We found evidence that self-stigma and stigma-related cognitions predict service use among people with serious and chronic mental illness, independent of baseline psychopathology, diagnosis and the level of perceived stigma. Cognitions associated with resilience to stigma (rejecting stigma as unfair; strong group identification)3,4
may facilitate use of out-patient services and be more relevant to help-seeking than the level of perceived stigma per se
. Increased self-stigma, on the other hand, could be associated with reduced willingness or ability to seek help, possibly leading to decreased coping resources and thus to psychiatric hospitalisation as a last resort. The time lag between baseline assessment of psychopathological symptoms and subsequent hospitalisation may explain the lack of association between the two.
Limitations of our study should be considered. First, we did not collect information on service use from sources other than service users, and dichotomous dependent variables limited the power of our analyses. Second, despite our longitudinal data, firm conclusions on causality cannot be drawn because treatment participation before baseline assessment may have influenced stigma-related predictor variables. Third, our conclusions are limited to people with serious and chronic mental illness who already participate in mental health services. Finally, stigma-related variables, accessibility, quality and use of services should be investigated in different healthcare systems internationally.
Stigma-related factors appear to affect mental health service use. High self-stigma could be a risk factor for psychiatric hospitalisation, whereas strong group identification may encourage people with mental illness to turn to peers for mutual help, thus increasing empowerment. Research should investigate how initiatives meant to reduce self-stigma, public stigma and structural discrimination can facilitate help-seeking.