Investigating the Relationship Between Self-Esteem, Stereotype Awareness, and Suicide Attempts

Background and purpose

Stigma towards individuals with mental illness, including negative social stereotypes, can internalize over time within individuals experiencing mental illness. Stereotype awareness is negatively correlated with psychological variables such as hope, self-esteem, and empowerment. Self-esteem may be relevant in understanding the impact of stigma among individuals with a history of suicidal behavior since impaired self-esteem is a leading predictor of suicide ideation and suicide re-attempts. Thus, understanding the effects of stigma on the post-attempt population may have direct implications for suicide prevention. This study aims to better understand the relationship between stereotype awareness and self esteem among young adults who have and have not attempted suicide.  In accordance with modified labeling theory, we hypothesized that stereotype awareness would be related to lower self-esteem among young adults with suicide attempts, but would not be related to self-esteem among young adults without suicide attempts.

Methods

Data were collected using a cross-sectional survey design, with a convenience sample of undergraduate students (N=622, 63% female, 65% Caucasian). Measures included the Rosenburg Self Esteem Scale and The Stereotype Awareness scale (young adult version), as well as items assessing suicide attempt history and demographics. Both scales are validated measures with good internal consistency in this sample.

Participants who made suicide attempts were compared to those without attempts on demographic factors using t-tests and chi square. Linear regression was used to test for an association between stereotype awareness and self-esteem and whether this association varied by suicide attempt status (i.e., an attempt by stereotype awareness interaction), adjusted for age, sex, and race/ethnicity.

Results

In univariate analyses, attempt history was unrelated to sex  (Χ²  (1, N =  637) = 1.14, p = .26), race (c²(1,  N =  637) = .002, p = .97), and age t(635) = 1.94, p = .26, as well as self-esteem t(635) = -1.37, p = .17 , and stereotype awareness t(635) = .69, p = .49. Race, sex, age, and stereotype awareness significantly predicted self esteem scores R² = 0.042, F(6, 630) = 4.58, p< .001. In the regression analysis, there were significant main effects of stereotype awareness (β = -.09, SE = .067, p = .036) and suicide attempts (β = .68, SE = 7.05, p = .011) on self-esteem, and a significant stereotype awareness x attempt interaction (β = -.74, SE = .27, p = .006).

Conclusions and Implications

This is the first study to our knowledge to show that stereotype awareness is associated with lower self-esteem among young adults with histories of suicide attempts. Individuals with past attempts and low self-esteem may be at risk for repeated attempts, which may be accentuated by awareness of negative stereotypes regarding mental illness. On a community level, stigma alleviation efforts may reduce suicide rates by improving self-esteem among individuals with attempt histories, contributing to other known public health benefits of reducing stigma. Future research should explore interventions to reduce the effect of stigma within communities and among individuals at risk for suicide.