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"Corrigan, Patrick W"
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On the Self-Stigma of Mental Illness: Stages, Disclosure, and Strategies for Change
People with mental illness have long experienced prejudice and discrimination. Researchers have been able to study this phenomenon as stigma and have begun to examine ways of reducing this stigma. Public stigma is the most prominent form observed and studied, as it represents the prejudice and discrimination directed at a group by the larger population. Self-stigma occurs when people internalize these public attitudes and suffer numerous negative consequences as a result. In our article, we more fully define the concept of self-stigma and describe the negative consequences of self-stigma for people with mental illness. We also examine the advantages and disadvantages of disclosure in reducing the impact of stigma. In addition, we argue that a key to challenging self-stigma is to promote personal empowerment. Lastly, we discuss individual- and societal-level methods for reducing self-stigma, programs led by peers as well as those led by social service providers.
Journal Article
Reducing Self-Stigma by Coming Out Proud
Self-stigma has a pernicious effect on the lives of people with mental illness. Although a medical perspective might discourage patients from identifying with their illness, public disclosure may promote empowerment and reduce self-stigma. We reviewed the extensive research that supports this assertion and assessed a program that might diminish stigma’s effect by helping some people to disclose to colleagues, neighbors, and others their experiences with mental illness, treatment, and recovery. The program encompasses weighing the costs and benefits of disclosure in deciding whether to come out, considering different strategies for coming out, and obtaining peer support through the disclosure process. This type of program may also pose challenges for public health research.
Journal Article
The Self–Stigma of Mental Illness: Implications for Self–Esteem and Self–Efficacy
Self-stigma is distinguished from perceived stigma (stereotype awareness) and presented as a three-level model: stereotype agreement, self-concurrence, and self-esteem decrement. The relationships between elements of this model and self-esteem, self-efficacy, and depression are examined in this study. In Study 1, 54 people with psychiatric disabilities completed a draft version of the Self-Stigma of Mental Illness Scale (SSMIS) to determine internal consistency and test-retest reliability of composite scales. In Study 2, 60 people with psychiatric disabilities completed the revised SSMIS plus instruments that represent self-esteem, self-efficacy, and depression. Stereotype awareness was found to not be significantly associated with the three levels of self-stigma. The remaining three levels were significantly intercorrelated. Self-concurrence and self-esteem decrement were significantly associated with measures of self-esteem and self-efficacy. These associations remained significant after partialing out concurrent depression. Implications for better understanding self-stigma are discussed. [PUBLICATION ABSTRACT]
Journal Article
Attitudes towards disclosing a mental illness: impact on quality of life and recovery
PurposeThe decision whether to disclose a mental illness has individual and social consequences. Secrecy may protect from stigma and discrimination while disclosure can increase social support and facilitate help-seeking. Therefore, disclosure decisions are a key reaction to stigma. The first aim of this study was to test a newly developed scale to measure disclosure attitudes, the Attitudes to Disclosure Questionnaire (AtDQ). The second aim was to examine the impact of attitudes towards disclosing a mental illness on quality of life and recovery.MethodsAmong 100 participants with mental illness, disclosure attitudes, quality of life, recovery, benefits of disclosure, secrecy, social withdrawal, self-stigma, and depressive symptoms were assessed at weeks 0, 3 and 6. Psychometric properties of the AtDQ were analysed. Longitudinal associations between disclosure attitudes at baseline and quality of life and recovery after 6 weeks were examined in linear regressions.ResultsThe analyses of the AtDQ indicated one-factor solutions, high acceptability, high internal consistency, and good retest reliability for the total scale and the subscales as well as high construct validity of the total scale. Results provided initial support for sensitivity to change. More positive disclosure attitudes in general and in particular regarding to family at baseline predicted better quality of life and recovery after 6 weeks.ConclusionThe current study provides initial support for the AtDQ as a useful measure of disclosure attitudes. Disclosing a mental illness, especially with respect to family, may improve quality of life and recovery of people with mental illness.
Journal Article
Research and the elimination of the stigma of mental illness
Video-based and in vivo (face-to-face) contact have been shown to be effective ways to change stigmatising attitudes and behaviours. The two approaches reflect the strengths and weakness of sometimes conflicting priorities in anti-stigma programmes: broad audience v. grassroots control. Regardless of perspective, anti-stigma interventions have the greatest impact when contact is targeted, local, credible and continuous.
Journal Article
The Power of Peer Providers in Mental Health Services
People with lived experience of mental illness and recovery are joining leagues of skilled providers who offer services to meet the needs of people with serious psychiatric disorders. The emergence of peer power rides the crest of insights that appeared over the past 50 years related to hope, recovery, and self-determination. Key to these insights is support: coaches, navigators, mentors, and care coordinators who are in the field, addressing the persons goals, and barriers to goals, as they emerge. Peers can clearly learn the interpersonal and instrumental skills of support. In fact, their learned experience may give them special skills and insight into this supportiveness. This book is a deep review into both the conceptual and empirical elements of peer support services.
eBook
Self-stigma in alcohol dependence scale: development and validity of the short form
Background
Self-stigma is associated with low self-esteem, high shame and reduced drinking-refusal self-efficacy in people with alcohol use disorder (AUD). The Self-Stigma in Alcohol-Dependence Scale-Short Form (SSAD-SF) was designed to enable a brief, but valid assessment of AUD self-stigma.
Methods
We reduced the 64-item SSAD, originally derived from 16 stereotypes towards people with AUD, by removing the most offensive items based on perspectives of people with lived experience. The newly created scale was then assessed and validated in a cross-sectional study involving 156 people reporting alcohol issues in various treatment settings.
Results
The 20-item SSAD-SF includes five stereotypes, with good internal consistency for each subscale and the overall scale. It reflects the four-stage progressive model of self-stigmatization with decreasing scores over the stages
awareness of stereotypes
,
agreement with stereotypes
,
self-application of stereotypes
, and
harmful consequences for self-esteem
, and highest correlations between adjacent stages. The subscales
apply
and
harm
were associated with internalized stigma, shame, reduced self-esteem, and lower drinking-refusal self-efficacy, as supported by multivariate regression models.
Discussion
The SSAD-SF is a valid instrument for measuring the process of self-stigmatization in people with AUD. Self-stigma is a consistent predictor of reduced self-esteem, higher shame and lower drinking-refusal self-efficacy in people with AUD. We discuss merits of the progressive model for understanding and addressing self-stigma in AUD.
Journal Article
Does the peer-led Honest, Open, Proud program reduce stigma’s impact for everyone? An individual participant data meta-regression analysis
Purpose
Many people with mental illness experience self-stigma and stigma-related stress and struggle with decisions whether to disclose their condition to others. The peer-led Honest, Open, Proud (HOP) group program supports them in their disclosure decisions. In randomized controlled trials, HOP has shown positive effects on self-stigma and stigma stress on average. This study examined individual predictors of HOP outcomes and tested the hypothesis that stigma stress reduction at the end of HOP mediates positive HOP effects at follow-up.
Methods
Six RCTs were included with data at baseline, post (after the HOP program) and at 3- or 4-week follow-up. Baseline variables were entered in meta-regression models to predict change in self-stigma, stigma stress, depressive symptoms and quality of life among HOP participants. Mediation models examined change in stigma stress (post) as a mediator of HOP effects on self-stigma, depressive symptoms, and quality of life at follow-up.
Results
More shame at baseline, and for some outcomes reduced empowerment, predicted reduced HOP effects on stigma stress, self-stigma, depressive symptoms, and quality of life. Younger age was related to greater improvements in stigma stress after the HOP program. Stigma stress reductions at the end of HOP mediated positive effects on self-stigma, depressive symptoms and quality of life at follow-up.
Conclusion
Participants who are initially less burdened by shame may benefit more from HOP. Stigma stress reduction could be a key mechanism of change that mediates effects on more distal outcomes. Implications for the further development of HOP are discussed.
Journal Article