Concealable stigma such as sexual or gender identity or mental illness has been linked to numerous adverse outcomes. Additionally, stigma of mental illness and help seeking stigma has been associated with reduced treatment utilization for psychological problems. Research on internalized stigma of mental illness (ISMI) has largely focused on a) the stigma associated with serious mental illness (e.g., schizophrenia; psychosis spectrum; bipolar-spectrum disorders) and b) the impact of stigma on disparities in treatment access/utilization. However, there have been few studies that have examined the impact of ISMI on treatment outcome or mechanisms through which ISMI influences treatment outcome. The current study addresses these gaps in literature by focusing on ISMI in a diverse outpatient sample within the Psychological Services Center (PSC) at Temple University. In this study, we investigated how mental health self-stigma influences outcome; processes that account for the relationship between mental health self-stigma and outcome; and how self-stigma changes over the course of up to ten therapy sessions in an outpatient setting. Data were drawn from adults participating in individual therapy at the PSC. Participants included 50 individuals (54% female; 76% White, 6% African American, 8% Multiracial, 6% Hispanic, 2% Middle-Eastern and Asian-American) who completed self-report measures of internalized stigma, psychological distress, shame, self-efficacy, social isolation, and hope for up to ten therapy sessions. Multilevel models were used to identify the trajectories of change for the main outcomes (psychological distress) and other variables of interest (stigma, shame, self-efficacy, social isolation, hope) across treatment. Baseline assessment of stigma was used to predict changes in the primary outcome in a set of conditional multilevel models. Logistic regression was used to examine effect of baseline stigma on treatment dropout. Additionally, multilevel models with indirect effects were used to examine the mechanism of relationship between ISMI and treatment outcome. Gender, gender role conflict and demographic variables were considered as potential covariates. Psychological distress, social isolation, and shame significantly reduced over the course of treatment. We did not find significant changes in depression, self-efficacy or hope. Stigma did not significantly change over the course of treatment. Most notably, greater stigma at baseline and over time (at each time point) was significantly associated with greater psychological distress (i.e., poorer treatment outcome), and greater baseline stigma predicted a greater likelihood of treatment dropout. However, baseline stigma was not associated with rate of change in psychological distress. There were no significant indirect effects mediating the impact of stigma on treatment outcome. Findings suggest that greater ISMI impacts subjective report of psychological distress in the beginning stages of treatment and contributes to early treatment dropout. These findings suggest that clients' personal beliefs about mental health and stigma should be attended to throughout treatment to help clients achieve better treatment outcomes, not only in terms of symptom/distress reduction, but also functionally. / Psychology
| Identifer | oai:union.ndltd.org:TEMPLE/oai:scholarshare.temple.edu:20.500.12613/7234 |
| Date | January 2021 |
| Creators | Wojcieszak, Zuzanna, 0000-0003-1540-721X |
| Contributors | Olino, Thomas, Heimberg, Richard G., Chen, Eunice Y., Giovannetti, Tania, Fauber, Robert L., Sayers, Margaret |
| Publisher | Temple University. Libraries |
| Source Sets | Temple University |
| Language | English |
| Detected Language | English |
| Type | Thesis/Dissertation, Text |
| Format | 57 pages |
| Rights | IN COPYRIGHT- This Rights Statement can be used for an Item that is in copyright. Using this statement implies that the organization making this Item available has determined that the Item is in copyright and either is the rights-holder, has obtained permission from the rights-holder(s) to make their Work(s) available, or makes the Item available under an exception or limitation to copyright (including Fair Use) that entitles it to make the Item available., http://rightsstatements.org/vocab/InC/1.0/ |
| Relation | http://dx.doi.org/10.34944/dspace/7213, Theses and Dissertations |
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