title: Internalized stigma predicts erosion of morale among psychiatric outpatients.
abstract: Stigma in society causes harm to people with severe mental illness (SMI) and internalized stigma represents its psychological point of impact. We evaluated the extent of internalized stigma in a sample of outpatients with SMI, using the Internalized Stigma of Mental Illness (ISMI) Scale, developed with consumer input. About a third of the sample reported high levels of internalized stigma. We tested whether internalized stigma predicted increased depressive symptoms and reduced self-esteem at 4-month follow-up, controlling for baseline levels. Depression was predicted by Alienation, Stereotype Endorsement, Social Withdrawal Scales and total ISMI score. Reduced self-esteem was predicted by Alienation. ISMI results were stronger than those for the widely used Devaluation-Discrimination Scale. The finding that alienation further reduces morale speaks to the difficulty of pulling oneself out of this type of vicious cycle without assistance.
authors.affiliation: Department of Psychiatry (116A), University of California and the San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA. ritsher@itsa.ucsf.edu
authors.forename: Jennifer Boyd
authors.initials: JB
authors.lastname: Ritsher
authors.forename: Jo C
authors.initials: JC
authors.lastname: Phelan
mesh_terms: D000553:Ambulatory Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D009013:Morale; D012307:Risk Factors; D012649:Self Concept; D012720:Severity of Illness Index; D012918:Social Alienation; D013240:Stereotyping; D011795:Surveys and Questionnaires