title: Self-stigma as a mediator between social capital and empowerment among people with major depressive disorder in Europe: the ASPEN study.
abstract: BACKGROUND
  Individual social capital has been recognized as having an important role for health and well-being. We tested the hypothesis that poor social capital increases internalized stigma and, in turn, can reduce empowerment among people with major depressive disorder (MDD).
  
  
  METHODS
  This is a cross-sectional multisite study conducted on a sample of 516 people with MDD in 19 European countries. Structural Equation Models were developed to examine the direct and indirect effects of self-stigma and social capital on empowerment.
  
  
  RESULTS
  Social capital and self-stigma accounted for 56% of the variability in empowerment. Higher social capital was related to lower self-stigma (r=-0.72, P<0.001) which, in turn, partially mediated the relationship between social capital and empowerment (r=0.38, P<0.001).
  
  
  CONCLUSIONS
  Social capital plays a key role in the appraisal of empowerment, both directly and through the indirect effect mediated by self-stigma. In order to improve empowerment of people with MDD, we identify strategies to foster individual social capital, and to overcome the negative consequences related to self-stigma for attainment of life goals.
authors.affiliation: Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, via Pilastroni 4, I-25125, Brescia, Italy. Electronic address: mlanfredi@fatebenefratelli.it.
authors.forename: M
authors.initials: M
authors.lastname: Lanfredi
authors.affiliation: Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Zoppei
authors.affiliation: IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Ferrari
authors.affiliation: Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Bonetto
authors.affiliation: Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom.
authors.forename: T
authors.initials: T
authors.lastname: Van Bortel
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, King's College London, Institute of Psychiatry, London, United Kingdom.
authors.forename: G
authors.initials: G
authors.lastname: Thornicroft
authors.affiliation: Centre for Health Policy, University of Strathclyde, Glasgow, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Knifton
authors.affiliation: Centre for Health Policy, University of Strathclyde, Glasgow, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Quinn
authors.affiliation: Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, via Pilastroni 4, I-25125, Brescia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.affiliation: Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lasalvia
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011209:Power, Psychological; D066270:Social Capital; D057545:Social Stigma
keywords: Depression; Empowerment; Self-stigma; Social capital