The association between mental health self-stigma and multiple mental health conditions: A systematic review

Background Self-stigma is commonly experienced among people with mental health conditions, across disorders and across the lifespan, with negative impacts. Objective This systematic review aimed to synthesize the literature on self-stigma among people with multiple co-occurring mental health conditions, inclusive of substance use conditions. We further explored whether multiple mental health conditions are associated with an added burden of self-stigma compared to single conditions. Method A systematic search was conducted of Medline, APA PsycInfo, Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science, and Applied Social Sciences Index and Abstracts (ASSIA). A total of 9246 records were found. We included reports providing quantitative self-stigma scores of individuals with co-occurring mental health or co-occurring mental health and substance use conditions. Quality assessment was conducted. Data were summarized narratively and presented in table format. Results Eleven studies were included with results reported across a sample of 1774 cases. Findings support that substance use conditions may confer an additional burden of self-stigma, but not cannabis use disorder. Self-stigma seems to be high for select comorbidities, in the case of depression, anxiety, and personality disorders, although results are mixed and inconclusive. Negative presentations are associated with higher self-stigma, such as higher symptom levels and illness severity, and lower functioning. Conclusion Substantial self-stigma is associated with comorbid mental health and substance use conditions. However, the literature is not yet fully developed to understand whether and to what degree there might be an additive effect of multiple mental health conditions on self-stigma.