Stigma is a major stressor for many individuals with mental illness. Recent stigma models highlight the role of cognitive stress appraisal, emotional and cognitive coping responses, and their impact on outcomes such as self-esteem and social interactions. We tested this model, applying it to mental illness stigma.

In 85 people with mental illness, stigma stress appraisal and stress predictors (level of perceived stigma, rejection sensitivity, ingroup perception) as well as emotional reactions (anxiety, shame) and cognitive coping responses to stigma-related stress were assessed. In addition to selfdirected outcome (self-esteem, hopelessness), social performance in contact with outgroup members (i.e. members of the general public) was assessed by role-play and seating distance measures.

Higher levels of perceived stigma, rejection sensitivity and holding one's ingroup in low regard predicted high stigma stress which in turn was associated with anxiety and shame, but not with cognitive coping responses. Anxiety and shame predicted lower self-esteem and more hopelessness; the coping mechanism of ingroup comparisons predicted poorer social performance.

Our findings support the stress-coping model of stigma when applied to people with mental illness. Emotional reactions to stigma stress as well as coping responses predicted largely negative outcomes. Trade-offs between different stress reactions may render them helpful for some, but harmful for other outcome domains. Predictors of stress appraisal and poor outcomes could be useful targets for interventions that aim to reduce the impact of stigma on people with mental illness.