The Effects of Self-Stigma on Occupational Engagement for Adults With Mental Illness

PURPOSE: This study explores the impact of self-stigma on everyday occupations of persons with chronic mental illness. Self-stigma is defined as internalized negative beliefs of public stigma (Corrigan, 2000). Greater understanding of the impact of self-stigma aids development of occupation-based interventions and early establishment of health-promoting behaviors.

DESIGN: A phenomenological design and the Ecology of Human Performance model guided the study. Six participants ages 31–58 yr with chronic mental illness were recruited using convenience sampling from a community-based mental health agency. Diagnoses included schizoaffective and bipolar disorders with past history of substance abuse, anxiety, and depression. Inclusion criteria consisted of a mental health diagnosis, age 21+ yr, English speaking, and community living. Exclusion criteria included psychosis or mania or a legal guardian.

METHOD: Following institutional review board approval and completion of informed consent forms, two 45-min semistructured interviews were conducted. Interviews were transcribed verbatim followed by high-level in vivo coding; theorized principles from Moustakas’s approach were used to interpret and analyze responses. Trustworthiness was established through audit trail, triangulation, weekly peer debriefing, member checks, reflexive journaling, and descriptive data analysis.

RESULTS: Four themes emerged: (1) negative impact on self and (2) difficulty coping with negative social encounters early in the experience, followed by (3) positive contributions to sense of self and (4) acceptance of diagnosis and need for medication. Occupations notably influenced by self-stigma as evidenced by the findings are medication management, adaptive coping, social relationships, employment, and self-care. One assertion emerged: Self-stigma has its greatest impact shortly after the initial diagnosis; with time and supports, the individual learns to accept and cope with the diagnosis, resulting in decreased self-stigma and increased occupational engagement.

CONCLUSION: This study provides preliminary evidence that self-stigma is most prominent initially following a mental health diagnosis, which impacts the individual’s sense of self and personal expectations for future performance. Addressing self-stigma provides opportunities for occupational therapists to focus on health prevention and maintenance behaviors early in the recovery process. Research findings concur with Krupa, Woodside, and Pocock (2010) in identifying the period following first diagnosis as high risk for disengagement from occupational engagement. Further research may wish to address occupational therapy interventions to assist the individual to counteract the negative impacts of self-stigma and positively influence engagement in occupation. A screening tool to determine affected occupations and associated skills may also be useful to guide therapy implementation.

IMPACT STATEMENT: Occupational therapists need to assist individuals to identify meaningful occupations, counteract the effects of self-stigma in the early stages of diagnosis, develop skill-building strategies for continued engagement in health-promoting behaviors, and make the transition to a lifestyle of managing a chronic illness.

References

Caltaux, D. (2002). Internalised stigma—A barrier to recovery. New Zealand Journal of Occupational Therapy, 49(1), 25–27.

Corrigan, P. W. (2000). Mental health stigma as a social attribution: Implications for research methods and attitude change. Clinical Psychology Science and Practice, 7, 48–67. https://doi.org/10.1093/clipsy.7.1.48

Corrigan, P., Larson, J., & Rusch, N. (2009). Self-stigma and the “why try” effect: Impact on life goals and evidence-based practices. World Psychiatry, 8(2), 75–8l. https://doi.org/10.1002/j.2051-5545.2009.tb00218.x

Krupa, T., Woodside, H., & Pocock, K. (2010). Activity and social participation in the period following a first episode of psychosis and implications for occupational therapy. British Journal of Occupational Therapy, 73, 13–20. https://doi.org/10.4276/030802210X12629548272628