The Aversive Impact of Stigma on Black People Diagnosed with Schizophrenia

Compared to their White counterparts, Black people diagnosed with schizophrenia (PDWS) are at elevated risk for poor outcomes (e.g., greater likelihood of misdiagnosis, poorer treatment engagement, higher suicide rates). Although it is well known that there are racial disparities in schizophrenia treatment and service utilization, little is known about the mechanisms driving these disparities. Studies have found that Black Americans hold more negative attitudes towards mental illness than White Americans and that the impact of such stigmatizing attitudes on help-seeking for mental health problems is detrimental. Mental illness stigma may generate disparities in schizophrenia by delaying or preventing treatment seeking among Blacks. This study sought to identify the mechanisms by which mental illness stigma, a racialized and politicized construct historically used to push Black Americans to the margins, acts as a barrier to care for Black PDWS and generates worse overall outcomes. It was hypothesized that Black PDWS who access routine outpatient care less frequently would be more likely to experience deterioration in their conditions and enter the mental health care system through less favorable inpatient access points. Depressive symptoms caused by stigma were thought to promote suboptimal patterns of service utilization, thereby resulting in increased substance use. Social support was expected to serve as a buffer against the harmful effects of stigma. The hypotheses of this study were partially supported. Findings were consistent with prior research indicating that stigma is a determinant of psychological wellbeing in individuals with serious mental illness and that depression is one pathway by which the effect occurs. Stigma was found to be less detrimental at higher levels of social support. Additionally, this study provides some evidence that stigma generates negative outcomes by reducing use of outpatient mental health services in Black PDWS. This finding, which must be taken with caution, comes alongside the finding that usage of outpatient mental health visits is negatively associated with misuse of various substances. Integrating perspectives from other disciplines, this study adds to the modest literature in psychology that either centers the experiences of Black Americans or examines stigma in relation to race. Its results have major public health implications. Indeed, this study was the first to examine the relationships among stigma, depression, service utilization, substance use, and overall behavioral health. Future research directions include examining whether there are differential levels of support for the proposed structural model across racial groups, whether Black men are more vulnerable to the disadvantages of mental illness stigma, replicating these findings with theory-driven covariates and in larger samples, conducting qualitative analyses to inform conceptualization of service use variables, and testing these research questions longitudinally