Mental Illness Symptoms and Mental Illness Stigma: A Test of Bidirectional Influences




Kendra, Matthew Stephen

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People with mental illness cope not only with symptoms but also with stigmatization. Prior between-subjects, cross-sectional research has shown that perceived stigmatization is correlated with poor psychosocial functioning. However, little is known about the direction of causality between these variables or the extent to which their association reflects effects at the within-person level, between-person level, or both levels. The literature has also overlooked stigmatization in disorders other than schizophrenia, as well as the day-to-day experience of stigma. The purpose of the study was to examine bidirectional relationships between aspects of stigma (self-stigma, perceived public stigma, and severity of stigma experiences) and psychosocial functioning (anxiety and depression symptoms, impairment due to mental illness, interpersonal self-esteem), separate these relations into within- and between-persons components, and examine day-to-day and lifetime stigmatization experiences in a sample with more varied disorders. Participants were 112 community members with mental illness recruited nationwide from mental health advocacy organizations to complete daily diary surveys for a week. Of these adults, 96 provided sufficient amounts of data for inclusion in the main analyses. The within-person relationship between daily stigmatization and psychosocial functioning appears to be mostly unidirectional: self-stigma and perceived public stigma predicted next day psychosocial functioning variables, except depression symptoms; the only psychosocial functioning variable to predict a next day stigma variable was anxiety symptoms, which predicted next day perceived public stigma. Most of the relationship between stigma and psychosocial functioning was explained by within-person processes. For example, when an individual was experiencing high levels of perceived public stigma and self-stigma relative to his or her own typical levels, the individual also tended to report more severe depression and anxiety symptoms, more impairment, and worse self-esteem. At the between-person level, such relations were only found with self-stigma. Because most participants were Caucasian, highly educated females with mood disorders, the results may not be generalizable to the overall population of people with mental illness. Nonetheless, this study is among the first to investigate day-to-day stigmatization experiences and bidirectional relationships between stigmatization and psychosocial functioning.



Stigma, Multilevel modeling, Mental illness, Symptoms, Depression, Within-persons