perceive higher stigma tend to avoid in-person social interaction and prefer interacting in virtual spaces because their stigmatized identity is more salient offline, and (2) Chinese/Asian people who perceive stigma tend to engage in altruistic behavior to improve their group's image.

First, Chinese/Asian people who perceive higher stigma tend to avoid in-person social interaction but not online interaction because they fear disclosing their stigmatized identity in real life. For example, a qualitative study showed that one of the outcomes of COVID-19-related anti-Asian discrimination is avoidance (Hahm et al., 2021b). One study found that perceived discrimination since the COVID-19 outbreak is negatively related to interacting with friends, indicating withdrawal from social activities (Chen et al., 2021b). In addition, another study found that experiencing discrimination is positively related to social media use, including posting, commenting, browsing, and private messaging (Yang et al., 2020).

Second, Chinese/Asian people who perceive higher stigma tend to engage in altruistic behavior to improve their group's image. For example, one study found that perceived stigma is positively related to altruistic tendencies through emotional mechanism (e.g., grief) in a Chinese sample (Chen X. et al., 2021).

The influence of stigma on (suspected) patients' and survivors' mental health (e.g., depression, feelings of loneliness, and wellbeing) has received much research attention. Stigma negatively affects (suspected) patients' and survivors' mental health because the stigmatized perceive themselves as alienated, isolated, and belonging to a devalued group and perceive stigma as unfair. Indeed, empirical findings generally show that stigma harms (suspected) patients' and survivors' mental health and leads to issues like depression (Liu D. et al., 2020; Xin et al., 2020; Grover et al., 2021; Harjana et al., 2021; Jayakody et al., 2021; Kang et al., 2021; Yuan et al., 2021), anxiety (Liu D. et al., 2020; Atinga et al., 2021; Gopichandran and Subramaniam, 2021; Grover et al., 2021; Harjana et al., 2021; Jayakody et al., 2021; Kang et al., 2021), mental health disorders (Adom et al., 2021; Miconi et al., 2021a; Paleari et al., 2021), lower well-being (Ransing et al., 2020; Al Eid et al., 2021; Paleari et al., 2021; Sahoo and Patel, 2021), PTSD (Liu D. et al., 2020; Grover et al., 2021; Kang et al., 2021; Mahmoudi et al., 2021; Poyraz et al., 2021; Gan et al., 2022), and even self-harm or suicide (Ransing et al., 2020; Xin et al., 2020; Sahoo and Patel, 2021). For example, in a large sample involving more than 20,000 Chinese students, one study found that perceived discrimination due to COVID-19 is positively related to self-harm or suicidal ideation (Xin et al., 2020).

Stigma toward (suspected) patients and survivors also harms their physical health (Earnshaw et al., 2020; Ransing et al., 2020; Atinga et al., 2021; Bhanot et al., 2021; Lohiniva et al., 2021; Mahmoudi et al., 2021; Poyraz et al., 2021). The influence of stigma toward (suspected) patients and survivors on their physical health can be understood in two ways: (1) (suspected) patients and survivors' poor mental health resulting from perceived stigma further deteriorates their physical health conditions, and (2) (suspected) patients and survivors try to avoid stigma by concealing COVID-19-related symptoms and delaying treatment, which threatens one's own physical health.

First, (suspected) patients and survivors' poor mental health resulting from perceived stigma negatively impacts their physical health conditions. For example, one study found that self-stigma is associated with insomnia and poor physical quality of life via poor mental health (Mahmoudi et al., 2021). A qualitative study also documented various adverse physical health consequences for patients who have experienced stigma, such as delays in recovery, insomnia, and eating disorders (Atinga et al., 2021).

Second, (suspected) patients and survivors try to avoid stigma by concealing COVID-19-related symptoms and delaying treatment, which threatens one's own physical health. For example, one study found that stigma toward COVID-19 patients—both anticipated stigma and stereotypes—is negatively related to COVID-19 testing because people want to avoid being labeled as having the stigmatized disease (Earnshaw et al., 2020). Another study showed that one of the outcomes of perceived stigma among patients is reluctance to disclose their COVID-19 status (Lohiniva et al., 2021). Moreover, delayed testing and concealment of symptoms could hinder progress toward controlling COVID-19 and thereby threaten public health (Bhanot et al., 2021; Lohiniva et al., 2021).

Stigma toward (suspected) patients and survivors negatively affects their social interaction (Atinga et al., 2021; Lohiniva et al., 2021) because they worry about and fear being stigmatized when disclosing their COVID-19 status during interactions. For example, one study interviewed COVID-19 patients and found that social withdrawal is a common consequence of experiencing stigma (Atinga et al., 2021).

Stigma toward (suspected) patients and survivors may negatively affect their work outcomes via lowering work motivation and engagement (Ransing et al., 2020). Stigma toward (suspected) patients and survivors may aggravate poverty and social inequality because the stigmatized may suffer from unemployment (Ransing et al., 2020).

Stigma may have two-sided effects on (suspected) patients' and survivors' coping strategies: (1) (suspected) patients and survivors increase their compliance with health guidelines because they hope to eliminate the risk of transmitting COVID-19 and end their stigmatization; (2) they may reduce their use of coping strategies to avoid being identified and stigmatized. For example, a qualitative study found that increased compliance with health guidelines is a strategy used by (suspected) patients to avoid stigma (Lohiniva et al., 2021). However, a review paper discussed that due to fear of being stigmatized, (suspected) patients may avoid using coping strategies, such as self-isolation (Saeed et al., 2020).

Empirical findings generally show that stigma toward HCWs harms their mental health [e.g., depression (Elhadi et al., 2020; Khanal et al., 2020; Teksin et al., 2020; Campo-Arias et al., 2021; Greene et al., 2021; Kirk et al., 2021), anxiety (Elhadi et al., 2020; Khanal et al., 2020; Teksin et al., 2020; Campo-Arias et al., 2021; Greene et al., 2021; Kirk et al., 2021), burnout (Patel et al., 2021; Shiu et al., 2022), and suicide risk (Campo-Arias et al., 2021)]. The negative impacts of stigma on HCWs may be due to compromised work meaningfulness and diminished self-esteem and self-worth. For example, one study found that perceived stigma is significantly associated with anxiety, depression, and PTSD (Teksin et al., 2020). Two other studies also showed that perceived stigma is positively related to burnout among HCWs (Patel et al., 2021; Shiu et al., 2022).

The negative influence of stigma on HCWs' mental health may further affect their physical health (Khanal et al., 2020; Teksin et al., 2020). For example, one study found that experienced stigma is positively related to insomnia among HCWs (Khanal et al., 2020).

Stigma toward HCWs may increase their turnover intention as a way to avoid the stigmatized identity. For example, in a sample of frontline nurses, one study found that perceived COVID-19-associated discrimination is positively related to turnover intention (Labrague et al., 2021).

Stigma affects HCWs' coping strategies because they may increase the use of maladaptive coping strategies to manage the negative influence of stigma. A qualitative study found that increased alcohol use was one response to being stigmatized (Zolnikov and Furio, 2020).