A stress-coping model of mental illness stigma: II. Emotional stress responses, coping behavior and outcome

Joint Research Programs in Psychiatric Rehabilitation, Illinois Institute of Technology, 3424 S State Street, Chicago, IL 60616, USA.
Schizophrenia Research (Impact Factor: 4.43). 03/2009; 110(1-3):65-71. DOI: 10.1016/j.schres.2009.01.005
Source: PubMed

ABSTRACT Stigma can be a major stressor for people with schizophrenia and other mental illnesses, leading to emotional stress reactions and cognitive coping responses. Stigma is appraised as a stressor if perceived stigma-related harm exceeds an individual's perceived coping resources. It is unclear, however, how people with mental illness react to stigma stress and how that affects outcomes such as self-esteem, hopelessness and social performance. The cognitive appraisal of stigma stress as well as emotional stress reactions (social anxiety, shame) and cognitive coping responses were assessed by self-report among 85 people with schizophrenia, schizoaffective or affective disorders. In addition to self-directed outcomes (self-esteem, hopelessness), social interaction with majority outgroup members was assessed by a standardized role-play test and a seating distance measure. High stigma stress was associated with increased social anxiety and shame, but not with cognitive coping responses. Social anxiety and shame predicted lower self-esteem and more hopelessness, but not social performance or seating distance. Hopelessness was associated with the coping mechanisms of devaluing work/education and of blaming discrimination for failures. The coping mechanism of ingroup comparisons predicted poorer social performance and increased seating distance. The cognitive appraisal of stigma-related stress, emotional stress reactions and coping responses may add to our understanding of how stigma affects people with mental illness. Trade-offs between different stress reactions can explain why stress reactions predicted largely negative outcomes. Emotional stress reactions and dysfunctional coping could be useful targets for interventions aiming to reduce the negative impact of stigma on people with mental illness.

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    • "Nonetheless, experiences of being stigmatized and the burden of a family member's mental illness do threaten the physical, psychological , emotional, and functional health of the family of a person with mental illness (Angermeyer et al., 2003; Phelan et al., 1998). Experiences of being stigmatized affect their levels of self-esteem, stress and anxiety, as well as their social performance (Rüsch et al., 2009); these "
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    • "In a previous cross-sectional analysis of the current sample at baseline (Rüsch et al., 2014b), we found associations of perceived stigma, shame and self-labeling with increased stigma-related stress; and of more stigma stress with reduced well-being. Therefore the aims of the current study were twofold: first, to confirm these cross-sectional findings in longitudinal analyses; and second, to use a stress-coping model of mental illness stigma (Rüsch et al., 2009a, 2009b) to identify relevant stigma mechanisms as targets for future interventions. This model is based on Lazarus' and Folkman's (1984) work on stress appraisal processes and on identity threat models of stigma (Major and O'Brien, 2005); stigma stress occurs if persons with mental illness feel that stigma-related harm exceeds their perceived resources to cope with stigma. "
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    ABSTRACT: Stigma may undermine the well-being of young people at risk of psychosis. We therefore measured self-labeling, stigma variables and well-being at baseline and again one year later among 77 at-risk participants. An increase in self-labeling during this period predicted heightened stigma stress after one year and a decrease in stigma stress predicted better well-being at follow-up, controlling for symptoms, psychiatric comorbidity and sociodemographic variables. Besides early intervention programmes, strategies are needed to reduce the public stigma associated with at-risk status and to support young people at risk to better cope with self-labeling and stigma stress.
    Schizophrenia Research 07/2014; 158(1-3). DOI:10.1016/j.schres.2014.07.016 · 4.43 Impact Factor
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    • "In family members of individuals with psychosis , shame has been associated with greater presence of expressed emotion (EE; Wasserman et al., 2012). More broadly, in populations with mental health disorders, higher levels of shame have been associated with greater levels of hopelessness, stress, and lower self-esteem (Rüsch et al., 2009, 2014). Shame has also been found to mediate the association between insight and self-stigma, which may be detrimental for levels of self-esteem, hope, and inter-personal relationships (Hasson-Ohayon et al., 2012). "
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    ABSTRACT: Shame is associated with a range of psychological disorders, and is a trans-diagnostic moderator of the association between stressors and symptoms of disorder. However, research has yet to investigate shame in relation to specific psychotic symptoms in clinical groups. In order to address this, the present study investigated shame in young adults with mental health problems, to test whether shame was i) directly associated with paranoia, a prevalent psychotic symptom, and ii) a moderator of the association between stress and paranoia. Sixty participants completed measures of stressful events, paranoia, shame, depression and anxiety. Results from a cross-sectional regression analysis suggested that shame was associated with paranoia after the stressful life event measure was entered into the model, and shame moderated the association between stress and paranoia. For individuals scoring high on shame, shame amplified the association between stress and paranoia, but for low-shame individuals, the association between stress and paranoia was non-significant. These findings suggest that high levels of shame could confer vulnerability for paranoia amongst clinical groups, and that resistance to experiencing shame could be a marker of resilience.
    Psychiatry Research 07/2014; 220(1-2). DOI:10.1016/j.psychres.2014.07.022 · 2.68 Impact Factor
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