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Background: Due to public stigma or self-stigma and shame, many adolescents with mental illness (MI) struggle with the decision whether to disclose their MI to others. Both disclosure and nondisclosure are associated with risks and benefits. Honest, Open, Proud (HOP) is a peer-led group program that supports participants with disclosure decisions in order to reduce stigma's impact. Previously, HOP had only been evaluated among adults with MI., Methods: This two-arm pilot randomized controlled trial included 98 adolescents with MI. Participants were randomly assigned to HOP and treatment as usual (TAU) or to TAU alone. Outcomes were assessed pre (T0/baseline), post (T1/after the HOP program), and at 3-week follow-up (T2/6 weeks after T0). Primary endpoints were stigma stress at T1 and quality of life at T2. Secondary outcomes included self-stigma, disclosure-related distress, empowerment, help-seeking intentions, recovery, and depressive symptoms. The trial is registered on ClinicalTrials (NCT02751229; http://www.clinicaltrials.gov)., Results: Compared to TAU, adolescents in the HOP program showed significantly reduced stigma stress at T1 (d = .92, p < .001) and increased quality of life at T2 (d = .60, p = .004). In a longitudinal mediation model, the latter effect was fully mediated by stigma stress reduction at T1. HOP further showed significant positive effects on self-stigma, disclosure-related distress, secrecy, help-seeking intentions, attitudes to disclosure, recovery, and depressive symptoms. Effects at T1 remained stable or improved further at follow-up. In a limited economic evaluation HOP was cost-efficient in relation to gains in quality of life., Conclusions: As HOP is a compact three-session program and showed positive effects on stigma and disclosure variables as well as on symptoms and quality of life, it could help to reduce stigma's negative impact among adolescents with MI., (© 2017 Association for Child and Adolescent Mental Health.)

Background: To date, there has been little research into effective strategies for preventing the detrimental effects of stigma on the well-being of people with mental illness., Aim: The present research set out to identify adaptive strategies for dealing with the stigma of mental illness., Methods: On the basis of the responses of 355 people with mental illness (PWMI) a standardized questionnaire assessing 10 identity management strategies was developed. Participants also reported their personal experiences with stigma, depression and self-esteem., Results: Hierarchical regression analyses showed that after controlling for depression and stigmatizing experiences, the strategies of community involvement, humour and positive ingroup stereotyping were related to higher self-esteem. Secrecy, selective disclosure and attempts at overcompensation or disproving stereotypes were related to lower self-esteem. The following strategies were unrelated to self-esteem: comparing the present social position of PWMI with that in the past, normalization of the illness within a medical model, information seeking and selective withdrawal., Conclusions: PWMI should be encouraged to seek support within their community and to develop a positive image of their ingroup.

Objective: The study sought to better understand why some people with mental illness self-stigmatize and develop low self-esteem while others remain indifferent to stigma or respond with a sense of empowerment. The authors hypothesized that a high level of perceived discrimination, little sense of identification with the group of people with mental illness, and a high level of perceived legitimacy of discrimination lead to self-stigma., Methods: Sixty women with borderline personality disorder and 30 women with social phobia, who were recruited at three centers in Germany and Switzerland, completed stigma-related questionnaires., Results: After depression and index diagnosis were controlled for, a low level of perceived discrimination and of the legitimacy of discrimination predicted high self-esteem and high empowerment. Identification with the group of people with mental illness did not predict self-esteem or empowerment., Conclusions: Perceived legitimacy of discrimination may be a crucial determinant of a person's response to stigma.

Research on barriers to treatment and rehabilitation readiness in people with schizophrenia, especially focusing on risk factors of poor outcome in social and vocational functioning, has focused on the role of social cognition and neurocognition. Others have hypothesized that social cognition (i.e., encoding and understanding of social cues guided by social schemas or scripts) may be one mediator between basic neurocognition and functional outcome. Our study analyzes data from 133 DSM-IV schizophrenic inpatients on a rehabilitation ward using structural equation modeling (SEM) to test whether social cognition has a stronger and more direct influence on vocational functioning than nonsocial cognition. The results supported the hypothesized model; that is, 25% of work-related social skills could be explained by social cognition and nonsocial cognition. The direct impact of nonsocial cognition on vocational functioning was smaller than the impact of social cognition on work-related social skills. Nevertheless, an overwhelming proportion of social cognition (83%) could be explained by nonsocial cognition.