title: A Cross-Diagnostic Investigation of the Differential Impact of Discrimination on Clinical and Personal Recovery.
abstract: Although the negative association between discrimination and recovery has been established, only a few studies have attempted to investigate the underlying mechanism of how perceived discrimination dampens both clinical and personal recovery among people with psychiatric disorders. This study aimed to examine the mediating roles of self-stigma and mental health service engagement in the relationship between perceived discrimination and recovery.
  
  
  
  A total of 374 people (half men and half women; mean±SD age=43.47±12.76) living in Hong Kong and in recovery with a primary diagnosis of a psychotic disorder, mood disorder, or substance use disorder responded to a cross-sectional questionnaire on discrimination, self-stigma, mental health service adherence, recovery orientation of services, clinical recovery, and personal recovery. Multisample structural equation modeling was conducted to examine whether the hypothesized model for perceived discrimination and recovery produced results that could be generalized across people with various psychiatric diagnoses.
  
  
  
  Findings indicated that respondents perceived discrimination from the general public and from health care professionals, which was positively associated with self-stigmatization and service disengagement and was negatively associated with clinical and personal recovery across three different types of psychiatric disorder.
  
  
  
  This study showed that the influence of perceived discrimination on recovery was universal and could be generalized across people with different psychiatric diagnoses. Multipronged stigma reduction interventions targeting the general public, health care professionals, and people in recovery, along with policies that avert discrimination and uphold human rights in health care settings and beyond, should be implemented.
authors.affiliation: Dr. Mak, Mr. Chan, and Dr. Cheung are with the Department of Psychology, Chinese University of Hong Kong, Shatin (e-mail: wwsmak@psy.cuhk.edu.hk ). Dr. Wong is with the Division of Family Medicine and Primary Care and Dr. Lau is with the Centre for Epidemiology and Biostatistics, both in the School of Public Health and Primary Care, Chinese University of Hong Kong. They are also with the School of Public Health and Dr. Wai Kwong Tang and Dr. Alan Tang are with the Department of Psychiatry, all at Prince of Wales Hospital, Shatin. Dr. Chiang is with the General Adult Psychiatry Department, Castle Peak Hospital, Hong Kong. Dr. Cheng is with the Clinical Psychology Service Unit, Kwai Chung Hospital, Hong Kong. Dr. Chan is with the Department of Psychiatry, Northern District Hospital, Hong Kong. Dr. Woo is with the Faculty of Medicine and Dr. Lee is with the Nethersole School of Nursing, Chinese University of Hong Kong, Shatin.
authors.forename: Winnie W S
authors.initials: WW
authors.lastname: Mak
authors.affiliation: Dr. Mak, Mr. Chan, and Dr. Cheung are with the Department of Psychology, Chinese University of Hong Kong, Shatin (e-mail: wwsmak@psy.cuhk.edu.hk ). Dr. Wong is with the Division of Family Medicine and Primary Care and Dr. Lau is with the Centre for Epidemiology and Biostatistics, both in the School of Public Health and Primary Care, Chinese University of Hong Kong. They are also with the School of Public Health and Dr. Wai Kwong Tang and Dr. Alan Tang are with the Department of Psychiatry, all at Prince of Wales Hospital, Shatin. Dr. Chiang is with the General Adult Psychiatry Department, Castle Peak Hospital, Hong Kong. Dr. Cheng is with the Clinical Psychology Service Unit, Kwai Chung Hospital, Hong Kong. Dr. Chan is with the Department of Psychiatry, Northern District Hospital, Hong Kong. Dr. Woo is with the Faculty of Medicine and Dr. Lee is with the Nethersole School of Nursing, Chinese University of Hong Kong, Shatin.
authors.forename: Randolph C H
authors.initials: RC
authors.lastname: Chan
authors.affiliation: Dr. Mak, Mr. Chan, and Dr. Cheung are with the Department of Psychology, Chinese University of Hong Kong, Shatin (e-mail: wwsmak@psy.cuhk.edu.hk ). Dr. Wong is with the Division of Family Medicine and Primary Care and Dr. Lau is with the Centre for Epidemiology and Biostatistics, both in the School of Public Health and Primary Care, Chinese University of Hong Kong. They are also with the School of Public Health and Dr. Wai Kwong Tang and Dr. Alan Tang are with the Department of Psychiatry, all at Prince of Wales Hospital, Shatin. Dr. Chiang is with the General Adult Psychiatry Department, Castle Peak Hospital, Hong Kong. Dr. Cheng is with the Clinical Psychology Service Unit, Kwai Chung Hospital, Hong Kong. Dr. Chan is with the Department of Psychiatry, Northern District Hospital, Hong Kong. Dr. Woo is with the Faculty of Medicine and Dr. Lee is with the Nethersole School of Nursing, Chinese University of Hong Kong, Shatin.
authors.forename: Samuel Y S
authors.initials: SY
authors.lastname: Wong
authors.affiliation: Dr. Mak, Mr. Chan, and Dr. Cheung are with the Department of Psychology, Chinese University of Hong Kong, Shatin (e-mail: wwsmak@psy.cuhk.edu.hk ). Dr. Wong is with the Division of Family Medicine and Primary Care and Dr. Lau is with the Centre for Epidemiology and Biostatistics, both in the School of Public Health and Primary Care, Chinese University of Hong Kong. They are also with the School of Public Health and Dr. Wai Kwong Tang and Dr. Alan Tang are with the Department of Psychiatry, all at Prince of Wales Hospital, Shatin. Dr. Chiang is with the General Adult Psychiatry Department, Castle Peak Hospital, Hong Kong. Dr. Cheng is with the Clinical Psychology Service Unit, Kwai Chung Hospital, Hong Kong. Dr. Chan is with the Department of Psychiatry, Northern District Hospital, Hong Kong. Dr. Woo is with the Faculty of Medicine and Dr. Lee is with the Nethersole School of Nursing, Chinese University of Hong Kong, Shatin.
authors.forename: Joseph T F
authors.initials: JT
authors.lastname: Lau
authors.affiliation: Dr. Mak, Mr. Chan, and Dr. Cheung are with the Department of Psychology, Chinese University of Hong Kong, Shatin (e-mail: wwsmak@psy.cuhk.edu.hk ). Dr. Wong is with the Division of Family Medicine and Primary Care and Dr. Lau is with the Centre for Epidemiology and Biostatistics, both in the School of Public Health and Primary Care, Chinese University of Hong Kong. They are also with the School of Public Health and Dr. Wai Kwong Tang and Dr. Alan Tang are with the Department of Psychiatry, all at Prince of Wales Hospital, Shatin. Dr. Chiang is with the General Adult Psychiatry Department, Castle Peak Hospital, Hong Kong. Dr. Cheng is with the Clinical Psychology Service Unit, Kwai Chung Hospital, Hong Kong. Dr. Chan is with the Department of Psychiatry, Northern District Hospital, Hong Kong. Dr. Woo is with the Faculty of Medicine and Dr. Lee is with the Nethersole School of Nursing, Chinese University of Hong Kong, Shatin.
authors.forename: Wai Kwong
authors.initials: WK
authors.lastname: Tang
authors.affiliation: Dr. Mak, Mr. Chan, and Dr. Cheung are with the Department of Psychology, Chinese University of Hong Kong, Shatin (e-mail: wwsmak@psy.cuhk.edu.hk ). Dr. Wong is with the Division of Family Medicine and Primary Care and Dr. Lau is with the Centre for Epidemiology and Biostatistics, both in the School of Public Health and Primary Care, Chinese University of Hong Kong. They are also with the School of Public Health and Dr. Wai Kwong Tang and Dr. Alan Tang are with the Department of Psychiatry, all at Prince of Wales Hospital, Shatin. Dr. Chiang is with the General Adult Psychiatry Department, Castle Peak Hospital, Hong Kong. Dr. Cheng is with the Clinical Psychology Service Unit, Kwai Chung Hospital, Hong Kong. Dr. Chan is with the Department of Psychiatry, Northern District Hospital, Hong Kong. Dr. Woo is with the Faculty of Medicine and Dr. Lee is with the Nethersole School of Nursing, Chinese University of Hong Kong, Shatin.
authors.forename: Alan K L
authors.initials: AK
authors.lastname: Tang
authors.affiliation: Dr. Mak, Mr. Chan, and Dr. Cheung are with the Department of Psychology, Chinese University of Hong Kong, Shatin (e-mail: wwsmak@psy.cuhk.edu.hk ). Dr. Wong is with the Division of Family Medicine and Primary Care and Dr. Lau is with the Centre for Epidemiology and Biostatistics, both in the School of Public Health and Primary Care, Chinese University of Hong Kong. They are also with the School of Public Health and Dr. Wai Kwong Tang and Dr. Alan Tang are with the Department of Psychiatry, all at Prince of Wales Hospital, Shatin. Dr. Chiang is with the General Adult Psychiatry Department, Castle Peak Hospital, Hong Kong. Dr. Cheng is with the Clinical Psychology Service Unit, Kwai Chung Hospital, Hong Kong. Dr. Chan is with the Department of Psychiatry, Northern District Hospital, Hong Kong. Dr. Woo is with the Faculty of Medicine and Dr. Lee is with the Nethersole School of Nursing, Chinese University of Hong Kong, Shatin.
authors.forename: Tin Po
authors.initials: TP
authors.lastname: Chiang
authors.affiliation: Dr. Mak, Mr. Chan, and Dr. Cheung are with the Department of Psychology, Chinese University of Hong Kong, Shatin (e-mail: wwsmak@psy.cuhk.edu.hk ). Dr. Wong is with the Division of Family Medicine and Primary Care and Dr. Lau is with the Centre for Epidemiology and Biostatistics, both in the School of Public Health and Primary Care, Chinese University of Hong Kong. They are also with the School of Public Health and Dr. Wai Kwong Tang and Dr. Alan Tang are with the Department of Psychiatry, all at Prince of Wales Hospital, Shatin. Dr. Chiang is with the General Adult Psychiatry Department, Castle Peak Hospital, Hong Kong. Dr. Cheng is with the Clinical Psychology Service Unit, Kwai Chung Hospital, Hong Kong. Dr. Chan is with the Department of Psychiatry, Northern District Hospital, Hong Kong. Dr. Woo is with the Faculty of Medicine and Dr. Lee is with the Nethersole School of Nursing, Chinese University of Hong Kong, Shatin.
authors.forename: Sammy K W
authors.initials: SK
authors.lastname: Cheng
authors.affiliation: Dr. Mak, Mr. Chan, and Dr. Cheung are with the Department of Psychology, Chinese University of Hong Kong, Shatin (e-mail: wwsmak@psy.cuhk.edu.hk ). Dr. Wong is with the Division of Family Medicine and Primary Care and Dr. Lau is with the Centre for Epidemiology and Biostatistics, both in the School of Public Health and Primary Care, Chinese University of Hong Kong. They are also with the School of Public Health and Dr. Wai Kwong Tang and Dr. Alan Tang are with the Department of Psychiatry, all at Prince of Wales Hospital, Shatin. Dr. Chiang is with the General Adult Psychiatry Department, Castle Peak Hospital, Hong Kong. Dr. Cheng is with the Clinical Psychology Service Unit, Kwai Chung Hospital, Hong Kong. Dr. Chan is with the Department of Psychiatry, Northern District Hospital, Hong Kong. Dr. Woo is with the Faculty of Medicine and Dr. Lee is with the Nethersole School of Nursing, Chinese University of Hong Kong, Shatin.
authors.forename: Fu
authors.initials: F
authors.lastname: Chan
authors.affiliation: Dr. Mak, Mr. Chan, and Dr. Cheung are with the Department of Psychology, Chinese University of Hong Kong, Shatin (e-mail: wwsmak@psy.cuhk.edu.hk ). Dr. Wong is with the Division of Family Medicine and Primary Care and Dr. Lau is with the Centre for Epidemiology and Biostatistics, both in the School of Public Health and Primary Care, Chinese University of Hong Kong. They are also with the School of Public Health and Dr. Wai Kwong Tang and Dr. Alan Tang are with the Department of Psychiatry, all at Prince of Wales Hospital, Shatin. Dr. Chiang is with the General Adult Psychiatry Department, Castle Peak Hospital, Hong Kong. Dr. Cheng is with the Clinical Psychology Service Unit, Kwai Chung Hospital, Hong Kong. Dr. Chan is with the Department of Psychiatry, Northern District Hospital, Hong Kong. Dr. Woo is with the Faculty of Medicine and Dr. Lee is with the Nethersole School of Nursing, Chinese University of Hong Kong, Shatin.
authors.forename: Fanny M
authors.initials: FM
authors.lastname: Cheung
authors.affiliation: Dr. Mak, Mr. Chan, and Dr. Cheung are with the Department of Psychology, Chinese University of Hong Kong, Shatin (e-mail: wwsmak@psy.cuhk.edu.hk ). Dr. Wong is with the Division of Family Medicine and Primary Care and Dr. Lau is with the Centre for Epidemiology and Biostatistics, both in the School of Public Health and Primary Care, Chinese University of Hong Kong. They are also with the School of Public Health and Dr. Wai Kwong Tang and Dr. Alan Tang are with the Department of Psychiatry, all at Prince of Wales Hospital, Shatin. Dr. Chiang is with the General Adult Psychiatry Department, Castle Peak Hospital, Hong Kong. Dr. Cheng is with the Clinical Psychology Service Unit, Kwai Chung Hospital, Hong Kong. Dr. Chan is with the Department of Psychiatry, Northern District Hospital, Hong Kong. Dr. Woo is with the Faculty of Medicine and Dr. Lee is with the Nethersole School of Nursing, Chinese University of Hong Kong, Shatin.
authors.forename: Jean
authors.initials: J
authors.lastname: Woo
authors.affiliation: Dr. Mak, Mr. Chan, and Dr. Cheung are with the Department of Psychology, Chinese University of Hong Kong, Shatin (e-mail: wwsmak@psy.cuhk.edu.hk ). Dr. Wong is with the Division of Family Medicine and Primary Care and Dr. Lau is with the Centre for Epidemiology and Biostatistics, both in the School of Public Health and Primary Care, Chinese University of Hong Kong. They are also with the School of Public Health and Dr. Wai Kwong Tang and Dr. Alan Tang are with the Department of Psychiatry, all at Prince of Wales Hospital, Shatin. Dr. Chiang is with the General Adult Psychiatry Department, Castle Peak Hospital, Hong Kong. Dr. Cheng is with the Clinical Psychology Service Unit, Kwai Chung Hospital, Hong Kong. Dr. Chan is with the Department of Psychiatry, Northern District Hospital, Hong Kong. Dr. Woo is with the Faculty of Medicine and Dr. Lee is with the Nethersole School of Nursing, Chinese University of Hong Kong, Shatin.
authors.forename: Diana T F
authors.initials: DT
authors.lastname: Lee
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology* / Q000628:therapy; D010349:Patient Compliance / Q000523:psychology*; D011287:Prejudice / Q000523:psychology*; D011618:Psychotic Disorders / Q000523:psychology* / Q000628:therapy; D012649:Self Concept; D057545:Social Stigma; D019966:Substance-Related Disorders / Q000523:psychology* / Q000628:therapy
keywords: Discrimination; Psychotic disorders; Recovery; Self-stigma; Substance use disorders