How Are Various Aspects of Personal Stigma Related to Secrecy About Mental Health Problems Among People Diagnosed With Psychotic Disorders? A Cross-Sectional Analysis

Objective: Service users commonly keep their mental illness secret in order to avoid rejection. However, this stigma-coping orientation is not necessarily effective and may lead to a number of negative psychological consequences. The purpose of the present study was to investigate the roles of various aspects of personal stigma in predicting secrecy about mental health problems among persons with psychosis. Methods: A sample of 147 individuals diagnosed with psychotic disorders was recruited for the study. They were administered a set of questionnaires to gather data about sociodemographic and illness-related background characteristics, levels of social functioning, depressive symptoms, and overall psychopathology, elements of personal stigma (i.e., perceived stigma, experienced discrimination, self-stigma, and stigma-related stress), as well as the endorsement of secrecy as a way of coping with stigma. Hierarchical linear regression was utilized for data analysis. Results: Personal stigma measures were entered into the regression equation as a block and explained as much as 29% of variance in the dependent variable over and above sociodemographic and clinical features. After accounting for all controls, higher perceived stigma (β = 0.47, p < .01) and higher stigma stress (β = 0.19, p < .05) were found to be independent predictors of secrecy, whereas experienced discrimination and self-stigma were not. Conclusions and Implications for Practice: Perceived stigma and stigma stress appraisal should be considered as targets of interventions aiming to reduce the shame and fear of rejection associated with mental illness and to guide and support people's everyday decisions about coming out. Impact and Implications The study findings demonstrate that personal stigma strongly predicts secrecy about mental health problems among people diagnosed with psychotic disorders. A higher degree of perceived stigma and appraisal of stigma as stressful and exceeding personal coping resources emerged as key factors deterring service users from coming out. Interventions aiming to support individuals with psychiatric disabilities in their disclosure decisions need to address these aspects of personal stigma.