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
Lasalvia,Antonio Bonetto,Chiara van Bortel,Tine Cristofalo,Doriana Brouwers,Evelien Lanfredi,Mariangela van Weeghel,Jaap Chang,Chih-Cheng Chee,Kok-Yoon Harangozó,Judit
Lasalvia,Antonio
Bonetto,Chiara
van Bortel,Tine
Cristofalo,Doriana
Brouwers,Evelien
Lanfredi,Mariangela
van Weeghel,Jaap
Chang,Chih-Cheng
Chee,Kok-Yoon
Harangozó,Judit
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.
Description
Date
2025-12-01
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Research Projects
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Keywords
depression, self-stigma, empowerment, self-esteem, moderated mediation, multisite study
Citation
Lasalvia, A, Bonetto, C, van Bortel, T, Cristofalo, D, Brouwers, E, Lanfredi, M, van Weeghel, J, Chang, C-C, Chee, K-Y, Harangozó, J, van Audenhove, C, Ola, B, Jorge-Monteiro, F, James, B, Ouali, U, Germanavičius, A, Abdulmalik, J, Ucok, A, Oshodi, Y & Thornicroft, G 2025, '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', Journal of Affective Disorders, vol. 390, no. 1, 119802. https://doi.org/10.1016/j.jad.2025.119802