The Role of Self-Stigma,Optimism,and Coping in Psychosocial Adaptation to Serious Mental Illness: A Parallel Mediation Analysis Through a Disability Centrality Lens

Abstract

This study examined the relationship between psychiatric symptom severity and psychosocial adaptation to serious mental illness (SMI) and investigated the mediating role of optimism, self-stigma, and coping within the framework of the Disability Centrality Model (DCM). A Qualtrics survey consisting of measures of psychosocial adaptation to SMI, psychiatric symptom severity, coping, self-stigma, and optimism was disseminated through identified community entities. A total sample of 300 adults with SMI completed the survey. Correlational analyses and parallel mediation analysis were conducted. Results indicated that optimism, self-stigma, and coping collectively fully mediate the relationship between symptom severity and psychosocial adaptation to SMI, with the full model accounting for 62.4% of the variance. Among the mediators, self-stigma demonstrated the strongest indirect effect. Findings underscore the importance of DCM-informed mechanisms, namely, maladaptive identity centrality, positive expectancies, and behavioral coping strategies, in shaping psychosocial adaptation outcomes. Rehabilitation professionals should target self-stigma, cultivate optimism, and strengthen adaptive coping to support successful psychosocial adaptation to SMI.

Keywords

serious mental illness psychosocial adaptation disability centrality self-stigma

According to the National Institute of Mental Health, 14.1 million adults in the United States are diagnosed with a serious mental illness (SMI) in a year, accounting for approximately 5% of the U.S. population (Substance Abuse and Mental Health Services Administration [SAMHSA], 2021). Individuals with SMI made US$16,306 less in average annual earnings than their non-SMI counterparts, totaling US$193.2 billion of earning reduction in the United States (Kessler et al., 2008). Recent integrated economic model estimates the overall annual cost of mental illness to be about US$282 billion, reflecting both income loss and broader labor market effects (Abramson et al., 2024). Seabury et al. (2019) estimated that people with SMI had 10.4 years of shorter life expectancy and US$96,500 higher total lifetime medical expenses. People with SMI have diminished quality of life, increased risk of comorbid physical illness, and higher levels of disability (De Hert et al., 2011). Substance use and misuse are more prevalent among this population (SAMHSA, 2020). Despite the availability of effective medical treatment and psychiatric rehabilitation, many individuals do not seek or sustain care due to stigma and other personal, structural, political, and economic factors (Corrigan et al., 2014).

Psychosocial adaptation refers to the process through which individuals with SMI manage the psychological and social consequences of their condition to achieve optimal functioning and well-being across life domains. Psychosocial adaptation is inherently dynamic, particularly for SMI, where symptoms may fluctuate between remission and recurrence and social contexts may shift, prompting an evolving process of identity negotiation, reappraisal, and adjustment (Biesecker & Erby, 2008; Livneh & Antonak, 1997). Multiple models have conceptualized this adaptive process, including Wright’s (1983) coping versus succumbing framework and Livneh and Antonak’s (2005) stage-based conceptualization of emotional, cognitive, and behavioral responses to illness. However, the Disability Centrality Model (DCM; Bishop, 2005a) offers a particularly useful framework for understanding the mechanisms underlying psychosocial adaptation to SMI.

The DCM builds on the conceptual overlap between subjective quality of life (QoL) and psychosocial adaptation, both of which involve multidimensional and personally weighted evaluations of well-being across life domains (Bishop, 2005b). The model proposed that the onset of disability disrupts the homeostasis of overall QoL to the extent that it reduces perceived control in domains central to the individual’s identity and values. Because people are inherently motivated to maintain an homeostasis of QoL, they actively respond to these disruptions through several pathways: shifting the importance of life domains so that domains that are less affected by disability become more central (i.e., “importance change”); or increasing perceived control in affected domains through self-management, treatment, and supports (i.e., “control change”) (Bishop, 2005a). Thus, DCM conceptualized psychosocial adaptation as a dynamic and iterative process of appraisal, value transformation, and behavioral response rather than a static endpoint.

The DCM holds particular relevance for SMI, where disability centrality operates in complex and dynamic ways. Unlike visible or stable physical disabilities, SMI is often characterized by fluctuating symptoms, periods of remission, and a varying visibility to others (Pan et al., 2025). Symptom recurrence, remission, and fluctuating functioning can all influence whether the disability becomes salient or backgrounded at different times. Thus, individuals may repeatedly renegotiate the importance of life domains, perceived control, and role functioning (Martz et al., 2002).

Furthermore, DCM is conceptually compatible with the personal recovery paradigm, which emphasizes person-centered, strength-based approaches to living a meaningful life despite ongoing psychiatric symptoms (Anthony, 1993). Both frameworks prioritize the subjective experience of individuals, self-defined QoL, and the active process of rebuilding identity in the context of illness. Within this integrated perspective, psychosocial adaptation for individuals with SMI involves not only symptom management but also redefining valued roles, restoring perceived control, and sustaining satisfaction across life domains in ways that reflect personal priorities (Pan, 2021).

One key psychosocial variable aligned with DCM is self-stigma. Self-stigma can be understood as a maladaptive form of disability centrality in which the disability becomes incorporated into the self in a negative, identity-diminishing way. The social context surrounding SMI, marked by pervasive and prevalent public stigma and discrimination, fertilizes internalization of negative beliefs (Parcesepe & Cabassa, 2013; Angermeyer & Dietrich, 2006). This internalization process, known as self-stigma (Corrigan et al., 2010), disrupts value transformation by embedding negative narratives into the individual’s core identity. When disability centrality becomes infused with self-stigmatizing beliefs, individuals might experience diminished perceived control and QoL in different life domains, narrowed valued domains, and impeded engagement in meaningful roles, leading to poor psychosocial adaptation (Corrigan et al., 2009). Empirical studies consistently demonstrate that self-stigma leads to reduced self-esteem, diminished perceived control, and lower QoL among people with SMI (Corrigan et al., 2016; Mashiach-Eizenberg et al., 2013; Murphy et al., 2024; Qin et al., 2023; Ritsher & Phelan, 2004).

Another psychosocial factor relevant to DCM is coping, which represents the cognitive and behavioral strategies individuals utilize to manage the stress associated with chronic illness and disability. Within the DCM, coping plays a central mechanistic role by shaping perceived control and satisfaction across valued domains, which are key pathways connecting disability impact to overall psychosocial adaptation (Bishop, 2005a). Wright (1983) distinguished “positive and proactive” coping (e.g., developing alternative skills for achieving goals) from “negative and passive” coping strategies (e.g., allowing disability to overshadow one’s identity). Individuals who engage in positive and proactive coping are more likely to maintain a sense of control and continuity in valued roles, thereby supporting adaptive centrality and better psychosocial adaptation (Folkman & Moskowitz, 2004). Conversely, negative and passive coping strategies are associated with diminished perceived control, restricted participation, and lower QoL among people with SMI (Holubova et al., 2015; Lee et al., 2011; Lysaker et al., 2006).

Optimism is a broad expectation that positive outcomes will likely happen (Scheier & Carver, 1985). As a steady expectancy of positive outcomes across both contexts and time, it functions as a personal resource that can buffer the negative impact of disability. Within DCM, optimism may strengthen adaptive centrality by shaping how individuals appraise the controllability of their circumstances, remain resilient toward valued goals and roles, and promote greater satisfaction within important life domains (Gallagher et al., 2020; Scheier & Carver, 1985). Optimistic individuals are more likely to perceive stressors as manageable, leading them to prioritize approach-oriented and problem-focused coping responses rather than disengagement or avoidance (Carver et al., 2009). Research revealed that higher levels of optimism were associated with better social functioning, more efficient coping with stress, and greater QoL among individuals with schizophrenia and depression (Potempa & Krupka-Matuszczyk, 2014).

Taken together, DCM provides a cohesive theoretical framework linking psychiatric symptom severity to psychosocial adaptation to SMI through value-transforming, cognitive, and behavioral mechanisms. Self-stigma, optimism, and coping each represent distinct yet interconnected components of this framework: self-stigma represents maladaptive disability centrality; optimism serves as a cognitive resource supporting adaptive centrality; and coping reflects the behavioral strategies that translate identity and cognitive appraisals into functional outcomes. Understanding how these factors jointly impact psychosocial adaptation is critical for informing recovery-oriented interventions for individuals with SMI.

Based on DCM, this study examines whether self-stigma, optimism, and coping mediate the relationship between psychiatric symptom severity and psychosocial adaptation among individuals with SMI. It is hypothesized that there is a significant association between symptom severity and psychosocial adaptation to SMI, and optimism, coping strategies, and self-stigma mediate such a relationship. Shedding light on these pathways may support the development of more targeted, theory-driven approaches to enhance QoL and recovery.

Method

Procedures

This study was reviewed and approved by the Institutional Review Board at The University of Iowa. The authors identified several listservs and organizations that are associated with the target population, including ResearchMatch, the National Alliance on Mental Illness (NAMI), and treatment facilities that provide services to people with SMI. ResearchMatch is a program funded by the National Institutes of Health (NIH), designed to connect prospective research participants to corresponding researchers across the U.S. Recruitment emails with a link to the study survey were distributed through these identified entities. The survey was administered using Qualtrics, a web-based platform for survey creation, management, and data collection.

The Qualtrics survey consisted of informed consent, a demographic questionnaire (e.g., age, sex, and primary and secondary psychiatric diagnosis), and measures of adaptation to disability, psychiatric symptom severity, coping, self-stigma, and optimism. Eligibility criteria for the study included (a) individuals aged 18 to 65 years old, (b) self-reported as having a psychiatric diagnosis, (c) such psychiatric diagnosis substantially interfered with the pursuit of major life activities (e.g., employment, social, education, and independent living), and (d) not having a chronic physical disability (to avoid the confounding effect of physical disability on the psychosocial adaptation to SMI). Participants were screened against the eligibility criteria based on their responses to a four-item screener on age, psychiatric diagnosis, functional impact, and physical disability; only eligible respondents proceeded to the main survey. Participants who completed the full survey were given the opportunity to provide their names and emails to be entered in a lottery for 1 of 100 possible US$10 gift cards as compensation.

Participants

Four hundred and eight individuals initiated the survey during the spring of 2021; among these, 108 were excluded due to missing more than 10% of the responses on survey items. This resulted in a final sample of 300 (completion rate 73.5%). The participants’ average age was 31.5 years (standard deviation [SD] = 12.7). Most participants identified as female (85.8%), non-Hispanic White (82.7%), and single, never married (65.6%). With regard to primary psychiatric diagnosis, 26.3% of participants reported having major depressive disorder, followed by 20% with anxiety disorders, 18.9% with bipolar disorders, 18.3% with post-traumatic stress disorder, and 13% with other mental illnesses. The majority (82.0%) of participants reported having more than one psychiatric diagnosis.

Measures

Psychosocial Adaptation to SMI

Psychosocial adaptation to SMI was assessed using the Adaptation to Disability Scale-Revised-23 (ADS-R-23; Sánchez et al., 2016). Participants were asked to rate their level of agreement for items (e.g., “Mental health problems or not, I am going to make good in life.”) on a 4-point Likert-type scale (1 = strongly disagree; 4 = strongly agree). The internal consistency coefficient alpha of ADS-R-23 was .92 among a sample of adults with SMI. Its convergent and divergent validity were supported by correlating to resilience, social functioning, social support, and self-stigma (Sánchez et al., 2016). The coefficient alpha in this study was .94.

Psychiatric Symptom Severity

Psychiatric symptom severity was assessed using the nine-item version of the Symptom Checklist SCL-K-9 (Klaghofer & Brähler, 2001). Participants were asked to rate their level of distress experienced due to specific symptoms (e.g., “worrying too much about things” and “temper outbursts that you could not control”) in the past week on a 5-point Likert-type scale (0 = Not at all; 4 = Extremely). The SCL-K-9 scores demonstrated strong internal consistency, with a coefficient alpha of .86 in a U.S. sample of adults with SMI (Sánchez et al., 2020) and a coefficient omega of .83 in another U.S. sample of working-age adults with SMI (Pan, Qin, Brown, & Sánchez, 2023). Preliminary evidence of convergent validity for the SCL-K-9 scores was supported by relatively high correlations with neuroticism, self-stigma, and disability acceptance, and its discriminant validity was supported by relatively low correlations with societal stigma and hope (Pan, Qin, Brown, & Sánchez, 2023). The coefficient alpha was .84 in this study.

Coping

Coping was measured by the Brief Approach/Avoidance Coping Questionnaire (BACQ; Finset et al., 2002). BACQ consists of 12 items that assess two different coping styles: approach coping and avoidance coping. In the original validation study, Finset et al. (2002) found a two-factor structure: (a) the general approach/avoidance factor includes all items related to active coping, plus three items from avoidance coping, and (b) the diversion factor encompasses another three items of the avoidance coping. Participants were asked to rate their usage of different coping strategies (e.g., “I like to talk with a few chosen people when things get too much for me”) with a 5-point Likert scale (0 = strongly disagree to 4 = strongly agree). Items from the avoidance coping were reverse-coded, and a higher total score is reflective of more frequent usage of active coping strategies. The coefficient alpha for the general approach/avoidance factor was .59, and for the diversion factor, it was .55 (Finset et al., 2002). In contrast, this study revealed an alpha of .74 for the general approach/avoidance factor. The diversion factor’s alpha remained at .60 and was, therefore, excluded from subsequent analyses due to low reliability.

Self-Stigma

Self-stigma was measured by the Self-Stigma Scale-Short (SSS-S; Mak & Cheung, 2010). It consists of nine items that assess three domains of self-stigma: cognitive, affective, and behavioral (e.g., “I fear that others would know that I am a mental health consumer”). Participants rated each item on a 4-point Likert-type scale (1 = strongly disagree; 4 = strongly agree). The SSS-S scores demonstrated strong internal consistency: the coefficient alpha ranged from .88 to .93 in previous studies (Golay et al., 2022; Mak & Cheung, 2010; Sánchez et al., 2020). Concurrent validity of the SSS-S scores among U.S. adults with SMI was supported by correlating with societal stigma, symptom severity, psychiatric disability acceptance, general self-efficacy, and hope (Pan, Babb, et al., 2023). The coefficient alpha was .89 in this study.

Optimism

Optimism was measured by the Life Orientation Test-Revised (LOT-R; Scheier et al., 1994). Considered the most frequently used test for measuring dispositional optimism, the LOT-R consists of six 5-point Likert (0 = strongly disagree to 4 = strongly agree) items: three items are phrased in an optimistic direction (e.g., “In uncertain times, I usually expect the best”) and three in a pessimistic direction (e.g., “If something can go wrong for me, it will”). The LOT-R demonstrated satisfactory psychometric properties: the coefficient alpha was .78, and test–retest reliability ranged from .56 to .79; convergent validity was supported by positive correlations with the original life orientation test, self-mastery, and self-esteem; discriminant validity was supported by negative correlations with trait anxiety and neuroticism (Scheier et al., 1994). The coefficient alpha was .87 in this study.

Data Analysis

IBM SPSS (version 26) was used for preliminary analyses, including descriptive statistics on sample and scale characteristics, and correlation coefficients between variables. We also checked the potential violations of regression assumptions: All variables met normality assumptions (kurtosis values range: −.578 to .468; skewness values range: −.569 to .107), and no multicollinearity was found (variance inflation factor [VIF] values < 5). Coefficient alphas were used to estimate the internal consistency of scores for measures. Pearson correlation coefficients were computed to examine the relationship among psychosocial adaptation to SMI, psychiatric symptom severity, optimism, coping, and self-stigma.

A multiple mediation analysis was conducted to examine optimism, coping, and self-stigma as parallel mediators of the relationship between psychiatric symptom severity and psychosocial adaptation to SMI. Hayes (2017) defined parallel mediation models as multiple regression models where the independent variable (X) influences the dependent variable (Y) directly and indirectly via two or more mediators (Ms). Such models can be estimated using Baron and Kenny’s (1986) procedure: (a) regress X on Y, (b) regress X on hypothesized Ms, and (c) regress Ms on Y when controlling for X. If all three steps in this procedure are statistically significant, then the mediating role of Ms can be established. The analysis was carried out using the PROCESS v4.3 macro (Model 4) for SPSS by Andrew Hayes (2017). The total, direct, and indirect effects were estimated with bootstrap testing of a 95% bias-corrected confidence interval (CI) based on 5,000 bootstrap samples.

Results

Correlation Analysis

All interested variables were significantly correlated with one another, with the absolute value of Pearson coefficients ranging from .36 to .70 (p < .01). Specifically, psychosocial adaptation to SMI was positively associated with coping (r = .67) and optimism (r = .66), and negatively associated with psychiatric symptom severity (r = −.43) and self-stigma (r = −.70). The correlation matrix, along with the means and standard deviations of all variables, is presented in Table 1.

Table 1.

Correlations, Means, and Standard Deviations for All Variables.

	X	M₁	M₂	M₃	Y
X	−
M₁	−.36	−
M₂	.49	−.56	−
M₃	−.38	.59	−.51	−
Y	−.43	.67	−.70	.66	−
M	1.81	3.15	2.44	1.72	2.77
SD	0.84	0.64	0.68	0.92	0.54

Note. X = SCL-K-9, psychiatric symptom severity; M₁ = BACQ, coping; M₂ = SSS-S, self-stigma; M₃ = LOT-R, optimism; Y = ADS, adaptation to disability. All correlations are statistically significant (p < .05).

Parallel Mediation Analysis

The hypothesized mediation model is depicted in Figure 1. It illustrates the standardized path coefficients from the parallel mediation model, showing the relationships between psychiatric symptom severity, the three mediators (self-stigma, coping, and optimism), and psychosocial adaptation. The total effect between psychiatric symptom severity and psychosocial adaptation to SMI was significant (path c: β = −.42, p < .01). We then assessed the relationship between psychiatric symptom severity and each of the mediators. Psychiatric symptom severity was positively correlated with self-stigma (path a₁: β = .48, p < .01) and negatively related to optimism (path a₂: β = −.39, p < .01), and coping (path a₃: β = −.24, p < .01). Next, we assessed the relationships between each of the mediators and psychosocial adaptation to SMI while controlling for psychiatric symptom severity and other mediators. The parallel mediation model was significant and accounted for 62.41% of the variance in psychosocial adaptation to SMI, F(4, 263) = 109.15, p < .01. All of the four mediators were independently associated with psychosocial adaptation to SMI (path b_1–3: βs = −.43, .31, and .19 for self-stigma, optimism, and coping, respectively, p < .05). Notably, the direct effect between psychiatric symptom severity and psychosocial adaptation to SMI was no longer significant after introducing the mediating effect (path c’: β = −.04, p = .37), suggesting that the three mediators together completely mediated the direct effect of psychiatric symptom severity on psychosocial adaptation to SMI.

Figure 1.

Path coefficients for parallel mediation analysis on adaptation to disability (N = 300).

Using PROCESS macro in SPSS with 5,000 bootstrap samples, we found significant indirect effects of psychiatric symptom severity on psychosocial adaptation to SMI through self-stigma (point estimate = −.21, 95% CI = [−.27, −.15]); optimism (point estimate = −.12, 95% CI = [−.18, −.07]); and coping (point estimate = −.05, 95% CI = [−.08, −.02]). We then conducted pairwise comparisons among the four indirect effects to determine whether the three indirect effects impact the association between psychiatric symptom severity and psychosocial adaptation to SMI to the same degree. Results revealed that the indirect effect of psychiatric symptom severity on psychosocial adaptation to SMI through the self-stigma pathway was significantly greater than indirect effects of all other individual pathways: coping, β = −.16, 95% CI = [−.24, −.10]; and optimism, β = −.09, 95% CI = [−.17, −.003]. In addition, the indirect effect of the optimism pathway was significantly greater than that of the coping pathway (β = −.08, 95% CI = [−.15, −.01]). Despite significant indirect effects, the cross-sectional design limits causal interpretation. The directionality of relationships among variables cannot be conclusively established, and the observed mediation effects should be interpreted as associative rather than causal.

Discussion

This study investigated whether self-stigma, optimism, and coping mediate the relationship between psychiatric symptoms and psychosocial adaptation to SMI and interpreted through the lens of the DCM. The correlation analyses broadly indicated that the relationships among the variables aligned with our hypotheses. Subsequent parallel mediation analyses not only validated the significant overall effect but also demonstrated that each of the three mediators significantly contributed to this effect individually. Collectively, these factors explained 62.4% of the variance in participants’ psychosocial adaptation to their SMI, which is considered a large effect size (Cohen, 1988), thereby highlighting the substantial explanatory value of the DCM.

This study builds on and extends existing literature by offering a consolidated framework that explains how psychiatric symptom severity influences psychosocial adaptation to SMI through three interconnected mechanisms. Prior work has primarily examined these constructs in silo or as part of narrower conceptual pathways. For example, Research on self-stigma has shown that self- stigma can lead to the “why try” effect, a process in which individuals begin to doubt their ability to succeed and withdraw from goal-directed behavior, thereby reducing psychosocial functioning and personal recovery (Corrigan et al., 2009; Qin et al., 2023). Similarly, other studies have separately linked optimism and coping to better psychosocial functioning (Chen et al., 2019; Seo & Lim, 2019). By testing these mediators simultaneously, this study provides a more integrated understanding of the psychosocial adaptation to SMI and demonstrates the usefulness of DCM in integrating value transformation, cognitive, and behavioral processes into a unified explanatory mode. This integrated approach provides a more comprehensive understanding of psychosocial adaptation than previously offered in the literature and points toward novel targets for intervention.

Of the three mediators, self-stigma emerged as the strongest pathway of the relationship between symptom severity and psychosocial adaptation to SMI, underscoring the profound influence of internalized negative beliefs in the value transformation process of DCM. This observation connects to the social model of disability (Oliver, 1996), suggesting that societal attitudes and a lack of awareness contribute significantly to the challenges faced by individuals with disabilities, a perspective that holds particular pertinence for SMI. The additional barriers created by societal attitudes not only restrict opportunities and access to resources essential for psychosocial adaptation but also undermine identity development and constrain valued roles, leading to negative self-evaluations and self-stigma (Corrigan et al., 2012; Kao et al., 2016).

When internalized, these societal narratives form a maladaptive type of disability centrality. Self-stigma not only impedes individuals’ pursuit of key life goals such as education, employment, and independent living (Corrigan et al., 2016; Qin et al., 2023) but also diminishes their engagement in treatment and effective management of their condition. A common reason for delaying treatment or discontinuing medication is the internalization of societal bias among this population (Velligan et al., 2017). Such that, individuals might perceive themselves as unworthy of care, anticipate a poor prognosis, or fear others finding out their condition. Notably, the avoidance of being labeled as mentally ill and efforts to maintain secrecy become particularly significant in the context of SMI, given the non-apparent nature of the illness (Corrigan, 2016; Corrigan & Wassel, 2008).

Although not as strong as self-stigma, optimism nevertheless significantly mediated the symptom-adaptation relationship, highlighting its role as an important cognitive resource for individuals with SMI. Optimism shapes positive expectations about the future and supports continued engagement in meaningful roles and domains. Optimism is crucial in ensuring successful psychosocial adaptation for individuals with SMI (Laranjeira & Querido, 2022). As shown in prior research, optimism enhanced social functioning, coping effectiveness, and QoL (Potempa & Krupka-Matuszczyk, 2014). Consistent with DCM, optimistic beliefs may promote adaptive disability centrality by boosting perceived controllability, motivating resilience during adversity, and sustaining satisfaction within valued life domains.

General coping also significantly mediated the relationship between symptom severity and psychosocial adaptation. Despite the measure used in this study operationalizing coping as a unidimensional construct due to the exclusion of the diversion factor, the findings nonetheless underscored coping as a key behavioral mechanism in the psychosocial adaptation process through the DCM lens. Prior research differentiated between approach coping and avoidance coping and found that approach coping was associated with decreased negative mood and better social functioning (Yanos et al., 2010), while more frequent use of avoidance coping was associated with higher psychological distress and poorer adaptation to psychiatric disability. Avoidance coping might help mitigate the stress initially but impede adaptation to disability in the long run (McNeill & Galovski, 2015; Pan & Sánchez, 2022).

Implications

The results of this study underscore the importance of addressing self-stigma, optimism, and coping as core mechanisms of psychosocial adaptation among individuals with SMI. Rehabilitation counselors play a central role in supporting clients’ identity reconstruction and promoting adaptive disability centrality. When working with individuals experiencing elevated self-stigma, counselors should incorporate well-established components of effective self-stigma interventions, including psychoeducation that corrects misconceptions about mental illness, cognitive restructuring to help clients identify and combat self-stigmatizing beliefs, and empowerment-oriented approaches that support individuals in making meaning of their illness experience and reclaiming valued roles (Yanos et al., 2015).

Optimism also plays a meaningful role in supporting psychosocial adaptation, and rehabilitation counselors’ demonstration of genuine belief in the possibility of recovery can positively influence clients’ future orientation and engagement in treatment (Salyers et al., 2013). Facilitating opportunities for clients to connect with peers who have successfully adapted to psychiatric disabilities may further promote optimism, as exposure to such recovery role models can convey positive expectancies and strengthen adaptive identity development.

Because coping emerged as a significant mediator, rehabilitation professionals should routinely assess clients’ preferred coping styles and guide them in strengthening approach-oriented coping strategies in place of avoidance coping that undermines long-term adaptation. Rehabilitation counselors can also promote practicing and learning of mindfulness-oriented coping strategies, as it was found to not only reduce symptom distress and psychiatric hospitalization but also increase self-efficacy and resilience (Davis & Kurzban, 2012).

These findings also suggest the need for policy initiatives that embrace, implement, and sustain recovery-oriented care for individuals with SMI (Banko et al., 2025). Public anti-stigma campaigns should counter harmful stereotypes that contribute to self-stigma and discourage help-seeking. Contact-based anti-stigma initiatives, which involve interactions with people with SMI, have repeatedly shown the strongest effects on reducing prejudice and improving public attitudes toward mental illness (Corrigan et al., 2012; Thornicroft et al., 2016). Sustained funding for recovery-focused psychiatric rehabilitation approaches, such as assertive community treatment, Individual Placement and Support, and Housing First, is essential, given evidence that such programs enhance empowerment, community integration, and QoL (Bond et al., 2025; Davidson et al., 2005). Furthermore, workforce development efforts should prioritize the promotion of stigma-free work environments by training employers, supervisors, and service providers to recognize mental health as a diversity issue, counter discriminatory practices and policies, and implement inclusive workplace support. Doing so is critical to allow individuals with SMI to engage in meaningful competitive employment that aligns with their valued roles and goals, consistent with person-centered and rights-based international mental health guidelines (World Health Organization [WHO], 2021).

Limitations and Future Research Directions

There are limitations to this study that should be noted when interpreting and applying the results. First, participants were primarily recruited through ResearchMatch and treatment organizations, which may have resulted in a sample more engaged in treatment and clinical research than the broader population of individuals with SMI. This may have influenced levels of self-stigma, coping, optimism, and psychological adaptation, limiting generalizability to those who are more disengaged from care. The sample was also predominantly White and female, with many participants reporting multiple comorbid conditions. These demographic characteristics may shape psychosocial adaptation experience and mediational pathways via cultural, gendered, and clinical complexity. Hence, more diverse and representative samples are warranted in future research. Second, the collection of the data was entirely through online self-report measures, which might be influencing the objectivity of the findings due to social desirability. This reliance can artificially inflate the observed relationships due to shared method variance. Moreover, social desirability bias may have influenced participants to respond in a manner they perceived as more socially acceptable rather than entirely truthful. As a result, the strength of certain associations in our findings may be partially attributable to this bias. Future research should consider incorporating multi-method approaches, such as medical record data or clinical interviews (e.g., structured clinical interview for Diagnostic and Statistical Manual), to reduce the potential impact of method and social desirability biases. Third, coping was treated as a unidimensional construct following the removal of the diversion factor, which limited the distinction between approach and avoidance coping. As different styles of coping strategies are linked to distinct adaptation trajectories and outcomes, future studies should use more reliable multidimensional coping measures. Fourth, the cross-sectional design precludes causal inference. Future researchers could benefit from conducting longitudinal and experimental design research to clarify temporal relationships and determine whether modifying self-stigma, optimism, and coping leads to improvements in psychosocial adaptation. Finally, the sampling process occurred during the COVID-19 pandemic, and the impact of this unprecedented event should be taken into account. The pandemic’s widespread effects can significantly influence various factors, including participants’ experiences of hope and accessibility to coping resources.

Conclusion

This study found that self-stigma, optimism, and coping function as parallel mediators linking psychiatric symptom severity to psychosocial adaptation to SMI. Guided by the DCM, the findings conceptualize adaptation as a dynamic process shaped by value-transforming, cognitive, and behavioral mechanisms. Self-stigma emerged as the strongest mediator, highlighting the profound impact of internalized stigma on adaptation. By examining these psychosocial factors within a single theoretical framework simultaneously, this study offers a unique contribution to the adaptation literature and supports the importance of recovery-oriented care for individuals with SMI.

Footnotes

ORCID iDs

Deyu Pan

Sang Qin

Qingyun Zhang

Sai Snigdha Talluri

Jiayi Fu

Xin Zou

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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