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Epidemiol Psychiatr Sci. 2019 Aug;28(4):458-465. doi: 10.1017/S2045796018000021. Epub 2018 Jan 31.

Involuntary psychiatric hospitalisation, stigma stress and recovery: a 2-year study.

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Department of Psychiatry II,University of Ulm and BKH Günzburg,Ulm,Germany.
Department of Psychiatry, Psychotherapy and Psychosomatics,Zürich University Hospital of Psychiatry,Zurich,Switzerland.
Institute of Epidemiology and Medical Biometry, University of Ulm,Ulm,Germany.



Compulsory admission can be experienced as devaluing and stigmatising by people with mental illness. Emotional reactions to involuntary hospitalisation and stigma-related stress may affect recovery, but longitudinal data are lacking. We, therefore, examined the impact of stigma-related emotional reactions and stigma stress on recovery over a 2-year period.


Shame and self-contempt as emotional reactions to involuntary hospitalisation, stigma stress, self-stigma and empowerment, as well as recovery were assessed among 186 individuals with serious mental illness and a history of recent involuntary hospitalisation.


More shame, self-contempt and stigma stress at baseline were correlated with increased self-stigma and reduced empowerment after 1 year. More stigma stress at baseline was associated with poor recovery after 2 years. In a longitudinal path analysis more stigma stress at baseline predicted poorer recovery after 2 years, mediated by decreased empowerment after 1 year, controlling for age, gender, symptoms and recovery at baseline.


Stigma stress may have a lasting detrimental effect on recovery among people with mental illness and a history of involuntary hospitalisation. Anti-stigma interventions that reduce stigma stress and programs that enhance empowerment could improve recovery. Future research should test the effect of such interventions on recovery.


Coercion; compulsory admission; empowerment; recovery; stigma stress


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