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Stigma as a barrier to recognizing personal mental illness and seeking help: a prospective study among untreated persons with mental illness

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Abstract

It is unclear to what extent failure to recognize symptoms as potential sign of a mental illness is impeding service use, and how stigmatizing attitudes interfere with this process. In a prospective study, we followed a community sample of 188 currently untreated persons with mental illness (predominantly depression) over 6 months. We examined how lack of knowledge, prejudice and discrimination impacted on self-identification as having a mental illness, perceived need, intention to seek help, and help-seeking, both with respect to primary care (visiting a general practitioner, GP) and specialist care (seeing a mental health professional, MHP). 67% sought professional help within 6 months. Fully saturated path models accounting for baseline depressive symptoms, previous treatment experience, age and gender showed that self-identification predicted need (beta 0.32, p < 0.001), and need predicted intention (GP: beta 0.45, p < 0.001; MHP: beta 0.38, p < 0.001). Intention predicted service use with a MHP after 6 months (beta 0.31, p < 0.01; GP: beta 0.17, p = 0.093). More knowledge was associated with more self-identification (beta 0.21, p < 0.01), while support for discrimination was associated with lower self-identification (beta − 0.14, p < 0.05). Blaming persons with mental illness for their problem was associated with lower perceived need (beta − 0.16, p < 0.05). Our models explained 37% of the variance of seeking help with a MHP, and 33% of help-seeking with a GP. Recognizing one’s own mental illness and perceiving a need for help are impaired by lack of knowledge, prejudice, and discrimination. Self-identification is a relevant first step when seeking help for mental disorders.

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Funding

This work was supported by the Deutsche Forschungsgemeinschaft (DFG) (Grant-ID SCHO 1337/4-1 and SCHM 2683/4-1).

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Authors and Affiliations

  1. Department of Psychiatry, University Medicine Greifswald, Ellernholzstraße 2, 17475, Greifswald, Germany

    Georg Schomerus, Susanne Stolzenburg, Sven Speerforck & Deborah Janowitz

  2. Department Health and Prevention, University Greifswald, Greifswald, Germany

    Simone Freitag, Holger Muehlan & Silke Schmidt

  3. Personal Social Services Research Unit, London School of Economics and Political Science, London, UK

    Sara Evans-Lacko

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  1. Georg Schomerus
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  2. Susanne Stolzenburg
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Correspondence to Georg Schomerus.

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The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

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Schomerus, G., Stolzenburg, S., Freitag, S. et al. Stigma as a barrier to recognizing personal mental illness and seeking help: a prospective study among untreated persons with mental illness. Eur Arch Psychiatry Clin Neurosci 269, 469–479 (2019). https://doi.org/10.1007/s00406-018-0896-0

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