Identity Construction in Emerging Adults with Serious Mental Illness: Examining Identity Exploration, Self-Sufficiency, Self-Stigma, and Mental Health

Background: This study focuses on self-stigma among emerging adults (ages 18-29) with serious mental illness. It examined whether the developmental milestones of identity exploration and self-sufficiency mediate self-stigma and mental health outcomes (e.g., depression, self-esteem, “why try” effect, quality of life) in emerging adults with serious mental illness (e.g., schizophrenia, bipolar disorder, major depressive disorder). The “why try” effect reflects an individual’s belief that pursuing their life goals is futile. Hypotheses were: (a) Self-stigma will have a negative impact on mental health outcomes (MHO); (b) Self-stigma will have a negative impact on identity exploration and self-sufficiency; (c) Identity exploration and self-sufficiency will have a positive impact on MHO; (d) Self-stigma will negatively impact MHO indirectly through identity exploration and self-sufficiency.

Methods: 254 individuals receiving current clinical services at one of the largest community mental health centers in the United States were recruited in person and via flyers at clinics. All participants satisfied the following eligibility criteria: (a) between ages 18-29, (b) self-reported diagnosis of at least one: schizophrenia, bipolar disorder, major depressive disorder, schizoaffective disorder, or psychosis, and (c) can read and respond in English. The mean age was 24.23. Participant gender was woman n = 144, man n = 98, nonbinary n =12 and race was Black n = 94, Hispanic n = 98, Caucasian n = 33, other n = 29.

During in-person recruitment, prospective participants were handed a flyer and asked if they would like to have an e-flyer and the survey hyperlink texted to their phone. The survey was administered online through a hyperlink to Qualtrics and completed via cell phone. Measures included self-stigma, identity exploration, self-sufficiency, and MHO. The Self-Stigma of Mental Illness Scale-Short Form was used. Three factors of self-stigma were evaluated as distinct independent variables (e.g., aware, apply, harm).

Results: The hypothesized observed‐variable SEM was estimated with robust maximum likelihood estimation using lavaan (v0.6‑19). Overall model fit had a standard chi‐square of 7.01 (df = 4, p = .14), a Comparative Fit Index (CFI) of .99, a TLI of .93, Goodness-of-Fit Index (GFI) of 0.98, a Standardized Root Mean Square Residual (SRMR) of .03, and an RMSEA of .05, 90% C. I. [.00 -.12].

As expected, self-stigma was negatively associated with all MHO. Self-stigma was negatively related to identity exploration, but not self-sufficiency. Self-sufficiency and identity exploration had a robust positive impact on self-esteem and quality of life and a negative impact on the “why try” effect. Lower identity exploration had indirect negative effects on self-stigma and self-esteem and indirect positive effects on self-stigma and “why try” effect. Significant total effects were found between self-stigma and depression, self-esteem, and quality of life.

Implications: Findings show that the developmental milestones of emerging adulthood are highly predictive of the MHO examined. Identity exploration’s mediating effect on self-stigma and MHO supports future work examining stigma and development together. Continued research on how identity exploration and self-sufficiency work with self-stigma to impact MHO in emerging adults with SMI is recommended.