Belittled, Avoided, Ignored, Denied: Assessing Forms and Consequences of Stigma Experiences of People With Mental Illness

Abstract

People with mental illness experience discrimination, paternalistic treatment, and avoidance. To facilitate assessment of such experiences, the authors developed the Multifaceted Stigma Experiences Scale. It assesses four dimensions of experienced stigma in interpersonal interaction: hostile discrimination, benevolent discrimination, taboo, and denial. The influence of stigma experiences on mental health was modeled in a two-wave panel with persons with mental illness (N = 367, 79% repeated response rate). Results indicate that both subtle and blatant forms of stigma constitute a barrier to recovery and may be interpreted as attempts to increase social distance and reinforce the existing social order.

ACKNOWLEDGMENTS

This research was conducted during a Ph.D. fellowship of the first author at the Graduate College “Group Focused Enmity” at the University of Bielefeld (funded by the German Research Foundation, DFG GK 884).

Notes

Note. The table contains the translation of the German original scale conducted by a translator with experience in social sciences. Statistics are computed with baseline data. Bold printed factor loadings are loadings on the higher order factor. Means and standard deviations are reported for the total sample, factor loadings are reported for the total sample, and the two halves of the sample used for the development of the scale. The fit for the measurement model of the total sample is χ²(86, N = 365) = 172.153, p < .001, CFI = 951, RMSEA =.052 (due to two cases with missing variables on all items).

Note. N = 367. Pearson correlations, all correlations significant with p < .001.

^a n = 83. ^b n = 72. ^c n = 241. ^d n = 171.

*p < .05. **p < .01. ***p ≤ .001.

¹The causal interpretation that experienced stigma predicts mental health and not vice versa was supported by a cross-lagged analysis, which is reported in the Appendix. We used multiple group comparisons to test if our finding that stigma adversely influences mental health holds across different subgroups. We consistently observed that stigma predicts both the latent change and the latent intercept of mental health regardless of gender, recruitment during inpatient versus outpatient treatment, and self-reported diagnosis. There was an exception for the diagnostic group of people with severe mental illness. In this group, stigma was correlated with the latent intercept but not with the latent change variable. We suggest that this might be due to a ceiling effect or insufficient power because of n = 83 in this subgroup. Details about these analyses are available from the first author upon request.

Note. The difference between regression coefficients with different superscripts in a row is significant with p < .05.

*p < .05. ***p ≤ .001.

Note. Numbers in italics are correlations. The variables were computed as latent variables as described in the text for the latent growth model. The influence from stigma at T₁ to mental health at T₂ (b_unstand = −.25, p < .001) is significantly larger (z = 2.261) than from mental health at T₁ on stigma at T₂ (b_unstand = −.05, p = .59).

***p ≤ .001.