Abstract
Intervention effectiveness research requires that investigators include “real world” variables in the design of studies to develop an understanding of how interventions perform in the “real world.” Two areas that have been neglected in effectiveness research on mental health case management are mental illness self-stigma and the effects of different case managers. Self-stigma is a reality for many consumers that negatively impacts their lives. Case managers, themselves, are a potential source of autocorrelation and likely provide services differently. This study explores the relationship between self-stigma and quality of life for consumers receiving services from different case managers. Cross-sectional data were collected from 160 consumers of an urban case management agency. Self-stigma was negatively associated with quality of life. Case managers did not account for a significant amount of variance in quality of life scores. However, the interaction between case manager and self-stigma was significant. Some case managers were able to mitigate the negative effects of self-stigma on quality of life. Future effectiveness research in community mental health case management needs to account for the effects of self-stigma, case managers, and the interaction between the two in the research design.
Similar content being viewed by others
References
American Psychiatric Association (APA). (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders (4th ed. Text revision). Washington, DC: American Psychiatric Association.
Anthony, W. A. (2003). Letters: Process, not practice. Psychiatric Services, 54, 402.
Anthony, W., Rogers, E. S., & Farkas, M. (2003). Research on evidence-based practices: Future directions in an era of recovery. Community Mental Health Journal, 39(2), 101–114.
Becker, H. (1964). The other side: Perspectives on deviance. Glencoe: Free press.
Cooley, C. H. (1967). Human nature and the social order. New York: Schocken Books. (Original work published 1902).
Gallo, K. M. (1994). First person account: Self-stigmatization. Schizophrenia Bulletin, 20(2), 407–410.
Hair, J. F., Anderson, R. E., Tatham, R. L., & Black, W. C. (1998). Multivariate data analysis (5th ed.). Upper Saddle River, NJ: Prentice Hall.
Hohmann, A. (1999). A contextual model for clinical mental health effectiveness research. Mental Health Services Research, 1, 83–91.
Hohmann, A. A., & Shear, M. K. (2002). Community-based intervention research: Coping with the “noise” of real life in study design. American Journal of Psychiatry, 159(2), 201–207.
Howard, J. (2008). Negotiating an exit: Existential, interactional, and cultural obstacles to disorder disidentification. Social Psychology Quarterly, 71(2), 177–192.
Hox, J. J. (2002). Multilevel analysis: Techniques and applications. Mahwah, NJ: Lawrence Erlbaum Associates.
Kazdin, A. E. (2003). Research design in clinical psychology. (4th ed.). Boston: Allen & Bacon.
Kenny, D. A., & Judd, C. M. (1986). Consequences of violating the independence assumption in analysis of variance. Psychology Bulletin, 99, 422–431.
Kondrat, D. C. (2008). Expanding understanding of mental health recovery: Effects of stigma and working alliance on the quality of life of persons with severe mental disability receiving community-based case management services. (Doctoral dissertation, The Ohio State University, 2008). Dissertation Abstracts International, 69, 05.
Kondrat, D. C., & Early, T. J. (in press). An exploration of the working alliance in mental health case management. Social Work Research.
Lehman, A. F. (1983). The effects of psychiatric symptoms on quality of life assessments among the chronic mentally ill. Evaluation and Program Planning, 6, 143–151.
Lehman, A. F. (1988). A quality of life interview for the chronically mentally ill. Evaluation and Program Planning, 11, 51–62.
Link, B. (1982). Mental patient status, work, and income: An examination of the effects of a psychiatric label. American Sociological Review, 47, 202–215.
Link, B. G. (1987). Understanding labeling effects in the area of mental disorders: An assessment of the effects of expectation of rejection. American Sociological Review, 52, 96–112.
Link, B. G., Cullen, F. T., Struening, E., Shrout, P. E., & Dohrenwend, B. P. (1989). A modified labeling theory approach to mental disorders: An empirical assessment. American Sociological Review, 54, 400–432.
Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385.
Link, B. G., Struening, E. L., Neese-Todd, S., Asmussen, S., & Phelan, J. C. (2002). On describing and seeking to change the experiences of stigma. Psychiatric Rehabilitation Skills, 6, 201–231.
Link, B. G., Struening, E. L., Rahav, M., Phelan, J. C., & Nuttbrock, L. (1997). On stigma and its consequences: Evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. Journal of Health and Social Behavior, 38(2), 177–190.
Luke, D. A. (2004). Multilevel modeling. Thousand Oaks, CA: Sage.
Markowitz, F. E. (1998). The effects of stigma on psychological well-being and life satisfaction of persons with mental illness. Journal of Health and Social Behavior, 39, 335–347.
Mead, G. H. (1934). Mind, self & society from the standpoint of a social behaviorist. Chicago: The University of Chicago Press.
Pedhazur, E. J. & Pedhazur-Schmelkin, L. (1991). Measurerment, design and analysis: An integrated approach.: Hilldale, NJ: Lawrence Erlbaum.
Perlick, D. A. (2001). Special section on stigma as a barrier to recovery: Introduction. Psychiatric Services, 52, 1613–1614.
Pinfold, V., Thornicrof, G., Huxley, P., & Farmer, P. (2005). Active ingredients in anti-stigma programs in mental health. International Review of Psychiatry, 17(2), 123–131.
Raudenbush, S. W., Bryk, A. S., Cheong, Y. K., & Congdon, R. T., Jr. (2004). HLM 6: Hierarchical linear and nonlinear modeling. Lincolnwood, IL: Scientific Software International.
Rosenfield, S. (1997). Labeling mental illness: The effects of received services and perceived stigma on life satisfaction. American Sociological Review, 62, 660–672.
Rüsch, N., Angermayer, M. C., & Corrigan, P. W. (2005). Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. European Pschiatry, 20, 529–539.
Ryan, C. S., Sherman, P. S., & Judd, C. M. (1994). Accounting for case manager effects in the evaluation of mental health services. Journal of Consulting and Clinical Psychology, 62, 965–974.
Scheff, T. J. (1966). Being mentally ill: A sociological theory. New York: Aldine.
Sirey, J. A., Bruce, M. L., Alexopoulos, G. S., Perlick, D. A., Friedman, S. J., & Meyers, B. S. (2001). Perceived stigma and patient rated severity of illness as predictors of antidepressant drug adherence. Psychiatric Services, 52, 1615–1620.
Solomon, P., Draine, J., & Delaney, M. A. (1995). The working alliance and consumer case management. Journal of Mental Health Administration, 22, 126–134.
Solomon, P., & Stanhope, V. (2004). Recovery: Expanding the vision of evidence-based practice. Brief Treatment and Crisis Intervention, 4, 311–321.
Test, M. A. (1992). Training in community living. In R. P. Liberman (Ed.), Handbook of psychiatric rehabilitation (pp. 153–170). New York: Macmillan.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kondrat, D.C., Early, T.J. Battling in the Trenches: Case Managers’ Ability to Combat the Effects of Mental Illness Stigma on Consumers’ Perceived Quality of Life. Community Ment Health J 47, 390–398 (2011). https://doi.org/10.1007/s10597-010-9330-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-010-9330-4