The Influence of Mental Illness and Criminality Self-Stigmas and Racial Self-Concept on Outcomes in a Forensic Psychiatric Sample

• Published in: Psychiatric rehabilitation journal 2015-06, Vol.38 (2), p.150-157
• Main Authors: West, Michelle L., Vayshenker, Beth, Rotter, Merrill, Yanos, Philip T.
• Format: Article
• Language: English
• Subjects: Adult; African Americans - psychology; Aged; Arabs - psychology; Asian Americans - psychology; Bipolar Disorder - drug therapy; Bipolar Disorder - psychology; Clinical outcomes; Criminal justice; Criminal Offenders; Criminals - psychology; Depression - psychology; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - psychology; Ethnic Groups - psychology; European Continental Ancestry Group - psychology; Female; Forensic Psychiatry; Hispanic Americans - psychology; Human; Humans; Indians, North American - psychology; Inpatient; Male; Medication Adherence - psychology; Mental Disorders; Mental Disorders - drug therapy; Mental Disorders - psychology; Mental health care; Middle Aged; Physician-Patient Relations; Psychotic Disorders - drug therapy; Psychotic Disorders - psychology; Racial and Ethnic Groups; Racism - psychology; Schizophrenia - drug therapy; Schizophrenic Psychology; Self Concept; Self esteem; Self image; Self-Stigma; Social Discrimination - psychology; Social Stigma; Stigma; Stress Disorders, Post-Traumatic - drug therapy; Stress Disorders, Post-Traumatic - psychology; Treatment Compliance; Treatment Outcomes; Young Adult
• ISSN: 1095-158X; 1559-3126
• DOI: 10.1037/prj0000133

Objective: Research has increasingly explored mental illness self-stigma: when people with mental illness believe that society's negative beliefs are true of them. Self-stigma predicts poorer functional and treatment outcomes. Stigma research has typically investigated the impact of a single stigma on people, without considering the potential effects of multiple stigmatizing labels. People with mental illness and a history of criminal conviction, however, may experience multiple stigmas related to mental illness and criminal history. This study investigated the impact of the combination of multiple stigmatized identities on self-esteem, depression, therapeutic alliance, and treatment adherence in a forensic psychiatric sample. It extended previous research on mental illness self-stigma to a forensic psychiatric sample. Methods: Participants (N = 82) were people with mental illness and a history of criminal conviction recruited from their treatment sites. Participants completed self-report questionnaires focused on mental illness and criminality self-stigma, racial self- concept, self-esteem, depression, working alliance, and medication/psychosocial treatment adherence. Researchers confirmed demographics through a chart review and treatment adherence from participants' clinicians. Multiple regression analyses examined the relationship between self-stigma and outcome variables. Results: Mental illness self-stigma, racial self-concept, and to a lesser extent criminality self-stigma were associated with reduced self-esteem (p ≤ .05) and medication adherence (p ≤ .05). Criminality self-stigma also appeared to magnify the effects of racial and mental illness self-stigma on outcomes. Conclusions and Implications: This study shows that self-stigma related to involvement in the criminal justice system may further contribute to the impact of mental illness self-stigma on important outcomes. Future research and interventions may tailor self-stigma interventions to a forensic psychiatric population.