Talking about mental illness, professional help, self-esteem and health. A structural equation model of implicit and explicit internalized stigma

This study aims to investigate the development and consequences of the internalized stigma (IS) explicitly and implicitly assessed, in relation to a longer time seeking professional help, avoidance of talking about the mental illness, self-esteem and general health perception. A structural equation model was developed in a clinical sample with heterogeneous psychiatric diagnoses (N = 160). Results show that not talking about the illness and taking longer to ask for professional help is related to a higher IS, leading to poorer self-esteem and general health. Time in asking for help also has impact on the self-esteem, with the IS as a mediator between both variables. The self-esteem also mediates the negative relationship between IS and general health. Additionally, implicit IS has direct negative effects over self-esteem. The research underlines the important relationship between these psychosocial variables and IS. More studies are needed about implicit IS in order to better understand its effects and relationship with explicit IS and other relevant variables. Efforts should be made to encourage professional help and talking about mental illness in order to prevent IS, as well as interventions focused on damaged self-esteem to reduce its impact.