Stigma Apprehension Among Adolescents Discharged From Brief Psychiatric Hospitalization

Background and Purpose: Psychiatric problems are the leading reason for hospitalization for youth. While psychiatric inpatient treatment has changed over decades, it likely remains a stigmatizing type of treatment because psychiatric inpatients are often regarded by the public as dangerous or violent. Little is known about youths' experiences with stigma in relation to psychiatric inpatient treatment. Yet, the scant research available indicates that hospitalized youth do worry about social stigma. Based on our understanding of stigma dynamics, one concern is that youth who are more apprehensive about stigma will not only experience more distress, but may also cope in ways that undermine their post-hospital adjustment.

The first objective of this study is to examine the extent of stigma apprehension (fear of being devalued or rejected) among adolescents discharged from their first psychiatric hospitalization. Our second objective is to identify individual and contextual factors related to youths' stigma apprehension. Major and O'Brien's (2005) “Model of Stigma-Induced Identity Threat” informed the selection of factors hypothesized to relate to stigma apprehension; these include: (A) Collective Representations of Stigma (perceived societal stigma and previous stigma experiences); and (B) Individual Characteristics (social identification and affiliation, self-identification as having a mental disorder, need for external approval, identity centrality, perceived visibility of problems, clinical and demographic factors). We added a third domain (C) Interpersonal Support (from family and friends and attachment to school).

Methods: A voluntary sample of 80 adolescents was interviewed face-to-face within 7 days of discharge from brief psychiatric hospitalization in a community-based hospital (response rate of 37.9%). Participants were hospitalized for an average of 8 days (SD=4.5); most were admitted because of suicidality (81.25%). The average age of participants was 15.3 (SD=1.5), most were female (62.5%), White (72.5%), and almost 25% received Medicaid. Stigma apprehension was measured using a newly developed scale(alpha=.77); it was dichotomized because of a positively skewed rating distribution. Following descriptive and bivariate analyses, we used logistic regression (2-tailed tests) to assess the most robust bivariate correlates (sig. at p<.05) of adolescents' stigma apprehension.

Results: On average, participants rated feeling stigma apprehension ‘a little', but 29% rated relatively highly on stigma apprehension. Multivariate analysis demonstrated that higher stigma apprehension was most strongly associated with female gender, greater need for others' approval, less friendship and identification with peers with emotional/behavior problems, and more previous stigma experiences. These factors accounted for 60% of the variance; the final model classified 87.8% of the cases into the correct stigma apprehension classification.

Conclusions and Implications: A significant minority of recently-discharged adolescents reported feeling threatened by potential stigma following psychiatric hospitalization. Our findings about the relevance of social context/identification, history with mental illness stigma, and need for external approval, as correlates of higher stigma apprehension following psychiatric hospitalization, have theoretical and clinical implications. Future research is needed to tie stigma apprehension with psychosocial outcomes. With more attention to this problem, we can improve our ability to identify adolescent inpatients at risk for feeling threatened by stigma when reintegrating into the community and tailor our interventions accordingly.