Stigmatization of mental health disorders leads to a decreased quality of life, missed opportunities, and lost independence for the affected individual. A new study reports that stigmatization also determines if and when people will seek mental health care for themselves.

A large population-based survey in Finland evaluated the stigmatizing attitudes about mental illness and the use of mental health services. The study used a questionnaire to explore participant’s beliefs about mental illness. They were asked to respond “yes” or “no” to a variety of statements, including “Depression is a sign of failure,” “Mental health problems are a sign of weakness and sensitivity,” and “Depression is not a real disorder.” Other questions reflected participant’s desire for social distance from others affected by mental illness, as well as attitudes toward antidepressant medication. Respondents also reported their own experiences with depression. In total, nearly 5200 people aged 15 to 80 years old completed the survey.

Stigma is a complex concept that can be divided into three main categories: perceived public stigma (the general belief that people with mental illness are stigmatized by society), personal stigma (an individual belief about mental illness), and self-stigma (an individual’s view of his own mental illness). These attitudes and beliefs are closely related to people’s knowledge and education about mental health and treatments and services for mental illnesses.

Overall, people with depression reported more social tolerance of mental illness and held more positive beliefs about antidepressant medications compared to people without depression. People with more severe depression were more likely to seek healthcare compared to those with mild to moderate cases of depression. The study showed that stigmatizing attitudes do not prevent care-seeking behavior among people with depression, but the depression must be severe enough to overcome the social and self-stigmatization.

Throughout industrialized nations, only one-third of people with major depression seek help, and many who do seek help discontinue treatment prematurely. Factors such as age, gender, education, income, insurance, and availability of services influence the decision to seek treatment, but these qualities do not fully explain care-seeking attitudes. The costs and benefits of treatment impact this decision, and stigma is a substantial cost to many people.

Stigma is not isolated to depression, but has been studied across many populations and many diagnoses: young and old, military and civilian, urban and rural, and even among healthcare professionals themselves. Like mental illness, stigma does not discriminate. Multidimensional efforts may be needed to overcome mental illness stigma, including changes in legislation, alterations in media depictions of mental illness, inclusion of family-based treatment programs, and improved public education.

The good news to come out of the current study is that stigma does not prevent people from seeking help for their own mental illness. The disheartening news, though, is that the illness must be severe before most will seek treatment.  No one would wait until his cancer or cardiovascular disease was “severe” before seeking care or initiating treatment. When will mental illness be viewed the same way?

References

Aromaa E, Tolvanen A, Tuulari J, & Wahlbeck K (2011). Personal stigma and use of mental health services among people with depression in a general population in Finland. BMC psychiatry, 11 PMID: 21453504

Hinshaw SP, & Stier A (2008). Stigma as related to mental disorders. Annual review of clinical psychology, 4, 367-93 PMID: 17716044

Horsfall J, Cleary M, & Hunt GE (2010). Stigma in mental health: clients and professionals. Issues in mental health nursing, 31 (7), 450-5 PMID: 20521914

Jones AR, Cook TM, & Wang J (2011). Rural-urban differences in stigma against depression and agreement with health professionals about treatment. Journal of affective disorders PMID: 21665289

Kim PY, Thomas JL, Wilk JE, Castro CA, & Hoge CW (2010). Stigma, barriers to care, and use of mental health services among active duty and National Guard soldiers after combat. Psychiatric services (Washington, D.C.), 61 (6), 582-8 PMID: 20513681

Yap MB, & Jorm AF (2011). The influence of stigma on first aid actions taken by young people for mental health problems in a close friend or family member: Findings from an Australian national survey of youth. Journal of affective disorders PMID: 21658776