Skip to main content Accessibility help

Involuntary psychiatric hospitalisation, stigma stress and recovery: a 2-year study

  • Z. Xu (a1), B. Lay (a2), N. Oexle (a1), T. Drack (a2), M. Bleiker (a2), S. Lengler (a2), C. Blank (a2), M. Müller (a2), B. Mayer (a3), W. Rössler (a2) (a4) (a5) and N. Rüsch (a1)...



Compulsory admission can be experienced as devaluing and stigmatising by people with mental illness. Emotional reactions to involuntary hospitalisation and stigma-related stress may affect recovery, but longitudinal data are lacking. We, therefore, examined the impact of stigma-related emotional reactions and stigma stress on recovery over a 2-year period.


Shame and self-contempt as emotional reactions to involuntary hospitalisation, stigma stress, self-stigma and empowerment, as well as recovery were assessed among 186 individuals with serious mental illness and a history of recent involuntary hospitalisation.


More shame, self-contempt and stigma stress at baseline were correlated with increased self-stigma and reduced empowerment after 1 year. More stigma stress at baseline was associated with poor recovery after 2 years. In a longitudinal path analysis more stigma stress at baseline predicted poorer recovery after 2 years, mediated by decreased empowerment after 1 year, controlling for age, gender, symptoms and recovery at baseline.


Stigma stress may have a lasting detrimental effect on recovery among people with mental illness and a history of involuntary hospitalisation. Anti-stigma interventions that reduce stigma stress and programs that enhance empowerment could improve recovery. Future research should test the effect of such interventions on recovery.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Involuntary psychiatric hospitalisation, stigma stress and recovery: a 2-year study
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Involuntary psychiatric hospitalisation, stigma stress and recovery: a 2-year study
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Involuntary psychiatric hospitalisation, stigma stress and recovery: a 2-year study
      Available formats


Corresponding author

*Address for correspondence: N. Rüsch, Department of Psychiatry II, University of Ulm and BKH Günzburg, Parkstrasse 11, 89073 Ulm, Germany. (Email:


Hide All
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. American Psychiatric Association: Washington, DC.
Andresen, R, Caputi, P, Oades, LG (2010). Do clinical outcome measures assess consumer-defined recovery? Psychiatry Research 177, 309317.
Corrigan, PW, Larson, J, Michaels, P, Buchholz, B, Del Rossi, R, Fontecchio, M, Castro, D, Gause, M, Krzyzanowski, R, Rüsch, N (2015). Diminishing the self-stigma of mental illness by coming out proud. Psychiatry Research 229, 148154.
Corrigan, PW, Larson, JE, Rüsch, N (2009). Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. World Psychiatry 8, 7581.
de Jong, MH, Kamperman, AM, Oorschot, M, Priebe, S, Bramer, W, van de Sande, R, Van Gool, AR, Mulder, CL (2016). Interventions to reduce compulsory psychiatric admissions: a systematic review and meta-analysis. JAMA Psychiatry 73, 657664.
Gilbert, P, Andrews, B (1998). What is shame? Some core issues and controversies. In Gilbert, P, Andrews, B (eds) Shame: Interpersonal Behavior, Psychopathology, and Culture. Oxford University Press: New York; 1998, pp. 338.
Goffman, E (1963). Notes on the Management of Spoiled Identity. Simon & Schuster: New York.
Green, S, Moll, J, Deakin, JF, Hulleman, J, Zahn, R (2013). Proneness to decreased negative emotions in major depressive disorder when blaming others rather than oneself. Psychopathology 46, 3444.
Henderson, C, Farrelly, S, Moran, P, Borschmann, R, Thornicroft, G, Birchwood, M, the Crimson and Joshua Study Groups (2015). Joint crisis planning in mental health care: the challenge of implementation in randomized trials and in routine care. World Psychiatry 14, 281283.
Katsakou, C, Priebe, S (2007). Patient's experiences of involuntary hospital admission and treatment: a review of qualitative studies. Epidemiologia e Psichiatria Sociale 16, 172178.
Katsakou, C, Rose, D, Amos, T, Bowers, L, McCabe, R, Oliver, D, Wykes, T, Priebe, S (2012). Psychiatric patients’ views on why their involuntary hospitalisation was right or wrong: a qualitative study. Social Psychiatry and Psychiatric Epidemiology 47, 11691179.
Kenny, D (2015). SEM: Measuring Model Fit.
Khazaal, Y, Manghi, R, Delahaye, M, Machado, A, Penzenstadler, L, Molodynski, A (2014). Psychiatric advance directives, a possible way to overcome coercion and promote empowerment. Front Public Health 2, 37.
Lay, B, Salize, HJ, Dressing, H, Rüsch, N, Schönenberger, T, Bühlmann, M, Bleiker, M, Lengler, S, Korinth, L, Rössler, W (2012). Preventing compulsory admission to psychiatric inpatient care through psycho-education and crisis focused monitoring. BMC Psychiatry 12, 136.
Lazarus, R, Folkman, S (1984). Stress, Appraisal, and Coping. Springer: New York.
Leamy, M, Bird, V, Le Boutillier, C, Williams, J, Slade, M (2011). Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. British Journal of Psychiatry 199, 445452.
Link, B, Castille, DM, Stuber, J (2008). Stigma and coercion in the context of outpatient treatment for people with mental illnesses. Social Science & Medicine 67, 409419.
Link, BG, Phelan, JC (2001). Conceptualizing stigma. Annual Review of Sociology 27, 363385.
Lipfird, AC (2015). Self-stigma: a personal journey. Psychiatric Rehabilitation Journal 38, 201202.
Livingston, JD, Rossiter, KR (2011). Stigma as perceived and experienced by people with mental illness who receive compulsory community treatment. Stigma Research and Action 1, 18.
Livingston, JD, Rossiter, KR, Verdun-Jones, SN (2011). ‘Forensic’ labelling: an empirical assessment of its effects on self-stigma for people with severe mental illness. Psychiatry Research 188, 115122.
Lukoff, D, Liberman, RP, Nuechterlein, KH (1986). Symptom monitoring in the rehabilitation of schizophrenic patients. Schizophrenia Bulletin 12, 578.
Major, B, O'Brien, LT (2005). The social psychology of stigma. Annual Review of Psychology 56, 393421.
Mittal, D, Sullivan, G, Chekuri, L, Allee, E, Corrigan, PW (2012). Empirical studies of self-stigma reduction strategies: a critical review of the literature. Psychiatric Services 63, 974981.
Mulfinger, N, Müller, S, Böge, I, Sakar, V, Corrigan, PW, Evans-Lacko, S, Nehf, L, Djamali, J, Samarelli, A, Kempter, M, Ruckes, C, Libal, G, Oexle, N, Noterdaeme, M, Rüsch, N (2018). Honest, Open, Proud for adolescents with mental illness: pilot randomized controlled trial. Journal of Child Psychology and Psychiatry doi: 10.1111/jcpp.12853.
Muthén, L, Muthén, B (1998–2002). Mplus User's Guide, 7th edn. Muthén & Muthén: Los Angeles, CA.
Ritsher, JB, Otilingam, PG, Grajales, M (2003). Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Research 121, 3149.
Rogers, ES, Chamberlin, J, Ellison, ML, Crean, T (1997). A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatric Services 48, 10421047.
Rosenberg, M (1965). Society and the Adolescent Self-Image. Princeton University Press: Princeton.
Rüsch, N, Abbruzzese, E, Hagedorn, E, Hartenhauer, D, Kaufmann, I, Curschellas, J, Ventling, S, Zuaboni, G, Bridler, R, Olschewski, M, Kawohl, W, Rössler, W, Kleim, B, Corrigan, PW (2014 a). Efficacy of coming out proud to reduce stigma's impact among people with mental illness: pilot randomised controlled trial. British Journal of Psychiatry 204, 391397.
Rüsch, N, Corrigan, PW, Powell, K, Rajah, A, Olschewski, M, Wilkniss, S, Batia, K (2009 b). A stress-coping model of mental illness stigma: II. Emotional stress responses, coping behavior and outcome. Schizophrenia Research 110, 6571.
Rüsch, N, Corrigan, PW, Wassel, A, Michaels, P, Olschewski, M, Wilkniss, S, Batia, K (2009 a). A stress-coping model of mental illness stigma: I. Predictors of cognitive stress appraisal. Schizophrenia Research 110, 5964.
Rüsch, N, Hölzer, A, Hermann, C, Schramm, E, Jacob, GA, Bohus, M, Lieb, K, Corrigan, PW (2006). Self-stigma in women with borderline personality disorder and women with social phobia. Journal of Nervous and Mental Disease 194, 766773.
Rüsch, N, Müller, M, Lay, B, Corrigan, PW, Zahn, R, Schönenberger, T, Bleiker, M, Lengler, S, Blank, C, Rössler, W (2014 b). Emotional reactions to involuntary psychiatric hospitalization and stigma-related stress among people with mental illness. European Archives of Psychiatry and Clinical Neurosciences 264, 3543.
Schibalski, JV, Müller, M, Ajdacic-Gross, V, Vetter, S, Rodgers, S, Oexle, N, Corrigan, PW, Rössler, W, Rüsch, N (2017). Stigma-related stress, shame and avoidant coping reactions among members of the general population with elevated symptom levels. Comprehensive Psychiatry 74, 224230.
Silverstein, SM, Bellack, AS (2008). A scientific agenda for the concept of recovery as it applies to schizophrenia. Clinical Psychology Review 28, 11081124.
Slade, M, Amering, M, Farkas, M, Hamilton, B, O'Hagan, M, Panther, G, Perkins, R, Shepherd, G, Tse, S, Whitley, R (2014). Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems. World Psychiatry 13, 1220.
Svindseth, MF, Nottestad, JA, Dahl, AA (2013). Perceived humiliation during admission to a psychiatric emergency service and its relation to socio-demography and psychopathology. BMC Psychiatry 13, 217.
Thornicroft, G, Brohan, E, Rose, D, Sartorius, N, Leese, M (2009). Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 373, 408415.
Tsang, HW, Ching, SC, Tang, KH, Lam, HT, Law, PY, Wan, CN (2016). Therapeutic intervention for internalized stigma of severe mental illness: a systematic review and meta-analysis. Schizophrenia Research 173, 4553.
White, IR, Royston, P, Wood, AM (2011). Multiple imputation using chained equations: issues and guidance for practice. Statistics in Medicine 30, 377399.
Zahn, R, Lythe, KE, Gethin, JA, Green, S, Deakin, JF, Young, AH, Moll, J (2015). The role of self-blame and worthlessness in the psychopathology of major depressive disorder. Journal of Affective Disorders 186, 337341.


Type Description Title
Supplementary materials

Xu et al. supplementary material 1
Xu et al. supplementary material

 Word (101 KB)
101 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed