The impact of illness identity on recovery from severe mental illness: A review of the evidence

Psychiatry Res. 2020 Jun:288:112950. doi: 10.1016/j.psychres.2020.112950. Epub 2020 Apr 5.

Abstract

The "Illness Identity" model proposed that self-stigma impacts hope and self-esteem and subsequently leads to a cascade of negative effects on outcomes related to recovery among people diagnosed with severe mental illnesses. The purpose of the present review is to take stock of research support for the model. The citation index SCOPUS was reviewed for all papers published in peer-reviewed journals in English between 2010 and 2019 citing one of the initial 3 articles discussing the model: 111 studies met inclusion criteria and were reviewed. The most frequently tested, and supported, aspects of the model were relationships between self-stigma and self-esteem, hope, psychiatric symptoms and social relationships. Least frequently studied areas were relationships with suicide, avoidant coping, treatment adherence and vocational functioning, although they were supported in the majority of studies. The "insight paradox" was also tested in a relatively small number of studies, with mixed results. Findings were robust to geographic location of study, method, and subpopulation studied. Findings indicate that a large body of research has tested, and largely supported, the various components of the Illness Identity model, although some components need further investigation and there is a need for more comprehensive tests of the model.

Keywords: Identity; Insight; Recovery; Self-stigma.

Publication types

  • Review

MeSH terms

  • Cross-Sectional Studies
  • Hope / physiology
  • Humans
  • Mental Disorders / diagnosis
  • Mental Disorders / psychology*
  • Prospective Studies
  • Recovery of Function* / physiology
  • Self Concept*
  • Severity of Illness Index*
  • Social Stigma*