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Psychiatry Res. 2018 Jan;259:526-531. doi: 10.1016/j.psychres.2017.11.036. Epub 2017 Nov 13.

Perceived provider stigma as a predictor of mental health service users' internalized stigma and disempowerment.

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Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA. Electronic address:
School of Public Policy, University of California Riverside, Riverside, CA, USA.
College of Psychology, Illinois Institute of Technology, Chicago, IL, USA.
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.


Despite increasing awareness of stigma from mental health service providers as a barrier to recovery, little research has directly examined how it might influence the service users' self-perceptions and treatment experience. The present study examined the association of service users' perceived provider stigma with their experience of internalized stigma and disempowerment, two psychosocial constructs known to hinder recovery. Mental health service users (N = 350) completed questionnaires assessing perceived stigma from mental health service providers, including perceptions of negative affective reactions towards individual users and desired social distance towards people with mental illnesses across various life domains, internalized stigma, and disempowerment (i.e., diminished self-efficacy and mastery) in mental health treatment settings. Structural equation modeling showed that both perceived negative affective reactions and perceived social distance were positively associated with disempowerment. Furthermore, these associations were significantly mediated by internalized stigma. These findings illuminate how perceived stigma from providers can "get under the skin" of mental health service users and contribute to their overall sense of disempowerment in mental health settings. They also highlight the need for future stigma reduction interventions to specifically target the attitudes and beliefs held by mental health professionals.


Empowerment; Internalized stigma; Mental health professionals; Mental health service users; Perceived stigma

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