Emotional reactions to involuntary psychiatric hospitalization and stigma-related stress among people with mental illness

  • Nicolas Rüsch
  • Mario Müller
  • Barbara Lay
  • Patrick W. Corrigan
  • Roland Zahn
  • Thekla Schönenberger
  • Marco Bleiker
  • Silke Lengler
  • Christina Blank
  • Wulf Rössler
Original Paper


Compulsory admission to psychiatric inpatient treatment can be experienced as disempowering and stigmatizing by people with serious mental illness. However, quantitative studies of stigma-related emotional and cognitive reactions to involuntary hospitalization and their impact on people with mental illness are scarce. Among 186 individuals with serious mental illness and a history of recent involuntary hospitalization, shame and self-contempt as emotional reactions to involuntary hospitalization, the cognitive appraisal of stigma as a stressor, self-stigma, empowerment as well as quality of life and self-esteem were assessed by self-report. Psychiatric symptoms were rated by the Brief Psychiatric Rating Scale. In multiple linear regressions, more self-stigma was predicted independently by higher levels of shame, self-contempt and stigma stress. A greater sense of empowerment was related to lower levels of stigma stress and self-contempt. These findings remained significant after controlling for psychiatric symptoms, diagnosis, age, gender and the number of lifetime involuntary hospitalizations. Increased self-stigma and reduced empowerment in turn predicted poorer quality of life and reduced self-esteem. The negative effect of emotional reactions and stigma stress on quality of life and self-esteem was largely mediated by increased self-stigma and reduced empowerment. Shame and self-contempt as reactions to involuntary hospitalization as well as stigma stress may lead to self-stigma, reduced empowerment and poor quality of life. Emotional and cognitive reactions to coercion may determine its impact more than the quantity of coercive experiences. Interventions to reduce the negative effects of compulsory admissions should address emotional reactions and stigma as a stressor.


Compulsory admission Coercion Shame Self-stigma Empowerment 



This work was supported by the Zürich Impulse Program for the Sustainable Development of Mental Health Services ( We are grateful to all participants.

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Nicolas Rüsch
    • 1
    • 2
  • Mario Müller
    • 1
  • Barbara Lay
    • 1
  • Patrick W. Corrigan
    • 3
  • Roland Zahn
    • 4
  • Thekla Schönenberger
    • 1
  • Marco Bleiker
    • 1
  • Silke Lengler
    • 1
  • Christina Blank
    • 1
  • Wulf Rössler
    • 1
    • 5
  1. 1.Department of Psychiatry, Psychotherapy and PsychosomaticsPsychiatric University Hospital ZürichZürichSwitzerland
  2. 2.Department of Psychiatry IIUniversity of UlmUlmGermany
  3. 3.Illinois Institute of TechnologyChicagoUSA
  4. 4.School of Psychological SciencesUniversity of ManchesterManchesterUK
  5. 5.Collegium Helveticum (a Joint Research Institute between the University of Zürich and the Swiss Federal Institute of Technology)ZurichSwitzerland

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