Visible and concealable stigmatized identities and mental health: Experiences of racial discrimination and anticipated stigma.

Abstract

Experiencing and anticipating discrimination because one possesses a visible (e.g., race) or concealable (e.g., mental illness) stigmatized identity has been related to increased psychological distress. However, little research has examined whether experiencing and anticipating discrimination related to possessing both a visible and concealable stigmatized identity (e.g., a racial/ethnic minority with a history of mental illness) impacts mental health. In the current study, we test 2 hypotheses. In the first, we examine whether experienced discrimination due to a visible stigma (race/ethnicity) and anticipating stigma due to a concealable stigma (e.g., substance abuse) each predict unique variance in depressive symptomatology. In the second, we examine whether experienced discrimination due to a visible stigma is related to greater anticipated stigma for a concealable stigma, which in turn is related to more depression. A total of 265 African American and Latinx adults who reported concealing a stigmatized identity at least some of the time completed measures of racial/ethnic discrimination, anticipated stigma of a concealable stigmatized identity, and depressive symptomatology. Results of a simultaneous linear regression revealed that increased racial/ethnic discrimination and anticipated stigma independently predicted greater depressive symptomatology (controlling for each other). A mediation analysis showed that the positive association between increased racial/ethnic discrimination and higher depressive symptomatology was partially mediated by greater anticipated stigma. These results demonstrate that a person can experience increased psychological distress from multiple types of stigma separately but also may anticipate greater stigma based on previous experiences of racial discrimination, which in turn relates to increased distress.

Systematic Review of Cultural Aspects of Stigma and Mental Illness among Racial and Ethnic Minority Groups in the United States: Implications for Interventions

“…Fear was ubiquitous including of being perceived as “weak,” “crazy,” or “dangerous” (Carpenter‐Song et al., 2014; Haynes et al., 2017; Johnson et al., 2009), and of the “double” discrimination of being Black and having a mental illness, particularly among women (Alang, 2019). In a quantitative study, experiencing stigma for being Black or Latinx led to more anticipated stigma for having a mental illness (Quinn et al., 2019). Black adolescents expressed shame about needing medications (Kranke et al., 2012) and using mental health services, although the latter was moderated by social support (Lindsey et al., 2010).…”

A process model of having and keeping secrets.

“…If an individual expects the other person to respond poorly to an admission, confiding in them should be less likely. For instance, prior episodes of devaluation will prompt expectancies of future devaluation (e.g., Mendoza-Denton et al, 2002; Quinn et al, 2019). Accordingly, prior experiences of being stigmatized will likely inform whether a secret is kept entirely to oneself or selectively confided.…”

Substance use, racial/ethnic identity, and suicidal ideation during COVID-19 lockdown in an international adult sample

“…Nevertheless, our results are consistent with other recent investigations using US and UK samples ( Bray et al, 2021 ; Czeisler et al, 2020 ; Fitzpatrick et al, 2020 ; Proto and Quintana-Domeque, 2021 ) which have documented disparities in psychological distress and suicidality among Black and other racial/ethnic groups compared to their White peers. Numerous studies have demonstrated that factors such as overt racial discrimination and racial microaggressions ( Paradies et al, 2015 ; Quinn et al, 2020 ; Rosario-Williams et al, 2022 ; Shi et al, 2022 ), socioeconomic inequalities ( Lo and Cheng, 2018 ; Williams, 2018 ), and medical mistrust ( Hammond, 2010 ; Powell et al, 2019 ) have contributed significantly to greater risks of suicidality, particularly among racial/ethnic minority groups in the United States. The substantially greater relative risk of suicidality among racial/ethnic minorities highlights the critical need of culturally responsive suicide prevention services for this population, particularly given that disparities in mental health by race/ethnicity in the United States have been demonstrated in the emerging COVID-19 literature.…”