Perceived stigma and self-stigma in young people at ultra-high risk for psychosis: Associations with identity-related, psychological and functional outcomes

Background and hypothesis: Perceived stigma and self-stigma negatively affect identity-related, psychological and functional outcomes among stigmatised populations. There is limited research exploring the impact of stigma among young people at ultra-high risk (UHR) for psychosis. We investigated the association of perceived stigma and self-stigma with these outcomes in young people at UHR. Methods: Young people meeting the UHR criteria (N = 61) aged 12—25 years were recruited. Participants completed an online survey including UHR-specific measures of perceived stigma and self-stigma, as well as self-esteem, self-efficacy, self-compassion, psychological distress, perceived stress and disclosure distress. All participants took part in the CanARY trial in which they completed measures of depression, anxiety, attenuated psychotic symptoms, and social and occupational functioning. Multiple regressions explored perceived stigma and self-stigma as predictors of identity-related (i.e., self-esteem, self-efficacy, self-compassion), psychological and functional outcomes. Results: Bivariate correlations between perceived stigma, self-stigma, and all outcomes were in the expected direction and generally moderate in size, except for psychological symptoms (i.e., anxiety, depression, and positive psychotic symptoms). Perceived stigma, but not self-stigma, was positively associated with disclosure distress, For regressions, self-stigma uniquely and negatively predicted self-esteem, psychological distress, and perceived stress. Conclusions: Perceived stigma and self-stigma are related to harmful outcomes among young people at UHR. Self-stigma may be more damaging to self-related aspects, whereas perceived stigma may be more damaging to interactions with others. Understanding the long-term impacts of perceived stigma and self-stigma, and what factors mitigate these experiences, is important for supporting young people at UHR.