What is the impact of mental health-related stigma on help-seeking? Psychol Med. jan .2015

20.01.2015

Even in Europe and USA between 52-74% of those with mental disorders do not receive treatment. Some of these disorders  may be self-limiting or self-help responsive. At least for the severe disorders, we know that duration of untreated illness can lead to worse outcomes. Among those who receive treatment, poor adherence and disengagement from services are all too common. Stigma continue to play a big role in all these.

There are various forms of stigma.

1. Anticipated stigma: ( I am going to be seen by others or treated by others differently),

2. experienced stigma:(the personal experience of being perceived or treated unfairly);

3. Internalized stigma (holding stigmatizing views about oneself);

4. Perceived stigma:  (our  views about the extent to which people in general have stigmatizing attitudes/behaviour towards people with mental illness)

5. Endorsed stigma: (participants’ own stigmatizing attitudes/behaviour towards other people with mental illness)

6. Treatment stigma (the stigma associated with seeking or receiving treatment for mental illness)

It is common sense to think that stigma is a barrier to help seeking. Is stigma  a really significant factor in help seeking? what extent is it a barrier? what are the process behind such associations? Are there any particular group whom stigma prevents help seeking disproportionately?

S. Clement et al reports the results of the first systematic review of the impact of stigma on help seeking. Comprehensive search ( for articles until 2011) resulted in 144 studies being included in the analysis. 56 studies provided data on association between stigma and help-seeking, 44 on stigma-related barriers and 51 qualitative studies on processes underlying the stigma–help-seeking relationship.

Results

Majority of association studies reported statistically significant negative association between stigma and help seeking.Median effect size was −0.27,indicating a small effect size. Internalised stigma and treatment stigma were particularly prominent.

Disclosure and confidentiality concerns seem to be the most prominent type of barrier to help seeking. Stigma is a moderately important barrier, ranking fourth out of 10 barriers.

Stigma had a disproportionate effect on help-seeking on  those from Asian, Arabic, African American and other minority ethnic groups; young people; males; and those in military and health occupations

Internalized stigma is known as a mediator in a pathway from public stigma to health care avoidance. It is  important to see stigma as part of a larger network of beliefs and other constraints reducing help-seeking.

Comments:

Clinicians would want to discuss  about stigma with patients and carers and help them counter them on day-to-day basis. Avoiding labelling and respecting confidentiality are key factors.   Policies need to consider system wide issues of social rejection of individuals and marginalisation of mental health services. Various forms of discrimination and stereotyping of mentally ill need to be vigilantly opposed.

Summary of the article:

What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies.

Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, Morgan C, Rüsch N, Brown JS, Thornicroft G. Psychol Med. 2015 Jan;45(1):11-27

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