The effect of internalized stigmatization on self-esteem and coping styles with stress in individuals with mental illness

Purpose: This study was conducted to determine the effect of internalized stigma on self-esteem and coping styles with stress in individuals with mental illness. Method: The study was conducted between 15/12/2022 and 15/06/2023 as a descriptive, cross-sectional and correlational study among individuals followed up in Tokat Dr. Cevdet Aykan Mental Health and Diseases Hospital, Tokat Community Mental Health Center and Tokat Gaziosmanpaşa University Hospital Psychiatry clinics and outpatient clinics. The study sample consisted of 352 individuals who met the inclusion criteria. Data collection was achieved using a Personal Information Form prepared by the researcher after reviewing relevant sources, along with the Internalized Stigma of Mental Illness Scale (ISMIS), Rosenberg Self-Esteem Scale (RSES), and Coping Styles with Stress Scale (CSSS). Data were collected through one-on-one interviews with individuals who voluntarily agreed to participate in the study. SPSS Statistics 25.0 software was preferred for data analysis. Statistical analysis included descriptive statistics such as numbers, percentages, minimum, maximum, median, mean, and standard deviation, as well as t-test, One-Way ANOVA, Post-Hoc tests, Tamhane's, and Pearson correlation analysis. A significance level of p<0.05 was accepted for statistical significance. Findings: Of the participants in the study, 72.7% were male, 40.1% were aged 40 and above, 52.4% were single, 32.1% had a high school diploma, 42% were parents, 42% had income lower than their expenses, 63.1% lived in urban areas, and 82.7% lived with their families. The mean total score of the ISMIS was found to be 67.22±15.00, and the scores of its sub-dimensions were as follows: Alienation Sub-Dimension mean score was 13.89±4.53, Stereotype Endorsement Sub-Dimension mean score was 15.20±4.13, Perceived Discrimination Sub-Dimension mean score was 11.65±3.61, Social Withdrawal Sub-Dimension mean score was 13.77±4.54, and Resistance Against Stigma Sub-Dimension mean score was 12.69±3.24. The mean total score of the RSES was determined to be 2.26±0.57. The mean scores of the participants' CSSS sub-dimensions were as follows: Self-Confidence Approach Sub-Dimension mean score was 2.83±0.80, Optimistic Approach Sub-Dimension mean score was 2.78±0.73, Helpless Approach Sub-Dimension mean score was 2.52±0.66, Resigned Approach Sub-Dimension mean score was 2.27±0.60, Social Support Seeking Approach Sub-Dimension mean score was 2.25±0.87, and the total mean score was 12.66±2.44. Accordingly, a statistically significant, direct relationship was found between the mean values of RHIDÖ and all its dimensions and the mean value of RBSÖ (p<0.05). It was observed that as the mean scores of the ISMIS and its sub-dimensions increased, the mean score of the RSES also increased. There was also a statistically significant relationship between the mean scores of the ISMIS and CSSS (p<0.05). The relationship between the mean scores of the ISMIS and its sub-dimensions and the mean scores of the Self-Confidence Approach, Optimistic Approach, and Social Support Seeking Approach sub-dimensions of the CSSS was found to be statistically significant and negatively correlated. As the mean scores of the ISMIS and its sub-dimensions increased, the mean scores of the Self-Confidence Approach, Optimistic Approach, and Social Support Seeking Approach sub-dimensions of the CSSS decreased. A statistically significant and positive relationship was found between the mean scores of ISMIS and its sub-dimensions and the mean scores of the Helpless Approach sub-dimension of CSSS. As the mean scores of the ISMIS and its sub-dimensions increased, the mean score of the Helpless Approach sub-dimension of the CSSS also increased. Conclusion: In this study, it was determined that individuals with mental illness experience a moderate level of internalized stigma, and this condition has an impact on participants' self-esteem and coping strategies with stress. More research is needed to further examine internalized stigmatizing behavior and the relationship between self-esteem and stress in terms of causality and to find solutions. Keywords: Mental Illness, Stigma, Internalized Stigma, Self-Esteem, Stress, Coping with Stress