Factors Influencing Self-Esteem among Individuals with Severe Mental Illness: Implications for Social Work

This study analyzed factors affecting self-esteem among individuals with severe mental illness to identify effective targets for social work interventions. Data were obtained from 290 individuals with psychiatric disability recruited from community-based psychosocial rehabilitation agencies. Analyses using structural equation modeling revealed that self-esteem consists of two independent dimensions--self-worth and self-deprecation; affective characteristics are more influential than cognitive characteristics in predicting self-esteem; and the predictive factors and paths of the two dimensions differ from each other. Implications for future social work research are discussed. Key words: affect; cognition; mental illness; social work practice; stigma ********** Due to deinstitutionalization and improved treatment and rehabilitation services, more individuals with mental illness (MI) receive services at community, agencies. Social work is a major professional discipline for community mental health service providers (Stromwall, 2002). Unfortunately, the stigma of MI remains a significant problem encountered by psychiatric consumers (Dudley, 2000; Farina, Fisher, & Fisher, 1992), especially those pursuing education or employment (Link, Cullen, Struening, Shrout, & Dohrenwend, 1989; Link, Struening, Rahav, Phelan, & Nuttbrock, 1997). The influence of stigma encompasses stereotype, prejudice, discrimination, separation, and status loss (Corrigan & Lundin, 2001; Corrigan & Penn, 1999; Link & Phelan, 2001), which make individuals with MI more vulnerable to social rejection, income loss, limited opportunities for employment or education, relapse, and experiencing another psychiatric disorder (Link et al., 1989, 1997). Stigma conveys a devalued social identity and expedites loss of self-esteem (Crocker, Major, & Steele, 1998; Goffman, 1963). As maintaining a certain level of self-esteem is crucial to a successful recovery for individuals with MI (Davidson & Strauss, 1992), a significant amount of stigma research has focused on self-esteem (Link, Struening, Neese-Todd, & Phelan, 2001). The literature on stigma and self-esteem has been largely sociological, positing that expected stigma--that is, cognitive beliefs in devaluation-discrimination concerning individuals with MI (Link et al., 1989, 2001)--negatively affects self-esteem. Cognitive and affective processes are often intertwined in individual evaluations of the self (Levine, Wyer, & Schwarz, 1994). However, sociological stigma studies have not examined "affective factors" in relationship to self-esteem, nor how they are intertwined with social and cognitive processes. If affective factors are influential, they could provide additional targets and strategies for social work interventions. The current study takes a step toward an integrated model that includes both cognitive and affective factors influencing self-esteem. THEORETICAL BACKGROUND Sociological Approach Modified labeling theory (MLT), developed by Link and colleagues (1987, 1989, 1997), has provided a paradigm for examining the processes involved in MI stigma, suggesting hypothetical mechanisms to explain the negative outcomes of labeling. MLT proposes that both individuals with MI and the general public internalize negative societal conceptions of "devaluation-discrimination" associated with MI. When a person is diagnosed as mentally ill, these negative conceptions become personally relevant. The psychological, behavioral, social, and mental health outcomes of individuals with MI are thus negatively affected. According to MLT, self-esteem is critically influenced by internalized beliefs in devaluation-discrimination; and both beliefs and self-esteem are further affected by sociodemographics, mental health history (for example, diagnosis or duration of mental illness), clinical characteristics (for example, symptoms), and rejection experiences. …