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Self-stigma, when people with mental illness apply negative stereotypes about serious mental health conditions (SMHCs) to themselves, is found among 1/3 to 1/2 of people with SMHC and is associated with treatment avoidance and a longer time to recovery. To date, interventions specifically addressing self-stigma among emerging adults (ages 18-29) with SMHCs remain underdeveloped. One key pathway toward self-stigma may be perceived parental stigma (PPS), the perception an individual has regarding the level of stigma their parents endorse toward mental illness. Although parents may exert a substantial influence on their emerging adult children, the extent to which PPS is associated with self-stigma has not been established. Aims included: (1) Examining whether PPS is associated with stages of the self-stigma regressive model (e.g., aware, agree, apply, harm); (2) Identifying whether self-stigma stages mediate the association of PPS with outcomes of self-stigma including worse self-esteem and increased "why try" effect. The "why try" effect is a feeling of futility about achieving life goals due to having a mental illness.
Methods:
239 emerging adults with a SMHC (e.g., schizophrenia, schizoaffective disorder, psychosis, bipolar disorder, major depressive disorder) who were receiving services at a large, urban community mental health center (CMHC) were recruited in person at clinics and via e-flyers. All participants satisfied the following eligibility criteria: (a) between ages 18-29; (b) self-reported diagnosis of a SMHC; (c) assent to reading and responding in English; (d) verified client status at the CMHC. The survey was accessed via a link, administered via Qualtrics, and completed on cell phones.
Results:
SEM was estimated with robust maximum likelihood estimation in lavaan. Overall model fit had a scaled χ²(586) = 226.255 (p = 1.00), scaled CFI = 1.00, SRMR = 0.072, and scaled RMSEA = .000 [.000-.000]. PPS was associated with Aware ( β = .395, p <.01) and Apply/Harm ( β = .430, p <.01) stages of self-stigma. Aim 2 was supported with an indirect effect found between PPS and self-esteem ( β = -.177, p <.05), such that higher levels of PPS were associated with significantly lower levels of self-esteem. Significant total effects were found between PPS and self-esteem ( β = -.222, p <.01), and PPS and the "why try" effect ( β = .230, p <.05). Findings indicate that perceived parental stigma (PPS) is associated with more self-stigma, worse self-esteem, and more "why try" effect among emerging adults with SMHC.
Conclusions and Implications:
Findings suggest that emerging adults with SMHCs who perceive their parents as holding more stigma toward mental illness tend to report higher self-stigma themselves. Clinicians may want to assist emerging adults to challenge stigmatizing beliefs that originate in the public, among parents or guardians, and within themselves. Future research may want to investigate the utility of developing self-stigma reduction interventions that (a) help emerging adults question parental beliefs about stigma, (b) include a parental psychoeducation component to reduce stigma toward people with SMHCs, and (c) address stigma in a family therapy context.