Objective-The mechanisms by which internalized stigma affects outcomes related to recovery among people with severe mental illness have yet to be explicitly studied. This study empirically evaluated a model for how internalized stigma affects important outcomes related to recovery.Methods-A total of 102 persons with schizophrenia spectrum disorders completed measures of internalized stigma, awareness of mental illness, psychiatric symptoms, self-esteem, hopefulness, and coping. Path analyses tested a predicted model and an alternative model for the relationships between the variables.Results-Results from model 1 supported the view that internalized stigma increases avoidant coping, active social avoidance, and depressive symptoms and that these relationships are mediated by the impact of internalized stigma on hope and self-esteem. Results from model 2 replicated significant relationships from model 1 but also supported the hypothesis that positive symptoms may influence hope and self-esteem.Conclusions-Findings from two models supported the hypothesis that internalized stigma affects hope and self-esteem, leading to negative outcomes related to recovery. It is recommended that interventions be developed and tested to address the important effects of internalized stigma on recovery.Research has increasingly revealed that outcomes for persons with severe mental illness encompass a wide range of possibilities and challenges. As noted by several authors (1)(2)(3), what is referred to as recovery involves nonlinear changes across several semi-independent domains. Recovery can be manifested in more externally evident and objectively measured changes such as symptoms, frequency of socialization, and employment (2), as well in terms of more internally experienced and subjectively measured domains such as perceived quality of life and sense of purpose in life (3). The personal experience of mental illness and the potential transformation of identity that often accompanies this experience has been identified as a potential facilitator or inhibitor of recovery among people with severe mental illness (4), and there is evidence that transforming identity is an important part of the process of improving both subjective and objective outcomes in this population (5,6). A type of identity transformation that may affect many people with severe mental illness is the internalization of stereotypic or stigmatizing views (7-11). The state in which a person with severe mental illness loses previously held or hoped for identities (self as student, self as worker, self as parent, and so on) and adopts stigmatizing views (self as dangerous, self as incompetent, and so on) is typically referred to as "internalized stigma." As an illustration, a person with a college degree and prior aspirations to become a math teacher might conclude that he or she could never achieve this goal if he or she believes that the diagnosis of mental illness means that one is unpredictable and not to be trusted. Internalized stigma has been found to be...

Objective The mechanisms by which internalized stigma affects outcomes related to recovery among people with severe mental illness have yet to be explicitly studied. This study empirically evaluated a model for how internalized stigma affects important outcomes related to recovery. Methods A total of 102 persons with schizophrenia spectrum disorders completed measures of internalized stigma, awareness of mental illness, psychiatric symptoms, self-esteem, hopefulness, and coping. Path analyses tested a predicted model and an alternative model for the relationships between the variables. Results Results from model 1 supported the view that internalized stigma increases avoidant coping, active social avoidance, and depressive symptoms and that these relationships are mediated by the impact of internalized stigma on hope and self-esteem. Results from model 2 replicated significant relationships from model 1 but also supported the hypothesis that positive symptoms may influence hope and self-esteem. Conclusions Findings from two models supported the hypothesis that internalized stigma affects hope and self-esteem, leading to negative outcomes related to recovery. It is recommended that interventions be developed and tested to address the important effects of internalized stigma on recovery.

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