Socio-psychological mediators of the relationship between behavioral health stigma and psychiatric symptoms

Abstract

The stigma associated with mental illness or addiction is significantly and positively related to psychiatric symptoms. According to Modified Labeling Theory, several processes should mediate this relationship, including rejection experiences, stigma management (secrecy coping), and social support. In the first comprehensive test of this theory, we examined a serial mediation model on three waves of data from 138 adults receiving outpatient behavioral health treatment. Participants were recruited from outpatient behavioral health clinics in a large northeastern city in the United States and completed interviews that assessed stigma, rejection experiences, stigma management, social support, and psychiatric symptoms. There was a direct effect between stigma and psychiatric symptoms and an indirect effect in which perceived rejection, secrecy coping and social support sequentially and longitudinally intervened in the stigma and psychiatric symptom relationship. Higher perceptions of stigma predicted more rejection experiences, which marginally increased secrecy coping and decreased social support. In turn, decreased social support increased psychiatric symptoms. We provide support for Modified Labeling Theory and the clinical utility of specific mediators in the relationship between stigma and psychiatric symptoms among adults in behavioral health treatment living in urban settings.

Contextualizing public stigma: Endorsed mental health treatment stigma on college and university campuses

“…This heightened attention is, in part, due to the important associations between stigma and the severity of mental illness symptoms (Andrade et al 2014;Brown 2017;Drapalski et al 2013), disclosure of conditions to friends, family, and healthcare professionals (Dew et al 2007;Donnelly 2017;Prior et al 2003), self-esteem (Corrigan 2004;Corrigan and Watson 2002;Corrigan, Watson, and Barr 2006), and treatment-seeking behavior (Clement et al 2015;Tsang, Fung, and Chung 2010;Vogel, Wade, and Haake 2006). While population estimates suggest that many individuals with symptoms of mental illness do not receive treatment or are undertreated Wang et al 2005Wang et al , 2007, scholars, healthcare providers, and other stakeholders hope that stigma reduction efforts will increase treatment-seeking behavior (Clair, Daniel, and Lamont 2016;Hatzenbuehler, Phelan, and Link 2013;Hunter et al 2017;Pilgrim and Rogers 2005).…”

“…However, previous operationalizations of public stigma ask individual respondents to report on perceived stigma from a generic "most people" originally used in Bruce Link's (1987;Link, Mirotznik, and Cullen 1991) Devaluation-Discrimination scale, with few exceptions (Moses 2010; also see Eisenberg et al 2009 for discussion of this issue). These inconsistencies regarding the level of analysis at which public stigma truly takes place perhaps explain the mixed findings on whether public stigma has a positive, negative, or no association with severity of symptoms, disclosure, self-esteem, and treatment (Corrigan et al 2016;Eisenberg et al 2009;Gollust 2008, 2009;Hunter et al 2017;Sirey et al 2001). …”

Adult children of parents with mental illness: Dehumanization of a parent – ‘She wasn't the wreck in those years that she was to become later’

“…Negative perceptions that others hold about a person can influence how the person views themselves, resulting in non-disclosure of mental illness and limiting help-seeking behaviours (Matsea 2017). Individuals with mental illness might attempt to cope with stigma by keeping secrets (Hunter et al 2017). This response might alter the emotional connectivity with their families, further contributing to intra-familial dehumanization, particularly for people diagnosed with schizophrenia, which is associated with increased social stigma (Berna et al 2017).…”

The Impact of Criminal Record Stigma on Quality of Life: A Test of Theoretical Pathways

“…Next, these theories include a distinct labeling experience, in which the stigmatized label is self‐ or socially assigned (Bradley‐Engen, 2011; Corrigan et al, 2016; Corrigan & Rao, 2012; Corrigan, Watson, & Barr, 2006; Link et al, 1989; Tannenbaum, 1938). Finally, they highlight that maladaptive responses to stigma can lead to negative psychological and external life repercussions (Bradley‐Engen, 2011; Corrigan & Rao, 2012; Hunter et al, 2017; Link et al, 1989, 1997; Link & Phelan, 2014; Moore, Stuewig, et al, 2016; Moore & Tangney, 2017; Newheiser & Barreto, 2014; Perlick et al, 2001; Tannenbaum, 1938). These maladaptive responses include coping (i.e., stigma management ) strategies in response to perceived stigma and discrimination or rejection.…”