Exploring Internalized Stigma, Self-Esteem, and Symptom Severity in Depression: A Comparative Study of Active and Remitted Phases

Abstract

Objective: Internalized stigma, which refers to the internalization of negative attitudes and beliefs towards persons with mental illness, significantly impacts their self-perception and overall well-being. This research examines the correlations among internalized stigma, the severity of symptoms, and self-esteem in individuals diagnosed with major depressive disorder (MDD), specifically comparing those currently experiencing active depression with those who are in remission. Material and Method: Participants were selected from a psychiatric outpatient unit based on their diagnosis of MDD. Participants provided sociodemographic information and completed assessments measuring the severity of depression, level of anxiety, self-esteem, and internalized stigma. Results: Participants experiencing active depression exhibited elevated levels of depression severity, anxiety severity, and internalized stigma, while also reporting diminished self-esteem in comparison to those who were in a state of remission. Strong positive relationships were observed between the severity of depression and internalized stigma where self-esteem was negatively correlated with the stigma. The results of the regression analysis showed that there was a significant relationship between the severity of depression, self-esteem, and internalized stigma in the group of individuals with active MDD. Conclusion: This study underscores the impact of depression severity and self-esteem on internalized stigma in individuals with MDD. The findings indicate the need to implement comprehensive treatment techniques that address psychological and social variables like self-esteem and internalized stigma in addition to symptom management. Future studies should investigate the long-term connections and assess the efficacy of interventions in reducing the obstacles caused by stigma in the process of recovering from depression.

Keywords

• internalized stigma
• depression
• self-esteem
• anxiety
• remission
• symptom

References

1. 1. Calear AL, Griffiths KM, Christensen H. Personal and perceived depression stigma in Australian adolescents: magnitude and predictors. J Affect Disord 2011;129(1–3):104–8.
2. 2. Corrigan PW, Morris SB, Michaels PJ et al. Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatr Serv 2012;63(10):963–73.
3. 3. Du N, Chong ESK, Wei D et al. Prevalence, risk, and protective factors of self-stigma for people living with depression: A systematic review and meta-analysis. J Affect Disord 2023;332:327–40.
4. 4. Fan C-W, Chang K-C, Lee K-Y et al. Rasch modelling and differential item functioning of the self-stigma scale-short version among people with three different psychiatric disorders. Int J Environ Res Public Health 2022;19(14):8843.
5. 5. Dubreucq J, Plasse J, Franck N. Self-stigma in serious mental illness: A systematic review of frequency, correlates, and consequences. Schizophr Bull 2021;47(5):1261–87.
6. 6. Çilek NZ, Akkaya C. A Review on Mental Illness and Stigma. Psikiyatride Güncel Yaklaşımlar - Current Approaches in Psychiatry. December 2022;14(4):545-54.
7. 7. Suwalska J, Suwalska A, Szczygieł M et al. Medical students and stigma of depression. Part 2. Self-stigma. Psychiatr Pol 2017;51(3):503–13.
8. 8. Yang F, Yang BX, Stone TE et al. Stigma towards depression in a community-based sample in China. Compr Psychiatry 2020;97:152152.

9. 9. Grant JB, Bruce CP, Batterham PJ. Predictors of personal, perceived and self-stigma towards anxiety and depression. Epidemiol Psychiatr Sci 2016;25(3):247–54.
10. 10. Kanter JW, Rusch LC, Brondino MJ. Depression self-stigma: a new measure and preliminary findings. J Nerv Ment Dis 2008;196(9):663–70.
11. 11. Manos RC, Rusch LC, Kanter JW et al. Depression self-stigma is a mediator of the relationship between depression severity and avoidance. J Soc Clin Psychol 2009;28(9):1128–43.
12. 12. Perlick DA, Miklowitz DJ, Link BG et al. Perceived stigma and depression among caregivers of patients with bipolar disorder. Br J Psychiatry 2007;190(6):535–6.
13. 13. Freidl M, Piralic Spitzl S, Aigner M. How depressive symptoms correlate with stigma perception of mental illness. Int Rev Psychiatry 2008;20(6):510–4.
14. 14. Jahn DR, Leith J, Muralidharan A et al. The influence of experiences of stigma on recovery: Mediating roles of internalized stigma, self-esteem, and self-efficacy. Psychiatr Rehabil J 2020;43(2):97.
15. 15. Bhattacharya S, Kennedy M, Miguel C et al. Effect of psychotherapy for adult depression on self-esteem: A systematic review and meta-analysis. J Affect Disord 2023;325:572–81.
16. 16. Boyd JE, Otilingam PG, DeForge BR. Brief version of the Internalized Stigma of Mental Illness (ISMI) scale: psychometric properties and relationship to depression, self-esteem, recovery orientation, empowerment, and perceived devaluation and discrimination. Psychiatr Rehabil J 2014;37(1):17.
17. 17. Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Soc Sci Med 2010;71(12):2150–61.
18. 18. Alonso J, Buron A, Rojas-Farreras S et al. Perceived stigma among individuals with common mental disorders. J Affect Disord 2009;118(1–3):180–6.
19. 19. Akdemir A, Türkçapar MH, Örsel SD et al. Reliability and validity of the Turkish version of the Hamilton Depression Rating Scale. Compr Psychiatry 2001;42(2):161–5.
20. 20. Yazıcı MK, Demir B, Tanrıverdi N et al. Hamilton anksiyete değerlendirme öiçeği, değerlendiriciler arası güvenirlik ve geçerlik çalışması. Türk Psikiyatr Derg 1998;9(2):114–7.
21. 21. Çuhadaroğlu F. Adolesanlarda benlik saygısı. Hacettepe University, Faculty of Medicine, Department of Psychiatry Specialty Thesis. Ankara: Hacettepe University. 1986.
22. 22. Ersoy MA, Varan A. Reliability and validity of the Turkish version of the internalized stigma of mental illness scale. Turk Psikiyatr Derg 2007;18(2):163.
23. 23. Werner P, Aviv A, Barak Y. Self-stigma, self-esteem and age in persons with schizophrenia. Int Psychogeriatrics 2008;20(1):174–87.
24. 24. Picco L, Pang S, Lau YW et al. Internalized stigma among psychiatric outpatients: Associations with quality of life, functioning, hope and self-esteem. Psychiatry Res 2016;246:500–6.
25. 25. Kamış GZ, Aki ŞÖE, Yildiz MI et al. The Validity and the Reliability of the Turkish Version of the Self-Stigma of Depression Scale. Turk Psikiyatr Derg 2019;30(3).
26. 26. Ociskova M, Prasko J, Kamaradova D et al. Individual correlates of self-stigma in patients with anxiety disorders with and without comorbidities. Neuropsychiatr Dis Treat 2015;1767–79.
27. 27. Schmitz N, Kugler J, Rollnik J. On the relation between neuroticism, self-esteem, and depression: results from the National Comorbidity Survey. Compr Psychiatry 2003;44(3):169–76.
28. 28. Abo-Rass F, Werner P, Shinan-Altman S. Self-stigma formation process among younger and older Israeli Arabs diagnosed with depression. Aging Ment Health 2021;25(6):1071–6.
29. 29. Barney LJ, Griffiths KM, Christensen H et al. The Self‐Stigma of Depression Scale (SSDS): development and psychometric evaluation of a new instrument. Int J Methods Psychiatr Res 2010;19(4):243–54.
30. 30. Shimotsu S, Horikawa N. Self-stigma in depressive patients: Association of cognitive schemata, depression, and self-esteem. Asian J Psychiatr 2016;24:125–9.