129P
Empowerment As a Mediator in the Relationship Between Social Support and Internalized Stigma in Family Caregivers of Adults with Severe Mental Illness
Internalized stigma refers to the extent of self-stigmatization among associates of the targeted minorities (e.g. adults with severe mental illness). Previous studies on caregiver stigma show that greater social support was related to lower levels of internalized stigma and higher levels of empowerment among family caregivers of adults with severe mental illness (SMI). While empowerment has also been identified as an effective strategy in lowering stigma, this study investigate the path among social support, empowerment and internalized stigma. We hypothesized that the relationship between social support and internalized stigma is mediated by empowerment.
Methods
This study employed a cross-sectional survey design. A total of 177 caregivers were recruited. The final sample size was 137 individuals after deletion of data with missing values. Social support consists of three indicators: the level of client contributions to the household, support group participation and the number of other family members involving in caregiving. Empowerment Scale was utilized to measure individual’s sense of intra-personal, inter-personal, and socio-political empowerment. A 22-item Internalized Stigma Scale was used to measure the extent of internalized stigma among caregivers of persons with SMI. A mediation analysis was performed using the Baron and Kenny (1986) causal steps approach. The exogenous variable was social support, the outcome variable was stigma, and the mediating variable was empowerment. The control variables were caregiver’s age and gender. Sobel’s Test of mediation (1982) was utilized to calculate the indirect effect.
Results
The total effects of both other family’s involvement (b = -1.34, p = .01) and client’s contribution (b = -.40, p = .01) on stigma were significant. However, support group participation was not significant. Client’s contribution (b = .34, p = .03) and support group participation (b = 7.96, p ≤ .001) were significantly predictive of empowerment; however, other family’s involvement was not significant. When controlling for social support, empowerment was significantly predictive of stigma, b = -.50, p ≤ .001. The estimated direct effects of social support variables were not significant, after controlling for empowerment. Based on Baron and Kenny’s approach, only the indirect effect of client’s contribution on stigma was calculated. By using the Sobel test, the indirect effect was significant, b = -.17, p = .04. While the direct path from client’s contribution to stigma was not statistically significant, the effect of client’s contribution on stigma was totally mediated by empowerment. Overall, stigma was predicted well from social support and empowerment, with R2 = .38, p ≤ .001.
Conclusion/ Implications
The results indicate that, among caregivers, more contributions from adults with SMI is associated with lower internalized stigma, through a higher level of empowerment. Also, support group participation is associated with higher levels of empowerment. In order to address caregiver’s internalized stigma, mental health professionals are recommend to encourage clients to engage in chores with family and empower family caregivers. Also, more support group participation is recommended for caregivers. Future studies exploring additional potential mediators are needed to better understand the relationship between social support and internalized stigma.