Self‐stigma and coming out about one's mental illness

TLDR

Self‑stigma undermines self‑esteem and self‑efficacy in people with serious mental illness, and coming out is hypothesized to mediate its negative impact on quality of life. The study compares coming out with other self‑stigma control strategies to assess their relative effectiveness. Eighty‑five participants with serious mental illness completed the COMIS, self‑stigma, quality‑of‑life, and self‑stigma‑management strategy questionnaires. Factor analysis identified benefits of being out and reasons for staying in as distinct constructs, and mediation analysis showed that benefits of being out reduced self‑stigma’s negative impact on quality of life, being associated with affirming and aloof strategies rather than shame strategies.

Abstract

Self-stigma can undermine self-esteem and self-efficacy of people with serious mental illness. Coming out may be one way of handling self-stigma and it was expected that coming out would mediate the effects of self-stigma on quality of life. This study compares coming out to other approaches of controlling self-stigma. Eighty-five people with serious mental illness completed measures of coming out (called the Coming Out with Mental Illness Scale, COMIS), self-stigma, quality of life, and strategies for managing self-stigma. An exploratory factor analysis of the COMIS uncovered two constructs: benefits of being out (BBO) and reasons for staying in. A mediational analysis showed BBO diminished self-stigma effects on quality of life. A factor analysis of measures of managing self-stigma yielded three factors. Benefits of being out was associated with two of these: affirming strategies and becoming aloof, not with strategies of shame. Implications for how coming out enhances the person's quality of life are discussed.