Abstract
Purpose
The present study aimed to investigate how the interpersonal (experienced discrimination) and intrapersonal (anticipated stigma and internalized stigma) manifestations of psychiatric stigma may affect engaged living and life satisfaction among people with mental illness. In this study, we developed and evaluated a conceptual model to clarify how experienced discrimination may lead to anticipated stigma and internalized stigma and thereby impede engaged living and reduce life satisfaction.
Methods
A total of 205 Hong Kong Chinese people with mental illness completed standardized questionnaire measures of experienced discrimination, anticipated stigma, internalized stigma, engaged living, and life satisfaction. The associations among these variables were analyzed using path analyses and bootstrap analyses.
Results
Path analyses showed that experienced discrimination was related to higher levels of anticipated stigma and internalized stigma, which were, in turn, linked to lesser engaged living and consequently lower life satisfaction. Bootstrap analyses further revealed that experienced discrimination had significant indirect effects on life satisfaction via anticipated stigma and engaged living and via internalized stigma and engaged living.
Conclusions
Theoretically, our study uncovers how the interpersonal and intrapersonal manifestations of psychiatric stigma may adversely affect engaged living and life satisfaction among people with mental illness. Practically, our study points to the importance of developing and implementing stigma-related interventions at societal and individual levels in order to enable people with mental illness to live fulfilling and satisfying lives.
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References
Corrigan, P. W., Morris, S. B., Michaels, P. J., Rafacz, J. D., & Rüsch, N. (2012). Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services, 63(10), 963–973. https://doi.org/10.1176/appi.ps.201100529
Thornicroft, G., Brohan, E., Rose, D., Sartorius, N., Leese, M., & INDIGO Study Group. (2009). Global pattern of experienced and anticipated discrimination against people with schizophrenia: A cross-sectional survey. The Lancet, 373(9661), 408–415. https://doi.org/10.1016/S0140-6736(08)61817-6
Chan, K. K. S., & Fung, W. T. W. (2019). The impact of experienced discrimination and self-stigma on sleep and health-related quality of life among individuals with mental disorders in Hong Kong. Quality of Life Research, 28(8), 2171–2182. https://doi.org/10.1007/s11136-019-02181-1
Quinn, D. M., Williams, M. K., & Weisz, B. M. (2015). From discrimination to internalized mental illness stigma: The mediating roles of anticipated discrimination and anticipated stigma. Psychiatric Rehabilitation Journal, 38(2), 103–108. https://doi.org/10.1037/prj0000136
Corrigan, P. W., Rafacz, J., & Rüsch, N. (2011). Examining a progressive model of self-stigma and its impact on people with serious mental illness. Psychiatry Research, 189(3), 339–343. https://doi.org/10.1016/j.psychres.2011.05.024
Brohan, E., Slade, M., Clement, S., & Thornicroft, G. (2010). Experiences of mental illness stigma, prejudice and discrimination: A review of measures. BMC Health Services Research, 10(1), 80. https://doi.org/10.1186/1472-6963-10-80
Corrigan, P. W., & Shapiro, J. R. (2010). Measuring the impact of programs that challenge the public stigma of mental illness. Clinical Psychology Review, 30(8), 907–922. https://doi.org/10.1016/j.cpr.2010.06.004
Ye, J., Chen, T. F., Paul, D., McCahon, R., Shankar, S., Rosen, A., & O’Reilly, C. L. (2016). Stigma and discrimination experienced by people living with severe and persistent mental illness in assertive community treatment settings. International Journal of Social Psychiatry, 62(6), 532–541. https://doi.org/10.1177/0020764016651459
Cavelti, M., Kvrgic, S., Beck, E. M., Rüsch, N., & Vauth, R. (2012). Self-stigma and its relationship with insight, demoralization, and clinical outcome among people with schizophrenia spectrum disorders. Comprehensive Psychiatry, 53(5), 468–479. https://doi.org/10.1016/j.comppsych.2011.08.001
Farrelly, S., Clement, S., Gabbidon, J., Jeffery, D., Dockery, L., Lassman, F., Brohan, E., Henderson, R. C., Williams, P., Howard, L. M., Thornicroft, G., & MIRIAD Study Group. (2014). Anticipated and experienced discrimination amongst people with schizophrenia, bipolar disorder and major depressive disorder: A cross sectional study. BMC Psychiatry, 14(1), 157. https://doi.org/10.1186/1471-244X-14-157
Gabbidon, J., Brohan, E., Clement, S., Henderson, R. C., Thornicroft, G., & MIRIAD Study Group. (2013). The development and validation of the Questionnaire on Anticipated Discrimination (QUAD). BMC Psychiatry, 13(1), 297. https://doi.org/10.1186/1471-244X-13-297
Üçok, A., Brohan, E., Rose, D., Sartorius, N., Leese, M., Yoon, C. K., Plooy, A., Ertekin, B. A., Milev, R., Thornicroft, G., & INDIGO Study Group. (2012). Anticipated discrimination among people with schizophrenia. Acta Psychiatrica Scandinavica, 125(1), 77–83. https://doi.org/10.1111/j.1600-0447.2011.01772.x
Chan, K. K. S., & Mak, W. W. S. (2017). The content and process of self-stigma in people with mental illness. American Journal of Orthopsychiatry, 87(1), 34–43. https://doi.org/10.1037/ort0000127
Chan, K. K. S., Lee, C. W. L., & Mak, W. W. S. (2018). Mindfulness model of stigma resistance among individuals with psychiatric disorders. Mindfulness, 9(5), 1433–1442. https://doi.org/10.1007/s12671-018-0887-2
Chan, K. K. S., & Mak, W. W. S. (2014). The mediating role of self-stigma and unmet needs on the recovery of people with schizophrenia living in the community. Quality of Life Research, 23(9), 2559–2568. https://doi.org/10.1007/s11136-014-0695-7
Chan, K. K. S., & Lam, C. B. (2018). The impact of familial expressed emotion on clinical and personal recovery among patients with psychiatric disorders: The mediating roles of self-stigma content and process. American Journal of Orthopsychiatry, 88(6), 626–635. https://doi.org/10.1037/ort0000327
Ehrlich-Ben Or, S., Hasson-Ohayon, I., Feingold, D., Vahab, K., Amiaz, R., Weiser, M., & Lysaker, P. H. (2013). Meaning in life, insight and self-stigma among people with severe mental illness. Comprehensive Psychiatry, 54(2), 195–200. https://doi.org/10.1016/j.comppsych.2012.07.011
Trompetter, H. R., ten Klooster, P. M., Schreurs, K. M. G., Fledderus, M., Westerhof, G. J., & Bohlmeijer, E. T. (2013). Measuring values and committed action with the Engaged Living Scale (ELS): Psychometric evaluation in a nonclinical sample and a chronic pain sample. Psychological Assessment, 25(4), 1235–1246. https://doi.org/10.1037/a0033813
Park, K., MinHwa, L., & Seo, M. (2019). The impact of self-stigma on self-esteem among persons with different mental disorders. International Journal of Social Psychiatry, 65(7–8), 558–565. https://doi.org/10.1177/0020764019867352
Corrigan, P. W., Bink, A. B., Schmidt, A., Jones, N., & Rüsch, N. (2016). What is the impact of self-stigma? Loss of self-respect and the “why try” effect. Journal of Mental Health, 25(1), 10–15. https://doi.org/10.3109/09638237.2015.1021902
Corrigan, P. W., Larson, J. E., & Rüsch, N. (2009). Self-stigma and the “why try” effect: Impact on life goals and evidence-based practices. World Psychiatry, 8(2), 75–81. https://doi.org/10.1002/j.2051-5545.2009.tb00218.x
Huguelet, P., Guillaume, S., Vidal, S., Mohr, S., Courtet, P., Villain, L., Girod, C., Hasler, R., Prada, P., Olié, E., & Perroud, N. (2016). Values as determinant of meaning among patients with psychiatric disorders in the perspective of recovery. Scientific Reports, 6, 27617. https://doi.org/10.1038/srep27617
Chan, K. K. S., & Yip, C. C. H. (2021). The impact of psychological flexibility on sexual identity stress and well-being among lesbian, gay, and bisexual individuals. American Journal of Orthopsychiatry, 91(5), 660–670. https://doi.org/10.1037/ort0000567
Jo, D., Spencer, S. D., & Masuda, A. (2022). Mindfulness as a moderator of the relationship between engaged living and depression in emerging adulthood. Mindfulness, 13(3), 742–750. https://doi.org/10.1007/s12671-022-01831-9
Froh, J. J., Kashdan, T. B., Yurkewicz, C., Fan, J., Allen, J., & Glowacki, J. (2010). The benefits of passion and absorption in activities: Engaged living in adolescents and its role in psychological well-being. The Journal of Positive Psychology, 5(4), 311–332. https://doi.org/10.1080/17439760.2010.498624
Rüsch, N., Corrigan, P. W., Heekeren, K., Theodoridou, A., Dvorsky, D., Metzler, S., Müller, M., Walitza, S., & Rössler, W. (2014). Well-being among persons at risk of psychosis: The role of self-labeling, shame, and stigma stress. Psychiatric Services, 65(4), 483–489. https://doi.org/10.1176/appi.ps.201300169
Rüsch, N., Müller, M., Heekeren, K., Theodoridou, A., Metzler, S., Dvorsky, D., Corrigan, P. W., Walitza, S., & Rössler, W. (2014). Longitudinal course of self-labeling, stigma stress and well-being among young people at risk of psychosis. Schizophrenia Research, 158(1–3), 82–84. https://doi.org/10.1016/j.schres.2014.07.016
Peter, L. J., Schindler, S., Sander, C., Schmidt, S., Muehlan, H., McLaren, T., Tomczyk, S., Speerforck, S., & Schomerus, G. (2021). Continuum beliefs and mental illness stigma: A systematic review and meta-analysis of correlation and intervention studies. Psychological Medicine, 51(5), 716–726. https://doi.org/10.1017/S0033291721000854
Tsang, H. W. H., Angell, B., Corrigan, P. W., Lee, Y. T., Shi, K., Lam, C. S., Jin, S., & Fung, K. M. T. (2007). A cross-cultural study of employers’ concerns about hiring people with psychotic disorder: Implications for recovery. Social Psychiatry and Psychiatric Epidemiology, 42(9), 723–733. https://doi.org/10.1007/s00127-007-0208-x
Lam, C. S., Tsang, H. W. H., Corrigan, P. W., Lee, Y. T., Angell, B., Shi, K., Jin, S., & Larson, J. E. (2010). Chinese lay theory and mental illness stigma: Implications for research and practices. Journal of Rehabilitation, 76(1), 35–40.
Bentler, P. M., & Chou, C. P. (1987). Practical issues in structural modeling. Sociological Methods and Research, 16(1), 78–117. https://doi.org/10.1177/0049124187016001004
Hoelter, J. W. (1983). The analysis of covariance structures: Goodness-of-fit indices. Sociological Methods and Research, 11(3), 325–344. https://doi.org/10.1177/0049124183011003003
Ritsher, J. B., Otilingam, P. G., & Grajales, M. (2003). Internalized stigma of mental illness: Psychometric properties of a new measure. Psychiatry Research, 121(1), 31–49. https://doi.org/10.1016/j.psychres.2003.08.008
Li, J., Guo, Y. B., Huang, Y. G., Liu, J. W., Chen, W., Zhang, X. Y., Evans-Lacko, S., & Thornicroft, G. (2017). Stigma and discrimination experienced by people with schizophrenia living in the community in Guangzhou, China. Psychiatry Research, 255, 225–231. https://doi.org/10.1016/j.psychres.2017.05.040
Trindade, I. A., Ferreira, C., Pinto-Gouveia, J., & Nooren, L. (2016). Clarity of personal values and committed action: Development of a shorter engaged living scale. Journal of Psychopathology and Behavioral Assessment, 38(2), 258–265. https://doi.org/10.1007/s10862-015-9509-7
Roush, J. F., Cukrowicz, K. C., Mitchell, S. M., Brown, S. L., & Seymour, N. E. (2018). Valued living, life fulfillment, and suicide ideation among psychiatric inpatients: The mediating role of thwarted interpersonal needs. Journal of Contextual Behavioral Science, 7, 8–14. https://doi.org/10.1016/j.jcbs.2017.11.001
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71–75. https://doi.org/10.1207/s15327752jpa4901_13
Yu, B. C. L., Chio, F. H. N., Mak, W. W. S., Corrigan, P. W., & Chan, K. K. Y. (2021). Internalization process of stigma of people with mental illness across cultures: A meta-analytic structural equation modeling approach. Clinical Psychology Review, 87, 102029. https://doi.org/10.1016/j.cpr.2021.102029
Mak, W. W. S., Poon, C. Y. M., Pun, L. Y. K., & Cheung, S. F. (2007). Meta-analysis of stigma and mental health. Social Science and Medicine, 65(2), 245–261. https://doi.org/10.1016/j.socscimed.2007.03.015
Leleux-Labarge, K., Hatton, A. T., Goodnight, B. L., & Masuda, A. (2015). Psychological distress in sexual minorities: Examining the roles of self-concealment and psychological inflexibility. Journal of Gay and Lesbian Mental Health, 19(1), 40–54. https://doi.org/10.1080/19359705.2014.944738
Fung, K. M. T., Tsang, H. W. H., Corrigan, P. W., Lam, C. S., & Cheng, W. M. (2007). Measuring self-stigma of mental illness in China and its implications for recovery. International Journal of Social Psychiatry, 53(5), 408–418. https://doi.org/10.1177/0020764007078342
Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., Koschorke, M., Shidhaye, R., O’Reilly, C., & Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet, 387(10023), 1123–1132. https://doi.org/10.1016/S0140-6736(15)00298-6
Heijnders, M., & Van Der Meij, S. (2006). The fight against stigma: An overview of stigma-reduction strategies and interventions. Psychology, Health and Medicine, 11(3), 353–363. https://doi.org/10.1080/13548500600595327
Isaksson, A., Corker, E., Cotney, J., Hamilton, S., Pinfold, V., Rose, D., Rüsch, N., Henderson, C., Thornicroft, G., & Evans-Lacko, S. (2017). Coping with stigma and discrimination: Evidence from mental health service users in England. Epidemiology and Psychiatric Sciences, 27(6), 577–588. https://doi.org/10.1017/S204579601700021X
Mittal, D., Sullivan, G., Chekuri, L., Allee, E., & Corrigan, P. W. (2012). Empirical studies of self-stigma reduction strategies: A critical review of the literature. Psychiatric Services, 63(10), 974–981. https://doi.org/10.1176/appi.ps.201100459
Yanos, P. T., Lucksted, A., Drapalski, A. L., Roe, D., & Lysaker, P. (2015). Interventions targeting mental health self-stigma: A review and comparison. Psychiatric Rehabilitation Journal, 38(2), 171–178. https://doi.org/10.1037/prj0000100
Hasan, A. A. H., & Musleh, M. (2018). Self-stigma by people diagnosed with schizophrenia, depression and anxiety: Cross-sectional survey design. Perspectives in Psychiatric Care, 54(2), 142–148. https://doi.org/10.1111/ppc.12213
Kline, R. B. (2005). Principles and practice of structural equation modeling. Guilford Press.
Acknowledgements
We would like to express our sincere gratitude to the following non-governmental organizations (in alphabetical order) for facilitating us in recruiting eligible participants from their service users: Baptist Oi Kwan Social Service; Christian Oi Hip Fellowship Limited; New Life Psychiatric Rehabilitation Association; The Mental Health Association of Hong Kong; and The Society of Rehabilitation and Crime Prevention.
Funding
This study was funded by the Early Career Scheme of the Research Grants Council of Hong Kong (Project Number: 28611515).
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Yip, C.C.H., Fung, W.T.W., Leung, D.C.K. et al. The impact of stigma on engaged living and life satisfaction among people with mental illness in Hong Kong. Qual Life Res 32, 161–170 (2023). https://doi.org/10.1007/s11136-022-03218-8
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DOI: https://doi.org/10.1007/s11136-022-03218-8