The influence of experiences of stigma on recovery: Mediating roles of internalized stigma, self-esteem, and self-efficacy.

Abstract

Objective: Experiencing stigmatization regarding mental illness has harmful effects on recovery from serious mental illness (SMI). Stigma experiences can also lead to internalized stigma, the cognitive and emotional internalization of negative stereotypes, and application of those stereotypes to one's self. Internalized stigma may lead to additional harms, including decrements in self-esteem and self-efficacy. Therefore, this study examined the effects of stigmatization experiences on recovery-related outcomes through internalized stigma, self-esteem, and self-efficacy in a single comprehensive model. Methods: Adults with SMI (n ϭ 516) completed standardized measures assessing the variables of interest during baseline assessments for 2 randomized controlled trials. In a secondary analysis of the trial data, separate serial mediation models were tested for recovery orientation, perceived quality of life, and social withdrawal as outcomes, with experiences of stigma as the predictor variable and internalized stigma, self-esteem, and self-efficacy as serial mediators in that order. Alternate order and parallel mediation models were also tested to evaluate directionality. Results: The serial mediation model was the best fit, although self-efficacy was not found to be a critical mediator. Experiences of stigma led to internalized stigma, which influenced self-esteem and recovery-related outcomes, consistent with the socialcognitive model of internalized stigma. Conclusion: This indicates that internalized stigma is an essential target for reducing the negative impact of stigmatization on recovery. Impact and ImplicationsThis study found that how much one has internalized stigma about mental illness influences how exposure to societal stigma harms recovery among adults with serious mental illnesses. Therefore,

“We’re All in the Same Boat” – The Experience of People With Mental Health Conditions and Non-clinical Community Members in Integrated Arts-Based Groups

“…Some of the participants described the final performance as “a moving from the darkness into the light” and referred to the empowering experience of “being seen” or the “performance of the self” which validates one’s existence ( Ansdell, 2010 ). The sense of being transparent causes people with MHCs to hide from society ( Corrigan et al, 2016 ; Jahn et al, 2020 ), thus the experience of “being seen and being heard” was a particularly empowering experience for the participants with MHCs. The final performance was an opportunity to reveal themselves to their family, friends, and community, to share the healthy parts, their abilities, vitality, and creativity.…”

“…Public stigma is characterized by negative attitudes toward people with MHCs, including stereotypes, prejudices and discrimination ( Corrigan, 2000 ), and may lead to low willingness to engage in social, occupational, familial, or intimate relationships with people with MHCs ( Corrigan et al, 2003 ). The internalization of such negative attitudes by people with MHCs is termed self-stigma or internalized stigma ( Corrigan et al, 2016 ), which is associated with a decline in hope, self-esteem, social functioning, self-efficacy ( Mittal et al, 2012 ; Boyd et al, 2014 ; Yanos et al, 2015 ; Jahn et al, 2020 ), and less recovery motivation ( Drapalski et al, 2013 ; Link et al, 2015 ). The recovery-oriented approach reflects the transition from a medical model of isolation to a social model of integration ( Jacob, 2015 ), places the person at the center rather than the illness, perceives people with MHCs holistically and focuses on their integration in the community by improving their quality of life, sense of control, independence, meaning and hope ( Slade et al, 2012 ; Davidson, 2016 ).…”

The Role of Stigma in the Nursing Care of Families Impacted by Neonatal Abstinence Syndrome

“… 16 Furthermore, the extent to which individuals identify with the stereotype may determine the degree to which their self-esteem is impacted (ie, increased identification with a stereotype is related to lower self-esteem). 17 …”

Measuring the paradox of self-stigma: psychometric properties of a brief scale

“…Both "apply" and "harm" stages belong to the behavioral level. Corrigan's social-cognitive model of internalized stigma is currently viewed as the prevailing model [6][7][8] that describes this process. Internalized stigma therefore starts with the awareness of stereotypes associated with one's condition, followed by agreement with the stereotypes, and the ultimate adoption of the stereotypes on oneself, resulting in lowered self-esteem and self-discrimination [6].…”