title: Parsing the relationship of stigma and insight to psychological well-being in psychotic disorders.
abstract: BACKGROUND
  It has been postulated that the effects of the stigma of mental illness on the psychological well-being of patients is mediated through internalization of the stigma. On the other hand, there is reason to suppose that simple awareness of public stigma could also have an impact to the extent that an individual is aware of being ill.
  
  
  OBJECTIVE
  To investigate whether internalization of the stigma of having a psychotic disorder and an interaction between perceived public stigma and awareness of being ill make independent contributions to the prediction of psychological well-being in patients with psychotic disorder.
  
  
  METHODS
  102 patients in an early intervention program for psychoses were assessed for awareness of public stigma, internalization of stigmatizing beliefs, insight and various aspects of psychological well-being including self-esteem, depression, anxiety, anger/hostility and engulfment.
  
  
  RESULTS
  Internalization of stigma was associated with lower levels of psychological well-being. In addition, perception of public stigma also contributed to lower well-being for those individuals with greater awareness of being ill.
  
  
  CONCLUSIONS
  While internalization of stigma is an important contribution to psychological well-being in patients with psychosis, awareness of public stigma, even if this is not internalized, also is associated with lower self-esteem, and greater anxiety, anger/hostility, and engulfment in patients with better insight.
authors.affiliation: Prevention and Early Intervention Program for Psychoses, Department of Psychiatry, London Health Sciences Centre, 800 Commissioners Road, East London, Ontario, Canada N6A 5W9. rnorman@uwo.ca
authors.forename: Ross M G
authors.initials: RM
authors.lastname: Norman
authors.forename: Deborah
authors.initials: D
authors.lastname: Windell
authors.forename: Jill
authors.initials: J
authors.lastname: Lynch
authors.forename: Rahul
authors.initials: R
authors.lastname: Manchanda
mesh_terms: D000328:Adult; D001364:Awareness; D003469:Culture; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D019964:Mood Disorders / Q000209:etiology; D011237:Predictive Value of Tests; D011618:Psychotic Disorders / Q000150:complications* / Q000523:psychology*; D012649:Self Concept; D057545:Social Stigma; D013223:Statistics as Topic; D013240:Stereotyping; D055815:Young Adult