Psychological Correlates of Perceived Stigma in a NonClinical Sample

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Psychological Correlates of Perceived Stigma in a
Non-Clinical Sample

• Maeve Proctor
• Roger Woodward
• University of Ulster
• presenting author eveamp_at_gmail.com

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Abstract

• Research over the past number of decades
  indicates that individuals with mental health
  difficulties are likely to encounter
  discrimination and stigma in their lives.
  Modified labelling theory suggests that
  expectations of rejection may work to generate
  negative outcomes for these individuals. It has
  been noted that in this way stigma can act as a
  barrier to recovery and rehabilitation. Through
  the use of a postal questionnaire this study
  aimed to explore the psychological consequences
  for individuals who experience stigma.
  Ninety-four volunteers from the general public
  completed a battery of questionnaires. Results
  indicate that perceived experiences of stigma and
  discrimination were related to higher levels of
  shame, lower levels of positive mood and poor
  self-esteem. Expectations of rejection were found
  to mediate the relationship between stigma and
  psychological outcomes in some cases. The
  clinical implications for those working with
  individuals experiencing stigma and directions
  for future research are also discussed.

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What is Stigma?

• Stigma is
• A social construction that defines people in
  terms of a distinguishing characteristic or mark
  and devalues them as a consequence.
• Dinos et al. (2004) p176

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Stigma and Mental Health

• In a study by Crisp et al. (2000) participants
  agreed that individuals with mental health
  difficulties were dangerous, unpredictable, hard
  to talk to, have only themselves to blame, and
  could pull themselves together if they wanted to.

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Community Integration

• Kelly and McKenna (1997) argue that there is a
  real danger that seclusion within institutions
  will be eliminated only to be replaced with a
  different form of seclusion within the community.
• Prince and Prince (2002) point out that even
  when individuals do manage to participate
  sufficiently to experience physical and social
  integration, they often have difficulties in
  achieving psychological integration due to their
  perceptions of victimisation and stigmatisation.

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Expectations of Rejection

• Modified labelling theory (Link 1989) proposes
  that negative outcomes for those with mental
  health problems are the result of a process
  consisting of several steps.
• Firstly, the individual concerned develops an
  internalised model of societal beliefs of what it
  means to be mentally unwell. This involves
  beliefs about the devaluation of and
  discrimination against the mentally ill.
• If the individual then receives a label of mental
  illness themselves, these internalised beliefs
  become personally relevant. It now matters if the
  individual believed that society would devalue or
  reject persons with mental health problems.
• The individual will then respond to the
  experience of being labelled. This may involve a
  range of reactions such as withdrawal, secrecy
  and educating others. Outcomes arise as a result
  of beliefs as well as reactions. These outcomes
  may include social isolation or poor self-esteem.

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Outcomes of Stigma

• Self-Esteem Studies show conflicting results-
  self-estem may be damaged (Nese-Todd et al. 2001)
  or relatively protected (Crocker et al. 1993) by
  the experience of stigma
• Anxiety Stigma has been related to higher levels
  of anxiety (Gilman et al. 2001). The anxiety of
  disclosure appears to be particularly pertinent
  for those with mental health problems (?sbring
  and Närvänen 2002)

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Outcomes of Stigma continued..

• Mood Low mood has often been associated with the
  experience of stigma e.g. Lee et al. (2005) have
  found that over half of respondents reported
  feelings of worthlessness due to the stigma of
  their psychotic illness and almost 44 had
  considered suicide.
• Shame Dinos et al. (2004) found that individuals
  with mental illnesses were likely to feel guilt
  and embarrassment as a result of stigmatising
  experiences.

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Method

• This study was carried out by means of a postal
  questionnaire. Notices were placed in a variety
  of community settings asking for participants.
  These settings including third-level colleges and
  universities in the Dublin region, a variety of
  support groups, community health centres, gyms,
  libraries and online community websites.

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Participants

• One hundred and thirty one questionnaires were
  sent to volunteers who expressed a desire to
  participate in the study. Ninety-four
  participants (72) completed and returned
  questionnaires between October 2006 and January
  2007.

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Outcome Measures Used

• Harveys Stigma Scale
• The Schedule of Racist Events
• Devaluation-Discrimination Scale
• Penn State Worry Questionnaire
• Positive and Negative Affect Schedule
• The Experience of Shame Scale
• Rosenberg Self-Esteem Scale
• Brief COPE
• Personal Details Form

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Results and Discussion

• Participants who experienced Discrimination
  52.7
• Participants who had experienced discrimination
  who felt stigmatised as a result 46.9
• Most common reason for feeling stigmatised A
  combination of two or more reasons!
• Reasons cited for experiencing stigma sexuality,
  academic ability, job status, financial status,
  unemployment, religious beliefs, smoking, age,
  political beliefs, gender, race, family
  background, mental health, physical health, and
  disability.

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Stigma and Outcome Variables

• Stigma was found to have significant
  relationships with poor self-esteem, low levels
  of positive mood, and high levels of shame.
• Crocker and Major (2003) suggested that
  individuals who felt personally responsible for
  the stigma they experienced were more likely to
  experience low self-esteem. Although individuals
  in this study were readily able to identify the
  factors behind the discrimination they had
  experienced e.g. appearance, it is possible that
  they felt a sense of personal responsibility for
  these issues. This would be likely to lead the
  individual to feel less worthy of positive
  outcomes, thus impacting negatively on their
  self-esteem.

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Stigma and Outcome Variables Continued..

• Negative mood was not shown to be related to
  stigma. Therefore, the results of this study
  cannot be said to support the previous literature
  in the area, which shows a link between low mood
  and stigma.
• The significant findings in relation to positive
  mood, but not with regard to negative mood, in
  this study may indicate a lessened capacity for
  positive emotion for those who are stigmatised.
  This may occur even in the absence of mood
  difficulties. The findings of the study are still
  of concern as positive mood has been shown to
  play a role in mental health, particularly in
  terms of recovery (MacLeod and Moore 2000).
  Folkman and Moskowitz (2000) suggest that
  positive emotions may play a functional role
  during stress and may aid coping. Thus, the fact
  that stigma appears to be related to lower levels
  of positive mood is of note.

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Stigma and Outcome Variables Continued..

• It would appear that those individuals who feel
  they do not live up to societal expectations are
  likely to experience shame (Miller and Mason
  2005). This would appear to tie-in with
  suggestions posed in relation to self-esteem,
  i.e. attributions of personal deservingness
  bringing about higher levels of shame

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Stigma and Outcome Variables Continued..

• Much of the literature looking at anxiety in this
  area has focused on issues that may be specific
  to particular types of stigma e.g. disclosure
  about ones stigmatising condition. It is
  possible that the more anxiety-provoking aspects
  of stigma were not prominent in this study.

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Other findings

• The results in terms of discrimination follow a
  similar pattern to those obtained in relation to
  stigma
• Rejection was found to mediate the relationship
  between stigma and the outcome variables of
  anxiety, shame and positive mood.

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Possible Clinical Implications

• In this study stigma and discrimination were
  found to be linked to poor self-esteem, lower
  positive mood and higher levels of shame. These
  difficulties are likely to impact on an
  individuals lifestyle and social functioning.
  The difficulties outlined here may be even more
  pronounced within a mental health population.

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Possible Clinical Implications Continued..

• We can see that issues such as self-esteem, shame
  and mood should therefore be addressed within
  populations who experience stigma when offering
  them health services.
• Poor self-esteem, high levels of shame and
  lowered positive mood may also serve to compound
  already existing psychological difficulties. This
  may need to be teased out and addressed
  separately if necessary.
• Given that shame and embarrassment can persist
  despite effective treatment of the illness that
  causes them (Miller and Mason 2005) it is of
  particular importance that this issue be
  addressed separately.

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Possible Clinical Implications Continued..

• Given that discrimination was associated with
  similar outcomes to those obtained in relation to
  stigma we need to be mindful of similar issues
  when working with individuals who have
  experienced discrimination. Individuals who find
  discriminatory experiences more stressful and
  those who perceive that their lives would be more
  different if it were not for the discrimination
  are more likely to experience shame and to have
  higher levels of stigmatisation and higher
  expectations of rejection. These factors can
  therefore be used clinically as a potential
  marker of greater difficulties in these areas.

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Possible Clinical Implications Continued..

• Some of the difficulties outlined here have been
  seen to be barriers to treatment. Shame, poor
  self-esteem and the preception of stigma itself
  have been highlighted as significant obstacles
  to initiating and maintaining treatment (Ehrim
  2001, Wahl 1999, Sirey et al. 2001 ).
• Given that this is the case it is important for
  services to address these issues with their
  clients and patients from the outset of their
  involvement.
• It would also appear that there is a need for
  less traditional forms of service that may serve
  to cater for individuals who find it difficult to
  engage with more conventional services. Assertive
  outreach is an example of the types of service
  option that has been found to cater for patients
  who find it difficult to engage (Meaden,
  Nithsdale, Rose, Smith, and Jones 2004).

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PossibleClinical Implications Continued..

• This study has highlighted the role that
  expectations of rejection may play in
  perpetuating the difficulties caused by
  experiences of stigma and discrimination. This is
  an issue that needs to be addressed within the
  wider community.
• Previous programmes attempting this task have
  shown benefits within target groups (Gaebel and
  Baumann 2003) but further work is needed to
  generalise these gains to the wider community.
• For the individual who has already experienced
  these difficulties and developed these
  expectations, we need to offer them strategies to
  manage these challenges and assistance in dealing
  with the problems they bring about.

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References

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