title: Pathways between stigma and suicidal ideation among people at risk of psychosis.
abstract: Mental illness stigma may contribute to suicidality and is associated with social isolation and low self-esteem among young people at risk of psychosis. However, it is unclear whether mental illness stigma contributes to suicidality in this population. We therefore examined the associations of self-labeling and stigma stress with suicidality among young people at risk. Self-labeling as "mentally ill", stigma stress, social isolation, self-esteem, symptoms and suicidal ideation were assessed in 172 individuals at risk of psychosis. Self-labeling and stigma stress were examined as predictors of suicidality by path analysis. Increased self-labeling as "mentally ill" was associated with suicidality, directly as well as indirectly mediated by social isolation. More stigma stress was related to social isolation which in turn was associated with low self-esteem, depression and suicidal ideation. Social isolation fully mediated the link between stigma stress and suicidal ideation. Interventions to reduce the public stigma associated with risk of psychosis as well as programs to facilitate non-stigmatizing awareness of at-risk mental state and to reduce stigma stress among young people at risk of psychosis might strengthen suicide prevention in this population.
authors: Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany. Electronic address: ziyan.xu@uniklinik-ulm.de.
authors: Ziyan
authors: Z
authors: Xu
authors: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
authors: Mario
authors: M
authors: Müller
authors: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
authors: Karsten
authors: K
authors: Heekeren
authors: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
authors: Anastasia
authors: A
authors: Theodoridou
authors: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
authors: Sibylle
authors: S
authors: Metzler
authors: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
authors: Diane
authors: D
authors: Dvorsky
authors: Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany.
authors: Nathalie
authors: N
authors: Oexle
authors: Department of Child and Adolescent Psychiatry, University of Zürich, Switzerland.
authors: Susanne
authors: S
authors: Walitza
authors: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience, LIM27, University of Sao Paulo, Brazil.
authors: Wulf
authors: W
authors: Rössler
authors: Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany.
authors: Nicolas
authors: N
authors: Rüsch
mesh_terms: D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008960:Models, Psychological; D011618:Psychotic Disorders / Q000453:epidemiology / Q000523:psychology*; D012306:Risk; D012559:Schizophrenia / Q000453:epidemiology; D012565:Schizophrenic Psychology; D012934:Social Isolation / Q000523:psychology; D057545:Social Stigma; D013240:Stereotyping; D059020:Suicidal Ideation; D055815:Young Adult
keywords: At-risk mental state; Self-labeling; Stigma; Suicidality