Anxiety Specific Mental Health Stigma and Help-Seeking in Adolescent Males

Abstract

Objectives

Stigmatising attitudes towards mental illness are an established barrier to help-seeking in adolescent males with anxiety. This study aimed to investigate specific forms of personal mental health stigma elicited in response to vignettes of individuals with clinical and non-clinical symptoms of anxiety within a sample of Australian adolescent males. The relationship between stigma and mental health help seeking was also investigated.

Methods

Seven hundred and two males (aged 12–18 years) completed a vignette-based mental health literacy survey and measures of help-seeking attitudes, intentions and behaviour online. Open-response items were coded for frequency, intensity and form of stigma.

Results

A larger percentage of participants exhibited stigma in response to the non-clinical vignette than in response to the non-clinical vignettes. Stigmatising comments towards the non-clinical vignette were also found to be more severe than towards the clinical vignettes. When stigma occured, it was predominantly related to a belief that a mental disorder was due to a personal weakness. Individuals who used stigmatising comments were also more likely to have negative views towards help-seeking. Yet individuals who made stigmatising comments about a peer with clinical social anxiety were more likely to have previously sought mental health help.

Conclusions

It is uncommon for adolescent males to hold stigmatising views towards other adolescent males with clinical levels of anxiety. More severe stigma is evident in response to experiences of normative levels of anxiety in response to an event which would typically be considered mildly anxiety-provoking (leaving home to go to university). Implications for youth mental health initiatives targeting help-seeking for anxiety in adolescent males are discussed.

Appendices

Appendix A: Study Vignettes

Craig

Craig is 18 and about to leave home to go to university. He likes the university he is going to and thinks his course (computer software design) will be interesting. However, Craig is worried about what it will be like to leave home and look after himself. He is also concerned about whether he will make new friends and like the people he will be living with. He is starting to think he may have chosen one a bit too far away from home (around 8-h drive).

Jack

Jack is 16. He gets very worried about saying or doing something stupid in front of other people and this worry interferes with him going to school and seeing friends. To make sure that he sounds interesting, Jack will look up interesting things to say on the internet before going to school and avoids conversations with what he considers to be ‘interesting and popular’ kids in case he doesn’t know what to say. He worries that if people notice that he is anxious when talking to them then they will think he is stupid and odd. Jack has noticed that he gets really red when he worries and so to keep himself cool he will only ever wear a thin t-shirt or shirt (even in winter). He always carries a bottle of water with him and splashes his face with water several times a day. Jack finds all this worrying about looking stupid really tiring and time-consuming. The worries stop Jack from doing things that he likes to do, such as basketball, as he fears someone will talk to him or he will go red. Jack wishes he was more like his friends who don’t seem to get as worried about things.

Tony

Tony is 12. Everyone describes him as a ‘worrier’. Tony is particularly worried at the moment because he has a piano grade exam which he thinks he is likely to fail, even though his piano teacher tells him that he is very good and ready to take the exam. Tony will often say he had difficulties sleeping and sometimes gets headaches. He worries about things happening to his parents, his friends at school being cross with him and what will happen to the environment if people don’t do more about climate change.

Appendix B: Stigma Coding Framework

Craig (Non-Clinical Anxiety)

Presence–absence of stigma

0—Absence of stigma

1—Presence of stigma

NOTE: Craig is a non-clinical vignette so any comments where it is suggested that he is worrying is excessive should be coded as 1.

Stigma severity

0—No stigma—no evidence of stigmatizing views towards the individual in the vignette

1—Mild stigma—mild or potential negative evaluation e.g. ‘gets worried easily’, ‘worrying too much’ ‘overthinking’ ‘take a chill pill’

2—Moderate stigma—implicit indication of negative evaluation through indicating that the subject should behave differently or is failing to live up to standards e.g. ‘He has no friends’, ‘He has no resilience’ or ‘He has social issues’

3—Significant stigma—explicit negative language about subject, clear negative evaluation but none or very mild pejorative language e.g. ‘He needs to toughen up’, ‘Mentally weak’, ‘he can’t look after himself’

4—Extreme stigma—explicit negative language about subject, clear negative evaluation with pejorative language e.g. ‘, ‘He shouldn’t be so girly’, ‘He’s weird’, ‘he’s a sook’

Form of stigma

1—Social distance stigma (a desire to maintain distance from the stigmatized individual)

2—Dangerous/unpredictable stigma (a belief that the individual is dangerous)

3—Weak not sick stigma (a belief that a mental disorder is due to a personal weakness rather than an illness)—form 1—stigma that relates to a sense that a change is within the individuals control e.g. ‘needs to toughen up’, ‘doesn’t wasn’t to grow up’

4—Weak not sick stigma (a belief that a mental disorder is due to a personal weakness rather than an illness)—form 2—stigma that relates to a sense that the individual is somehow defective or change may not be in their control or straightforward e.g. ‘he is homesick easily’, ‘he can’t look after himself’, ‘mentally weak’

5—Other—form of stigma not clear or able to be coded

Jack (Social Anxiety Disorder)

Presence–absence of stigma

• 0—Absence of stigma

• 1—Presence of stigma

NOTE: Jack and Tony are clinical vignettes so any comments where it is suggested that the participants are worrying excessively would not be coded as 1. However please code items which have a negative connotation as a result of severity: ‘extremely insecure’, ‘over- reacting’, ‘scared of everything’.

Stigma Severity

0—No stigma—no evidence of stigmatizing views towards the individual in the vignette

1—Mild stigma—mild or potential negative evaluation e.g. ‘take a chill pill’

2—Moderate stigma—implicit indication of negative evaluation through indicating that the subject should behave differently or is failing to live up to standards

3—Significant stigma—explicit negative language about subject, clear negative evaluation but no or very mild pejorative language e.g. ‘He needs to toughen up’, ‘Mentally weak, ‘he can’t look after himself’

4—Extreme stigma—explicit negative language about subject, clear negative evaluation with pejorative language e.g. ‘He shouldn’t be so girly’, ‘He’s weird’, ‘he’s a sook’

NOTE: Unfounded assumptions by participants relating to social skills (e.g. ‘he makes a bad impression’, ‘he has social issues’ or he doesn’t fit in) should be coded as 2.

Form of stigma

1—Social distance stigma (a desire to maintain distance from the stigmatized individual)

2—Dangerous/unpredictable stigma (a belief that the individual is dangerous)

3—Weak not sick stigma (a belief that a mental disorder is due to a personal weakness rather than an illness)—form 1—stigma that relates to a sense that a change is within the individuals control e.g. ‘needs to toughen up’ or ‘doesn’t wasn’t to grow up’

4—Weak not sick stigma (a belief that a mental disorder is due to a personal weakness rather than an illness)—form 2—stigma that relates to a sense that the individual is somehow defective or change may not be in their control or straightforward e.g. ‘he is homesick easily’, ‘he can’t look after himself’, ‘mentally weak’

5—Other—form of stigma not clear or able to be coded

Tony (GAD)

Presence–absence of stigma

• 0—Absence of stigma

• 1—Presence of stigma

Stigma Severity

0—No stigma—no evidence of stigmatizing views towards the individual in the vignette

1—Mild stigma—mild or potential negative evaluation e.g. ‘take a chill pill’

2—Moderate stigma—implicit indication of negative evaluation through indicating that the subject should behave differently or is failing to live up to standards

3—Significant stigma—explicit negative language about subject, clear negative evaluation but no or very mild pejorative language

4—Extreme stigma—explicit negative language about subject, clear negative evaluation with pejorative language

Form of stigma

1—Social distance stigma (a desire to maintain distance from the stigmatized individual)

2—Dangerous/unpredictable stigma (a belief that the individual is dangerous)

3—Weak not sick stigma (a belief that a mental disorder is due to a personal weakness rather than an illness)—form 1—stigma that relates to a sense that a change is within the individuals control e.g. ‘needs to toughen up’ or ‘doesn’t wasn’t to grow up’

4—Weak not sick stigma (a belief that a mental disorder is due to a personal weakness rather than an illness)—form 2—stigma that relates to a sense that the individual is somehow defective or change may not be in their control or straightforward e.g. ‘he is homesick easily’, ‘he can’t look after himself’, ‘mentally weak’.

5—Other—form of stigma not clear or able to be coded