Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim / University Heidelberg, Mannheim, Germany.
Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim / University Heidelberg, Mannheim, Germany.
PLoS One. 2019 Oct 29;14(10):e0224418. doi: 10.1371/journal.pone.0224418. eCollection 2019.
The progressive model of self-stigma describes four stages of internalizing stereotypes of mental illness: stereotype awareness, personal agreement, self-concurrence, and harm to self (i.e., self-esteem). Successive stages are postulated to be the most highly related. Endorsement is presumed to decrease by stage. The model has been supported in most but not all elements in various studies. The procedural character has not yet been investigated in one integrative model. The aim of this study was to test the progressive model of self-stigma in three respects: I) successive stages have the strongest associations, II) endorsements decrease with each stage, and III) the procedural character can be represented by one serial mediation model.
A cross-sectional computer-based survey was conducted in two samples of patients with depression; one online sample (NA = 550; only self-report) and one clinical face-to-face sample (NB = 180; screening by treatment staff). The inclusion criteria were, age of 18-70 years, sufficient cognitive abilities and German language skills. IBM SPSS statistics 24 was used for Cronbach's alphas, descriptive statistics, Spearman correlations, and Mann-Whitney-U tests. The PROCESS procedure for SPSS Version 3.00 was used for mediation analyses.
The results support the progressive model of self-stigma in people with depression in most respects: Endorsements for stereotype awareness were higher than for personal agreement and self-concurrence, and no relevant difference was found between personal agreement and self-concurrence. Successive stages had the strongest associations, with the exception of the association between stereotype awareness and self-esteem, which was higher than the association between stereotype awareness and personal agreement and self-concurrence. The association between stereotype awareness and self-esteem was mediated via personal agreement and self-concurrence.
The progressive model of self-stigma offers a theoretical foundation for the process research of self-stigma. Longitudinal research may investigate predictive effects and whether different stages of self-stigma require specific consideration in their prediction, consequences, and potential interventions.
自我污名的渐进模型描述了内化精神疾病刻板印象的四个阶段：刻板印象意识、个人认同、自我一致和自我伤害（即自尊）。各阶段之间的关系被认为是最密切的。随着阶段的推进，认同度被假定会降低。该模型在大多数研究中得到了支持，但并非所有研究都得到了支持。程序特征尚未在一个综合模型中得到研究。本研究旨在从三个方面检验自我污名的渐进模型：I）连续阶段具有最强的关联，II）每个阶段的认同度都降低，III）程序特征可以用一个序列中介模型来表示。
在两个抑郁症患者样本中进行了一项基于计算机的横断面调查；一个在线样本（NA=550；仅自我报告）和一个临床面对面样本（NB=180；由治疗人员进行筛查）。纳入标准为年龄在 18-70 岁之间，认知能力和德语语言能力足够。使用 IBM SPSS statistics 24 进行 Cronbach's alphas、描述性统计、Spearman 相关和 Mann-Whitney-U 检验。使用 SPSS 版本 3.00 的 PROCESS 程序进行中介分析。
结果在大多数方面支持抑郁症患者的自我污名渐进模型：对刻板印象意识的认同度高于对个人认同和自我一致的认同度，而个人认同和自我一致之间没有发现相关差异。连续阶段之间的关联最强，刻板印象意识与自尊之间的关联除外，该关联高于刻板印象意识与个人认同和自我一致之间的关联。刻板印象意识与自尊之间的关联通过个人认同和自我一致来介导。
自我污名的渐进模型为自我污名的过程研究提供了理论基础。纵向研究可以调查预测效果，以及自我污名的不同阶段在预测、后果和潜在干预方面是否需要特别考虑。
