Psychological factors involved in the operation of mental illness stigma: Implications for practice and *policy.

Abstract

The perceived stigma of serious mental illness (SMI) has often been found to negatively influence individuals with SMI. Previous stigma research, however, has provided limited practical directions about how to minimize the negative affects of stigma. The goal of this dissertation research was to expand knowledge of possible interventions by identifying psychological mechanisms involved in the influence of MI stigma, with specific focuses on self-stigma. In order to achieve this goal, this study examined psychological processes involved in self-stigma and its influence through structural equation modeling (SEM), to test a hypothesized framework that reconstructs the Modified Labeling Theory using attitude literature. Specifically, this dissertation research aimed to accomplish three goals. The first was to describe the characteristics of both community-living consumers and community-based psychosocial rehabilitation agencies serving those consumers. The second was to study factors predicting consumers' self-attitudes with specific focus on the predictors of psychological characteristics. The third was to examine whether self-attitudes mediate the relationships between consumers' psychological characteristics and behavioral tendencies. To achieve these aims, 461 community-living individuals with SMI in southeast Michigan were recruited from 25 public mental health psychosocial rehabilitation agencies, such as supported education, consumer drop-in centers, or clubhouse programs. The participants responded in a semi-structured small group format or individual interviews to questions about their background characteristics (demographic, mental health, evaluation of agency, and rejection-experience due to MI), psychological characteristics (affects and beliefs), self-attitudes (self-worth and self-deprecation), and behavioral tendencies (withdrawal-tendency and secrecy-tendency). The results indicated that consumers' background and psychological characteristics are significantly associated with their self-attitudes and behavioral tendencies. The findings further indicated that consumers have positive and negative self-attitudes and that they are associated with differing psychological predictors and behavioral consequences. The two dimensions of self-attitudes also presented different roles in mediating the relationships between psychological characteristics and behavioral consequences. In summary, the findings of the study indicate that psychological factors play critical roles in the operation of stigma. This study also suggests that the structure of stigma is multifaceted and that multi-level interventions are necessary. Study limitations and implications for social work research and interventions are discussed.