Stigma Coping Responses Among Adolescents Discharged From Psychiatric Hospitalization: Correlates and Effects

Purpose: Adolescents suffering from mental health (MH) problems sometimes anticipate public-stigma (i.e. devaluation, rejection, harassment). When youth utilize restrictive MH services such as psychiatric hospitalization are utilized, public and self-stigma may be particularly profound given cultural references associating this treatment with severe problems and potential dangerousness. The extent to which adolescents are negatively affected by stigma may be largely determined by how they cope with it. The literature shows that the coping strategies used by youth to deal with stress are important mediators and moderators of outcomes related to stress. At this time, little is known about the extent to which youth, at-risk for mental illness stigma, appraise and respond to prejudice and discrimination (including that which is self-imposed), and the effects of their coping efforts.

This short-term longitudinal study explores how adolescents discharged from brief psychiatric hospitalization (N=102) anticipate coping with a hypothetical social stigma incident in which they are ridiculed and teased about their hospitalization. To better understand the meaning and implications of various styles of coping, individual and contextual factors associated with the anticipated coping strategies are examined. Six-month follow-up data (N=80) are used to test the extent to which the coping strategies endorsed following discharge predict adolescents’ experience of self-stigma measured six months following psychiatric hospitalization.

Methods: This study uses crossectional and 6-month longitudinal data from a voluntary sample of 102 adolescents who were followed after their first-time psychiatric hospitalization. Participants were engaged two in-home, face-to-face interviews: within 7 days of discharge (Time 1) and following six months (Time 2). In the first interview, participants were surveyed with a modified version of Responses to Stress Questionnaire  (RSQ) to indicate the extent they would use various voluntary engagement coping strategies control when confronted with a  stressful stigmatizing situation. They were also to provide data on psychological, social, demographic, and illness related factors hypothesized as associated with coping. The analysis of associations between coping and correlates as well as coping and self-stigma outcomes utilized a series of hierarchical OLS regression models.   

Results: As hypothesized, primary and secondary control coping strategies were more favorable relative to strategies associated with disengagement, confrontation or efforts to disconfirm stereotypes; this was reflected in their association with more “coping resource factors” (e.g. optimistic illness perceptions, social network size and support) and less “coping vulnerability factors” (e.g., need for external approval, internalizing and externalizing symptoms, and perceived stress). Secondary engagement coping (measured at Time 1), which involves various strategies used to gain mastery over one's thoughts and feelings, was uniquely significant in predicting lower self-stigma at follow-up.

Implications: This study begins to identify coping strategies that may be more and less helpful for youth dealing with mental illness stigma following a recent psychiatric hospitalization. The findings have practical implications for interventions designed to promote resilience in this very vulnerable population. In particular, the results support the significance of positive thinking, cognitive restructuring, and acceptance (i.e. secondary control coping strategies) in protecting youth from the harmful effects of stigma.