How does psychiatric diagnosis affect young people's self-concept and social identity? A systematic review and synthesis of the qualitative literature

Abstract

Receiving a psychiatric diagnosis in childhood or adolescence can have numerous social, emotional and practical repercussions. Among the most important of these are the implications for a young person's self-concept and social identity. To ensure diagnoses are communicated and managed in a way that optimally benefits mental health trajectories, understanding young people's first-hand experience of living with a diagnosis is paramount. This systematic review collates, evaluates and synthesises the qualitative research that has explored how psychiatric diagnosis interacts with young people's self-concept and social identity. A search of 10 electronic databases identified 3892 citations, 38 of which met inclusion criteria. The 38 studies were generally evaluated as moderate-to-high quality research. Thematic synthesis of their findings highlighted the multifaceted ways diagnosis affects young people's self-concept and social identity. Diagnosis can sometimes threaten and devalue young people's self-concept, but can also facilitate self-understanding, self-legitimation and self-enhancement. A diagnosis can lead to social alienation, invalidation and stigmatisation, yet can also promote social identification and acceptance. Further research is needed to clarify which self and identity outcomes can be expected in a given set of circumstances, and to establish how self and identity effects interact with diagnoses' other clinical, practical, social and emotional consequences.

Characteristics of mental health recovery narratives: Systematic review and narrative synthesis

“…However, dismissing narratives of ‘Recovery within the system’, or any particular type of narrative, risks creating new “dominant recovery narratives” ([14], p.26) and dismissing the equally valid experiences of those for whom interaction with the mental health system has been positive. Diagnoses, for example, have been identified by some as useful resources in maintaining a positive self-concept [111].…”

The experience of the self in Canadian youth living with anxiety: A qualitative study

“…Quite notably, O'Connor et al [28] conducted a systematic review on how a psychiatric diagnosis (inclusive but not exclusive to disorders of anxiety) can influence the self-concept (one's beliefs about oneself) and social identity (selfconcept that derives from membership in social groups) of children and adolescents. However, while a diagnosis has the potential to devalue children's self-concept and contribute to social alienation, invalidation and stigmatization, O'Connor et al [28] noted that it can lead to understanding, validation, legitimation, and enhancement of the self as well as facilitate identification and acceptance within their social sphere.…”

Diagnostic trajectories in child and adolescent mental health services: exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register

“…This means that during a young person's engagement with Child and Adolescent Mental Health Services (CAMHS), a diagnosis once received can transition into or be supplemented by different diagnostic classifications. Such diagnostic shifts have potentially profound implications for young people and families, given diagnostic labels' significance for making sense of emotional and behavioural difficulties [7]. Knowledge of the frequency and directions of diagnostic adjustments in CAMHS is a precondition for supporting clinicians and service users with any challenges these clinical experiences may present.…”

“…Third, it is clinical diagnoses that influence the ways children and families make sense of a young person's difficulties. Research shows psychiatric diagnoses affect young people's self-identity in diverse ways [7]. The revision or supplementation of a diagnosis may have important social and emotional repercussions for service users.…”