Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong.
Clin Psychol Rev. 2021 Jul;87:102029. doi: 10.1016/j.cpr.2021.102029. Epub 2021 Apr 20.
This meta-analytic study synthesized findings from 108 independent data sets across 22 cultures to investigate whether the stigma internalization model (the internalization of experienced stigma and perceived stigma to self-stigma) is associated with well-being and recovery of people with mental illness. We also examined the moderating role of collectivism in the internalization process. Results of the meta-analytic structural equation modeling suggested that self-stigma is a significant mediator in the relationships between experienced stigma and perceived stigma with well-being and recovery variables (indirect effects = 0.02 to -0.16). Experienced and perceived stigma had significant direct effects on well-being and recovery variables (Bs = 0.07 to -0.21, p < 0.05), suggesting that both external (e.g., public stigma) and internal (i.e., self-stigma) influences of stigma work concurrently to affect recovery and well-being of people with mental illness. The results of the mixed effect three-level meta-analytic models showed that collectivism significantly moderated the relationship between experienced and perceived stigma with self-stigma (Bs = 0.06 to 0.11, p < 0.05). This implied that the more collectivistic a culture is, the stronger the correlation between experienced and perceived stigma with self-stigma. Implications to stigma reduction approaches were discussed.
本荟萃分析研究综合了 22 个文化中的 108 个独立数据集的结果，旨在探讨经历性耻辱感和感知性耻辱感内化到自我耻辱感的耻辱内化模型是否与精神疾病患者的幸福感和康复相关。我们还检验了集体主义在内化过程中的调节作用。荟萃分析结构方程模型的结果表明，自我耻辱感是经历性耻辱感和感知性耻辱感与幸福感和康复变量之间关系的重要中介（间接效应=0.02 到-0.16）。经历性耻辱感和感知性耻辱感对幸福感和康复变量有显著的直接影响（Bs=0.07 到-0.21，p<0.05），这表明耻辱感的外部（例如公众耻辱感）和内部（即自我耻辱感）影响会同时作用于精神疾病患者的康复和幸福感。混合效应三级荟萃分析模型的结果表明，集体主义显著调节了经历性耻辱感和感知性耻辱感与自我耻辱感之间的关系（Bs=0.06 到 0.11，p<0.05）。这意味着一个文化越集体主义，经历性耻辱感和感知性耻辱感与自我耻辱感之间的相关性就越强。讨论了减少耻辱感的方法的意义。
