Predictors of Stigma Among Young Adults with Serious Mental Illness

Background and Purpose: Stigma fundamentally disadvantages individuals who experience mental illness and serves as a persistent barrier to mental health service use, and a factor associated with self-esteem, quality of life, social network ties, employment, and recovery (Hatzenbuehler et al., 2013). To more effectively mitigate these pervasive outcomes and develop targeted and culturally responsive interventions, it is crucial to better understand stigma and its correlates particularly among young adults who face social and environmental stressors (i.e., racism, discrimination, complex trauma, poverty). The purpose of this study is to examine whether demographic (age, race/ethnicity, gender, education), clinical (depression, age of illness onset), and recovery (hope, recovery) factors predict levels of internalized stigma among a transdiagnostic sample of predominantly low-income young adults with serious mental illness (SMI) receiving outpatient treatment.

Methods: Data were drawn from a sample (N=121) of young adults with SMI aged 18-34 years who participated in Wave 1 of a small scale randomized explanatory trial. The dependent variable, indifference to stigma (i.e., higher scores reflect less internalized stigma), was operationalized using 8-items from the Inventory of Attitudes Toward Seeking Mental Health Services scale. Predictor variables included demographic (age, race/ethnicity, gender, education), clinical (depression, age of illness onset), and recovery (recovery and hope) factors. Bivariate analyses were used to examine preliminary relationships between variables. An ordinary least squares multiple regression model was used to estimate associations between demographic, clinical, and recovery factors on levels of indifference to stigma. Analyses were estimated using Stata and MPlus to treat missing data using Full Information Maximum Likelihood (FIML) imputation methods for non-biased estimates.

Results: The sample was predominately male (66%) and identified as Black (38%) or Latinx (33%), with a mean age of 26 (SD=3.91). Results indicated that level of depression symptoms are associated with internalized stigma, holding all other variables constant (b= -0.23, p<.001). This suggests that young adults who reported more severe symptoms of depression experienced higher levels of internalized stigma. Results also showed that education and race/ethnicity were associated with internalized stigma. For example, those who completed at least high school reported greater internalized stigma than those who did not complete high school (b=-2.53, p<.05). Further, those who identified as bi- or multi- racial reported significantly less internalized stigma (b=4.00, p<.05) when compared to those who identified as Black (ref group). Age of illness onset along with other demographic and recovery factors were not found to be significantly associated with internalized stigma.

Conclusions and Implications: These results suggest that severity of depression matters when we consider stigma, which captures an additional layer of complexity that young adults of color may face while attempting to navigate convoluted systems of care. Interestingly, the study also points to stigma concerns being more elevated among those who are more educated. Universal stigma campaigns are a prevailing prevention strategy for young adults and these data suggest that it may be important to target specific subgroups with culturally and developmentally responsive stigma reduction strategies.