For many individuals with mental disorders, stigma may represent a potent stressor that can disrupt sleep and impair health and quality of life. In this study, we tested a stigma model of sleep health, hypothesizing that public stigma (as indicated by experienced discrimination) and internalized stigma (as indicated by self-stigma content and process) would affect sleep and, in turn, health-related quality of life (HRQoL) among individuals with mental disorders.
A total of 282 individuals with mental disorders from Hong Kong, China, completed questionnaire measures of experienced discrimination, self-stigma content and process, sleep disturbance, and physical and mental HRQoL. Structural equation modeling and Bootstrap analyses were conducted to analyze the relations among the variables.
Structural equation modeling showed that experienced discrimination was positively associated with self-stigma content and process, which were, in turn, linked to greater sleep disturbance and consequently poorer physical and mental HRQoL. Bootstrap analyses further demonstrated that experienced discrimination had significant indirect effects on sleep disturbance, via self-stigma content and process, and on physical and mental HRQoL, via self-stigma content and process and sleep disturbance.
Theoretically, this study highlighted the importance of considering the contributions of both public and internalized stigma, and differentiating between self-stigma content and process, when evaluating the sleep quality and health status of individuals with mental disorders. Practically, this study pointed to the necessity of developing anti-stigma and anti-self-stigma interventions at societal and individual levels in order to reduce stigma-related stress and improve sleep and health outcomes among individuals with mental disorders.