The relationship between internalized stigma and quality of life among people with mental illness: are self-esteem and s
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The relationship between internalized stigma and quality of life among people with mental illness: are self-esteem and sense of coherence sequential mediators? Piotr S´witaj1 • Paweł Grygiel2 • Anna Chrostek1 • Izabela Nowak1 Jacek Wcio´rka1 • Marta Anczewska1
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Accepted: 14 May 2017 Ó The Author(s) 2017. This article is an open access publication
Abstract Purpose To elucidate the mechanism through which internalized stigma reduces the quality of life (QoL) of people with mental illness by exploring the mediating roles of self-esteem and sense of coherence (SOC). Methods A cross-sectional analysis of 229 patients diagnosed with schizophrenia or affective disorders was undertaken to test a sequential mediation model assuming that more severe internalized stigma is related to lower self-esteem, which is associated with weaker SOC, which in turn relates to worse QoL. Results The proposed model was supported by the data. A sequential indirect effect from internalized stigma to QoL via self-esteem and SOC turned out to be significant [beta = -0.06, SE = 0.02; 95% CI (-0.11, -0.03)]. Support was also found for simple mediation models with either self-esteem or SOC as single mediators between internalized stigma and QoL. Conclusions Self-esteem and SOC are personal resources that should be considered as potential targets of interventions aiming to prevent the harmful consequences of internalized stigma for the QoL of people receiving psychiatric treatment. Keywords Internalized stigma Quality of life Selfesteem Sense of coherence Mental illness
& Piotr S´witaj [email protected] 1
First Department of Psychiatry, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland
2
Educational Research Institute, Go´rczewska 8, 01-180 Warsaw, Poland
Introduction People with mental illness are frequent targets of public stigma, i.e., negative stereotypes, prejudice, and discrimination [1]. Many individuals turn these stigmatizing societal attitudes against themselves, which may result in internalized stigma (also referred to as self-stigma). Internalized stigma can be defined as ‘‘a subjective process, embedded within a socio-cultural context, which may be characterized by negative feelings (about self), maladaptive behaviour, identity transformation, or stereotype endorsement resulting from an individual’s experiences, perceptions, or anticipation of negative social reactions on the basis of their mental illness’’ [2, p. 2151]. This detrimental process may hamper the recovery of service users, limit their life chances and substantially reduce their quality of life (QoL) [1, 3]. However, although the negative impact of the internalized stigma of mental illness on QoL is well established [2, 4], the precise mechanism of this effect has not been fully explained. Some previous research has indicated that self-esteem may play a mediating role in this relationship. More specifically, in a study including 179 people with serious mental illness, Mashiach-Eizenberg et al. [5] found that self-esteem fully med
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