Internalization process of stigma of people with mental illness across cultures: A meta-analytic structural equation modeling approach

• Published in: Clinical psychology review Vol. 87; p. 102029
• Main Authors: Yu, Ben C.L., Chio, Floria H.N., Mak, Winnie W.S., Corrigan, Patrick W., Chan, Kelly K.Y.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.07.2021
• Subjects: People with mental illness; Public stigma; Recovery; Self-stigma; Stigma internalization process; Well-being; Stigma internalization process; Public stigma; Well-being; Self-stigma; Recovery; People with mental illness
• ISSN: 0272-7358; 1873-7811
• DOI: 10.1016/j.cpr.2021.102029

This meta-analytic study synthesized findings from 108 independent data sets across 22 cultures to investigate whether the stigma internalization model (the internalization of experienced stigma and perceived stigma to self-stigma) is associated with well-being and recovery of people with mental illness. We also examined the moderating role of collectivism in the internalization process. Results of the meta-analytic structural equation modeling suggested that self-stigma is a significant mediator in the relationships between experienced stigma and perceived stigma with well-being and recovery variables (indirect effects = 0.02 to −0.16). Experienced and perceived stigma had significant direct effects on well-being and recovery variables (Bs = 0.07 to −0.21, p < 0.05), suggesting that both external (e.g., public stigma) and internal (i.e., self-stigma) influences of stigma work concurrently to affect recovery and well-being of people with mental illness. The results of the mixed effect three-level meta-analytic models showed that collectivism significantly moderated the relationship between experienced and perceived stigma with self-stigma (Bs = 0.06 to 0.11, p < 0.05). This implied that the more collectivistic a culture is, the stronger the correlation between experienced and perceived stigma with self-stigma. Implications to stigma reduction approaches were discussed. •Self-stigma mediates the linkage between public stigma with recovery and well-being.•Experienced stigma has greater association with self-stigma than perceived stigma.•Experienced stigma remains detrimental after accounting for self-stigma.•Collectivistic cultures have stronger internalization of stigma.