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* Address for correspondence: A. Isaksson, Department of Psychiatry and Psychotherapy, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany. (Email: [email protected])
Background
Experiences of discrimination are common among people with mental health problems (Brohan et al. 2013; Corker et al. 2013; Henderson et al. 2014; Lasalvia et al. 2015). Moreover, stigma and discrimination represent important factors, which can impede help-seeking (Lewer et al. 2015) and recovery (Livingston & Boyd, 2010). Stigma and discrimination experienced by people with mental health problems can be considered within a stress and coping framework, with the stressor being a threat to social identity (Major & O'Brien, 2005). There are three coping orientations within the stigma-coping-framework by Link et al. (1991, 2002) that are commonly described in the literature: (1) secrecy (concealing mental illness), (2) educating others about mental illness and (3) challenging others about their stigmatising attitudes and behaviours.
Coping with stigma can help to maintain a positive self-concept (Major & O'Brien, 2005) and self-esteem (Ilic et al. 2011). But, depending on the coping strategy, outcomes may differ substantially. The literature suggests that secrecy is associated with lower self-esteem (Ilic et al. 2011), higher levels of experienced discrimination (Lasalvia et al. 2013) and perceived discrimination as well as self-stigma (Vauth et al. 2007). In contrast, active strategies like educating others and challenging others were not associated with less self-esteem or feeling ashamed (Link et al. 2002), and there was no effect on self-stigma (Moses, 2014) or on devaluation and discrimination (Link et al. 1991). Overall, there is only little evidence about positive and negative correlates of different coping orientations. In addition to anticipated and experienced stigma and discrimination, clinical and socio-demographic characteristics such as diagnosis (Brohan et al. 2011) and gender may be associated with variation in use of coping orientations (Rusch et al. 2011). Still, findings are contradictory and scarce, particularly for socio-demographic variables such as age, ethnicity and education (Ilic et al. 2011; Rüsch et al. 2011; Moses, 2014).
Aims
Our study describes the occurrence and pattern of use of three common stigma coping orientations (Link et al. 1991, 2002): (1) concealing mental health problems (=secrecy), (2) educating others and (3) challenging others among a sample of 3005 English mental health service users. Further, we describe associations...