Internalized stigma is defined as an individual's negative beliefs about their own attributes that are socially devalued (Crocker & Major, 1989; Crocker et al., 2006). It refers to the process by which individuals come to believe that they are flawed because society views them negatively (Jones et al., 2015). Perceived social support can be understood as the extent to which individuals feel supported by others when dealing with stressful situations (House & Kahn, 1985). Internalized stigma has been found to have detrimental effects on mental health outcomes such as anxiety, depression, and suicide ideation (Borowsky et al., 2006; Coker et al., 2014). Studies show that perceived social support may buffer against these harmful consequences (Ashby et al., 2014; Jones et al., 2015).
Research suggests that internalized stigma may moderate this effect such that higher levels of internalized stigma may diminish the positive impact of perceived social support on emotional well-being (Mereish et al., 2017; Nguyen et al., 2018). The present study aims to investigate how perceived social support interacts with internalized stigma to influence emotional well-being among adults in the US.
Methods:
The study used data from the National Epidemiologic Survey on Alcohol and Related Conditions III (NESARCIII) Wave 2, a nationally representative survey conducted between 2012 and 2013. Participants were recruited via random digit dialing and completed an anonymous self-report questionnaire. The sample consisted of 34,6553 respondents who reported being heterosexual or bisexual females and who provided information about their sexual orientation and experiences of discrimination based on sexuality. Perceived social support was assessed using a single item asking participants to rate the level of social support they had received in the past month, ranging from 0 (none) to 10 (very high). Internalized stigma was measured by summing responses to four items assessing participants' agreement with statements such as "I feel ashamed about my sexual identity" and "It bothers me when others make negative comments about my sexual identity." Emotional well-being was operationalized as a composite score consisting of six items measuring depressive symptoms, loneliness, positive mood, life satisfaction, stress levels, and self-esteem.
Results:
Linear regression analyses indicated that higher perceived social support was associated with greater emotional well-being even after controlling for demographic variables, alcohol use, and mental health history (β.47, p <.001).
The association between perceived social support and emotional well-being was moderated by internalized stigma such that this relationship became non-significant at higher levels of internalized stigma (β.01, p >.10). In other words, individuals with low levels of internalized stigma appeared to benefit more from increased perceived social support than those with high levels. The interaction effect was significant (p <.05).
Discussion:
These results suggest that social support may be particularly important for reducing emotional distress among individuals who experience less internalized stigma. Given the harmful consequences of internalized stigma on emotional well-being, interventions should aim to address both internalized stigma and social support simultaneously. Healthcare providers can play an essential role in promoting resilience among their patients by helping them identify and reduce sources of internalized stigma while also increasing social support networks. Future research should examine whether these effects vary depending on individual differences such as age, gender, or sexual identity.
How does perceived social support interact with internalized stigma to influence emotional well-being?
In recent years, researchers have demonstrated that perceived social support can play an important role in influencing mental health outcomes such as depression, anxiety, and stress. Social support is defined as the availability of resources from other individuals such as friends, family members, partners, or professionals that provide comfort, encouragement, advice, and assistance during difficult times.