Catalano Lauren T, Brown Clayton H, Lucksted Alicia, Hack Samantha M, Drapalski Amy L
Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.
Department of Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center, Baltimore, MD, USA; Department of Epidemiology & Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA.
J Psychiatr Res. 2021 May;137:41-47. doi: 10.1016/j.jpsychires.2021.02.014. Epub 2021 Feb 13.
One prominent social-cognitive model of internalized stigma by Corrigan and his colleagues (2012; 2002) proposes that individuals are exposed to societal stereotypes about mental illness, at least tacitly agree with them, and may apply them to oneself, engendering harmful self-beliefs. There is limited empirical support for this model in serious mental illness. Moreover, it is not clearly established how internalized stigma and its associated factors impact recovery in this population. The current study uses structural equation modeling (SEM) to assess the social-cognitive model's goodness of fit in a sample of Veterans with serious mental illness (Veteran sample, n = 248), and then validates the model in a second and independent sample of individuals receiving community-based psychiatric rehabilitation services (community sample, n = 267). Participants completed the Self-Stigma of Mental Illness Scale (SSMIS; Corrigan et al., 2006) and measures of self-esteem, self-efficacy, and recovery attitudes. Consistent with Corrigan and colleagues' formulation of internalized stigma, SEM analyses showed a significant indirect pathway from stereotype awareness, to stereotype agreement, to application to self, to self-esteem decrement, to poorer recovery attitudes. Additionally, there was a significant direct effect from stereotype awareness to self-esteem. This study shows that individuals with serious mental illness experience psychological harm from stigma in two ways: (1) through perceived public prejudice and bias, and (2) through internalizing these negative messages. In particular, stigma harms individuals' self-esteem, which then reduces their recovery attitudes.
科里根及其同事（2012年；2002年）提出的一个关于内化耻辱感的著名社会认知模型认为，个体接触到关于精神疾病的社会刻板印象，至少是默认这些刻板印象，并可能将其应用于自己，从而产生有害的自我信念。在严重精神疾病中，该模型的实证支持有限。此外，内化耻辱感及其相关因素如何影响这一人群的康复尚不清楚。本研究使用结构方程模型（SEM）来评估社会认知模型在患有严重精神疾病的退伍军人样本（退伍军人样本，n = 248）中的拟合优度，然后在接受社区精神康复服务的第二个独立个体样本（社区样本，n = 267）中验证该模型。参与者完成了精神疾病自我耻辱感量表（SSMIS；科里根等人，2006年）以及自尊、自我效能和康复态度的测量。与科里根及其同事对内化耻辱感的表述一致，SEM分析显示了一条从刻板印象意识，到刻板印象认同，再到应用于自我，再到自尊下降，最后到较差康复态度的显著间接路径。此外，从刻板印象意识到自尊有显著的直接影响。这项研究表明，患有严重精神疾病的个体在两个方面受到耻辱感的心理伤害：（1）通过感知到的公众偏见和歧视，以及（2）通过内化这些负面信息。特别是，耻辱感会损害个体的自尊，进而降低他们的康复态度。
