Modeling Processes of Recovery in Mental Illness: The Mediating Effect of Social Support on the Relationship Between Experienced Stigma and Positive Mental Health

Background/purpose: Experienced stigma is a reality for persons with mental illness, representing a significant obstacle to recovery above the effects of often debilitating symptoms. Stigma stops persons with mental illness from seeking or following through with treatment. Further, stigma interferes with the life chances of persons with mental illness, including finding housing, employment and meaningful relationships. In contrast, social support represents a protective factor for persons with mental illness. Having social support buffers persons from the effects of negative social and psychological events. For example, research suggests that social support mediates the effects of stress on symptoms of mental illness. We hypothesize that social support will mediate the effects of public stigma on mental health. 

Methods:  Data for this research came from the 2012 Canadian Community Health Survey (CCHS).  Data were collected using a two-step random sampling procedure. We used a subsample of participants who had received mental health treatment in the past 12 months (n = 2,105).  We used the recommended sample weights to derive estimates for each model. The dependent variable was the mental health, which was measured using the 14 item Mental Health Continuum – Short Form. Stigma, the independent variable, was measured using an eight item modified form of the Impact Scale of the Inventory of the Stigmatizing Experience. The eight items relate to situations in which participants might experience discrimination. The mediating variable, social support, was measured using the 10 item social provision scale. Controlling for age, gender, marital status, substance abuse, and mental health diagnosis, we used multivariate regression analysis. We used two approaches for estimating and testing the indirect effect, the Sobel test and bootstrapping (1,000 samples with replacement).           

Results:  The mediating model explained 38% of the variance in mental health, which was 17% more variance than the model without social support – the mediator.  The mediation hypothesis was tentatively confirmed. The Sobel test was significant (z = -7.98, p<.01). The 95% bootstrapped confidence interval of the indirect effect was -.13 to -.073. Stigma was negatively related to mental health (t=3.36, p<.05); Stigma was negatively related to social support (t = -8.51, p <.01); and social support was positively related to mental health (t=23.21, p<.01).      

Conclusions/Implications: The findings support past research on the buffering effect of social support on negative social and psychological events. While social support mediated the effects of experienced stigma on mental health, the relationship was not perfect. More research is needed to determine other possible mediators. While imperfect, the mediating role of social support was not insignificant. Mental health social workers are encouraged to help their clients develop meaningful social supports in the community, especially social supports outside of the mental health system of care.