The impact of perceived and internalised stigma on clinical and functional recovery among people with mental illness

Abstract

The present study aimed to develop and validate a conceptual model linking public and internalised stigma to recovery attitudes, processes and outcomes among people with mental illness. Specifically, we sought to examine whether perceptions of public stigma (i.e., perceived stigma) would affect experiences of internalised stigma (i.e., self‐stigma) and thereby influence recovery attitudes (i.e., recovery orientation), recovery processes (i.e., service engagement) and recovery outcomes (i.e., clinical recovery and functional recovery). A total of 205 people with mental illness from Hong Kong, China, completed questionnaire measures on perceived stigma, self‐stigma, recovery orientation, service engagement, clinical recovery and functional recovery. The associations among these variables were analysed using path analyses and bootstrap analyses. Path analyses showed that perceived stigma was related to greater self‐stigma, which was, in turn, linked to lower recovery orientation and then lesser service engagement and ultimately poorer clinical recovery and functional recovery. Bootstrap analyses further demonstrated that perceived stigma had significant indirect effects on recovery orientation via self‐stigma, on service engagement via self‐stigma and recovery orientation and on clinical recovery and functional recovery via self‐stigma, recovery orientation and service engagement. Theoretically, our findings reveal how public and internalised stigma may adversely affect recovery attitudes, processes and outcomes among people with mental illness. Practically, our findings point to the vital and urgent need to develop effective interventions to mitigate stigma and self‐stigma at community and individual levels in order to reduce the deleterious impact of stigma on recovery.

Self-Compassion Mediates the Impact of Family Support on Clinical and Personal Recovery Among People with Mental Illness

“…The item scores were averaged, with higher scores indicating higher levels of symptom severity. This scale has been used to measure symptom severity among people with different psychiatric diagnoses, including psychotic, depressive, bipolar, and anxiety disorders (Chan et al, 2022a). Its validity was established by its significant correlations with theoretically relevant constructs, and its reliability was shown by its high internal consistency (Chan et al, 2022a).…”

“…It also encompasses the re-establishment of the premorbid levels of social and work functioning (Andreasen et al, 2005). People with clinical recovery are considered as being free from the symptomatology of mental illness (symptomatic remission; Chan et al, 2022a) and being able to have effective interpersonal communications and social relationships and engage in education or employment (functional restoration; Chan & Lam, 2018).…”

Perceived stigma from mental health service providers and its adverse impact on service engagement and recovery among people with mental illness.

“…This finding indicates that perceptions of stigmatizing attitudes and behaviors from service providers may impede the recovery processes and outcomes of people with mental illness through exacerbating self-stigmatization. Importantly, the finding provides empirical support for the progressive model of stigma, which posits that perceptions of community stigma may adversely affect people with mental illness through the mechanism of stigma internalization (Chan et al, 2022;Yip et al, 2023).…”

“…As these people may feel unworthy or incapable of tackling the exigencies of mental health recovery, they may reduce their efforts to locate, participate in, and benefit from the mental health services available to them (Corrigan et al, 2014, 2016). Some studies have resonated with these views by showing that people with self-stigma are likely to have lower levels of help-seeking, service utilization, treatment adherence, and medication compliance (Chan et al, 2022; Kamaradova et al, 2016; Lien et al, 2018).…”

“…Notably, people who experience poor recovery from mental illness may be at risk of being stigmatized by others and developing more self-stigmatizing views toward themselves (Henderson et al, 2014). Such continued exposure to stigma and constant experience of self-stigma may further increase their service disengagement and worsen their recovery outcomes over time, creating a vicious cycle (Chan et al, 2022).…”