title: Internalized stigma of mental illness and depressive and psychotic symptoms in homeless veterans over 6 months.
abstract: We investigated the relationship between internalized stigma of mental illness at baseline and depressive and psychotic symptoms 3 and 6 months later, controlling for baseline symptoms. Data on homeless veterans with severe mental illness (SMI) were provided by the Northeast Program Evaluation Center (NEPEC) Special Needs-Chronic Mental Illness (SN-CMI) study (Kasprow and Rosenheck, 2008). The study used the Internalized Stigma of Mental Illness (ISMI) scale to measure internalized stigma at baseline and the Symptom Checklist-90-R (SCL-90-R) to measure depressive and psychotic symptoms at baseline and 3 and 6 month follow-ups. Higher levels of internalized stigma were associated with greater levels of depressive and psychotic symptoms 3 and 6 months later, even controlling for symptoms at baseline. Alienation and Discrimination Experience were the subscales most strongly associated with symptoms. Exploratory analyses of individual items yielded further insight into characteristics of potentially successful interventions that could be studied. Overall, our findings show that homeless veterans with SMI experiencing higher levels of internalized stigma are likely to experience more depression and psychosis over time. This quasi-experimental study replicates and extends findings of other studies and has implications for future controlled research into the potential long-term effects of anti-stigma interventions on mental health recovery.
authors.affiliation: Mental Health Service, San Francisco VA Health Care System, San Francisco, CA, USA; Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA. Electronic address: jennifer.boyd@va.gov.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Boyd
authors.affiliation: Mental Health Service, San Francisco VA Health Care System, San Francisco, CA, USA; Department of Clinical Psychology, California School of Professional Psychology, Alliant International University, San Francisco, CA, USA.
authors.forename: H'Sien
authors.initials: H
authors.lastname: Hayward
authors.affiliation: Mental Health Service, San Francisco VA Health Care System, San Francisco, CA, USA.
authors.forename: Elena D
authors.initials: ED
authors.lastname: Bassett
authors.affiliation: Departments of Psychiatry and Epidemiology, VA North East Program Evaluation Center and Yale School of Medicine, New Haven, CT, USA.
authors.forename: Rani
authors.initials: R
authors.lastname: Hoff
mesh_terms: D000328:Adult; D003863:Depression / Q000523:psychology*; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000523:psychology*; D012649:Self Concept; D057545:Social Stigma; D013240:Stereotyping; D013997:Time Factors; D014481:United States; D014728:Veterans / Q000523:psychology*
keywords: Depression; Internalized stigma of mental illness; Psychosis; Veterans