Predictors and Outcomes of Patient Stigma Perception Appraisal: Developing and Testing of a Dynamic Stigma Model of Mental Illness

Background The psychosocial perspectives of stigma have been explored over the years. However, research that encompasses the study of stigma as a socio-cultural, religious, and moral phenomenon is lacking. This study aimed to develop and test a Dynamic Stigma Model of Mental illness (DYSMO) among a cohort of Outpatients receiving care in Ghana. Methods The study examined hypothesized relationships within a newly developed stigma model using structural equation modeling techniques. A non-probabilistic convenience sampling technique was used to recruit 330 participants at the Out-Patient Department of two psychiatric hospitals in Southern Ghana. Results Confirmatory factor analysis produced a final model with five latent variables and 17 indicators. Mediation analysis on the full structural model produced standardized fit indices that include the following: (c2/df = 335.403 (105), p£ .000; RMSEA= .08 (90% CI: .072 -.092; CFI = .921; SRMSR=.059; TLI = .90). While some of the standardized regression coefficients of the DYSMO were significant, others were not. The significant regression coefficients of the DYSMO include structural violence (SV) versus religiocultural beliefs (RCB) = .463, p£ .000; stigma perception appraisal (SPA) versus SV = .698, p£ .000; SPA versus RCB = -.185, p£.042; anticipated discrimination (AD) versus SPA = .448, p£.000; and social withdrawal (SW) versus AD = .661, p£.000). The following coefficients were however not significant: AD versus SV = -.147, p = -.147; AD versus RCB = .064, p = .494; SW versus SPA = -.047 p = .710; SW versus SV = .016, p = .904; SW versus RCB = .039, p = .619). Conclusion The study results revealed that religious, cultural, and structural violence perspectives can promote and damage mental health perceptions and increase stigma. It is imperative that all stakeholders, gain increased awareness and knowledge of the role religious and cultural beliefs play in the perpetuation and outcomes of mental illness stigma