Lasalvia Antonio, Bonetto Chiara, Van Bortel Tine, Cristofalo Doriana, Brouwers Evelien, Lanfredi Mariangela, van Weeghel Jaap, Chang Chih-Cheng, Chee Kok-Yoon, Harangozó Judit, Van Audenhove Chantal, Ola Bola, Jorge-Monteiro Fátima, James Bawo, Ouali Uta, Germanavičius Arūnas, Abdulmalik Jibril, Ucok Alp, Oshodi Yewande, Thornicroft Graham
Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Centre for Medical Sciences (CISMED), Chair of Psychiatry, University of Trento, Trento, Italy.
Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
J Affect Disord. 2025 Dec 1;390:119802. doi: 10.1016/j.jad.2025.119802. Epub 2025 Jun 28.
Major Depressive Disorder (MDD) is a prevalent mental health condition often accompanied by self-stigma, negatively impacting self-esteem and empowerment. This study examines the mediating role of self-esteem in the relationship between self-stigma and empowerment and explores the moderating influence of socioeconomic and cultural contexts in an international sample.
This cross-sectional study, part of the ASPEN/INDIGO-Depression project, included participants with a diagnosis of MDD from 34 countries. Self-stigma, self-esteem, and empowerment were assessed using, respectively, the Internalized Stigma of Mental Illness (ISMI) scale, the Boston University Empowerment Scale (BUES), and the Rosenberg Self-Esteem Scale (RSES). A mediation model examined self-esteem's role in the self-stigma-empowerment relationship, and a conditional mediation model examined the moderating effect of the Human Development Index (HDI). All effects were adjusted for socio-demographic and clinical covariates.
A total of 1058 people participated. Mediation analysis confirmed that self-esteem significantly mediated the negative association between self-stigma and empowerment, suggesting that lower self-stigma leads to higher self-esteem, which in turn enhances empowerment. Moderation analysis revealed that the mediation effect varied across countries with different socioeconomic and cultural contexts. The indirect effect of self-stigma on self-esteem was stronger in countries with higher HDI, indicating that individuals in these settings experience greater vulnerability to the negative effects of self-stigma on self-esteem.
Self-esteem buffers the negative impact of self-stigma on empowerment in people with MDD. The strength of this effect varies by socioeconomic and cultural context, with stronger mediation in higher-HDI countries. These findings highlight the need for tailored interventions addressing self-stigma in specific contexts to enhance empowerment and recovery.
重度抑郁症（MDD）是一种常见的心理健康状况，常伴有自我污名化，对自尊和赋权产生负面影响。本研究考察自尊在自我污名化与赋权关系中的中介作用，并在国际样本中探讨社会经济和文化背景的调节影响。
这项横断面研究是ASPEN/INDIGO-抑郁症项目的一部分，纳入了来自34个国家的被诊断为MDD的参与者。分别使用精神疾病内化污名量表（ISMI）、波士顿大学赋权量表（BUES）和罗森伯格自尊量表（RSES）评估自我污名化、自尊和赋权。一个中介模型考察了自尊在自我污名化与赋权关系中的作用，一个条件中介模型考察了人类发展指数（HDI）的调节作用。所有效应均针对社会人口统计学和临床协变量进行了调整。
共有1058人参与。中介分析证实，自尊显著中介了自我污名化与赋权之间的负相关，表明较低的自我污名化导致较高的自尊，进而增强赋权。调节分析显示，中介效应在不同社会经济和文化背景的国家中有所不同。在HDI较高的国家，自我污名化对自尊的间接效应更强，表明这些环境中的个体更容易受到自我污名化对自尊负面影响的影响。
自尊缓冲了自我污名化对MDD患者赋权的负面影响。这种效应的强度因社会经济和文化背景而异，在HDI较高的国家中介作用更强。这些发现凸显了在特定背景下针对自我污名化进行量身定制干预以增强赋权和康复的必要性。
