title: Stigma-related stress, shame and avoidant coping reactions among members of the general population with elevated symptom levels.
abstract: It is unclear whether mental illness stigma affects individuals with subthreshold syndromes outside clinical settings. We therefore investigated the role of different stigma variables, including stigma-related stress and shame reactions, for avoidant stigma coping among members of the general population with elevated symptom levels.
  
  
  
  Based on a representative population survey, general stress resilience, stigma variables, shame about having a mental illness as well as avoidant stigma coping (secrecy and social withdrawal) were assessed by self-report among 676 participants with elevated symptom levels. Stigma variables and resilience were examined as predictors of avoidant stigma coping in a path model.
  
  
  
  Increased stigma stress was predicted by lower general stress resilience as well as by higher levels of perceived stigma, group identification and perceived legitimacy of discrimination. More shame was associated with higher perceived legitimacy. Lower resilience as well as more perceived stigma, group identification and perceived legitimacy predicted avoidant coping. Stigma stress partly mediated effects of resilience, perceived stigma and group identification on avoidant coping; shame partly mediated effects of perceived legitimacy on coping. Stigma stress and shame were also directly and positively related to avoidant stigma coping. Analyses were adjusted for symptoms, neuroticism and sociodemographic variables.
  
  
  
  Stigma may affect a larger proportion of the population than previously thought because stigma variables predicted secrecy and withdrawal among members of the general population with elevated, but overall mild symptom levels. Avoidant stigma coping likely has harmful effects, potentially exacerbating pre-existing psychological distress and undermining social networks. This highlights the need to reduce public stigma as well as to support individuals with subthreshold syndromes in their coping with stigma stress and shame reactions.
authors.affiliation: Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany.
authors.forename: J V
authors.initials: JV
authors.lastname: Schibalski
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Müller
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
authors.forename: V
authors.initials: V
authors.lastname: Ajdacic-Gross
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Vetter
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Rodgers
authors.affiliation: Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Oexle
authors.affiliation: Illinois Institute of Technology, Chicago, USA.
authors.forename: P W
authors.initials: PW
authors.lastname: Corrigan
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM27), University of Sao Paulo, Brazil; Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Rössler
authors.affiliation: Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany. Electronic address: nicolas.ruesch@uni-ulm.de.
authors.forename: N
authors.initials: N
authors.lastname: Rüsch
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001362:Avoidance Learning; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology*; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012649:Self Concept; D057566:Self Report; D012752:Shame; D057545:Social Stigma; D012944:Social Support; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology*