How stigma gets under the skin: the role of stigma, self-stigma and self-esteem in subjective recovery from psychosis

This study examined the impact of stigma on subjective recovery from psychosis, and whether self-esteem and internalised stigma (self-directed negative attitudes and thoughts regarding one's mental health issues) mediates the observed associations between stigmatising experiences and outcome. Fifty-nine services-users with schizophrenia or bipolar affective disorder diagnoses completed symptom (Positive and Negative Syndrome Scale) and subjective recovery (Process of Recovery Questionnaire) measures, as well as stigma measures (the King Stigma Scale, Internalised Stigma of Mental Illness Scale), and the Self-Esteem Rating Scale. Diagnosis was a persistently significant factor in all analyses, suggesting a negative effect of the term "schizophrenia" on subjective recovery. In a multiple serial mediation analysis, experiences of stigma predicated subjective recovery and this effect was mediated through internalised stigma, which consequently impaired self-esteem. Internalised stigma is an important psychological mechanism in recovery. Interventions aimed at improving self-esteem and recovery feelings for psychosis-spectrum service-users may benefit from taking the role of internalised stigma into account.