Stigma: a Unique Source of Distress for Family Members of Individuals with Mental Illness

  • Anjana Muralidharan
  • Alicia Lucksted
  • Deborah Medoff
  • Li Juan Fang
  • Lisa Dixon


To distinguish the impact of mental illness stigma from that of other negative caregiving experiences, this study examined the unique relationships between stigma and caregiver/family functioning. Adult relatives (n = 437) of individuals with mental illness completed questionnaires regarding caregiving experiences, distress, empowerment, and family functioning, as part of a larger study. Regression analyses examined the relationship between stigma and caregiver/family variables, while controlling for other negative caregiving experiences. Stigma was uniquely associated with caregiver distress, empowerment, and family functioning. Mental illness stigma is a potent source of distress for families and an important target of family services.


Stigma Mental illness Family Caregiver burden 



This project was supported by grant 1R01-MH72667-01A1 from the National Institute of Mental Health. This material is the result of work supported with resources and the use of facilities at the Department of Veterans Affairs (VA) Maryland Healthcare System. The authors extend sincere thanks to the Maryland NAMI affiliates and FTF teachers, and to study participants, without whose assistance, this investigation would not have been possible.

Conflict of Interest

The authors of this manuscript report no conflicts of interest with regard to the content of this manuscript.


  1. 1.
    Perlick DA, Rosenheck RA, Miklowitz DJ, et al. Prevalence and correlates of burden among caregivers of patients with bipolar disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder. Bipolar Disorders 2007; 9: 262-273.CrossRefPubMedGoogle Scholar
  2. 2.
    Perlick D, Rosenheck R, Kaczynski R, et al. Special section on CATIE baseline data: components and correlates of family burden in schizophrenia. Psychiatric Services 2006; 57(8): 1117-1125.CrossRefPubMedGoogle Scholar
  3. 3.
    Askey R, Holmshaw J, Gamble C, et al. What do carers of people with psychosis need from mental health services? Exploring the views of carers, service users and professionals. Journal of Family Therapy 2009; 31(3): 310-331.CrossRefGoogle Scholar
  4. 4.
    Uebelacker LA, Whisman MA. Moderators of the association between relationship discord and major depression in a national population-based sample. Journal of Family Psychology 2006; 20(1): 40.Google Scholar
  5. 5.
    Corrigan PW, Miller FE. Shame, blame, and contamination: A review of the impact of mental illness stigma on family members. Journal of Mental Health 2004; 13(6): 537-548.CrossRefGoogle Scholar
  6. 6.
    Greenberg JS, Greenley JR, McKee D, et al. Mothers caring for an adult child with schizophrenia: The effects of subjective burden on maternal health. Family Relations: An Interdisciplinary Journal of Applied Family Studies 1993; 42(2): 205-211.CrossRefGoogle Scholar
  7. 7.
    Larson JE, Corrigan P. The stigma of families with mental illness. Academic Psychiatry 2008; 32(2): 87-91.CrossRefPubMedGoogle Scholar
  8. 8.
    Struening EL, Perlick DA, Link BG, et al. Stigma as a barrier to recovery: The extent to which caregivers believe most people devalue consumers and their families. Psychiatric Services 2001; 52(12): 1633-1638.CrossRefPubMedGoogle Scholar
  9. 9.
    Phelan JC, Bromet EJ, Link BG. Psychiatric illness and family stigma. Schizophrenia Bulletin 1998; 24(1): 115-126.CrossRefPubMedGoogle Scholar
  10. 10.
    Drapalski A, Marshall T, Seybolt D, et al. Unmet needs of families of adults with mental illness and preferences regarding family services. Psychiatric Services 2008; 59(6): 655-662.CrossRefPubMedGoogle Scholar
  11. 11.
    Biegel DE, Milligan SE, Putnam PL, et al. Predictors of burden among lower socioeconomic status caregivers of persons with chronic mental illness. Community Mental Health Journal 1994; 30(5): 473-494.CrossRefPubMedGoogle Scholar
  12. 12.
    Perlick DA, Miklowitz DJ, Link BG, et al. Perceived stigma and depression among caregivers of patients with bipolar disorder. The British Journal of Psychiatry 2007; 190(6): 535-536.CrossRefPubMedGoogle Scholar
  13. 13.
    Perlick DA, Rosenheck RA, Miklowitz DJ, et al. Caregiver burden and health in bipolar disorder: a cluster analytic approach. The Journal of Nervous and Mental Disease 2008; 196(6): 484-491.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York, NY: Springer Publishing Company, 1984.Google Scholar
  15. 15.
    Szmukler GI, Burgess P, Herrman H, et al. Caring for relatives with serious mental illness: the development of the Experience of Caregiving Inventory. Social Psychiatry and Psychiatric Epidemiology 1996; 31(3–4): 137–148.CrossRefPubMedGoogle Scholar
  16. 16.
    Dixon LB, Lucksted A, Medoff DR, et al. Outcomes of a randomized study of a peer-taught Family-to-Family Education Program for mental illness. Psychiatric Services 2011; 62(6): 591-597.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Joyce J, Leese M, Szmukler G. The experience of caregiving inventory: Further evidence. Social Psychiatry and Psychiatric Epidemiology 2000; 35(4): 185-189.CrossRefPubMedGoogle Scholar
  18. 18.
    Koren PE, DeChillo N, Friesen BJ. Measuring empowerment in families whose children have emotional disabilities: A brief questionnaire. Rehabilitation Psychology 1992; 37(4): 305-321.CrossRefGoogle Scholar
  19. 19.
    Derogatis LR. BSI-18: Administration, Scoring and Procedures Manual. New York: NCS Pearson, 2001.Google Scholar
  20. 20.
    Epstein NB, Baldwin LM, Bishop DS. The McMaster Family Assessment Device. Journal of Marital and Family Therapy 1983; 9: 171-180.CrossRefGoogle Scholar
  21. 21.
    Miller IW, Epstein NB, Bishop DS, et al. The McMaster Family Assessment Device: Reliability and Validity. Journal of Marital and Family Therapy 1985; 11(4): 345-356.CrossRefGoogle Scholar
  22. 22.
    Kabacoff RI, Miller IW, Bishop DS, et al. A psychometric study of the McMaster Family Assessment Device in psychiatric, medical and nonclinical samples. Journal of Family Psychology 1990; 3: 431-439.CrossRefGoogle Scholar
  23. 23.
    Byles J, Byrne C, Boyle M, et al. Ontario Child Health Study: Reliability and validity of the general functioning subscale of the McMaster Family Assessment Device. Family Process 1988; 27: 97-104.CrossRefPubMedGoogle Scholar
  24. 24.
    Ridenour TA, Daley J, Reich W. Factor analyses of the family assessment device. Family Process 1999; 38(4): 497-510.CrossRefPubMedGoogle Scholar
  25. 25.
    McCubbin HI, Thompson AI, McCubbin MA. Family Problem-Solving Communication (FPSC). In: HI McCubbin, AI Thompson, MA McCubbin (Eds). Family Assessment: Resiliency, Coping and Adaptation - Inventories for Research and Practice. Madison: University of Wisconsin, 1996.Google Scholar

Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2014

Authors and Affiliations

  • Anjana Muralidharan
    • 1
    • 2
  • Alicia Lucksted
    • 1
    • 2
  • Deborah Medoff
    • 1
    • 2
  • Li Juan Fang
    • 2
  • Lisa Dixon
    • 3
    • 4
  1. 1.Veterans Affairs Capitol Health Care Network (VISN 5) Mental Illness, Research, Education, and Clinical Center (MIRECC)BaltimoreUSA
  2. 2.Division of Psychiatric Services Research, Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreUSA
  3. 3.Department of PsychiatryColumbia University Medical CenterNew YorkUSA
  4. 4.Center for Practice InnovationsNew York State Psychiatric InstituteNew YorkUSA

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