Anxiety and depression are stigmatised conditions. Stigma is the perception of an individual or group as undesirable or abnormal because of a particular trait – in this case, having depression or anxiety. Stigma can be divided into stereotypes (negative beliefs about the stigmatised group), prejudice (negative feelings about the stigmatised group) and discrimination (behaviour that excludes or marginalises people from the stigmatised group) (Corrigan & Kleinlein, 2005). It is broadly acknowledged that several types of stigma manifest at different levels of society and are experienced in different ways (Jones & Corrigan, 2014). Public stigma refers to negative ideas the public hold and enact toward the stigmatised group and is conceptualised on a broad community or cultural level (Jones & Corrigan, 2014). Experienced stigma refers to the stigma individuals within a stigmatised group are exposed to in their daily lives (e.g., in the words or actions of others or through the media) (Jones & Corrigan, 2014). Perceived stigma refers to an individual’s beliefs about the content and volume of the public stigma in their community (Pescosolido & Martin, 2015). Both experienced stigma and perceived stigma are conceptualised on an individual (personal) level (Pescosolido & Martin, 2015).

For people with anxiety and depression, experiences of stigma are associated with a range of adverse outcomes, including increased symptom severity, feelings of shame, limitations in work and daily activities, reduced help-seeking, and poorer quality of life (Curcio & Corboy, 2019; Ferrie et al., 2020; Parcesepe & Cabassa, 2013; Pescosolido, 2013; Thornicroft et al., 2022). Prior literature indicates that some of these consequences, and other negative outcomes, are a result of self-stigma, which is the internalisation of stigmatising ideas by individuals within the stigmatised group (Corrigan & Watson, 2002; Rüsch et al., 2005). Unfortunately, increased public awareness of mental health disorders in recent decades has not translated into increased social acceptance of people with these conditions, indicating that ongoing research is required to understand stigma experiences better and identify new ways to mitigate their impact (Parcesepe & Cabassa, 2013; Schomerus et al., 2012; Thornicroft et al., 2022).

The presence of public stigma toward children, adolescents and adults with mental health disorders is highly prevalent around the world, as documented in several large population studies and systematic reviews (Kaushik et al., 2016; O’Driscoll et al., 2012; Pescosolido et al., 1999; Reavley & Jorm, 2011; Seeman et al., 2016). Young people may be particularly vulnerable to the negative consequences of stigma because the developmental period of adolescence is focused on identify formation, making them more sensitive to negative perceptions (Heary et al., 2017; Hinshaw, 2005). Very little existing literature focuses on the stigma experiences of adolescents. Since 75% of lifetime mental health disorders emerge in adolescence, it is crucial that we examine their experiences of stigma as a potential pathway for mitigating the impact of these conditions (Erskine et al., 2015; Lee et al., 2014). Defining adolescence is a longstanding challenge for the psychological literature (Sawyer et al., 2018). We have used an expanded definition of adolescence (10–24) aligned with modern academic understanding of brain and social development (Sawyer et al., 2018). This definition overlaps with definitions of ‘youth’ and ‘young people’ in the literature, so these terms are used interchangeably hereafter, and ages are defined where necessary.

Mental health disorders are the leading cause of disability in children and young people globally (Erskine et al., 2015; Jones, 2013; Kessler et al., 2007; Vigo et al., 2016), with anxiety and depression being the most common of these conditions (Chiu et al., 2016; Lawrence et al., 2015; Polanczyk et al., 2015; Silva et al., 2020; Whiteford et al., 2013). Despite long-term investments in improving intervention and access to treatment, the prevalence and burden of these conditions have remained largely unchanged (Das et al., 2016; Kassebaum et al., 2017; McGorry et al., 2014). Considering the documented negative outcomes associated with public stigma in adults with anxiety and depression, understanding how young people with these conditions experience and perceive stigma may be crucial to reducing the burden of disease (Kaushik et al., 2016). We focused on young people with depression and anxiety disorders specifically because these conditions typically emerge in this period and are among the most common mental health disorders affecting this age group (Lawrence et al., 2015; Polanczyk et al., 2015; Silva et al., 2020; Whiteford et al., 2013). Further, the high comorbidity and relatedness of these conditions in young people mean that capturing depression or anxiety disorders as distinct entities in this population would be impracticable and unlikely to be a good representation of the lived experience of these conditions (Cummings et al., 2014). Finally, grouping anxiety and depression makes theoretical sense when investigating stigma because the content of stigmatising ideas about these conditions overlaps in many areas (e.g., the idea that people with depression and anxiety should be able to control their conditions) (Berjot & Gillet, 2011).

Several stigmatising ideas about people with anxiety and depression have been documented in adult public stigma literature. ‘Weak-not-sick’ ideas are commonly attributed to people with anxiety and depressive disorders, holding that these conditions reflect a personal weakness rather than a legitimate problem (Curcio & Corboy, 2019; Parcesepe & Cabassa, 2013; Pescosolido, 2013). Other stigmatising ideas that have been identified include that they are to blame for their conditions, are unpredictable, dangerous, undesirable to interact with, and best avoided (Curcio & Corboy, 2019; Reavley & Jorm, 2011). These ideas have been identified in studies of the general population’s perspectives about adults with anxiety and depression and identified by adults with these conditions when asked about their stigmatising experiences (Curcio & Corboy, 2019; Parcesepe & Cabassa, 2013; Pescosolido, 2013; Reavley & Jorm, 2011).

Currently, there is limited literature examining whether the content of stigma about adolescents with anxiety and depression mirrors this. One systematic review investigating all mental health disorders in children and adolescents concluded that public stigma was “significant, universal and multifaceted” (Kaushik et al., 2016, p. 491) and found preliminary evidence that stigma themes present in adult populations (ideas of blame, responsibility, dangerousness and the desire for social distance) were also relevant to children and adolescents. However, this review was not specifically about anxiety and depression, and there is limited literature about the stigma experienced by adolescents with these conditions specifically. A number of survey studies have indicated that the content of stigma held by young people is similar to that in adult populations in a range of samples (e.g., in the USA, Australia, South America and Ireland) (Beasley et al., 2020; Calear et al., 2011; Carmack et al., 2018; Dardas et al., 2017; Lynch et al., 2021; Martínez et al., 2020; Ross et al., 2020). These findings indicate that stigma is an ongoing problem for young people with anxiety and/or depression. However, these results are limited by their quantitative design and reliance on measures of stigma that were developed with adult samples.

Measures developed based on adult research do not necessarily translate well to adolescent populations for several reasons. Firstly, the social context of adolescents, having less power and status than adults, means that social ideas held about them related to mental health disorders may be different; for example, more paternalistic (Heary et al., 2017; Hinshaw, 2005). Secondly, this developmental period’s unique social and cognitive features mean adolescents may understand and experience stigma and its consequences differently from their adult counterparts (Heary et al., 2017; Hinshaw, 2005). For example, as identity development is a hallmark of adolescence, young people may be particularly sensitive to stigma as it threatens their emerging sense of self (Heary et al., 2017; Kroger, 2006). Further, young people may be more sensitive to stigma as an indicator of peer group rejection (which itself is associated with a range of negative outcomes) due to the importance of peer groups for social and emotional development in this period (Rubin et al., 2015). This means that academic understanding of the extent and content of public stigma experienced by young people with anxiety and depression is restricted because young people have not been written into the measures used to study their lives.

The result may be that we are missing crucial elements of adolescents’ stigma experiences or needlessly including harmful stigmatising ideas that they have not previously been exposed to. The low and inadequate internal consistency found in applications of a commonly used stigma measure (the personal stigma subscale of the Depression Stigma Scale) across several of the aforementioned studies (e.g., Calear et al., 2011; Dardas et al., 2017; Martínez et al., 2020), provides some preliminary quantitative evidence that using adult measures to quantify stigma in adolescents limits the validity and reliability of research in this area (Martínez et al., 2020). Qualitative research that centres the experiences and perceptions of young people is crucial to address this challenge as it provides an opportunity to develop foundational knowledge that can be translated into quantitative measures in future.

Two prior qualitative studies have been conducted in this area, but only one focused on the experiences of young people with mental health problems (Moses, 2009); the other utilised a general adolescent sample (Hanlon and Lorraine, 2019). The results of Moses (2009) indicated that, consistent with adult literature, young people with mental health disorders experience stigma that depicts them as weak, to blame for their condition, and dangerous. However, these results are limited by the nature of the sample interviewed. The sample of adolescents in a “high-care setting” with “severe emotional disturbance” is not understood to be a representative sample of adolescents with anxiety and depression. This is because the ambiguity around their diagnosis and their placement in a high-care service indicates that they represent a more severely affected and likely clinically complex subset of the population. This study provides some preliminary evidence that similar stigmatising ideas are applied to young people and adults with mental health disorders. However, research must be extended to increase these findings’ generalisability and capture the broader experiences of stigma in young people with mental health disorders. Further, given the changing awareness of mental health problems in the context of current world events, especially of anxiety and depression, this needs to be done in a contemporary sample.

To improve knowledge and understanding of stigma directed towards adolescents with anxiety and depression, there is a clear need to examine this topic from the perspective of the young people affected. We focused on addressing this gap by conducting a qualitative analysis of semi-structured interviews with young people with anxiety and/or depression. It directly asked young people with anxiety and depression in the community about their experiences of stigma and self-stigma. This improves our understanding of adolescent stigma experiences and creates opportunities to develop valid and reliable measures that reflect current-day stigma ideas to ensure that future research is a more accurate reflection of contemporary lived experiences (Silke et al., 2016).

Aims

We aimed to qualitatively describe the stigma experiences of contemporary young Australians with anxiety and depression. We divided the focus of this study into two key areas. Firstly, we aimed to describe how stigma is experienced phenomenologically in this population (e.g., how it is expressed to and impacts participants). Secondly, we aimed to identify the content of the stigma experienced by these populations, describing the messages and ideas they received about themselves because of their anxiety and depression. To do this, we used a thematic analysis of interviews with adolescents who have a primary diagnosis of anxiety and/or depression.

Method

Participants

A convenience sample of 13 young Australians (8 females, 4 males, 1 non-binary person; aged 16–24 years, mean age = 20.23) with a primary self-reported diagnosis of depression (n = 8) or an anxiety disorder (n = 5) participated in this study. Five reported being diagnosed with both depression and anxiety (i.e., listing one as their secondary diagnosis). This sample size was sufficient to meet Braun and Clarke’s (2006; 2013) recommendations for a medium-sized study using the reflexive thematic analytic method. Other secondary diagnoses were attention deficit hyperactivity disorder (n = 2), obsessive-compulsive disorder (n = 1), anorexia (n = 1), and schizophrenia (currently well-treated) (n = 1).

Participants were presented with an open answer box where they could identify their cultural identity if desired. Five participants identified as Caucasian, one as Indian and seven elected not to answer. Most participants (n = 12) described living in or around Australian capital cities except for one participant who disclosed living in a regional centre.

Procedure

Ethics approval for this study was provided by the University of Western Australia Human Research Ethics office (approval number 2020/ET000199). Morrow’s (2005) guidelines for trustworthiness were used in the design and writing of this study and are integrated throughout this section. We consulted a Youth Reference Group (YRG) of young people (n = 4) with depression and/or an anxiety disorder to ensure the design of this study and the interview questions were relevant and suitable for this age group, respectful, and sensitive to their language and experiences (Brett et al., 2014). The reference group was recruited from a mailing list of young people who had expressed interest in being involved in research at Telethon Kids Institute. The reference group met for an hour to review; several changes to proposed procedure (e.g., using Zoom software for interviews) and the interview (e.g., rewording question prompts) were made according to their suggestions.

We recruited participants from the community using flyers distributed on social media platforms (e.g., Facebook, Twitter) and placed in psychologist’s offices and public facilities. Participants were remunerated for their time with a $35 gift card. All participants provided consent to participate and have their interview recorded before being redirected to the online screening survey. Participants under 18 also required parent or guardian consent.

Interviews were conducted by the first author, individually online (via Zoom software) using a semi-structured interview schedule (taking place from June to August 2021). Questions designed to investigate stigma experiences included “Do you know of any negative ideas, attitudes, or behaviours towards people with anxiety/depression?” (and if so, participants were asked to describe them). In this way, participants were free to express that stigma was not something that they were aware of, but then could expand in an open-ended discussion if there were aware. Each question had accompanying prompts that could be used to rephrase questions where required to capture participant experiences. For example, “Do your friends (/family) have any negative ideas about Anxiety/Depression?”. Although all participants demonstrated a prior understanding of stigma, prompts were used in most interviews to encourage participants to elaborate on shorter answers.

We chose to interview using videoconferencing based on the recommendation of the YRG and considering COVID-19 restrictions. The interviews ranged from 36 min to 1 h and 5 min. Interviews were voice recorded and transcribed. Transcripts included notes about tone, pauses, intonation and conversational rhythm. Transcripts were checked by the interviewer (first author) for accuracy. Field notes were also taken during the interviews by the first author to provide further context to transcripts (e.g. tone, emphasis on particular points and researcher impressions).

Data Analysis

QSR NVivo software was used during analysis. Qualitative data was primarily analysed by the first author (M.A.), a female clinical psychology trainee. She has clinical and research experience working with young people with anxiety and depression and lived experience of adolescent anxiety and depression, stigma, and self-stigma. The other authors contributed to theme refinement, and include A.F.J, D.B. and, J.O.; the final author (J.O.), is a female clinical psychologist and academic with expertise in child and youth mental health and stigma. We noted that this context and background could not be removed from the process of data analysis and therefore used Braun and Clarke’s reflexive thematic analysis approach which holds that such experiences can be a resource in analysis (Braun & Clarke, 2006; Braun et al., 2019).

An inductive thematic analysis was deemed the most appropriate research method given the dearth of literature in this area (Braun & Clarke, 2006; Creswell, 2017). The theoretical framework for the analysis was decided beforehand (Braun & Clarke, 2006). A critical-realist perspective was taken, assuming that some reality of stigma exists and that representations of this are mediated by social factors, such as language and understanding (Nightingale & Cromby, 1999). Codes and themes were primarily identified at the semantic level to match this theoretical orientation, and because the research question was interested in the explicitly stated ways young people experience stigma rather than underlying subtext, discourse or assumptions (Braun & Clarke, 2006; Braun et al., 2019). A literature review was conducted before analysis, such that researchers were aware of any concepts in the data that could remain undetected if not understood prior (Braun & Clarke, 2006; Braun et al., 2019).

Braun and Clarke’s six-phase approach to thematic analysis was used in a non-linear and reflexive fashion (as recommended; (Braun et al., 2019)). The analysis was primarily performed by the first author (M.A). First, the first author (who conducted all interviews) gained familiarity with the data by reading all transcripts and making preliminary notes. Second, initial coding was performed by going through each transcript in turn, which was checked with the broader research team at meetings to ensure that codes were descriptive and suitable. Codes reflected participants’ perspectives on stigma and were made as descriptive as possible. During team meetings, excerpts that were assigned to codes were checked by the research team.

A reflexive journal was kept throughout the interviews and analysis. Where relevant these journal entries were linked to relevant passages of transcripts using NVivo software for team discussion. Further, the research team met on a regular basis to discuss coding and potential biases. If doubt about codes or discrepancies were raised in these discussions, the team would revisit longer passages of text that surrounded ideas in doubt, or, in some cases, recode all interviews with this query in mind, until agreement was reached about interpretation. Following this, the first author organised codes into provisional themes. Provisional themes were revised in discussions with all authors and using thematic maps to ensure each had a central organising concept, was supported by sufficient data, worked well in relation to the entire dataset, and did not overlap significantly with other themes (Braun et al., 2019). Finally, themes were named and defined.

To ensure the validity and reliability of the thematic construction all authors met regularly throughout the process (familiarisation, coding, thematic construction, and report production) to review the interpretive and methodological rigour of the analysis (M.A., A.F.J., D.B. and, J.O.). Participants were referred to by pseudonyms (see Table 1) that are also used in this report to maintain their anonymity (Kaiser, 2009).

Table 1 Participant pseudonyms and basic demographic information
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Results

Thematic analysis of the interviews resulted in an understanding of the way young people with anxiety and/or depression disorders experience stigma, how they understand its content, and how stigma impacts them. The organisation and a brief overview of these themes can be seen in Fig. 1. Themes have been organised into features of the stigma experience (Theme 1- Stigma is Omnipresent), the content of stigmatising ideas (Theme 2- Denied, Minimised and Blamed, Theme 3- Less than Others and Theme 4- Social Undesirability) and finally, the impacts of stigma (Theme 5- Self-doubt and Internalisation and Theme 6- Withdrawal).

Fig. 1
figure 1

Overview of themes

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Theme 1- Stigma is Omnipresent

Participants described stigma as ubiquitous; it varied in how it was expressed, how it was perceived, and when it is experienced most intensely, but it was always present. For all participants, stigma was frequently encountered, “anyone and everyone has said something to me” (Maggie, 19, female). All participants were aware of multiple stigmatising ideas about their condition and had had several stigmatising experiences (of varied forms and intensities). Participants explained that, despite the changing social environment where public education about mental health disorders is understood as having increased, stigma was still relevant to, and impacted, their lives, “it’s almost changed in a way, it hasn’t lessened” (Phoebe, 22, female). Thus, the omnipresence of stigma for all the young people in this sample is an important context for understanding all themes, especially those related to the impact of stigma.

Secondly, participants described that stigma was expressed across a range of communication styles – such as through direct comments (e.g., “you’re faking it” (Jane, 22, female)), indirect comments (e.g., “my parents…told everyone I had glandular fever” (Maggie, 19, female)), and behaviour (e.g., having needs related to their mental health ignored by teachers “My parents came in and told him that I needed to be left alone because I used to have panic attacks if I was singled out…he stood me up in choir and made me sing…(then) he turned around and said ‘I don’t think it was very good at all.’“(Rachel, 21, female)). Participants described being aware of stigma’s presence even where it was unspoken e.g., “a lot of the stuff that has been said to me has not necessarily been pointed…It’s just the general idea people have” (Jack, 20, male) and when they felt it had been propagated through the media; e.g., “I guess in movies, they portray people with depression as like a really sad, down person…as if they’re lazy, they can’t do anything, they can’t get – can’t be bothered to get out of bed in the morning” (Harry, 17, male).

When asked about (a) what stigmatising ideas there were about people with their condition or (b) what stigma they had experienced, participants usually described both things interchangeably. This was because indirect expressions of stigma made it difficult, if not impossible, for participants to separate ‘experiencing stigma’ from ‘perceiving stigma’. Indirect messages served to undermine participants in subtle ways that blurred the distinction between if the stigmatising message was intended by the perpetrator or assumed by the participant, with most often then assuming it applied to themselves. It was difficult to find margins between participants’ descriptions of things people had said to them directly (“my grandparents said…” (Jane, 22, female)) and what they believed other people in general thought about their condition (“a lot of people I know imagine someone anxious to be…” (Rachel, 21, female)).

Theme 2: Denied, Minimised and Blamed- ‘It’s Not Real’

Participants described having their experiences of depression and anxiety denied (‘not real’) or minimised (‘not that bad’) by others. Some were told these things directly, such as, “(they’re told that) it’s not real in a sense- the way that they’re feeling is not real” (Steph, 20, female) and, “everyone has sad days but you’re just exaggerating” (Jane, 22, female). However, other participants inferred that this is what other people thought, such as when people said that their recovery was assured in a way that felt minimised, e.g., “you’re okay, you’ll get over it, you’ll be fine” (Taylor, 23, female) and “as a 14-year-old I was inpatient and they were telling me, ‘You’ll get over it’” (Maggie, 19, female).

Participants also described feeling that their experience was minimised when others inferred they could choose to feel or behave differently. This often implied that they were to blame or responsible for the problem in the first place, or the lack of being recovered. For example, messages such as, “Just be happy” (Tom, 24, male), “You just gotta go out and do something” (Harry, 17, male), “If you really wanted to get better you would just do this” (Maggie, 19, female), and “just cop it. And if you can’t, then that’s on you” (Will, 20, male) minimised the participant’s condition and symptoms, whilst holding the participant responsible for making a presumably simple change to recover, “you should be able to change it.” (Rachel, 21, female). Minimisation with an undercurrent of responsibility for having the problem in the first place was also felt when others said that they shouldn’t have their condition or feel a particular way because there was “nothing wrong with their life” (Steph, 20, female), and, “Your parents are still together, you live in (redacted), you can’t be that bad” (Maggie, 19, female). Further, where it was stated or insinuated that their condition or symptoms were not real, there was an implicit message that participants were to blame for making up or harping on something that was not real, “It’s just all in your head, you need to get over it” (Taylor, 23, female).

Of all the stigma themes identified in the analysis, ‘Denied, Minimised and Blamed’ was most frequently experienced directly; being verbalised to participants by parents, teachers, health professionals or (significantly less often) peers. For example, participants described being told things like “you’re exaggerating” (Jane, 22, female) and “snap out of it” (Tom, 24, male). However, ideas of denial, minimisation and blame were also inferred from less direct comments and behaviour of others or the media.

Subtheme: ‘Faking it’ for Secondary Gain

In many cases, an additional layer was added to denying the validity of the participant’s experience of their anxiety/depression through the suggestion that participants were ‘faking’ or exaggerating their condition for some secondary gain, such as to avoid homework, responsibilities, or consequences, “I had a psychiatrist say to me…when I couldn’t get out of bed, ‘you just don’t want to go to school’” (Maggie, 19, female), “They play it as if they’re lazy, they can’t do anything- can’t be bothered to get out of bed in the morning so they just sit at home” (Harry, 17, male), and, “This is just something that the millennials have created to excuse themselves for being lazy…not working and that sort of stuff” (Jane, 22, female). Others were accused of making up or exaggerating their symptoms to gain attention from others, “I was told that I was attention-seeking” (Verity, 18, female). Commonly, adults told participants that increases in mental health disorders were merely a ‘trend’ for young people or being used as a marker of identity or to ‘fit in’, e.g., “you’re just saying that you have anxiety because you’ve watched an interview and your favourite celebrity said that she was anxious sometimes, and now you wanna be like her” (Phoebe, 22, female).

Theme 3: Less than Others- ‘You’re Just Weaker’

Many participants described being told, or having it implied, that their anxiety or depression indicated that they were weak, fragile, or incompetent. This was explicitly stated to some participants, for example, “you’re not as resilient” (Jane, 22, female). In other cases, these ideas were expressed as evaluations of the young people’s competence or ability to succeed in various domains, often school, “in high school, they told me I should drop out because I wasn’t going to make it to graduation- that sort of thing” (Maggie, 19, female), and in their future in general, “I was sort of informed (that) I wasn’t going to be able to do well because I had this” (Jack, 20, male).

Ideas about weakness and capability were expressed subtly through behaviour that participants viewed as infantilising, “almost like a bit infantilised, you know, where they’re like treated just like, children almost” (Jack, 20, male) and “I have friends that will ask me, like five or six times a day, ‘are you alright?’, just like, if I wasn’t alright, I’d probably say something” (Harry, 17, male). Many described thinking that people were treading carefully around them due to ideas about their fragility, “I think people really think that they…(need to) step on eggshells around someone with a mental condition. They have an idea that the person may be super unstable around everything” (Alison, 21, female). Other participants couldn’t identify circumstances where they had been told they were less capable (or inferred this) but still had a sense that this is what people thought, “I think there is that belief that people are weaker if they do experience anxiety or depression- whether people want to admit it in those words or not” (Phoebe, 22, female).

Theme 4: Socially Undesirable

Young people with anxiety and depression felt that they were seen as socially undesirable, difficult, or burdensome. Assertions about being difficult or a burden implied to participants that they were disliked or undesirable in social settings or interactions, “they’re not normal, there’s something up with them” (Harry, 17, male) and “people with depression are loners” (Tom, 24, male). These ideas were more frequently inferred by participants through the behaviour of others than expressed to them directly. Where these messages were not directly stated, participants described getting a sense of them from having people distance themselves or exclude them, for example, “people kind of avoid them” (Alison, 21, female) and “I could see people actually talking about it behind my back” (Harry, 17, male).

Participants also described receiving the message that they were burdensome; “I just really struggle with this – me being a burden on people, because that’s the idea that has always come up” (Maggie, 19, female). The specific nature of this burden varied between participants with anxiety and depression. Participants with only depression, or who were speaking about depression specifically, described the idea that they were boring or depressing to be around, “just like a bit of a buzzkill or somebody that’s not fun to be around” (Tom, 24, male), and, “I was told that if I wasn’t happy I wasn’t allowed to come to a dance class because it affected other people” (Verity, 18, female). With respect to anxiety, participants described the idea that they were difficult due to being clingy, needy, or restless, “a lot of people I know imagine someone anxious to be in this constant state of scratching or fidgeting…(and) how they’re very clingy and that kind of stuff” (Rachel, 21, female).

Theme 5: Self-doubt and Internalisation

When discussing the ways they were impacted by stigma, all participants described questioning whether the stigmatising ideas they experienced (outlined in Themes 2–4) were true of themselves (self-doubt) or applying stigmatising ideas to themselves outright (internalisation). The content of their self-doubt and internalisation was consistent with the stigmatising ideas they described perceiving or having experienced in interactions with others and the world.

In some cases, participants described their experiences of self-doubt involving questioning whether stigmatising ideas that they heard applied to them. For example, one participant described responding to having their condition minimised by questioning whether their condition was real, “Is this real? Am I actually feeling this or am I just being dramatic like the people saying I am?” (Steph, 20, female). In other instances, participants described experiencing self-doubt when they accepted stigmatising ideas as true about themselves and then used those negative ideas as a framework for questioning themselves in other areas. For example, one participant described internalising the idea that symptoms were his fault and then said, “I’ll literally overplay that moment in my head a million times and play out all these different scenarios of how it could’ve happened and try and figure out what I could’ve done better to make me not feel like this” (Tom, 24, male). Another described internalising the idea that their depression was in their head and their fault, then doubting whether other things in their lives were real or their fault, “I just always think I’m making things up” and “I think everything is my fault” (Maggie, 19, female).

At other times, participants described accepting stigmatising ideas as true of themselves outright (internalisation). For example, one participant described not believing that their condition was legitimate at one point; “I don’t actually have depression I’m just trying to fake it for attention subconsciously” (Jack, 20, male). Another said, “Someone told me ‘It’s all in your head, you’re going crazy’- I believed it.” (Taylor, 23, female).

Theme 6: Withdrawal

Most participants (n = 10) described withdrawing from others. This withdrawal included distancing themselves from family and peers socially and avoiding help-seeking for their mental health difficulties.

Socially, participants described physically withdrawing or avoiding talking to others about their difficulties. This often followed on from their descriptions of self-doubting and internalising stigmatising ideas (e.g., “I am super anxious, which means I am like this (oversensitive) in a social setting, so maybe I just won’t go to the social setting” (Alison, 21, female)). In some cases, participants had heard stigmatising ideas from people around them and so withdrew from those people or avoided talking about their experiences with them. For example, “In the past when I was going through all of this, it stopped me from reaching out…knowing what the people that were closest to me thought of mental health issues, definitely stopped me from reaching out and speaking up.” (Jane, 22, female) and “anytime I slightly mentioned it, it just got dismissed and that was the end of it…and then I just stopped talking to people about it because I was just like, you know what, clearly, people don’t wanna talk about it…. I just started bottling it all up and isolating myself away from people” (Taylor, 23, female). In other cases, participants described withdrawing from others because they assumed that they held negative stigmatising ideas that they had heard, “They think I’m boring. They don’t think that I’m gonna be much fun to hang out with, so I will just not go” (Steph, 20, female).

Similarly, participants described avoiding professional help-seeking because of stigmatising experiences. In some cases, this was because negative ideas about their condition from stigma made them feel ashamed to discuss it with others or be seen seeking help, “I was embarrassed to go and see a counsellor” (Jane, 22, female).

Discussion

This study qualitatively explored the stigma experienced by young people with anxiety and depression in a contemporary Australian context. We involved a YRG, which informed interview questions and format, resulted in an open discussion of stigma experiences, and facilitated the involvement of young people from all over Australia. This process resulted in an informed interview that led to a rich and nuanced picture of the stigma related to having a diagnosed anxiety and/or depression disorder in youth. The analysis supported the understanding that stigma remains a ubiquitous and negative experience for young people with anxiety and depression (Theme 1). The remaining themes developed have provided new insight into both the content of stigmatising ideas experienced by these young people (being denied, minimised and blamed, being viewed as ‘less than’ others and as socially undesirable), and how stigma affects them (self-doubt and internalisation and, withdrawal).

Our findings also indicated that the experiences of adolescents overlaps with findings from the adult literature in some areas but diverges in others. The ‘Less than Others’ and ‘Socially undesirable’ themes were largely consistent with prior literature about the content of stigma about anxiety and depression in adults (Curcio & Corboy, 2019; Parcesepe & Cabassa, 2013; Pescosolido, 2013; Reavley & Jorm, 2011). The ‘withdrawal’ theme was also consistent with prior literature, echoing prior findings that a negative consequence of stigma for people with anxiety and depression is reduced help-seeking and pulling away from social connections and support (Alonso et al., 2009; Rüsch et al., 2005; Sickel et al., 2014). The presence of internalisation was also consistent with prior literature, as the ways participants described this experience was consistent with definitions of ‘self-stigma’ (the internalisation of stigmatising ideas by individuals in the stigmatised group; (Corrigan & Watson, 2002)). A significant body of research holds self-stigma as an important consequence of stigma experiences, which also is associated with a range of negative outcomes itself (Corrigan & Rao, 2012; Livingston & Boyd, 2010).

However, our findings also deviate from prior literature. First, in extensive prior literature, a common stigmatising idea is that symptoms of depression and anxiety are a result of a personal weakness, rather than being seen as symptoms of a legitimate medical condition (Curcio & Corboy, 2019; Parcesepe & Cabassa, 2013). This idea that people with anxiety and depression are ‘weak-not-sick’ serves to deny and minimise their experiences and is often linked to idea that they are to blame for their symptoms (Curcio & Corboy, 2019; Parcesepe & Cabassa, 2013; Wright et al., 2011). The ‘weak-not sick’ idea, and associated ideas of blame have been observed in a range of studies with adults and some studies with adolescents, about a wide range of mental health challenges or disorders (Curcio & Corboy, 2019; Parcesepe & Cabassa, 2013). Further, these ideas and the connection between them have been observed in the general population (i.e., people who do not necessarily have a psychiatric disorder) and identified by people with psychiatric conditions (Curcio & Corboy, 2019; Parcesepe & Cabassa, 2013).

While ideas of weakness were also identified in our study (‘less than others’), and participants described having their symptoms denied and minimised, and being blamed for their condition (‘Denied, Minimised and Blamed’), these ideas were not intrinsically linked. That is, participants described having their experiences denied (the symptoms are not real), and minimised (the symptoms aren’t that bad), and being blamed for their symptoms; however, this was not necessarily linked to ‘weakness’ and was often connected to other interpretations, such as that they are motivated by some secondary gain (for example, the idea that individuals fabricate symptoms of mental illness to receive attention, excuse themselves from responsibilities, or try to fit in with others). The idea that young people with depression or anxiety have their experiences denied and minimised discretely or are making up or exaggerating their condition for secondary gain has not been identified in prior literature and is not captured in existing stigma measures. This is therefore potentially an important domain for future measures of mental illness stigma to capture.

It is unclear whether identifying ‘Denied, Minimised and Blamed’ as a distinct theme reflects changing attitudes towards anxiety and depression generally or is unique to youth populations due to social perceptions depression of this age group, or some combination of both. Stigma changes over time, and recent literature has indicated that discussions about mental health have become more accepted and commonplace over the last decade (Earnshaw et al., 2022; Robinson et al., 2019; Stupinski et al., 2022). While this has likely increased help-seeking due to the identification of previously under-reported symptoms, it has also led to increased trivialisation of mental health symptoms (Robinson et al., 2019). Therefore, it is plausible that one explanation for the identification of a distinct ‘Denied, Minimised and Blamed’ theme is that it reflects broad public attitudes towards anxiety and depression (not unique to adolescents).

Alternatively, the social status of adolescents, having less power that adults, could partially explain why they experience denial, minimisation and blame more intensely than their adult counterparts (Heary et al., 2017; Hinshaw, 2005). Since adolescents hold less power than adults, they could be more likely to experience paternalistic and patronising responses that invalidate their experiences. This explanation is supported by the observation that participants described being denied, minimised and blamed significantly more frequently in their interactions with adults than with their peers. Regardless of which explanation, or combination of explanations is more valid, the presence of ‘Denied, Minimised and Blamed’ as a distinct theme implies that we need updated quantitative measures to validly measure stigma and advance knowledge in this area.

Another deviation from the literature in our study was that participants did not describe experiences of being stigmatised and perceptions about the stigma others held about their condition in separate ways. Current theory holds that experienced stigma (actual experiences of being stigmatised reported by an individual within in a marginalised group) and perceived stigma (an individual’s perception of the amount and nature of stigma held by others) as separate constructs (Pescosolido & Martin, 2015). However, in the present study, perceiving stigma was often sufficient for participants to assume that the stigma was intended for them personally. Despite the material differences between the experiences versus perceptions of stigma, these phenomena did not seem to be experienced differently in terms of content or consequences for participants. Although preliminary, this indicates that it may not truly be representative of adolescents’ lived experiences to conceptualise their experiences of stigma and perceptions of stigma as separate phenomena. The conflation between these two concepts also indicates that perceptions of stigma can impact young people in the same ways as directly experiencing stigma.

A final difference between the findings of this study and prevailing understanding of stigma in the literature is the way participants described internalising and self-doubt as consequences of stigma they experienced. Prior literature focuses on self-stigma (consistent with internalising) as an important way that stigma causes harm to marginalised individuals (e.g., Corrigan et al., 2009; Corrigan et al., 2006; Watson et al., 2007), but pays little attention to self-doubt as part of experiencing stigma. A small number of prior qualitative studies have identified self-doubt as an important aspect of stigma experiences (Eaton et al., 2020; Gilbey et al., 2022). However, more detailed research needs to investigate the relationships and delineations between stigma, self-stigma and self-doubt, and the consequences of each to create a fuller picture of these experiences.

There are several of this study that could be addressed by future research. Firstly, this was a small sample of English-speaking young Australians. Therefore, the current findings may not be generalisable to young people within other cultural contexts. There is evidence that cultural beliefs and practices influence mental illness stigma (Misra et al., 2021), including in an Australian context (Mellor et al., 2013). Cross-cultural research with larger samples is required to develop an understanding of any differences in the experience and content of stigma for young people in other cultural contexts. Secondly, the study self-selected for people open to having conversations about their mental health and stigma experiences, likely excluding participants currently experiencing more intense iterations of the negative emotions and withdrawal than our participants described. Thirdly, although our data was not designed to pick up on developmental change within our age group, and only two participants were under 18, it is possible that a study with a larger sample could find that there are differences in the stigma experience according to age. Future research should investigate whether younger adolescents experience stigma differently or are impacted more severely due to being in closer proximity to peers (at school) and having less autonomy and a less developed identity than older adolescents.

Conclusion and Recommendations

This is the first study to qualitatively examine the stigma experiences of young people with anxiety and depression. It holds their experiences as unique from their adult counterparts and from older research that informs our current understanding and measures. Our findings indicate that despite our current-day climate of increased discussion about mental health and better mental health literacy especially, surrounding anxiety and depression, stigma is pervasively experienced by and impacts negatively upon young people with these disorders. Further, the results suggest that our understanding of contemporary stigma experiences should be updated to better reflect contemporary times, and to include such ideas as ‘faking it’ and ‘attention-seeking’. This would facilitate more accurate and valid knowledge about stigma experiences of young people with anxiety and depression and allow for better quality research into strategies that can mitigate its negative consequences.

Professionals working with young people could benefit from understanding the significance of stigma to young people and the key stigmatising ideas described in this study. Currently, practitioners are well trained and well placed to discuss symptoms, but this study suggests that stigma because of those symptoms can be a serious factor in these young lives and needs to also be addressed. This information can be used to avoid perpetuating stigmatising ideas and to correct them in clinical practice with young people who have anxiety and depression. Policymakers could improve strategies to address public stigma about young people with anxiety and depression by incorporating newer ideas (such as denial, minimisation, and blame) into their understanding of stigma experienced by young people. Without doing so, an opportunity to address the adverse impact of stigma on young people with anxiety and depression may be missed.