Stigma Influences Seeking Mental Health Care




Man in shadow

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

  • Harold A Maio

    Like mental illness, stigma does not discriminate.

    You err, claiming a stigma is an act of discrimination.

    Harold A. Maio, retired Mental Health Editor

    khmaio@earthlink.net

  • jane

    I still feel that there sometimes is still a stigma with depression – especially with older people. They don’t want to talk about it or discuss anyone else’s issues…just my personal observation!

  • Harold A Maio

    I am 74, have had depression most of my life. Talk about it every day.

    Never have more people talked about it. Prejudice? Rarer now than ever.

    Harold A. Maio, retired Mental Health Editor

    khmaio@earthlink.net

  • MIchelle

    Depression can truly bring a person into the ‘brink’ of sanity. If you always feel gloomy, you don’t find happiness in just about anything. This can be really scary for people surrounding you.

    • Harold A Maio

      You describe depression accurately. It can scare. I make no efforts to hide my depression from people I love. When it is intense, they need to know.

      They know how much it hurts, and what I have to do to address it.

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  • http://www.cchrflorida.org Jill Reichel

    Depression seems to be a common “condition”.
    It can be caused by various reasons.
    I would like to see more people be more informed of all treatments and causes of depression before they make a decision on how to treat their depression.

    Medication is not the only answer. Medications can be dangerous. There can be an underlying phyiscal condition causing the depression.

    One needs to go down all the avenues before making a decision on what should be done.

    • Harold A Maio

      Depression: I wonder why we are not aware, who made that choice for us? Imposed it upon us?

      In very real ways it relates to what we did not know about women, until women empowered themselves to insist we know. Forced education to tell us.

      We directed the word “stigma” at women who survived sexual assault, out of rote habit if not malice. Rarely was it malice. Now we train ourselves to direct that identical prejudice against someone else.

      We are fickle, we humans, empowerment often ends with the empowered.

      Harold A. Maio
      khmaio@earthlink.net

  • Gdarks

    Depression is a common diagnosis and most people would know someone affected. Other mental health conditions, not so much. It also doesn’t seem to get negative press. Would be interested to see a comparative study regarding attitudes to other psychological conditions and treatment sought. Think anxiety, OCD, dissociative disorders, bipolar / mood disorders, schizophrenia. Schizophrenia especially seems poorly understood in general public from what I hear. I would expect stigma might affect treatment seeking much more with less well known diagnoses than depression.

  • Sky Rodriguz

    I suffer from bipolar disoreder and although peoples views towards that havent been too negative; people are very confused on what bipolar disored is and often mistaken it for depression but there is more to it. However i had a eating disoreder when i was younger and the prejudice surrounding that was hugly negative; with people calling you an attention seeker and why don’t you just eat; not one of them understanding the compplexities behind it.
    We give education in school so why don’t we include mental health in that as well. I agree awareness is getting better thanks to the advertisng around now days for example the recent TV ad. To say the negativity doesn’t exist anymore wouldn’t be true but peoples knowledge in certaiin areas of mental health are getting better.

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  • GP Perth

    This is a very interesting topic. It is nice how you write facts about stigma.

  • http://www.spectrumpsychiatry.com/ Treatment for mental illness

    Depression is a state of mind, and it’s not an disorder, mainly happens to sensitive people.

    • T.A.

      “Depression is a state of mind, and it’s not an(sic) disorder, mainly happens to sensitive people.”

      As someone who has struggled with depression for many years, I find your statement offensive, stigmatizing, and one of ignorance! I would never wish what I’ve experienced with this illness on anyone.

  • keith ruthanum

    it is interesting to note that the actual labelling of the diagnosis is promoting the stigma associated with mental illness. so is it that important to diagnose and attach labels rather than just treat the actual problems that the person poresents with.

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Jennifer Gibson, PharmD

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.
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