Nathalie Oexle

Self-stigma and suicidality: a longitudinal study.

Mental illness stigma is a source of distress for persons with mental illness. Self-stigma occurs when negative stereotypes are internalized, leading to low self-esteem, shame and hopelessness. Due to its consequences self-stigma may contribute to suicidality and be a modifiable target for suicide prevention. Based on 222 disability pensioners with mental illness we examined whether self-stigma at baseline is associated with suicidal ideation over a 2-year period, controlling for baseline suicidal ideation, symptoms, age and gender. More self-stigma predicted suicidal ideation at baseline and longitudinally. Interventions on different levels to reduce self-stigma could improve suicide prevention.

Stigma and suicidal ideation among young people at risk of psychosis after one year

Suicidality is common among individuals at risk of psychosis. Emerging findings suggest that mental illness stigma contributes to suicidality. However, it is unclear whether stigma variables are associated with suicidality among young people at risk of psychosis. This longitudinal study assessed perceived public stigma and the cognitive appraisal of stigma as a stressor (stigma stress) as predictors of suicidal ideation among individuals at risk of psychosis over the period of one year. One hundred and seventy-two participants between 13 and 35 years of age were included who were at high or ultra-high risk of psychosis or at risk of bipolar disorder. At one-year follow-up, data were available from 73 completers. In multiple logistic regressions an increase of stigma stress (but not of perceived stigma) over one year was significantly associated with suicidal ideation at one-year follow-up, controlling for age, gender, symptoms, comorbid depression and suicidal ideation at baseline. Interventions to reduce public stigma and stigma stress could therefore improve suicide prevention among young people at risk of psychosis.

Mental illness stigma and suicidality: the role of public and individual stigma

AIMS Suicide rates are increased among unemployed individuals and mental illness stigma can contribute to both unemployment and suicidality. Persons with mental illness perceive negative attitudes among the general public and experience discrimination in their everyday life (=public stigma components) potentially leading to self-stigma and anticipated discrimination (=individual stigma components). Previous research found evidence for an association between aspects of mental illness stigma and suicidality, but has not yet clarified the underlying pathways explaining how different stigma components interact and contribute to suicidal ideation. METHOD Public and individual stigma components and their association with suicidal ideation were examined among 227 unemployed persons with mental illness. A path model linking public stigma components (experienced discrimination, perceived stigma) with suicidal ideation, mediated by individual stigma components (anticipated discrimination, self-stigma), was examined using structural equation modelling within Mplus. RESULTS Our sample was equally split in terms of gender, on average 43 years old and about half reported no suicidal ideation during the past 30 days. In bivariate analyses all stigma components were significantly associated with suicidal ideation. In the path model and controlling for symptoms, the association between experienced discrimination and suicidal ideation was fully mediated by anticipated discrimination and self-stigma. Perceived stigmas contribution to suicidal ideation was fully mediated by anticipated discrimination, but not by self-stigma. CONCLUSIONS In general, programmes addressing multiple stigma components seem to be most effective in improving suicide prevention. Besides interventions targeting negative attitudes and discriminating behaviours of the general public, programmes to support persons with mental illness in coping with perceived and experienced stigma could improve suicide prevention. Future studies should test the short- and long-term effects of such interventions on suicidality and further investigate the role of stigma coping (e.g. secrecy) and emotional consequences (e.g. hopelessness and loneliness) for the association between stigma components and suicidality.

Stigma-related stress, shame and avoidant coping reactions among members of the general population with elevated symptom levels

BACKGROUND It is unclear whether mental illness stigma affects individuals with subthreshold syndromes outside clinical settings. We therefore investigated the role of different stigma variables, including stigma-related stress and shame reactions, for avoidant stigma coping among members of the general population with elevated symptom levels. METHODS Based on a representative population survey, general stress resilience, stigma variables, shame about having a mental illness as well as avoidant stigma coping (secrecy and social withdrawal) were assessed by self-report among 676 participants with elevated symptom levels. Stigma variables and resilience were examined as predictors of avoidant stigma coping in a path model. RESULTS Increased stigma stress was predicted by lower general stress resilience as well as by higher levels of perceived stigma, group identification and perceived legitimacy of discrimination. More shame was associated with higher perceived legitimacy. Lower resilience as well as more perceived stigma, group identification and perceived legitimacy predicted avoidant coping. Stigma stress partly mediated effects of resilience, perceived stigma and group identification on avoidant coping; shame partly mediated effects of perceived legitimacy on coping. Stigma stress and shame were also directly and positively related to avoidant stigma coping. Analyses were adjusted for symptoms, neuroticism and sociodemographic variables. CONCLUSIONS Stigma may affect a larger proportion of the population than previously thought because stigma variables predicted secrecy and withdrawal among members of the general population with elevated, but overall mild symptom levels. Avoidant stigma coping likely has harmful effects, potentially exacerbating pre-existing psychological distress and undermining social networks. This highlights the need to reduce public stigma as well as to support individuals with subthreshold syndromes in their coping with stigma stress and shame reactions.

Predicting perceived need for mental health care in a community sample: an application of the self-regulatory model

PurposeMost people with mental health problems do not use mental health services, resulting in poor psychiatric outcomes and greater illness burden. Although perceiving the need for mental health care was identified to be a key factor for service use, factors that explain differences in perceived need for mental health care are incompletely understood. The present paper investigates the role of illness representations in predicting perceived need for mental health care.MethodsIn a community sample of 202 persons currently distressed by symptoms related to mental illness, illness representations were assessed using the Brief Illness Perception Questionnaire and perceived need for mental health care was measured by the Self-Appraisal of Illness Questionnaire. Multiple linear regression models were used to determine the association between a person’s illness representations and the level of perceived need for mental health care.ResultsTwo illness representations were positively associated with perceived need for mental health care: the belief that treatment could improve the current mental health problem and the attribution of experienced symptoms to a mental health problem. Increased perceived need for care was related to current mental health service use.ConclusionsInterventions that aim to increase mental health service use could focus on people’s attitudes toward mental health treatment and enable people to recognize symptoms as a mental illness.

Intersections of discrimination due to unemployment and mental health problems: the role of double stigma for job- and help-seeking behaviors

PurposeThe everyday lives of unemployed people with mental health problems can be affected by multiple discrimination, but studies about double stigma—an overlap of identities and experiences of discrimination—in this group are lacking. We therefore studied multiple discrimination among unemployed people with mental health problems and its consequences for job- and help-seeking behaviors.MethodsEveryday discrimination and attributions of discrimination to unemployment and/or to mental health problems were examined among 301 unemployed individuals with mental health problems. Job search self-efficacy, barriers to care, and perceived need for treatment were compared among four subgroups, depending on attributions of experienced discrimination to unemployment and to mental health problems (group i); neither to unemployment nor to mental health problems (group ii); mainly to unemployment (group iii); or mainly to mental health problems (group iv).ResultsIn multiple regressions among all participants, higher levels of discrimination predicted reduced job search self-efficacy and higher barriers to care; and attributions of discrimination to unemployment were associated with increased barriers to care. In ANOVAs for subgroup comparisons, group i participants, who attributed discrimination to both unemployment and mental health problems, reported lower job search self-efficacy, more perceived stigma-related barriers to care and more need for treatment than group iii participants, as well as more stigma-related barriers to care than group iv.ConclusionsMultiple discrimination may affect job search and help-seeking among unemployed individuals with mental health problems. Interventions to reduce public stigma and to improve coping with multiple discrimination for this group should be developed.

Stigma and suicidality among suicide attempt survivors: A qualitative study

Abstract Among people with mental illness, stigma experiences can increase suicidality, and suicidality itself is associated with negative stereotypes. Suicide attempt survivors experience both mental illness stigma and suicide stigma, which could contribute to their increased risk for completed suicide. We interviewed 13 suicide attempt survivors regarding experiences and consequences of stigma and identified five stigma-related themes. Stigma led to substantial emotional strain, including loneliness and hopelessness, which are important precursors of suicidality. Our findings suggest that both mental illness stigma and suicide stigma can contribute to suicidality among people with mental illness in general, and in suicide attempt survivors specifically.

The Self-Stigma of Suicide Attempt Survivors

Although suicide attempt survivors report feelings of shame and stigmatization, no published scale measures self-stigma experienced by attempt survivors. This article describes the creation and validation the Self-Stigma of Suicide Attempt Scale (SSSAS). In this study, the SSSAS was validated in an online sample (n = 292) of suicide attempt survivors. Results supported the progressive model of self-stigma, wherein a substantial proportion of suicide attempt survivors were aware of stigma, but fewer applied that stigma to themselves or felt harmed by it. Reliabilities of SSSAS subscales were high. Harm subscale scores were correlated with depression, self-esteem, recovery, empowerment, and stigma stress in the expected directions. Future research can seek to further validate the scale and explore relationship between self-stigma and other constructs.