The impact of self-stigma on empowerment in major depressive disorder: The mediating role of self-esteem and the moderating effects of socioeconomic and cultural context in an international multi-site study

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders Pub Date : 2025-06-28 DOI:10.1016/j.jad.2025.119802

Antonio Lasalvia , Chiara Bonetto , Tine Van Bortel , Doriana Cristofalo , Evelien Brouwers , Mariangela Lanfredi , Jaap van Weeghel , Chih-Cheng Chang , Kok-Yoon Chee , Judit Harangozó , Chantal Van Audenhove , Bola Ola , Fátima Jorge-Monteiro , Bawo James , Uta Ouali , Arūnas Germanavičius , Jibril Abdulmalik , Alp Ucok , Yewande Oshodi , Graham Thornicroft

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引用次数: 0

Abstract

Background

Major Depressive Disorder (MDD) is a prevalent mental health condition often accompanied by self-stigma, negatively impacting self-esteem and empowerment. This study examines the mediating role of self-esteem in the relationship between self-stigma and empowerment and explores the moderating influence of socioeconomic and cultural contexts in an international sample.

Methods

This cross-sectional study, part of the ASPEN/INDIGO-Depression project, included participants with a diagnosis of MDD from 34 countries. Self-stigma, self-esteem, and empowerment were assessed using, respectively, the Internalized Stigma of Mental Illness (ISMI) scale, the Boston University Empowerment Scale (BUES), and the Rosenberg Self-Esteem Scale (RSES). A mediation model examined self-esteem's role in the self-stigma–empowerment relationship, and a conditional mediation model examined the moderating effect of the Human Development Index (HDI). All effects were adjusted for socio-demographic and clinical covariates.

Results

A total of 1058 people participated. Mediation analysis confirmed that self-esteem significantly mediated the negative association between self-stigma and empowerment, suggesting that lower self-stigma leads to higher self-esteem, which in turn enhances empowerment. Moderation analysis revealed that the mediation effect varied across countries with different socioeconomic and cultural contexts. The indirect effect of self-stigma on self-esteem was stronger in countries with higher HDI, indicating that individuals in these settings experience greater vulnerability to the negative effects of self-stigma on self-esteem.

Conclusions

Self-esteem buffers the negative impact of self-stigma on empowerment in people with MDD. The strength of this effect varies by socioeconomic and cultural context, with stronger mediation in higher-HDI countries. These findings highlight the need for tailored interventions addressing self-stigma in specific contexts to enhance empowerment and recovery.

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自我耻辱感对重性抑郁症授权的影响：自尊的中介作用和社会经济文化背景的调节作用

重度抑郁症（MDD）是一种普遍的心理健康状况，通常伴随着自我耻辱感，对自尊和赋权产生负面影响。本研究在国际样本中考察了自尊在自我耻辱感和赋权之间的中介作用，并探讨了社会经济和文化背景的调节作用。方法：这项横断面研究是ASPEN/INDIGO-Depression项目的一部分，包括来自34个国家的MDD诊断参与者。分别采用心理疾病内化污名（ISMI）量表、波士顿大学赋权量表（BUES）和罗森博格自尊量表（RSES）对自我污名、自尊和赋权进行评估。自尊在自我羞辱-授权关系中的中介作用模型和人类发展指数（HDI）在自我羞辱-授权关系中的调节作用的条件中介作用模型。所有的影响都根据社会人口统计学和临床协变量进行了调整。结果共1058人参与。自尊在自我污名化与授权的负相关中起着显著的中介作用，表明自我污名化越低，自尊越高，自尊越高，授权越强。中介效应分析显示，中介效应在不同社会经济和文化背景的国家之间存在差异。在人类发展指数较高的国家，自我耻辱感对自尊的间接影响更强，这表明这些国家的个体更容易受到自我耻辱感对自尊的负面影响。结论自尊可以缓冲自我耻辱感对重度抑郁症患者赋权的负面影响。这种影响的强度因社会经济和文化背景而异，在高hdi国家具有更强的中介作用。这些发现突出表明，需要在特定情况下采取有针对性的干预措施，解决自我耻辱问题，以加强赋权和康复。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of affective disorders 医学-精神病学

CiteScore

10.90

自引率

6.10%

发文量

1319

审稿时长

9.3 weeks

期刊介绍： The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.