Stigmatisation and self-esteem of persons in recovery from mental illness: the role of peer
BACKGROUND: Persons with mental health problems often experience stigmatisation, which can
have detrimental consequences for their objective and subjective quality of life. Previous research
seeking for elements buffering this negative association focused on coping strategies and revealed
that none of the most often used strategies is successful.
AIMS: This article studies whether peer support among clients can moderate this negative link, and to
which extent. Following the buffering hypothesis on stress and social support it was expected that the
association between stigmatisation and self-esteem would be less among persons experiencing
greater peer support.
METHODS: This research problem was studied by means of ordinary least squares regression
analysis using quantitative data from structured questionnaires completed by 595 clients of
RESULTS AND CONCLUSIONS: The results confirm that stigmatisation is negatively related to self-
esteem, while peer support is positively linked with it. Furthermore, they show that peer support
moderates the negative association between stigmatisation and self-esteem, but not in the expected
way. These findings suggest that peer support can only have positive outcomes among clients with
few stigma experiences, and that stigmatisation itself could impede the formation and beneficial
consequences of constructive peer relationships among persons receiving professional mental health
STIGMATISATION AND SELF-ESTEEM OF PERSONS IN RECOVERY FROM MENTAL ILLNESS:
THE ROLE OF PEER SUPPORT.
Numerous studies have demonstrated the existence of negative attitudes towards persons with mental
health problems (Huxley, 1993 a & b; Hayward & Bright, 1997; Crisp et al., 2000; Phelan et al., 2000;
Angermeyer & Matschinger, 2005). According to the original labelling perspective on mental illness
(Scheff, 1966) the label ‘mentally ill’ activates these negative attitudes, resulting in social rejection of
clients of mental health services. Furthermore, the modified labelling theory (Link et al., 1987, 1989)
describes how people know that the negative attitudes become relevant once they are labelled, which
leads to fear of rejection and devaluation. Leaning on these arguments, several authors revealed that
there are detrimental consequences of stigmatisation to the self-esteem of labelled persons (e.g. Link
et al., 2001; Wright et al., 2000; Hayward et al., 2002). Others, however, disputed this link. One of their
counterarguments is that labelled persons could seek coping strategies to deal with stigmatisation
(e.g. Miller & Major, 2000). A study of Link et al. (1991) showed that three of the most often used
coping strategies among persons with mental health problems—secrecy, education and
avoidance/withdrawal—are not effective. In this study, we examine whether the same is true for
another possible buffer: social support. We are especially interested in whether peer support can
modify the assumed negative link between stigmatisation and self-esteem. This is of importance for
several reasons. First, it contributes to the discussion about the existence of a negative association
between both variables, as opinions differ on this topic. Furthermore, it links the literature on the
consequences of stigmatisation with the general literature on the social stress process and the role of
social support. Despite the fact that some authors argue that stigma should be considered as a
stressor (e.g. Miller & Major, 2000), and the fact that the role of coping strategies is studied (e.g. Link
et al., 1991), the role of social support as a buffer has not yet been studied. Finally, this study also has
practical implications. As self-esteem could be affected by stigmatisation, it is important to seek for
elements impeding this negative relationship.
Self-esteem can be considered as a central component of subjective well-being and mental
health in general (Arns & Linney, 1993; Rosenfield, 1997; Markowitz, 2001), and its enhancement is
one of the crucial goals in the rehabilitation of persons with psychological problems (Anthony et al.,
1990). Self-esteem theory (Rosenberg et al., 1989) sees self-esteem as a fundamental human motive:
all persons strive for self-maintenance or self-enhancement. According to this approach, self-esteem
has three sources: reflected appraisals, self-perceptions and social comparisons (Gecas, 1982, 1989).
This means that perceiving that others appreciate and like you, perceiving one’s self performing
efficacious actions, and comparing one’s self favourably with others, enhances self-esteem.
Stigmatisation can affect the self-esteem of persons with mental health problems in a direct
and indirect way. Direct rejection can lead to perceptions of being negatively evaluated and these
negative appraisals diminish self-esteem. However, more subtle mechanisms can also be at work.
Being officially labelled as mentally ill leads to expectations of devaluation and discrimination (Link,
1987) and so-called incidental stigma reminds labelled persons of their devalued status (Link &
Phelan, 1999). As labelled persons perceive that they belong to a devalued social category, they may
devalue themselves, even when no direct rejection takes place. Their expectations of being
discriminated against or devalued may enhance feelings of shame or a belief that they are set off from
others and thus are very different, and may therefore cause them to re-evaluate and re-conceptualize
themselves. Three other ways in which stigmatisation could affect self-esteem are unfavourable social
or temporal comparisons, the loss of valued roles and relationships, and lowered perceptions of
personal control (Camp et al., 2002). Several studies have reported empirical evidence about a
negative link between stigmatisation and self-esteem (e.g. Rosenfield, 1997; Link et al., 2001; Wright
et al., 2000; Hayward et al., 2002; Verhaeghe, 2003). On the other hand, several other authors argue
that stigmatisation and self-esteem are not necessarily related (Crocker, 1999; Camp et al., 2002;
Herman and Miall, 1990). Therefore, the first research question of this study is whether stigmatisation
and self-esteem are (negatively) linked in the sample under study.
One of the several arguments against the negative link between stigmatisation and self-
esteem is the possible attenuating effect of coping strategies (Miller & Major, 2000; Miller & Kaiser,
2001). The general reasoning behind this position is that the stress linked with stigmatisation will only
be detrimental for well-being if persons are not able to deal with it successfully. The effectiveness of
these coping strategies however, is also a subject of discussion (Thoits, 1995; Miller & Major, 2000;
Herman, 1993). Link et al. (1991) conducted empirical research to examine the effectiveness of three
coping strategies in the case of stigmatisation of persons with mental health problems, which are
prominent in the literature on stigmatisation and are recommended by health professionals to their
clients: secrecy, education and withdrawal/avoidance. The results of their study revealed that none of
these mechanisms moderates the negative consequences of stigmatisation. Another important buffer
in the general stress literature—social support—is paid less explicit attention to, when studying the
impact of stigmatisation of persons with mental health problems on well-being.
The general literature on stress and social support reveals that persons experiencing more
support will suffer less from the negative effects due to stressors (Cohen & Wills, 1985). Certain types
of support are especially important: having people to talk about problems with (appraisal or
informational support), and having people who make you feel better about yourself (self-esteem or
esteem support). Socioemotional support—defined as assertions or demonstrations of love, caring,
esteem, value, empathy, sympathy and/or group-belonging—from significant, or primary, others
appears to be the most powerful predictor of reduced psychological distress (Thoits, 1985), because it
bolsters one or more aspects of self that have been threatened by objective difficulties. Furthermore,
Thoits (1985) states empathetic understanding as a precondition for emotional support to be
efficacious. According to her, this is most likely to come from socially similar others facing or having
faced the same stressors, as similar others have more detailed knowledge of the situation and are
more likely to identify and address the problems perceived by the distressed individual. Furthermore,
as shared experience teaches persons that they are not the only ones with difficulties, it reduces self-
blame (Rosenfield & Wensel, 1997). In mental health services other clients or peers can be
considered as similar others.
Peer support is considered as an important element in the recovery of persons with mental
health problems (Anthony, 1993; Davidson et al., 1999). Concerning its specific role in the stigma
process, it is suggested that peer groups can help to ‘gain insight, support and ideas for action to
address their stigma problems’ and to ‘consider new, more effective ways of confronting stigma by
sharing their experiences, supporting each other, and rehearsing various ways to handle their stigma
encounters’ (Dudley, 2000: 452), but the empirical evidence about its functioning is scarce. Corrigan
(2003), for instance, reveals that stigmatisation can increase in-group feelings, which improve self-
esteem, but meanwhile, he acknowledges that few studies exist about the usefulness of this general
reasoning for persons with mental health problems. Link et al. (1991) showed that withdrawal to
insiders, which constitutes, together with social isolation, one of the three most often mentioned
stigma coping strategies, is not efficacious. However, avoidance and withdrawal are taken together in
that study, and what Goffman (1963) calls the ‘own’ and ‘wise’ are not distinguished. Therefore, it
remains useful to study the particular effect of ‘withdrawal’ to the ‘own’. Based on this previous
research, the second research question concerns the link between peer support and self-esteem:
does peer support enhance self-esteem among clients in rehabilitation centres? Furthermore, this
study focuses on the specific relationship between stigmatisation, peer support and self-esteem. We
are especially interested in whether peer support can moderate the negative link between
stigmatisation and self-esteem. This constitutes our third research question.
METHOD AND DATA
The data were collected as part of a larger sociological study of the determinants of well-being of
clients and staff members in semi-residential professional mental health organisations in Flanders
(Belgium). These services include a large variety of psychotherapeutic, vocational, relaxation and
leisure activities and are aimed at day structuring or rehabilitation of persons with more or less
sustained psychological problems. The study covers most of the day activity centres connected to the
psychosocial rehabilitation centres (N = 7 out of 9 centres) and a random sample of day activity
centres associated with vocational and social service organisations (N = 49 out of 90 organisations).
Within each participating agency, the researchers selected a random sample of clients. Size was
determined as the daily average number of clients, with a maximum of 30 participants for each centre.
Two researchers, who interviewed the clients using structured questionnaires, visited each facility.
Due to this approach, retention rates were very high, as we had only a few refusals to participate. In
this way, we collected data about 676 clients from 56 centres. However, as not all participants filled in
the questionnaires completely, the following analyses are based on data from only 595 clients. This
subsample consists of 380 men and 215 women. Their age varies from 16 through 80, with an
average of 44. Their mean length of stay is nearly 3 years. In Table 1 we provide additional
information about these clients and the variables used in the analysis.
The dependent variable self-esteem is measured by means of a Dutch translation of Rosenberg’s self-
esteem scale (Brutsaert, 1993; Bruynooghe et al., 2003). This is a frequently used Likert scale
containing 10 items with scores from 1 to 5, which we averaged to obtain a total score, with higher
levels expressing more self-esteem (alpha = .85). The main independent variables are stigmatisation
and peer support. A Likert scale that is based on Link et al. (1997) and Fife and Wright (2000) is used
to operationalise experienced stigmatisation. This scale (alpha = .87) consists of five items, such as
‘Since I come to the centre, some people treat me with less respect’. The scores from 1 to 5 are
averaged to obtain a total score, with higher scores expressing more rejection experiences. In the
absence of an internationally standardized and widely used scale measuring peer support among
persons with mental health problems in semi-residential settings, we used an instrument that was
especially designed for this study. It is a measure of socioemotional support and concerns
experiences of appreciation and acceptance by the other clients. It is operationalised by means of a
scale consisting of 5 items, such as ‘The other clients accept me the way I am’, with scores from 1
(fully disagree) to 5 (fully agree), which are averaged to compute a total score (alpha = .67).
Furthermore, an indicator of symptoms is included. Current mental health status is measured by the
Brief Symptom Inventory (Derogatis, 1993), using the Dutch translation of the parent instrument (SCL-
90) by Arrindell & Ettema (1986). The GSI-score is obtained by computing the mean score on 53 items
with scores from 0 to 4, with higher scores indicating more symptoms (alpha = .97). We include this
measure because some opponents of the labelling theory on mental illness state that stigma
experiences are subjective and due to the symptoms, which are manifestations of the mental illness
(e.g. Gove, 1970). Their reasoning is that the eventually occurring association between stigmatisation
and self-esteem could be explained by a negative, pessimistic, biased perception, typical of persons
with mental illness. Furthermore, the argument that lowered self-esteem could be a symptom of the
illness itself is also used in the discussion of former research linking stigmatisation with self-esteem
(Camp et al., 2002). In response to these critical views, it is necessary to account for psychiatric
symptoms. Finally, some background variables are included as controls: gender (men = 1), age (in
years), length of stay (in years) and education (primary degree = 1 to college degree = 4). Table 1
provides a summary of the variables.
Our research problems are analysed by means of ordinary least squares regression analyses, with
self-esteem as a dependent variable. In the first step, we included the background variables, followed
by our measure of stigmatisation in the second step. Peer support is added to our model in the third
step. Finally, to test the buffering hypothesis, we included an interaction term, which is computed as
the multiplication of stigmatisation and the social support indicator. To prevent problems of
multicollinearity, which can take place due to a strong correlation between the variables and the
product terms, the variables stigmatisation and peer support are centered.
In Table 3, we present the results of our ordinary least squares regression analysis. After we
introduced our background variables in the first step, our measure of stigmatisation is introduced. The
negative coefficient shows us that stigmatisation is negatively associated with self-esteem (β = .208; p
= .000): clients who experience more rejection by their environment because of their attendance at the
centre are characterized by lower self-esteem, as we could expect from our literature review.
Therefore, we can answer our first research question about a possible negative link between
stigmatisation and self-esteem affirmatively. An important note is that symptoms are controlled for.
This means that this result cannot be explained by the link of symptoms with both stigmatisation (R =
.355; p < .01) and self-esteem (R = -.634; p < .01; see Table 2). Therefore, we disagree with the
argument of some opponents of the labelling theory on mental illness that stigma experiences are
subjective and that the link between stigmatisation and self-esteem can be completely attributed to the
psychopathology of the clients.
In the third step, we introduce our variable concerning peer contact. Table 3 reveals that peer
support itself is positively related with self-esteem (β = .168; p = .000): clients who feel appreciated
and esteemed by their peers in the centre have more positive self-evaluations. This constitutes the
answer to our second research question. This finding is consistent with the view that perceived
support from similar others bolsters the self (Thoits, 1985). In addition, Table 3 shows that the
regression coefficient of stigmatisation diminishes slightly when introducing peer contact in the model.
Hence, the negative relation between stigmatisation and self-esteem can be partially attributed to the
fact that stigma experiences seem to obstruct peer support. Table 2 already revealed that clients who
experience more stigmatisation receive less peer support (R = .362; p < .01). Thus, negative outside
relationships seem to go together with negative inside ones. A possible explanation could be that
socially rejected clients feel ashamed about their attendance of the centre and therefore hesitate to
come in contact with peers.
Finally, the buffering hypothesis is tested by introducing an interaction term in the analysis as
a fourth step. According to this hypothesis, well-being should be higher among highly supported
people than among poorly supported ones, but only under conditions of high stress. Under conditions
of low stress, no differences should be found (Cohen & Wills, 1985). Applying this reasoning to our
third research problem, we should find higher levels of self-esteem among clients receiving more peer
support, but only under circumstances of high stigmatisation. Table 3 reveals that the interaction term
is negative and significant (β = -.069; p = .016), which implies that peer contact does modify the
negative link between stigmatisation and self-esteem. To answer whether this result supports the
buffering hypothesis, we take a closer look at the direction of the interaction effect. In Figure 1, the
mean scores on our self-esteem measure are compared among clients with low and high stigma
experiences, receiving high or low peer support (the distinction between ‘high’ and ‘low’ is based on
the median). This comparison shows us that we can only find differences in self-esteem between
highly and lowly supported clients in the case of low stigmatisation, revealing that peer support is only
effective among persons with low stigma experiences, not among those experiencing a lot of
stigmatisation. Translated to the general stress literature, this means that our results show that well-
being only differs between lowly and highly supported persons in the case of low stress. Therefore, we
can conclude that our data do not support the hypothesis that peer contact impedes the negative
impact of stigmatisation on self-esteem. This result will be discussed in the next section.
DISCUSSION AND CONCLUSION
Persons with mental health problems are often socially rejected, which can have detrimental
consequences for their well-being in general and their self-esteem in particular. Can this negative
effect of stigma experiences be attenuated? As Link et al. (1991) argued, the issue of coping
effectiveness is a matter of no small consequence. If coping works, persons with mental health
problems can be trained to use effective coping strategies. The same can be said of the effectiveness
of peer support. As self-esteem forms a central component of well-being, and as its enhancement can
be regarded as a central goal of rehabilitation, we became very interested in examining whether peer
contact can moderate the negative link between stigmatisation and self-esteem. Using data of 595
clients from 56 rehabilitation centres, we studied the relationship between stigmatisation, peer support
Before turning to the discussion of the central variables, we point out some findings
concerning background variables. First, the results revealed that men are higher in self-esteem than
women, a finding which is consistent in the literature on gender differences in the self-concept (Kling
et al., 1999). Furthermore, a strong, negative link between symptoms and self-esteem is found, which
is also revealed in other studies (e.g. Rosenberg, 1989). When symptoms lead persons to perform
worse than before, they can come to see themselves as less competent and attribute this to personal
failure or inadequacy which leads to lower self-esteem (Rosenberg, 1989). In addition, clients who
stay longer in the center are characterized by more self-esteem, which cannot be attributed to peer
relationships or symptoms, as these variables are controlled for. Also, this result has been found in
other studies (e.g. Commerford & Reznikoff, 1996). As our results replicate previous findings, they add
to the validity of our study.
Before discussing our main results, some shortcomings of our research should also be noted.
First, we do not dispose of longitudinal data, which means that we cannot make definite conclusions
about the direction of causality in our analyses. From a theoretical viewpoint, we based our analysis
on self-esteem theory, which argues that the maintenance and enhancement of self-esteem is a
central human motive, and which indicates several sources of self-esteem (Rosenberg et al., 1989).
Following this idea, we argued that experiences of stigma could have negative implications for one’s
self-esteem in both a direct and an indirect way. However, self-esteem could also have an impact on
stigma experiences. It is possible that persons who feel worthless stimulate others to avoid them or
reject them. Other studies using a longitudinal design showed that the link between stigmatisation and
self-esteem is bidirectional, but that the impact of stigmatisation on self-esteem is larger than the
reverse (e.g. Link, 2001). Following these studies and the theoretical reasoning, we considered self-
esteem as the dependent variable, although we cannot make definite conclusions about the direction
of the association. A second shortcoming concerns the limitations of our sample. As most of the
persons in our study already have a long history concerning psychiatric help, we cannot investigate
the differences between ‘new’ and ‘old’ clients in the way Link (1987) did.
Despite these shortcomings, we believe that our results do contribute to the discussion about
the role of social support in the link between stigmatisation and self-esteem. First, they revealed that
persons who feel socially rejected have lower self-esteem. It is very important to notice that this link is
found even after controlling for symptoms. Therefore, we disagree with some opponents of the
labelling perspective on mental illness, who state that stigma experiences are subjective and
attributable to the symptoms itself rather than to reactions by outsiders (Gove, 1970). This finding also
refutes the critical view of Camp et al. (2002) who comment on studies examining the relationship
between stigmatisation and self-esteem without controlling for symptoms. Moreover, it confirms other
studies revealing that clients experiencing more rejection have lower self-esteem (e.g. Link et al.,
1991; Wright et al., 2000; Link, 2001; Hayward et al., 2002; Verhaeghe, 2003).
Second, our results showed that peer contact is positively linked with clients’ self-esteem. This
is consistent with the view that perceived support from similar others bolsters the self (Thoits, 1985),
which has also been revealed by other studies of persons with psychological problems (e.g. Bracke,
2002). Therefore, we can confirm that peer contact plays an important role in the maintenance or the
recovery of positive self-evaluations for persons with mental health problems. While rejection by
‘outsiders’ diminishes their self-esteem, support by ‘insiders’ enhances it.
At the same time, our study showed that peer support could not attenuate the negative link
between stigmatisation and self-esteem. A possible explanation could be that stigmatisation impedes
the positive effect of social integration among peers. The shame of receiving professional help for
psychological problems is possibly so strong that it obstructs group formation, as joining a group with
(other) persons with mental health problems could imply identification with these persons, and
consequently self-labelling as mentally ill. As stigmatisation can lead to denial of mental health
problems (e.g. Spaniol & Gagne, 1997) as a self-protecting strategy (e.g. Miller & Kaiser, 2001),
persons with mental health problems could hesitate to affiliate with peers as a strategy to deny the
similarity because they try to protect their self-esteem. The strong negative link between stigmatisation
and peer support could be interpreted as a confirmation of this thesis. The fact that persons with more
rejection experiences have less peer support could be due to their hesitation in building peer
relationships as a denial strategy. Their higher level of stigma experiences could enhance their
feelings of shame and, consequently, augment their attempts to distinguish themselves from others
with mental health problems. This is in accordance with Goffman’s (1963) statement that rejected
persons are often ambivalent about others who are similarly marked and attempt to distinguish
themselves from these others. Swanson and Spitzer (1970: 49) state that during the admission of
hospital patients ‘individuals are believed to be most conscious of their spoiled identity and to deny
membership, association, or identification with the disparaged group’. Despite the fact that many of the
clients in this study have an inpatient history and have had a long length of stay in the current centre,
the data suggest that stigmatisation could also affect group identification in these clients.
Our finding concerning a negative link between stigmatisation and peer support is contrary to
the results of Link et al. (1989), who argued that positive relationships with persons who know about
and accept the stigmatized condition substitute the negative ones with non-household non-relatives.
Thus, it is possible that the explanation of Link et al. (1989) is only valid for persons who know and
accept the stigmatized condition and who are not peers. Therefore, it remains interesting to distinguish
what Goffman (1963) calls the ‘own’ (persons who are also stigmatized) and the ‘wise’ (persons who
know about the condition and accept it). Furthermore, our result forms an addition to other studies that
show how stigmatisation has detrimental effects on the social relationships of persons with mental
health problems (e.g. Link et al., 1989; Prince & Prince, 2002). Besides impairing relationships with
persons outside mental health services, it also seems to affect the contacts within.
The lack of support for the buffering hypothesis is surprising in the light of previous research
that shows or suggests the importance of peer support in dealing with stigmatisation (e.g. Segal et al.,
1993; Dudley, 2000). Many of these studies, however, focused on services where peers are explicitly
and purposefully involved in the service delivery (e.g. Salzer & Shear, 2002; Solomon, 2004; Wilson et
al., 1999). In the organisations in our study, this was not the case. To the contrary, staff members of
several centres remarked that clients are discouraged from discussing their emotional problems
among each other to avoid problems concerning the cost of caring. Therefore, we suggest the
possibility that the extent to which clients form a group they identify with and which works as a buffer,
depends on the service modalities. For that reason, it would be interesting to study these differences
between services to reveal the conditions that stimulate a positive effect of peer contact.
Following the discussion of these results, we can formulate several hypotheses for future
research. First, we hypothesize that for clients of mainstream professional mental help facilities (i.e.,
where peer support is not a goal in se), stigmatisation affects self-esteem negatively, whereas peer
support enhances it. Second, we hypothesize that in these facilities stigmatisation implies feelings of
shame, which impede the formation of peer groups and thus the receipt of peer support. Therefore, we
assume an indirect relationship between stigma and self-esteem other than those mentioned in the
introduction can be found by the peer support diminishing features of stigmatisation. Third, we
hypothesize that peer support does not function as a buffer in mainstream organisations. However, it
is possible that it does in specialized peer support facilities, as revealed by other studies. In these
organisations clients might also feel less ashamed to form peer groups. Therefore, we hypothesize
that in specially designed peer support mental health facilities the link between stigmatisation could
diminish because of the self-esteem enhancing features of peer support. Furthermore, in such
organizations, stigmatisation could even lead to strong in-group feelings and group identification,
which can enhance self-esteem, as suggested by Herman and Miall (1990). The differences among
the organizations under study could possibly partially explain the inconsistent findings in the literature.
As the link between stigma, peer support and self-esteem seems to depend on the context in general,
and on organizational features in particular, we suggest incorporating these in future research.
Before concluding, we wish to remark that not only peer support, but also contact with
outsiders is important. Even if peer support reduced the impact of stigmatisation in certain services
such as self-help organisations, one should keep in mind that stigmatisation itself can remain as long
as insiders remain separated from outsiders. It is outsiders’ contact that should be enhanced to
destigmatize, as it is one of the most effective means (Couture & Penn, 2003). Therefore, it remains
interesting to distinguish between reducing the impact of stigmatisation and reducing the rejection
itself. Both strategies are not always compatible in the short and the long term. For instance, even if
coping strategies such as secrecy or avoidance were effective in the short run, and on the individual
level—although this is contrary to Link et al.’s (1991) results—they can contribute to the maintenance
of stigmatisation by maintaining the categorisation, classification and separation of persons with
mental health problems. The same holds for social support. Even if inside support did reduce the
impact of stigmatisation in certain services, this does not imply destigmatisation. As Link et al. (1991)
argued, withdrawal could have negative effects because it can result in further isolation and because it
reinforces the negative self-concept. Therefore, additional research should distinguish the possible
effects of the enhancement of inside and outside social relationships on the reduction of stigmatisation
and its impact.
To conclude, despite the lack of a buffering effect in this study, the results suggest that peer
support should be stimulated. Even if it cannot function as a buffer—at least in those settings where it
is not explicitly implemented—it nevertheless seems to enhance self-esteem, which is still one of the
key goals of psychiatric rehabilitation.
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TABLES AND FIGURES
Table 1—Descriptive sample characteristics
N = 595 Mean Standard Deviation Minimum Maximum
Gender (men = 1) .64 .48 .00 1.00
Age 44.21 12.73 16.00 80.00
Education 2.28 .97 1.00 4.00
Length of stay 2.97 3.52 .00 26.00
Symptoms 1.04 .82 .00 3.55
Stigmatisation 2.57 1.19 1.00 5.00
Peer support 3.80 .67 1.80 5.00
Self-esteem 3.39 .79 1.30 5.00
Table 2—Correlations between variables: Pearson’s correlation coefficients
N = 595 Age Education Length of stay Symptoms Stigmatisation Peer support Self-esteem
Gender (men =
.040 -.063 .099* -.277** -.081* .047 .275**
Age -.148** .335** -.137** -.057 .081* .141**
Education -.015 .060 .078 -.023 -.037
Length of stay -.161** -.050 .047 .189**
Symptoms .355** -.199** -.634**
Stigmatisation -.362** -.403**
Peer support .333**
*** p < 0.001 ** p < 0.01 * p < 0.05
Table 3—The link between stigmatisation, peer support and self-esteem: results of ordinary least squares regression
analyses with self-esteem as a dependent variable. N = 595
Constant 3.715 .131 .000 3.613 .128
.000 3.630 .125
.000 3.611 .125
Gender (men = 1) .172 .054 .104 .002 .179 .052 .109 .001 .180 .051 .109 .000 .181 .051 .110 .000
Age .002 .002 .034 .317 .002 .002 .033 .310 .002 .002 .024 .450 .001 .002 .020 .541
Education .009 .026 .011 .726 .019 .025 .023 .455 .017 .025 .020 .498 .019 .025 .023 .435
Length of stay .016 .008 .073 .031 .017 .007 .074 .023 .017 .007 .074 .020 .018 .007 .080 .013
-.589 .000 -.499 .033 -.514 .000 -.487 .032 -.502 .000 -.485 .032 -.500 .000
-.208 .000 -.101 .022 -.152 .000 -.099 .022 -.149 .000
.168 .000 .200 .038 .169 .000
-.069 .029 -.072 .016
sig R² change
Figure 1 - The link between peer support and self-esteem among
clients with low and high stigma experiences
low stigmatisation high stigmatisation
low peer support high peer support
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A previous version of this paper was presented by the main author at the “Marktdag Sociologie 2005”
in Brussels on June 2, 2005.