(PS9-99) Who am I? Mental health identity and treatment progress

Abstract Text: Mental health identity is the concept of holding mental health as a central feature of one’s sense of self. Some research has shown that socially identifying with your mental health is associated with help-seeking (Klik et al., 2019), whereas holding stigmatizing self-views related to one’s mental health identity is associated with lower self-esteem, lower self-efficacy, and more depressive symptoms (Marcussen et al., 2019). Overall, mental health identity is understudied, and it is not clear whether it may aid or deter treatment outcomes. In this study, we examined mental health identity in a recent clinical trial of both cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). Participants met separate symptom and diagnostic eligibility criteria for each clinic, with 40 participating in CBT and 50 in DBT. All analyses collapse across clinics because we found no significant difference by clinic in mental health identity at intake or week 12. Mental health identity was assessed with a novel measure that assesses the centrality of one’s mental health in their identity. First, we examined correlates of mental health identity and found that age (r =- .23), disproportionality of emotional reactions (r = .41), and three personality traits – antagonism (r = .29), disinhibition (r = .29), psychoticism (r = .33) – were all significantly correlated with mental health identity. A paired t-test on mental health identity at intake and week 12 revealed significant decreases over treatment (t (68) = 3.98, p = .0002, d =.39). Mental health identity predicted early change in anxiety symptoms (from intake to week 4) (β = .27, p = .003) and change in anxiety over 12 weeks of treatment (β =.29, p =.01). The relationships remained significant when controlling for clinic. Furthermore, change in mental health identity was associated with concurrent change in anxiety symptoms across treatment (β = .26, p = .03). Parallel analyses of depressive symptoms showed mental health identity change was only related to early change in depressive symptoms (β =.28, p = .035), but this was no longer significant when controlling for clinic. Thus, mental health identity appears to have a unique effect on anxiety throughout treatment. This provides preliminary evidence that mental health identity impacts treatment outcomes and may be an important target in treatment.