Who Is a Source of Stigma: Examining Stigmatizing Social Network Members for Those with Serious Mental Illness Using Multiple Methods

Background:

Stigma poses a barrier for individuals with serious mental illness (SMIs) to engage in their communities. The fear of stigma, from past experiences or anticipated discrimination, obstructs their efforts to integrate into society, leading to social isolation and inadequate support systems. While existing studies have explored the broader effects of stigma, there is limited research examining the dynamics of stigma within relationships and how this influences social networks (SN) crucial for community integration. This study addresses this gap by investigating stigma within the SN of individuals with SMIs and its implications on their social integration into communities. This study seeks to offer insights that can inform interventions and support strategies aimed at mitigating stigma and fostering social inclusion for individuals with SMIs.

Methods:

Seven participants were selected from a multi-site study on the community experiences of racially/ethnically diverse individuals with SMIs. This smaller sample facilitated an in-depth analysis of stigma within specific relationships. The methodological decision to reduce the sample size allowed for a detailed investigation using innovative data sources and multiple research methods. Through the multiple case study analysis of semi-structured and egocentric SN interviews, cases rich in data regarding the sources and experiences of stigma were identified. Additionally, quantitative SN data was used to contextualize participant’s discourse on stigma within specific relationships. This utilization of diverse data sources and methodological approaches facilitated a nuanced understanding of the complexities of SN and their impact on community integration.

Findings:

Participants' ages ranged from 21 to 46 years, all diagnosed primarily with schizophrenia, comprising three Latinx, two Black, and two White individuals. The proportion of stigmatizing SN members varied from 6.7% to 60.5%. While it was observed that family and friends were the primary sources of stigma, consistent with previous research, the study also revealed that service providers played a crucial role as supportive figures in participants' SN. The thematic analysis identified cross-case themes including physical space & social networks, disclosure, stressed relationships, and social isolation. These themes, supplemented by proportional data, provided insights into the nature and extent of stigma experienced. For instance, although family members were identified as the most stigmatizing group proportionally, qualitative analysis highlighted their role as potential sources of support. Conversely, certain acquaintances in participants' SN were neither stigmatizing nor supportive. Service providers emerged as essential for offering non-judgmental support and bridging the gap between mental health and non-mental health network members.

Conclusion:

While participants exhibited varying network sizes, many of their SN members perpetuated stigma. This challenge underscores the importance of addressing quality vs. quantity of SN in community integration efforts. The findings demonstrate the significance of service providers in fostering supportive relationships rather than focusing solely on network quantity. Service providers can offer non-judgmental support, facilitate connections to supportive networks, and impart essential skills to manage stigma and foster healthy relationships. While existing relationships provide a sense of belonging, collaborations with service providers are pivotal in building community integration by facilitating connections and imparting skills necessary for navigating stigma in relationships.