Academic journal article Health and Social Work

Psychological Traits and Behavioral Coping of Psychiatric Consumers: The Mediating Role of Self-Esteem

Academic journal article Health and Social Work

Psychological Traits and Behavioral Coping of Psychiatric Consumers: The Mediating Role of Self-Esteem

Article excerpt

Deinstitutionalization has increased the importance of community mental health services, resulting in increasing numbers of consumers living in communities and more community-based psychosocial rehabilitation (PSR.) services agencies (Reid, 1995; Segal, 1995). PSR service agencies differ from traditional community mental health programs that mainly focus on managing psychiatric symptoms. In addition to symptom control, PSR agencies aim to better support consumers' choices and to promote more effective adaptation to society (Silverstein, 2000). Specifically, these agencies focus on social or vocational rehabilitation services to enhance consumers' social and vocational skills, assuming that attaining higher levels of education (Mowbray, Collins, & Bybee, 1999) or obtaining competitive employment (Mueser et al., 1997) are critical for consumers' successful adaptation to modern society.

One of the most significant problems encountered by psychiatric consumers is the experience of the stigma of mental illness (MI) (Farina, Fisher, & Fisher, 1992), which limits opportunities for education, employment, and social relations. In addition to the nature of MI, limited opportunities are the consequences of not only social rejection and discrimination (Noe, 1997; Link, Cullen, Frank, & Wozniak, 1987), but also social withdrawal (Link, Cullen, Struening, Shrout, & Dohrenwend, 1989; Link, Struening, Rahav, Phelan, & Nuttbrock, 1997). To do well in education or employment, psychiatric consumers must successfully cope with the stigma of MI that may negatively influence their self-esteem and behavioral coping (Link et al., 1989). How can social workers help consumers develop healthy behavioral coping mechanisms with more selectively tailored interventions corresponding to their psychological and behavioral characteristics? Because of a lack of empirical research on this question, limited practice guidelines are available.


Attitude theory posits that individuals' behaviors are directed by their attitudes, which are influenced by cognitive and affective traits (Fiske, 1998; Petty, Wegener, & Fabrigar, 1997). Attitudes are commonly defined as summary evaluations of objects (Petty, et al., 1997) that range from positive to negative (Petty, Priester, & Wegener, 1994). Rosenberg (1965) defined self-esteem as a positive or negative attitude toward the self. Thus, self-esteem reflects how individuals evaluate themselves (Brown, Dutton, & Cook, 2001). Conceptualizing self-esteem as an attitude toward the self allows us to use the paradigm of attitude theory in examining the mechanisms affecting and factors determinant of consumers' behaviors.

Behavioral Coping

Withdrawal as a coping behavior can undermine the provision of opportunities in education or employment. By contrast, inappropriate revelations of mental health treatment history (rather than keeping it secret) may cause social rejection and discrimination because of negative cultural beliefs (that is, stigma) associated with MI (Link et al., 1989; 1997). For psychiatric consumers served in rehabilitation agencies, healthy behavioral coping can be critical to success. According to attitude theory, behavioral coping is frequently determined by self-attitudes and psychological characteristics such as affective and cognitive traits.

Psychological Characteristics

Individuals' psychological characteristics are critical to the attitude formation process (Petty et al., 1997), and affective and cognitive traits influence self-evaluations (Levine, Wyer, & Schwarz, 1994). Although it has not been applied exactly from the perspective of attitude theory, the modified labeling theory developed by Link and colleagues (1989) accounts for the importance of cognitive traits (that is, beliefs in devaluation--discrimination) as predictors of self-esteem. Earlier studies endorsing this model (for example, Link, 1987; Link et al. …

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