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

Published online by Cambridge University Press:  06 December 2016

N. Oexle ,
T. Waldmann ,
T. Staiger ,
Z. Xu  and
N. Rüsch
N. Oexle*
Affiliation:
Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
T. Waldmann
Affiliation:
Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
T. Staiger
Affiliation:
Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
Z. Xu
Affiliation:
Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
N. Rüsch
Affiliation:
Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
*
*Address for correspondence: N. Oexle, Department of Psychiatry II, University of Ulm and BKH Günzburg, Parkstrasse 11, 89073 Ulm, Germany. (Email: nathalie.oexle@uni-ulm.de)
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Abstract

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 stigma's 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.

Keywords

Individual stigmamental illness stigmapublic stigmasuicidalityunemployment
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 27 , Issue 2 , April 2018 , pp. 169 - 175
Copyright
Copyright © Cambridge University Press 2016 

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References

Andrews, G, Kemp, A, Sunderland, M, Von Korff, M, Ustun, TB (2009). Normative data for the 12 item WHO disability assessment schedule 2.0. PLoS ONE 4, e8343.Google Scholar
Brown, RL, Rounds, LA (1995). Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wisconsin Medical Journal 94, 135–140.Google Scholar
Corrigan, PW, Larson, JE, Rüsch, N (2009). Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. World Psychiatry 8, 75–81.Google Scholar
Corrigan, PW, Michaels, PJ, Vega, E, Gause, M, Watson, AC, Rüsch, N (2012 a). Self-stigma of mental illness scale-short form: reliability and validity. Psychiatry Research 199, 65–69.Google Scholar
Corrigan, PW, Morris, SB, Michaels, PJ, Rafacz, JD, Rüsch, N (2012 b). Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatric Services 63, 963–973.Google Scholar
Corrigan, PW, Bink, AB, Schmidt, A, Jones, N, Rüsch, N (2016). What is the impact of self-stigma? Loss of self-respect and the “why try” effect. Journal of Mental Health 25, 10–15.Google Scholar
Evans-Lacko, S, Brohan, E, Mojtabai, R, Thornicroft, G (2012). Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries. Psychological Medicine 42, 1741–1752.Google Scholar
Farrelly, S, Jeffery, D, Rüsch, N, Williams, P, Thornicroft, G, Clement, S (2015). The link between mental health-related discrimination and suicidality: service user perspectives. Psychological Medicine 45, 2013–2022.Google Scholar
Gabbidon, J, Brohan, E, Clement, S, Henderson, RC, Thornicroft, G (2013). The development and validation of the Questionnaire on Anticipated Discrimination (QUAD). BMC Psychiatry 13, 297.Google Scholar
Hinkin, CH, Castellon, SA, Dickson-Fuhrman, E, Daum, G, Jaffe, J, Jarvik, L (2001). Screening for drug and alcohol abuse among older adults using a modified version of the CAGE. The American Journal on Addictions 10, 319–326.Google Scholar
Kenny, DA (2015). SEM: Measuring Model Fit. Retrieved 25 July 2016 from http://davidakenny.net/cm/fit.htm Google Scholar
Kessler, RC, Barker, PR, Colpe, LJ, Epstein, JF, Gfroerer, JC, Hiripi, E, Howes, MJ, Normand, S-LT, Manderscheid, RW, Walters, EE, Zaslavsky, AM (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry 60, 184–189.Google Scholar
Klaghofer, R, Brähler, E (2000). Konstruktion und teststatistische Prüfung einer Kurzform der SCL-90-R [construction and evaluation of the short version of SCL-90-R]. Zeitschrift für klinische Psychologie, Psychiatrie und Psychotherapie 49, 115–124.Google Scholar
Lasalvia, A, Zoppei, S, Van Bortel, T, Bonetto, C, Cristofalo, D, Wahlbeck, K, Bacle, SV, Van Audenhove, C, van Weeghel, J, Reneses, B, Germanavicius, A, Economou, M, Lanfredi, M, Ando, S, Sartorius, N, Lopez-Ibor, JJ, Thornicroft, G (2013). Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. The Lancet 381, 55–62.Google Scholar
Link, BG, Cullen, FT, Struening, E, Shrout, PE, Dohrenwend, BP (1989). A Modified Labeling Theory approach to mental disorders: an empirical assessment. American Sociological Review 54, 400–423.Google Scholar
Milner, A, Page, A, LaMontagne, AD (2013). Long-term unemployment and suicide: a systematic review and meta-analysis. PLoS ONE 8, e51333.Google Scholar
Mittal, D, Sullivan, G, Chekuri, L, Allee, E, Corrigan, PW (2012). Empirical studies of self-stigma reduction strategies: a critical review of the literature. Psychiatric Services 63, 974–981.Google Scholar
Muthén, LK, Muthén, BO (1998). MPlus User's Guide, 7th edn., Muthén & Muthén: Los Angeles, CA.Google Scholar
Oexle, N, Ajdacic-Gross, V, Kilian, R, Müller, M, Rodgers, S, Xu, Z, Rössler, W, Rüsch, N (2016 a). Mental illness stigma, secrecy and suicidal ideation. Epidemiology and Psychiatric Sciences, published online. doi: 10.1017/S2045796015001018 Google Scholar
Oexle, N, Rüsch, N, Viering, S, Wyss, C, Seifritz, E, Xu, Z, Kawohl, W (2016 b). Self-stigma and suicidality: a longitudinal study. European Archives of Psychiatry and Clinical Neuroscience, published online. doi: 10.1007/s00406-016-0698-1 Google Scholar
Ritsher, JB, Otilingam, PG, Grajales, M (2003). Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Research 121, 31–49.Google Scholar
Rüsch, N, Angermeyer, MC, Corrigan, PW (2005). Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. European Psychiatry 20, 529–539.Google Scholar
Rüsch, N, Zlati, A, Black, G, Thornicroft, G (2014). Does the stigma of mental illness contribute to suicidality? The British Journal of Psychiatry 205, 257–259.Google Scholar
Schomerus, G, Schwahn, C, Holzinger, A, Corrigan, PW, Grabe, HJ, Carta, MG, Angermeyer, MC (2012). Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica 125, 440–452.Google Scholar
van Spijker, BAJ, Batterham, PJ, Calear, AL, Farrer, L, Christensen, H, Reynolds, J, Kerkhof, AJFM (2014). The Suicidal Ideation Attributes Scale (SIDAS): community-based validation study of a new scale for the measurement of suicidal ideation. Suicide & Life – Threatening Behavior 44, 408–419.Google Scholar
Stuart, H (2006). Mental illness and employment discrimination. Current Opinion in Psychiatry 19, 522–526.Google Scholar
Thornicroft, G, Brohan, E, Rose, D, Sartorius, N, Leese, M, the INDIGO Study Group (2009). Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. The Lancet 373, 408–415.Google Scholar
Thornicroft, G, Mehta, N, Clement, S, Evans-Lacko, S, Doherty, M, Rose, D, Koschorke, M, Shidhaye, R, O'Reilly, C, Henderson, C (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet 387, 1123–1132.CrossRefGoogle ScholarPubMed
Üstün, TB, Chatterji, S, Kostanjsek, N, Rehm, J, Kennedy, C, Epping-Jordan, J, Saxena, S, von Korff, M, Pull, C (2010). Developing the World Health Organization disability assessment schedule 2.0. Bulletin of the World Health Organization 88, 815–823.Google Scholar
Wang, K, Weiss, NH, Pachankis, JE, Link, BG (2016). Emotional clarity as a buffer in the association between perceived mental illness stigma and suicide risk. Stigma and Health. doi: 10.1037/sah0000032.Google Scholar
Xu, Z, Müller, M, Heekeren, K, Theodoridou, A, Metzler, S, Dvorsky, D, Oexle, N, Walitza, S, Rössler, W, Rüsch, N (2016 a). Pathways between stigma and suicidal ideation among people at risk of psychosis. Schizophrenia Research 172, 184–188.Google Scholar
Xu, Z, Mayer, B, Müller, M, Heekeren, K, Theodoridou, A, Dvorsky, D, Metzler, S, Oexle, N, Walitza, S, Rössler, W, Rüsch, N (2016 b). Stigma and suicidal ideation among young people at risk of psychosis after one year. Psychiatry Research 243, 219–224.Google Scholar