The impact of stigma and social anxiety on social participation in people with severe mental illness

Background: People with severe mental illness (SMI), such as psychosis are faced with many challenges. As well as severe symptoms such as hallucinations, delusions, blunted affect, depressed mood and mania, many people with SMI suffer from social anxiety and significantly reduced social functioning. It has been proposed that discrimination and stigma may be key barriers to social functioning for people with SMI. Psychosis and comorbid social anxiety have been shown to decrease social participation and quality of life. Meanwhile, the fear of stigma can reduce social participation. In addition, it has been suggested that cognitive functioning (IQ) and chronicity of illness can have an impact on social functioning. Methods: We examined the effects of discrimination and stigma, duration of illness, intellectual functioning and the role of social anxiety on social functioning in a sample of 88 adults (54 females) aged 21 to 64 years of age, with severe mental illness. Data was analysed using multiple linear regression and path analysis, allowing the simultaneous evaluation of multiple variant and covariant relationships. Predictors included internalised stigma, perceived stigma, discrimination, social anxiety, duration of illness and IQ. The relationship between these and the dependent variable – social functioning – was examined in the model. Additionally, covariate relationships between internalised stigma, perceived stigma and discrimination and social anxiety were also examined. Results: A best-fit path analysis showed that the model accounted for 39% of the variance in social functioning. Intellectual functioning (β = .23) and social anxiety (β = .33) had strong positive relationships with social functioning. Duration of illness (β = -.17), expected internalised stigma (β = -.17) and discrimination (β = -.16) had moderate negative relationships with social functioning. Conclusion: Internalised stigma and intellectual functioning should be considered as clinical targets for interventions to reduce social anxiety and to thus improve social functioning among people with severe mental illness.