The influence of mental illness and criminality self-stigmas and racial self-concept on outcomes in a forensic psychiatric sample.
OBJECTIVE
Research has increasingly explored mental illness self-stigma: when people with mental illness believe that society's negative beliefs are true of them. Self-stigma predicts poorer functional and treatment outcomes. Stigma research has typically investigated the impact of a single stigma on people, without considering the potential effects of multiple stigmatizing labels. People with mental illness and a history of criminal conviction, however, may experience multiple stigmas related to mental illness and criminal history. This study investigated the impact of the combination of multiple stigmatized identities on self-esteem, depression, therapeutic alliance, and treatment adherence in a forensic psychiatric sample. It extended previous research on mental illness self-stigma to a forensic psychiatric sample.


METHODS
Participants (N = 82) were people with mental illness and a history of criminal conviction recruited from their treatment sites. Participants completed self-report questionnaires focused on mental illness and criminality self-stigma, racial self- concept, self-esteem, depression, working alliance, and medication/psychosocial treatment adherence. Researchers confirmed demographics through a chart review and treatment adherence from participants' clinicians. Multiple regression analyses examined the relationship between self-stigma and outcome variables.


RESULTS
Mental illness self-stigma, racial self-concept, and to a lesser extent criminality self-stigma were associated with reduced self-esteem (p ≤ .05) and medication adherence (p ≤ .05). Criminality self-stigma also appeared to magnify the effects of racial and mental illness self-stigma on outcomes.


CONCLUSIONS
This study shows that self-stigma related to involvement in the criminal justice system may further contribute to the impact of mental illness self-stigma on important outcomes. Future research and interventions may tailor self-stigma interventions to a forensic psychiatric population.
Department of Psychology.
Michelle L
ML
West
Department of Psychology.
Beth
B
Vayshenker
Department of Psychiatry, Albert Einstein College of Medicine.
Merrill
M
Rotter
Department of Psychology.
Philip T
PT
Yanos
D000328:Adult; D001741:Black or African American / Q000523:psychology; D000368:Aged; D018912:Arabs / Q000523:psychology; D001213:Asian / Q000523:psychology; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology; D057237:Criminals / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D005555:Forensic Psychiatry; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D007198:Indians, North American / Q000523:psychology; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D001523:Mental Disorders / Q000188:drug therapy / Q000523:psychology*; D008875:Middle Aged; D010817:Physician-Patient Relations; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology; D063505:Racism / Q000523:psychology*; D012559:Schizophrenia / Q000188:drug therapy; D012565:Schizophrenic Psychology; D012649:Self Concept; D063508:Social Discrimination / Q000523:psychology*; D057545:Social Stigma; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy / Q000523:psychology; D044465:White People / Q000523:psychology; D055815:Young Adult