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

Mariangela Lanfredi*, Silvia Zoppei, C. Ferrari, Chiara Bonetto, Tine Van Bortel, Graham Thornicroft, Lee Knifton, Neil Quinn, Giuseppe Rossi, Antonio Lasalvia, Samantha Treacy, Elaine Brohan, Shuntaro Ando, Diana Rose, Kristian Wahlbeck, Esa Aromaa, Johanna Nordmyr, Fredrica Nyqvist, Carolina Herberts, Oliver LewisJasna Russo, Dorottya Karsay, Rea Maglajlic, Doriana Cristofalo, Isabella Goldie, Norman Sartorius, Chantal Van Audenhove, Gert Scheerder, Else Tambuyzer, Valentina Hristakeva, Dimitar Germanov, Jean Luc Roelandt, Simon Vasseur Bacle, Nicolas Daumerie, Aude Caria, Harald Zaske, Wolfgang Gaebel, Marina Economou, Eleni Louki, Lily Peppou, Klio Geroulanou, Judit Harangozo, Julia Sebes, Gabor Csukly, Laura Pedrini, Arunas Germanavicius, Natalja Markovskaja, Vytis Valantinas, Jaap van Weeghel, Jenny Boumans, Eleonoor Willemsen, Annette Plooy, Teresa Duarte, Fatima Jorge Monteiro, Janka Hurova, Dita Leczova, Vesna Svab, Nina Konecnik, Alp Ucok, Gulsah Karaday

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


Introduction: 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). Materials and methods: 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. Results: 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). Conclusions: 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
Issue number1
Publication statusPublished - 1 Jan 2015


  • Depression
  • Empowerment
  • Self-stigma
  • Social capital


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