The relationship between contact with peers and self-stigma in people with mental illness

ABSTRACT

Public and self- mental health stigma have deleterious effects on the lives of people with mental illness (PWMI). Researchers have developed multiple interventions to reduce public stigma against this group, but little attention has been given to reducing self-stigma in spite of its closer association with adverse outcomes. There is some preliminary evidence suggesting that a strategy commonly used to address public stigma – contact with PWMI – may also reduce self-stigma in people with mental illness. However, the limitations of these studies necessitate a more rigorous examination. While overcoming the limitations of previous studies, we aimed to determine whether peer contact could represent an effective strategy for reducing self-stigma in PWMI. We recruited 991 participants with mental illness who reported their frequency of contact with other PWMI, frequency of contact with people without mental illness, self-stigma (the degree to which participants agreed with and applied common stereotypes about mental illness to themselves), and harm to self-respect, self-esteem, and self-efficacy. We tested a serial mediation model controlling for contact with people without mental illness. Consistent with hypotheses, more frequent peer contact was associated with reduced harm to self-respect and higher self-esteem and self-efficacy through lower agreement with stereotypes and lower self-application of stereotypes. The results suggest that peer contact may represent a viable strategy for reducing self-stigma and improving self-concept in PWMI. This substantially expands the usefulness of existing intergroup contact strategies and supports the development of an alternative, non-clinical intervention for reducing self-stigma. Future research should clarify the direction of the effect and investigate the nature of peer interactions in order to inform interventions.

KEYWORDS:

• Stigma
• internalized stigma
• mental health
• peer contact
• contact

Acknowledgments

The authors would like to acknowledge all the participants who took part in the study and/or shared the study with their friends on social media, as well as the organisations that assisted with recruitment by advertising the study on their webpages or posting fliers in their establishments.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability

The complete study materials and data can be accessed at https://osf.io/wpdjc/

Notes

1. We considered that peer contact may also act as a moderator for the relationship between stereotype agreement and self-application, and between these variables and the outcome variables. To examine this, we tested for interactions between peer contact and the mediators on the outcome variables (MacKinnon, 2012), but none of these interactions were significant (ps > .386).

2. Theory in relation to the stage model of stigma conceives of harm to self-respect as an outcome of agreement and self-application, rather than as a component of self-stigma that has subsequent impacts on self-esteem and self-efficacy (e.g. Corrigan & Rao, 2012; Watson et al., 2007). However, especially given the high correlation between harm to self-respect and self-application, it was speculated that agreement, self-application, and harm to self-respect might serially mediate the relationship between peer contact and self-esteem and self-efficacy as the outcome variables. The same Model 6 of Hayes (2018) PROCESS macro was used to test this possibility. The pathways from harm to self-respect to self-esteem and self-efficacy were significant (b = −.436, SE = .029, 95% CI [−.492, −.379]; b = −.350, SE = .033, 95% CI [−.416, −.285], respectively). The indirect effect with all three mediators was significant when self-esteem was the outcome variable (b = .026, SE = .007, 95% CI [.013, .042]) and when self-efficacy was the outcome variable (b = .021, SE = .006, 95% CI [.010, .033]). Except with the other two mediators, the indirect effects including harm to self-respect were not significant.

3. The demographic information collected from participants could also be entered as covariates in the model. We inspected associations with the predictor, mediating, and outcome variables for each demographic variable, and elected to enter into the model any variable that was significantly related to both the predictor and at least one mediator or outcome variable. This included age, gender, sexuality, political orientation, place of birth, years of education, and diagnosis. When these variables were added to the serial mediation model as covariates, the direct pathways between peer contact and self-esteem and self-efficacy became significant, and the direct pathway between stereotype agreement and self-esteem became non-significant.

Additional information

Funding

This work was supported by the University of Sydney [Postgraduate Research Support Scheme].

Notes on contributors

Rachel D. Maunder

Rachel D. Maunder is Lecturer at the Australian College of Applied Psychology. She completed her PhD in psychology at the University of Sydney, where her research concerned the moderating role of exemplar typicality in intergroup contact interventions aimed at reducing mental health stigma. Rachel is also interested in reducing prejudice against and internalized by other stigmatized groups, and examining individual and methodological factors that can enhance the effectiveness of interventions. The significance of Rachel’s research has been recognized in awards from her alma mater and from the Society of Australasian Social Psychologists.

Fiona A. White

Fiona A. Whiteis a Professor in social psychology at the University of Sydney. Her research expertise concerns the development and evaluation of effective strategies to promote cooperative intergroup relations. She has led a number of prejudice and stigma reduction projects involving contact and recategorization strategies. Alongside her research team, she has developed a new intergroup contact strategy called Electronic- or E-contact. Fiona has received competitive funding from the Australian Research Council, Office of Learning and Teaching and ViCHealth. Fiona is also the Director of the Sydney University Psychology of Intergroup Relations (SUPIR) Research Lab [http://www.supirlab.com/].