Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany.
Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
Compr Psychiatry. 2017 Apr;74:224-230. doi: 10.1016/j.comppsych.2017.02.001. Epub 2017 Feb 4.
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.
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.
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.
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.
目前尚不清楚精神疾病污名是否会影响临床环境之外的阈下综合征个体。因此，我们调查了不同污名变量（包括与污名相关的压力和羞耻反应）在具有较高症状水平的一般人群成员中对回避性污名应对的作用。
基于代表性的人群调查，在一个路径模型中，通过自我报告，在 676 名具有较高症状水平的参与者中评估了一般压力韧性、污名变量、对患有精神疾病的羞耻感以及回避性污名应对（保密和社交退缩）。考察了韧性和污名变量作为回避性污名应对的预测因子。
较高的污名压力与较低的一般压力韧性以及较高的感知污名、群体认同和感知歧视的合法性有关。更多的羞耻感与更高的感知合法性相关。较低的韧性以及更高的感知污名、群体认同和感知合法性预测了回避性应对。污名压力部分中介了韧性、感知污名和群体认同对回避性应对的影响；羞耻感部分中介了感知合法性对应对的影响。污名压力和羞耻感也与回避性污名应对呈直接正相关。分析调整了症状、神经质和社会人口学变量。
污名可能会影响比之前想象的更大比例的人群，因为污名变量预测了具有较高但总体轻度症状水平的一般人群成员的保密性和退缩。回避性污名应对可能有不良影响，可能会加剧先前存在的心理困扰，并破坏社交网络。这凸显了减少公众污名以及支持阈下综合征个体应对污名压力和羞耻反应的必要性。
