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. 2017 Aug 29;7(8):e018228.
doi: 10.1136/bmjopen-2017-018228.

Mediating effects of self-stigma on the relationship between perceived stigma and psychosocial outcomes among psychiatric outpatients: findings from a cross-sectional survey in Singapore

Louisa Picco  1 , Ying Wen Lau  1 , Shirlene Pang  1 , Edimansyah Abdin  1 , Janhavi Ajit Vaingankar  1 , Siow Ann Chong  1 , Mythily Subramaniam  1
Affiliations

Mediating effects of self-stigma on the relationship between perceived stigma and psychosocial outcomes among psychiatric outpatients: findings from a cross-sectional survey in Singapore

Louisa Picco et al. BMJ Open. .

Abstract

Objectives: To examine whether self-stigma mediates the relationship between perceived stigma and quality of life, self-esteem and general functioning among outpatients with depression, schizophrenia, anxiety and obsessive-compulsive disorder (OCD).

Design: Cross-sectional survey.

Setting: Outpatient clinics at a tertiary psychiatric hospital in Singapore.

Participants: 280 outpatients with a primary clinical diagnosis of either schizophrenia, depression, anxiety or OCD.

Methods: Data were collected in relation to self-stigma, perceived stigma, self-esteem, functioning and quality of life. In order to examine the mediating role of self-stigma on the relationship between perceived stigma and psychosocial outcomes, bootstrapping mediation analyses were used.

Results: Mediation analyses revealed that the relationship between perceived stigma and psychosocial outcomes was subject to the effects of self-stigma among the overall sample. Separate mediation analyses were conducted by diagnoses and showed differences in the mediating effects of self-stigma. Among the whole sample and the subsample with OCD, self-stigma mediated the relationship between perceived stigma and all psychosocial outcomes. For those with anxiety, depression and schizophrenia, the mediating effects of self-stigma were present in all relationships except (1) perceived stigma with physical health in the anxiety sample, (2) perceived stigma with social relationships in the depression sample and (3) perceived stigma with physical health in the schizophrenia sample.

Conclusions: The mediating effects of self-stigma on the relationship between perceived stigma and various psychosocial outcomes are evident and differ across diagnoses. Interventions to address and reduce the effects of self-stigma along with targeted treatments and psychoeducation to assist people with mental illness overcome or better manage self-stigma while providing them the skills to counteract public stigma are needed.

Keywords: adult psychiatry; mental health; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Mediation effect model.
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