Self-stigma as a mediator between social capital and empowerment among people with major depressive disorder in Europe: the ASPEN study

M Lanfredi, S Zoppei, C Ferrari, C Bonetto, T Van Bortel, G Thornicroft, L Knifton, N Quinn, G Rossi, A Lasalvia, The ASPEN Study group

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Individual social capital has been recognized as having an important role for health and well-being. We tested the hypothesis that poor social capital increases internalized stigma and, in turn, can reduce empowerment among people with major depressive disorder (MDD).  This is a cross-sectional multisite study conducted on a sample of 516 people with MDD in 19 European countries. Structural Equation Models were developed to examine the direct and indirect effects of self-stigma and social capital on empowerment.  Social capital and self-stigma accounted for 56% of the variability in empowerment. Higher social capital was related to lower self-stigma (r=-0.72, P<0.001) which, in turn, partially mediated the relationship between social capital and empowerment (r=0.38, P<0.001).  Social capital plays a key role in the appraisal of empowerment, both directly and through the indirect effect mediated by self-stigma. In order to improve empowerment of people with MDD, we identify strategies to foster individual social capital, and to overcome the negative consequences related to self-stigma for attainment of life goals.

Original languageEnglish
Pages (from-to)58-64
Number of pages7
JournalEuropean Psychiatry : the Journal of the Association of European Psychiatrists
Issue number1
Early online date29 Aug 2014
Publication statusPublished - 1 Jan 2015


  • self-stigma
  • social capital
  • depression
  • empowerment

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