Self-stigma in Serious Mental Illness: A Systematic Review of Frequency, Correlates, and Consequences

Abstract

Self-stigma is associated with poor clinical and functional outcomes in Serious Mental Illness (SMI). There has been no review of self-stigma frequency and correlates in different cultural and geographic areas and SMI. The objectives of the present study were: (1) to review the frequency, correlates, and consequences of self-stigma in individuals with SMI; (2) to compare self-stigma in different geographical areas and to review its potential association with cultural factors; (3) to evaluate the strengths and limitations of the current body of evidence to guide future research. A systematic electronic database search (PubMed, Web of Science, PsycINFO, Scopus, and Ovid SP Cumulative Index to Nursing and Allied Health Literature [CINAHL]) following PRISMA guidelines, was conducted on the frequency, correlates, and consequences of self-stigma in SMI. Out of 272 articles, 80 (29.4%) reported on the frequency of self-stigma (n = 25 458), 241 (88.6%) on cross-sectional correlates of self-stigma and 41 (15.0%) on the longitudinal correlates and consequences of self-stigma. On average, 31.3% of SMI patients reported high self-stigma. The highest frequency was in South-East Asia (39.7%) and the Middle East (39%). Sociodemographic and illness-related predictors yielded mixed results. Perceived and experienced stigma—including from mental health providers—predicted self-stigma, which supports the need to develop anti-stigma campaigns and recovery-oriented practices. Increased transition to psychosis and poor clinical and functional outcomes are both associated with self-stigma. Psychiatric rehabilitation and recovery-oriented early interventions could reduce self-stigma and should be better integrated into public policy.

Toward a Gender-Sensitive Approach of Psychiatric Rehabilitation in Autism Spectrum Disorder (ASD): A Systematic Review of Women Needs in the Domains of Romantic Relationships and Reproductive Health

“…Experienced stigma, anticipated stigma, and self-stigma were identified as barriers to intimacy in ASD ( 33 ). This concurs with findings in serious mental illness where self-stigma has been associated with reduced capacity for intimacy and more negative parenting experiences ( 61 ). Self-stigma has been found to affect one in five people with ASD ( 7 , 62 ).…”

“…Future research should further investigate perceived stigma, experienced stigma, anticipated stigma, and self-stigma in gender-diverse autistic individuals. Self-stigma reduction [e.g., narrative enhancement and cognitive therapy ( 65 ) or peer-delivered interventions ( 61 )] might improve the clinical and functional outcomes in autistic women, although this remains to be investigated. A longitudinal examination is needed to investigate the potential relationships between camouflage strategies, stigma-related issues, capacity for intimacy, and parenting experiences.…”

Narrative enhancement and cognitive therapy (NECT) to improve social functioning in people with serious mental illness: study protocol for a stepped-wedge cluster randomized controlled trial

“…Previous research from the French national REHABase network showed that (i) most patients were dissatisfied with their interpersonal relationships at the time of admission and asked for interventions improving social function [36] and (ii) elevated self-stigma was frequent (31.2% of the 738 participants [37]) and was negatively associated with recovery-related outcomes. Self-stigma has been negatively associated with patient's longitudinal outcomes and to lower benefits from psychiatric rehabilitation [38]. Providing NECT to all participants aims at not excluding participants from interventions improving social function (e.g.…”

Honest, Open, Proud to support disclosure decisions and to decrease stigma’s impact among people with mental illness: conceptual review and meta-analysis of program efficacy

“…Many people with mental illness are not only aware of public prejudices, but turn them against themselves which is referred to as self-stigma (“I have a mental illness, therefore I must be lazy” [ 6 ]). Self-stigma is associated with a range of negative outcomes [ 7 ] and leads to impaired self-esteem and a sense of demoralization, the so-called why try effect (“Why should I even try to achieve my goals? I am not worthy or not able” [ 8 ]).…”