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: 3.92). 03/2009; 110(1-3):65-71. DOI: 10.1016/j.schres.2009.01.005
Source: PubMed


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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    • "" ) and four items represent the secondary appraisal of perceived resources to cope with stigma-related harm (e.g., " I have the resources I need to handle problems posed by prejudice against people with mental illness. " ) (Rüsch et al., 2009a, 2009b). Internal consistencies for data from this study were acceptable (stigma harm: α¼0.90; coping resources: α¼0.81). "
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    ABSTRACT: This randomized controlled trial examined the impact of the Coming Out Proud (COP) program on self-stigma, stigma stress, and depression. Research participants who experienced mental health challenges were randomly assigned to a three session COP program (n=51) or a waitlist control (n=75). Outcome measures that assessed the progressively harmful stages of self-stigma, stigma stress appraisals, and depression were administered at pre-test, post-test, and one-month follow-up. People completing COP showed significant improvement at post-test and follow-up in the more harmful aspects of self-stigma compared to the control group. COP participants also showed improvements in stigma stress appraisals. Women participating in COP showed significant post-test and follow-up reductions in depression after COP compared to the control group. Men did not show this effect. Future research should determine whether these benefits also enhance attitudes related to recovery, empowerment, and self-determination. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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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.
    Full-text · Article · Jul 2014 · Schizophrenia Research
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