This investigation introduced the Internalized Stigma Model to test the mechanisms by which the stigma of mental illness and of seeking psychological help affect self-esteem and intentions to seek counseling. We hypothesized that both stigmas would predict decreased self-esteem, but only stigma of seeking psychological help would predict decreased intentions to seek counseling. Furthermore, we predicted that these links follow a process wherein people’s perceptions of societal stigma are fully mediated by internalization of that stigma. Public stigmas predict their respective self-stigmas, which subsequently predict self-esteem and intentions. Using structural equation modeling, we tested the hypothesized relationships in a sample of undergraduates (N = 448). Results supported the hypotheses. Self-stigma mediated the relationship between public stigma and both outcomes; both self-stigma of mental illness and self-stigma of seeking psychological help predicted decreased self-esteem, but only self-stigma of seeking psychological help predicted decreased intentions to seek counseling.
AddisM. E.MahalikJ. R. (2003). Men, masculinity, and the contexts of help seeking. American Psychologist, 58, 5-14. doi:10.1037/0003-066X.58.1.5
2.
Al-KrenawiA.GrahamJ. R.DeanY. Z.EltaibaN. (2004). Cross-national study of attitudes towards seeking professional help: Jordan, United Arab Emirates (UAE) and Arabs in Israel. International Journal of Social Psychiatry, 50, 102-114.
3.
AndersonJ. C.GerbingD. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103, 411-423.
4.
BarneyL. J.GriffithsK. M.JormA. F.ChristensenH. (2006). Stigma about depression and its impact on help-seeking intentions. Australian & New Zealand Journal of Psychiatry, 40, 51-54.
5.
Ben-PorathD. (2002). Stigmatization of individuals who receive psychotherapy: An interaction between help-seeking behavior and the presence of depression. Journal of Social & Clinical Psychology, 21, 400-413. doi:10.1521/jscp.21.4.400.22594
6.
BrohanE.GauciD.SartoriusN.ThornicroftG. (2011). Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 13 European countries: The GAMIAN–Europe study. Journal of Affective Disorders, 129, 56-63. doi:10.1016/j.jad.2010.09.001
7.
BrohanE.SladeM.ClementS.ThornicroftG. (2010). Experiences of mental illness stigma, prejudice and discrimination: A review of measures. BMC Health Services Research, 10(1), Article 80. doi:10.1186/1472-6963-10-80
8.
BrownC.ConnerK. O.CopelandV. C.GroteN.BeachS.BattistaD.ReynoldsC. F.III. (2010). Depression stigma, race, and treatment seeking behavior and attitudes. Journal of Community Psychology, 38, 350-368.
9.
CashT.BegleyP.McCownD.WeiseB. (1975). When counselors are heard but not seen: Initial impact of physical attractiveness. Journal of Counseling Psychology, 22, 273-279.
10.
Cepeda-BenitoA.ShortP. (1998). Self-concealment, avoidance of psychological services, and perceived likelihood of seeking professional help. Journal of Counseling Psychology, 45, 1-7. doi:10.1037/0022-0167.45.1.58
11.
ConnerK. O.CopelandV. C.GroteN. K.KoeskeG.RosenD.ReynoldsC. F.IIBrownC. (2010). Mental health treatment seeking among older adults with depression: The impact of stigma and race. American Journal of Geriatric Psychiatry, 18, 531-543.
12.
CooperA. E.CorriganP. W.WatsonP. W. (2003). Mental illness stigma and care seeking. Journal of Nervous and Mental Disease, 5, 339-341.
13.
CorriganP. W. (2004). How stigma interferes with mental health care. American Psychologist, 59, 614-625. doi:10.1037/0003-066X.59.7.614
14.
CorriganP. W.KosylukK. A.RüschN. (2013). Reducing self-stigma by coming out proud. American Journal of Public Health, 103, 794-800.
15.
CorriganP. W.LarsonJ. E.RüschN. (2009). Self-stigma and the “why try” effect: Impact on life goals and evidence-based practices. World Psychiatry, 8(2), 75-81. doi:10.1002/j.2051-5545.2009.tb00218.x
16.
CorriganP. W.MorrisS. B.MichaelsP. J.RafaczJ. D.RüschN. (2012). Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services, 63, 963-973. doi:10.1176/appi.ps.201100529
17.
CorriganP. W.RoaD. (2012). On the self-stigma of mental illness: Stages, disclosure, and strategies for change. Canadian Journal of Psychiatry, 57, 464-469.
18.
CorriganP. W.WatsonA. C.BarrL. (2006). The self-stigma of mental illness: Implications for self-esteem and self-efficacy. Journal of Social & Clinical Psychology, 25, 875-884.
19.
EvansC.Mellow-ClarkJ.MargisonF.BardhamM.AudinK.ConnellJ.McGrathG. (2000). CORE: Clinical outcomes in routine evaluation. Journal of Mental Health, 9, 247-255. doi:10.1080/713680250
20.
FarinaA. (1981). Are women nicer people than men? Sex and the stigma of mental disorders. Clinical Psychology Review, 1, 223-243.
21.
GoffmanE. (1963). Stigma: Notes on the management of spoiled identity. New York, NY: Simon & Schuster.
22.
HuL. T.BentlerP. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1-55.
23.
JormA. F.ModwayJ.ChristensenH.KortenA. E.JacombP. A.RodgersB. (2000). Attitudes towards people with depression: Effects on the public’s help-seeking and outcome when experiencing common psychiatric symptoms. Australian & New Zealand Journal of Psychiatry, 34, 612-618.
24.
JormA. F.WrightA. (2008). Influences on young people’s stigmatizing attitudes toward peers with mental disorders: National Survey of Young Australians and their parents. British Journal of Psychiatry, 192, 144-149.
25.
KellyA. E.AchterJ. A. (1995). Self-concealment and attitudes toward counseling in university students. Journal of Counseling Psychology, 42, 40-46.
26.
KesslerR. C.BerglundP. A.BruceM. L.KochJ. R.LaskaE. M.LeafP. J.. . . WangP. S. (2001). The prevalence and correlates of untreated serious mental illness. Health Services Research, 36, 987-1007.
27.
KingP.NewtonF.OsterlundB.BaberB. (1973). A counseling center studies itself. Journal of College Student Personnel, 14, 338-344.
28.
KomiyaN.GoodG.SherrodN. (2000). Emotional openness as a predictor of college students’ attitudes toward seeking psychological help. Journal of Counseling Psychology, 47, 138-143. doi:10.1037/0022-0167.47.1.138
29.
LanninD. G.GuyllM.VogelD. L.MadonS. (2013). Reducing the stigma associated with seeking psychotherapy through self-affirmation. Journal of Counseling Psychology, 60, 508-519. doi:10.1037/a0033789
30.
LauberC.RösslerW. (2007). Stigma towards people with mental illness in developing countries in Asia. International Review of Psychiatry, 19, 157-178.
31.
LinkB. G. (1987). Understanding labeling effects in the area of mental disorders: An assessment of the effects of expectations of rejection. American Sociological Review, 52, 96-112.
32.
LinkB. G.CullenF. T.StrueningE.ShroutP. E.DohrenwendB. P. (1989). A modified labeling theory approach to mental disorders: An empirical assessment. American Sociological Review, 54, 400-423.
33.
LinkB. G.PhelanJ. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363-385. Retrieved from http://www.jstor.org/stable/2678626
34.
LinkB. G.StrueningE. L.Neese-ToddS.AsmussenS.PhelanJ. C. (2001). Stigma as a barrier to recovery: The consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Services, 52(12), 1621-1626. doi:10.1176/appi.ps.52.12.1621
35.
LopezS. J.EdwardsL. M. (2008). The interface of counseling psychology and positive psychology: Assessing and promoting strengths. In BrownS.LentR. (Eds.), Handbook of counseling psychology (4th ed.). Hoboken, NJ: John Wiley.
36.
LudwikowskiW.VogelD. L.ArmstrongP. I. (2009). Attitudes towards career counseling: The role of public and self-stigma. Journal of Counseling Psychology, 56, 408-416.
37.
MajorB.O’BrienL. T. (2005). The social psychology of stigma. Annual Review of Psychology, 56, 393-421.
38.
MakW. W.PoonC. Y.PunL. Y.CheungS. F. (2007). Meta-analysis of stigma and mental health. Social Science & Medicine, 65, 245-261.
39.
ManosR. C.RüschL. C.KanterJ. W.CliffordL. M. (2009). Depression self-stigma as a mediator of the relationship between depression severity and avoidance. Journal of Social & Clinical Psychology, 28, 1128-1143. doi:10.1521/jscp.2009.28.9.1128
40.
MartensM. P. (2005). The use of structural equation modeling in counseling psychology research. The Counseling Psychologist, 33, 269-298. doi:10.1177/0011000004272260
41.
MuthénL. K.MuthénB. O. (2010). Mplus user’s guide (6th ed.). Los Angeles, CA: Author.
42.
PedersonE. L.VogelD. L. (2007). Men’s gender role conflict and their willingness to seek counseling: A mediation model. Journal of Counseling Psychology, 54, 373-384.
43.
QuinnD. M.ChaudoirS. R. (2009). Living with a concealable stigmatized identity: The impact of anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health. Journal of Personality and Social Psychology, 97, 634-651.
44.
RosenA.WalterG.CaseyD.HockingB. (2000). Combating psychiatric stigma: An overview of contemporary initiatives. Australasian Psychiatry, 8, 19-26.
45.
RosenbergM. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.
46.
RosenbergM. (1979). Conceiving the self. New York, NY: Basic Books.
47.
RussellD. W.KahnJ. H.SpothR.AltmaierE. M. (1998). Analyzing data from experimental studies: A latent variable structural equation modeling approach. Journal of Counseling Psychology, 45, 18-29.
48.
SatorraA.BentlerP. M. (2001). A scaled difference chi-squared test statistic for moment structure analysis. Psychometrika, 66, 507-514. doi:10.1007/BF02296192
49.
SchlomerG. L.BaumanS.CardN. A. (2010). Best practices for missing data management in counseling psychology. Journal of Counseling Psychology, 57, 1-10.
50.
SchomerusG.AngermeyerM. C. (2008). Stigma and its impact on help-seeking for mental disorders: What do we know?Epidemiologia e Psichiatria Sociale, 17, 31-37.
51.
SheaM.YehC. J. (2008). Asian American students’ cultural values, stigma, and relational self-construal: Correlates of attitudes toward professional help seeking. Journal of Mental Health Counseling, 30(2), 157-172.
52.
ShroutP. E.BolgerN. (2002). Mediation in experimental and non-experimental studies: New procedures and recommendations. Psychological Methods, 7, 422-445.
53.
SibickyM.DovidioJ. (1986). Stigma of psychological therapy: Stereotypes, interpersonal reactions, and the self-fulfilling prophecy. Journal of Counseling Psychology, 33, 148-154. doi:10.1037/0022-0167.33.2.148
54.
SinclairA.BarkhamM.EvansC.ConnellJ.AudinK. (2005). Rationale and development of a general population well-being measure: Psychometric status of the GP-CORE in a student sample. British Journal of Guidance & Counselling, 33, 153-173.
55.
SussmanL. K.RobinsL. N.EarlsF. (1987). Treatment-seeking for depression by black and white Americans. Social Science & Medicine, 24, 187-196.
56.
TamS.TsangH.Yee-ChiuI. P.ChanC. (2004). Preliminary evidence for the basis of self-concept in Chinese people with mental illness. Quality of Life Research, 13, 497-508.
57.
TuckerJ. R.HammerJ. H.VogelD. L.BitmanR. L.WadeN. G.MaierE. J. (2013). Disentangling self-stigma: Are mental illness and help-seeking self-stigmas different?Journal of Counseling Psychology, 60, 520-531. doi:10.1037/a0033555
58.
VegaW. A.RodriguezM. A.AngA. (2010). Addressing stigma of depression in Latino primary care patients. Psychiatry and Primary Care, 32(2), 182-191. doi:10.1016/j.genhosppsych.2009.10.008
59.
VogelD. L.ArmstrongP. I.TsaiP. C.WadeN. G.HammerJ. H.EfstathiouG.. . . TopkayaN. (2013). Cross-cultural validity of the Self-Stigma of Seeking Psychological Help (SSOSH) Scale: Examination across six nations. Journal of Counseling Psychology, 60, 303-310.
60.
VogelD. L.BitmanR. L.HammerJ. H.WadeN. G. (2013). Is stigma internalized? The longitudinal impact of public stigma on self-stigma. Journal of Counseling Psychology, 60, 311-316. doi:10.1037/a0031889
61.
VogelD. L.Heimerdinger-EdwardsS. R.HammerJ. H.HubbardA. (2011). “Boys don’t cry”: Examination of the links between masculine norms and help-seeking attitudes for men from diverse cultural backgrounds. Journal of Counseling Psychology, 58, 368-382.
62.
VogelD. L.ShechtmanZ.WadeN. (2010). The role of public and self-stigma in predicting attitudes toward group counseling. The Counseling Psychologist, 38, 904-922.
63.
VogelD. L.WadeN.HaakeS. (2006). Measuring the self-stigma associated with seeking psychological help. Journal of Counseling Psychology, 53, 325-337.
64.
VogelD. L.WadeN.HacklerA. (2007). Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes toward counseling. Journal of Counseling Psychology, 54, 40-50. doi:10.1037/0022-0167.54.1.40
65.
WadeN.PostB.CornishM.VogelD.TuckerJ. (2011). Predictors of the change in self-stigma following a single session of group counseling. Journal of Counseling Psychology, 58, 170-182. doi:10.1037/a0022630
66.
WatkinsD.HuntJ.EisenbergD. (2012). Increased demand for mental health services on college campuses: Perspectives from administrators. Qualitative Social Work, 11, 319-337. doi:10.1177/1473325011401468
