A stress-coping model of mental illness stigma: I. Predictors of cognitive stress appraisal

Abstract

Stigma can be a major stressor for individuals with schizophrenia and other mental illnesses. It is unclear, however, why some stigmatized individuals appraise stigma as more stressful, while others feel they can cope with the potential harm posed by public prejudice. We tested the hypothesis that the level of perceived public stigma and personal factors such as rejection sensitivity, perceived legitimacy of discrimination and ingroup perceptions (group value; group identification; entitativity, or the perception of the ingroup of people with mental illness as a coherent unit) predict the cognitive appraisal of stigma as a stressor. Stigma stress appraisal refers to perceived stigma-related harm exceeding perceived coping resources. Stress appraisal, stress predictors and social cue recognition were assessed in 85 people with schizophrenia, schizoaffective or affective disorders. Stress appraisal did not differ between diagnostic subgroups, but was positively correlated with rejection sensitivity. Higher levels of perceived societal stigma and holding the group of people with mental illness in low regard (low group value) independently predicted high stigma stress appraisal. These predictors remained significant after controlling for social cognitive deficits, depressive symptoms and diagnosis. Our findings support the model that public and personal factors predict stigma stress appraisal among people with mental illness, independent of diagnosis and clinical symptoms. Interventions that aim to reduce the impact of stigma on people with mental illness could focus on variables such as rejection sensitivity, a personal vulnerability factor, low group value and the cognitive appraisal of stigma as a stressor.

What is the Lived Experience of Being Discharged From a Psychiatric Inpatient Stay?

“…A study by Rüsch et al (2009a) provides some support for these hypotheses. They reported stress appraisal was positively correlated with rejection sensitivity.…”

“…Associating with 'the own' (people who are similarly stigmatised) can be a comfort, being around people who are accepting and have shared experiences (Knight, et al, 2003). Group identification has been linked to more perceived coping resources (Rüsch, et al, 2009a). Unfortunately, this study did not use measures that identified what these were.…”

“…Based on Major and O'Brien's identity threat model (2005), greater perceived public stigma has been found to predict the appraisal of stigma as more stressful (Rüsch, et al, 2009a). Rüsch et al reported that higher levels of rejection sensitivity and low perceived legitimacy of discrimination (perceiving the stigma as unfair), were associated with perceiving stigma as more harmful.…”

Neural processing of social rejection: The role of schizotypal personality traits

“…Across various psychiatric disorders, greater RS is associated with greater perceived social stress and fewer perceived coping resources (Rusch et al, 2009). …”

Cross-validation of bimodal health-related stress assessment

“…It may, for instance, result in depression or post-traumatic stress disorder (PTSD) [2]. To make things even worse, such stressrelated disorders stigmatize the people suffering from them, which in itself is an additional stressor [42,43].…”