title: Internalized stigma and quality of life domains among people with mental illness: the mediating role of self-esteem.
abstract: BACKGROUND
  People with mental illness who internalize stigma often experience reduced self-esteem and impaired quality of life (QOL).
  
  
  OBJECTIVE
  To propose a theoretical model in which self-esteem mediates the effects of internalized stigma on the multidimensional domains comprising QOL.
  
  
  METHODS
  In 403 inpatients and outpatients (DSM-IV, American Psychiatric Association, 1994), from hospital-based and community mental health facilities, self-report measures of internalized stigma (ISMI), self-esteem (RSES) and QOL (WHOQOL-Bref) were administrated.
  
  
  RESULTS
  Structural equation modeling results supported the proposed model. Self-esteem fully mediated the relation between internalized stigma and the physical and the social relationships domains, and partially mediated the relationship between internalized stigma and psychological, environment and level of independence QOL domains. Such results provided empirical support and shed light upon previous research. Specifically the results emphasize the mediating role that self-esteem plays in the degree to which internalized stigma exerts a negative effect on specific QOL domains.
  
  
  CONCLUSIONS
  Self-esteem appears to be a core element in reducing the negative effects of internalized stigma on aspects of QOL among people with mental illness. These findings suggest there is a crucial impact regarding clinical mental health interventions along with important theoretical implications.
authors.affiliation: a Instituto Universitário de Lisboa (ISCTE-IUL) , CIS-IUL, Lisboa , Portugal .
authors.forename: Sandra E H
authors.initials: SE
authors.lastname: Oliveira
authors.affiliation: b Instituto Universitário de Lisboa (ISCTE-IUL) , CIES-IUL, Lisboa , Portugal , and.
authors.forename: Helena
authors.initials: H
authors.lastname: Carvalho
authors.affiliation: c Mid Sweden University , Östersund, Suécia, & CIS-IUL, Lisboa , Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Esteves
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D011581:Psychological Tests; D011788:Quality of Life / Q000523:psychology*; D012649:Self Concept; D013240:Stereotyping; D055815:Young Adult
keywords: Mental disorders; QOL domains; self-esteem; self-stigma