Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-29T17:42:25.444Z Has data issue: false hasContentIssue false
  • English
  • Français

Mental illness stigma, secrecy and suicidal ideation

Published online by Cambridge University Press:  26 November 2015

N. Oexle ,
V. Ajdacic-Gross ,
R. Kilian ,
M. Müller ,
S. Rodgers ,
Z. Xu ,
W. Rössler  and
N. Rüsch
N. Oexle*
Affiliation:
Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
V. Ajdacic-Gross
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, Zurich University, Zurich, Switzerland
R. Kilian
Affiliation:
Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
M. Müller
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, Zurich University, Zurich, Switzerland
S. Rodgers
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, Zurich University, Zurich, Switzerland
Z. Xu
Affiliation:
Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
W. Rössler
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, Zurich University, Zurich, Switzerland Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
N. Rüsch
Affiliation:
Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
*
*Address for correspondence: N. Oexle, Department of Psychiatry II, University of Ulm and BKH Günzburg, Parkstrasse 11, 89073 Ulm, Germany. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

Whether the public stigma associated with mental illness negatively affects an individual, largely depends on whether the person has been labelled ‘mentally ill’. For labelled individuals concealing mental illness is a common strategy to cope with mental illness stigma, despite secrecy's potential negative consequences. In addition, initial evidence points to a link between stigma and suicidality, but quantitative data from community samples are lacking.

Methods.

Based on previous literature about mental illness stigma and suicidality, as well as about the potential influence of labelling processes and secrecy, a theory-driven model linking perceived mental illness stigma and suicidal ideation by a mediation of secrecy and hopelessness was established. This model was tested separately among labelled and unlabelled persons using data derived from a Swiss cross-sectional population-based study. A large community sample of people with elevated psychiatric symptoms was examined by interviews and self-report, collecting information on perceived stigma, secrecy, hopelessness and suicidal ideation. Participants who had ever used mental health services were considered as labelled ‘mentally ill’. A descriptive analysis, stratified logistic regression models and a path analysis testing a three-path mediation effect were conducted.

Results.

While no significant differences between labelled and unlabelled participants were observed regarding perceived stigma and secrecy, labelled individuals reported significantly higher frequencies of suicidal ideation and feelings of hopelessness. More perceived stigma was associated with suicidal ideation among labelled, but not among unlabelled individuals. In the path analysis, this link was mediated by increased secrecy and hopelessness.

Conclusions.

Results from this study indicate that among persons labelled ‘mentally ill’, mental illness stigma is a contributor to suicidal ideation. One explanation for this association is the relation perceived stigma has with secrecy, which introduces negative emotional consequences. If our findings are replicated, they would suggest that programmes empowering people in treatment for mental illness to cope with anticipated and experienced discrimination as well as interventions to reduce public stigma within society could improve suicide prevention.

Keywords

Hopelessnessmental illness stigmasecrecysuicidal ideation
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 26 , Issue 1 , February 2017 , pp. 53 - 60
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ajdacic-Gross, V, Müller, M, Rodgers, S, Warnke, I, Hengartner, MP, Landolt, K, Hagenmuller, F, Meier, M, Tse, L-T, Aleksandrowicz, A, Passardi, M, Knöpfli, D, Schönfelder, H, Eisele, J, Rüsch, N, Haker, H, Kawohl, W, Rössler, W (2014). The ZInEP epidemiology survey: background, design and methods. International Journal of Methods in Psychiatric Research 23, 451–468.Google Scholar
Bostwick, JM, Pankratz, VS (2000). Affective disorders and suicide risk: a reexamination. American Journal of Psychiatry 157, 1925–1932.Google Scholar
Bryan, CJ, Ray-Sannerud, B, Morrow, CE, Etienne, N (2013). Shame, pride, and suicidal ideation in a military clinical sample. Journal of Affective Disorders 147, 212–216.Google Scholar
Cavanagh, JT, Carson, AJ, Sharpe, M, Lawrie, SM (2003). Psychological autopsy studies of suicide: a systematic review. Psychological Medicine 33, 395–405.Google Scholar
Corrigan, PW, Watson, AC (2002). The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice 9, 35–53.Google Scholar
Corrigan, PW, Kosyluk, KA, Rüsch, N (2013). Reducing self-stigma by coming out proud. American Journal of Public Health 103, 794–800.Google Scholar
Farrelly, S, Jeffery, D, Rüsch, N, Williams, P, Thornicroft, G, Clement, S (2015). The link between mental health-related discrimination and suicidality: service user perspectives. Psychological Medicine 45, 2013–2022.Google Scholar
Gu, F, Preacher, KJ, Ferrer, E (2015). A state space modeling approach to mediation analysis. Journal of Education and Behavioral Statistics 39, 117–143.Google Scholar
Hancock, GR, Mueller, RO (2013). Structural Equation Modeling: A Second Course. Iap: Greenwich.Google Scholar
Hardt, J, Egle, UT, Kappis, B, Hessel, A, Brähler, E (2004). Die symptom-checkliste SCL-27. Ergebnisse einer deutschen Repräsentativbefragung [Symptom Checklist SCL-27. Results of a Representative German Survey]. Psychotherapie, Psychosomatik, Medizinische Psychologie 54, 214–223.Google Scholar
Harris, EC, Barraclough, B (1997). Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry 170, 205–228.Google Scholar
Hosmer, DW Jr., Lemeshow, S, Sturdivant, RX (2013). Applied Logistic Regression, Vol. 398. John Wiley & Sons: Hoboken.Google Scholar
Link, BG, Phelan, JC (2013). Labeling and stigma. In Handbook of the Sociology of Mental Health (ed. Aneshensel, CS, Phelan, JC and Bierman, A), pp. 525–541. Springer: Dordrecht.Google Scholar
Link, BG, Cullen, FT, Struening, E, Shrout, PE, Dohrenwend, BP (1989). A modified labeling theory approach to mental disorders: an empirical assessment. American Sociological Review 54, 400–423.CrossRefGoogle Scholar
Link, BG, Mirotznik, J, Cullen, FT (1991). The effectiveness of stigma coping orientations: can negative consequences of mental illness labeling be avoided? Journal of Health and Social Behavior 32, 302–320.CrossRefGoogle ScholarPubMed
Link, BG, Struening, EL, Neese-Todd, S, Asmussen, S, Phelan, JC (2002). On describing and seeking to change the experience of stigma. Psychiatric Rehabilitation Skills 6, 201–231.Google Scholar
Miret, M, Ayuso-Mateos, JL, Sanchez-Moreno, J, Vieta, E (2013). Depressive disorders and suicide: epidemiology, risk factors, and burden. Neuroscience and Biobehavioral Reviews 37, 2372–2374.Google Scholar
Niederkrotenthaler, T, Reidenberg, DJ, Till, B, Gould, MS (2014). Increasing help-seeking and referrals for individuals at risk for suicide by decreasing stigma: the role of mass media. American Journal of Preventive Medicine 47, 235–243.Google Scholar
Pachankis, JE (2007). The psychological implications of concealing a stigma: a cognitive-affective-behavioral model. Psychological Bulletin 133, 328–345.Google Scholar
Peduzzi, P, Concato, J, Kemper, E, Holford, TR, Feinstein, AR (1996). A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology 49, 1373–1379.Google Scholar
Preacher, KJ, Hayes, AF (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods 40, 879–891.Google Scholar
Reynders, A, Kerkhof, AJFM, Molenberghs, G, Van Audenhove, C (2014). Attitudes and stigma in relation to help-seeking intentions for psychological problems in low and high suicide rate regions. Social Psychiatry and Psychiatric Epidemiology 49, 231–239.Google Scholar
Rüsch, N, Angermeyer, MC, Corrigan, PW (2005). Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. European Psychiatry 20, 529–539.Google Scholar
Rüsch, N, Lieb, K, Bohus, M, Corrigan, PW (2006). Self-stigma, empowerment, and perceived legitimacy of discrimination among women with mental illness. Psychiatric Services 57, 399–402.CrossRefGoogle ScholarPubMed
Rüsch, N, Zlati, A, Black, G, Thornicroft, G (2014). Does the stigma of mental illness contribute to suicidality? British Journal of Psychiatry 205, 257–259.Google Scholar
Schomerus, G, Evans-Lacko, S, Rüsch, N, Mojtabai, R, Angermeyer, MC, Thornicroft, G (2015). Collective levels of stigma and national suicide rates in 25 European countries. Epidemiology and Psychiatric Sciences 24, 166–171.Google Scholar
Selby, E, Joiner, TE, Ribeiro, JD (2014). Comprehensive theories of suicidal behaviors. In The Oxford Handbook of Suicide and Self-Injury (ed. Nock, MK), pp. 286–308. Oxford University Press: Oxford, UK.Google Scholar
Sharaf, AY, Ossman, LH, Lachine, OA (2012). A cross-sectional study of the relationships between illness insight, internalized stigma, and suicide risk in individuals with schizophrenia. International Journal of Nursing Studies 49, 1512–1520.Google Scholar
Steinmetz, H (2014). Lineare Strukturgleichungsmodelle – Eine Einführung mit R, Vol. 9 Sozialwissenschaftfliche Forschungsmethoden. Rainer Hampp Verlag: Mering.Google Scholar
Sudak, H, Maxim, K, Carpenter, M (2008). Suicide and stigma: a review of the literature and personal reflections. Academic Psychiatry 32, 136–142.CrossRefGoogle ScholarPubMed
Taylor, AB, MacKinnon, DP, Tein, J-Y (2008). Tests of the three-path mediated effect. Organizational Research Methods 11, 241–269.Google Scholar
Vittinghoff, E, McCulloch, CE (2007). Relaxing the rule of ten events per variable in logistic and Cox regression. American Journal of Epidemiology 165, 710–718.Google Scholar
World Health Organization (2014). Preventing suicide: a global imperative. Retrieved 4 May 2015 from http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/ Google Scholar