Mental illness stigma and willingness to seek mental health care in the European Union

  • Ramin Mojtabai
Original Paper



It is often assumed that individual stigmatizing attitudes toward the mentally ill are linked to stigmatizing attitudes in the social milieu and that both, individual and social stigmatizing attitudes are major barriers to mental health treatment seeking. This study aims to examine these assumptions.


Data from the 2005–2006 Eurobarometer general population survey (N = 29,248) are used to examine the association of social stigmatizing attitudes assessed in a random half of the sample with individual stigmatizing attitudes assessed in the other half of the sample, and to examine the association of both individual and social stigmatizing attitudes with willingness to seek professional help.


Social stigmatizing attitudes are specifically and strongly associated with individual stigmatizing attitudes. Both social and individual stigmatizing attitudes are associated with willingness to seek professional help. Believing the mentally ill to be dangerous or not likely to recover, or living in a community with such beliefs, are associated with increased willingness to seek help; whereas, believing the mentally ill to be unpredictable or blameworthy for their illness, or living in a community with strong beliefs in blameworthiness of the mentally ill, are associated with decreased willingness to seek professional help.


The view that all stigmatizing attitudes toward mental illness are associated with reluctance to seek professional help may be naive as some stigmatizing attitudes may be associated with increased willingness to seek help. The complex association of different stigmatizing attitudes with professional help seeking should be carefully considered in planning anti-stigma campaigns.


Stigma Attitudes Public opinion Help seeking Barriers to treatment 



Author’s work was in part supported by the Center for Mental Health Initiatives at the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Conflict of interest statement

Dr. Mojtabai has received research funding and consultant fees from Bristol-Myers Squibb company.


  1. 1.
    Link BG, Phelan JC (1999) The labeling theory of mental disorder (II): the consequences of labeling. In: Horwitz AV, Scheid TL (eds) A handbook for the study of mental health. Cambridge University Press, Cambridge, UK, pp 361–376Google Scholar
  2. 2.
    Farina A, Feliner RD (1973) Employment interviewer reactions to former mental patients. J Abnorm Psychol 82:268–272CrossRefPubMedGoogle Scholar
  3. 3.
    Link BG (1982) Mental patient status, work and income: an examination of the effects of a psychiatric label. Am Soc Rev 47:202–215CrossRefGoogle Scholar
  4. 4.
    Link BG (1987) Understanding labeling effects in the area of mental disorders: an assessment of the effects of expectations of rejection. Am Soc Rev 52:96–112CrossRefGoogle Scholar
  5. 5.
    Page S (1995) Effects of the mental illness label in 1993: acceptance and rejection in the community. J Health Soc Policy 7:61–68CrossRefPubMedGoogle Scholar
  6. 6.
    Wahl OF (1999) Mental health consumers’ experience of stigma. Schiz Bull 25:467–478Google Scholar
  7. 7.
    Webber A, Orcutt JD (1984) Employers’ reactions to racial and psychiatric stigmata: a field experiment. Deviant Behav 5:327–336CrossRefGoogle Scholar
  8. 8.
    Britten N (1998) Psychiatry, stigma, and resistance. Psychiatrists need to concentrate on understanding, not simply compliance. BMJ 317:963–964PubMedGoogle Scholar
  9. 9.
    Corrigan P (2004) How stigma interferes with mental health care. Am Psychol 59:614–625CrossRefPubMedGoogle Scholar
  10. 10.
    Jorm AF, Angermeyer MC, Katschnig H (2000) Public knowledge of and attitudes to mental disorders: A limiting factor in the optimal use of treatment services. In: Andrews G, Henderson S (eds) Unmet need in psychiatry. Cambridge University Press, Cambridge, UK, pp 399–416CrossRefGoogle Scholar
  11. 11.
    Meltzer H, Bebbington P, Brugha T, Farrell M, Jenkins R, Lewis G (2003) The reluctance to seek treatment for neurotic disorders. Int Rev Psychiatry 15:123–128CrossRefPubMedGoogle Scholar
  12. 12.
    Cooper AE, Corrigan PW, Watson AC (2003) Mental illness stigma and care seeking. J Nerv Ment Dis 191:339–341CrossRefPubMedGoogle Scholar
  13. 13.
    Leaf PJ, Bruce ML, Tischler GL, Holzer CE (1987) The relationship between demographic factors and attitudes toward mental health services. J Community Psychol 15:275–284CrossRefPubMedGoogle Scholar
  14. 14.
    Mojtabai R (2007) Americans’ attitudes toward mental health treatment seeking: 1990–2003. Psychiatr Serv 58:642–651CrossRefPubMedGoogle Scholar
  15. 15.
    Sirey JA, Bruce ML, Alexopoulos GS, Perlick DA, Friedman SJ, Meyers BS (2001) Stigma as a barrier to recovery: perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatr Serv 52:1615–1620CrossRefPubMedGoogle Scholar
  16. 16.
    Sirey JA, Bruce ML, Alexopoulos GS, Perlick DA, Raue P, Friedman SJ, Meyers BS (2001) Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression. Am J Psychiatry 158:479–481CrossRefPubMedGoogle Scholar
  17. 17.
    Vogel DL, Wade NG, Hackler AH (2007) Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes toward counseling. J Counseling Psychol 54:40–50CrossRefGoogle Scholar
  18. 18.
    Crocker J, Lutsky N (1986) Stigma and the dynamics of social cognition. In: Ainlay SC, Becker G, Coleman LM (eds) The dilemma of difference: a multidisciplinary view of stigma. Plenum Press, New York, pp 95–121Google Scholar
  19. 19.
    European Union (2006) Mental well being: special Eurobarometer 248/Wave 64.4. Available at: Accessed 15 Jun 2007
  20. 20.
    Kreft IGG, Jd Leeuw (1998) Introducing multilevel modeling. Sage, London, UKGoogle Scholar
  21. 21.
    StataCorp (2008) Stata statistical software, Release 10.1. Stata Corporation, College StationGoogle Scholar
  22. 22.
    Corrigan P, Gelb B (2006) Three programs that use mass approaches to challenge the stigma of mental illness. Psychiatr Serv 57:393–398CrossRefPubMedGoogle Scholar
  23. 23.
    Angermeyer MC, Matschinger H (2003) The stigma of mental illness: effects of labelling on public attitudes towards people with mental disorder. Acta Psychiatr Scand 108:304–309CrossRefPubMedGoogle Scholar
  24. 24.
    Greenfield SF, Reizes JM, Muenz LR, Kopans B, Kozloff RC, Jacobs DG (2000) Treatment for depression following the 1996 national depression screening day. Am J Psychiatry 157:1867–1869CrossRefPubMedGoogle Scholar
  25. 25.
    Paykel ES, Hart D, Priest RG (1998) Changes in public attitudes to depression during the defeat depression campaign. Br J Psychiatry 173:519–522CrossRefPubMedGoogle Scholar
  26. 26.
    Schulze B, Richter-Werling M, Matschinger H, Angermeyer MC (2003) Crazy? So what! Effects of a school project on students’ attitudes towards people with schizophrenia. Acta Psychiatr Scand 107:142–150CrossRefPubMedGoogle Scholar
  27. 27.
    Thornicroft G, Rose D, Kassam A, Sartorius N (2007) Stigma: ignorance, prejudice or discrimination? Br J Psychiatry 190:192–193CrossRefPubMedGoogle Scholar
  28. 28.
    Warner R (2005) Local projects of the world psychiatric association programme to reduce stigma and discrimination. Psychiatr Serv 56:570–575CrossRefPubMedGoogle Scholar
  29. 29.
    Chong SA, Verma S, Vaingankar JA, Chan YH, Wong LY, Heng BH (2007) Perception of the public towards the mentally ill in developed Asian country. Soc Psychiatry Psychiatr Epidemiol 42:734–739CrossRefPubMedGoogle Scholar
  30. 30.
    Edlund MJ, Unutzer J, Curran GM (2006) Perceived need for alcohol, drug, and mental health treatment. Soc Psychiatry Psychiatr Epidemiol 41:480–487CrossRefPubMedGoogle Scholar
  31. 31.
    Mojtabai R, Olfson M, Mechanic D (2002) Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Arch Gen Psychiatry 59:77–84CrossRefPubMedGoogle Scholar
  32. 32.
    Benbow A (2007) Mental illness, stigma, and the media. J Clin Psychiatry 68(Suppl 2):31–35PubMedGoogle Scholar
  33. 33.
    Okazaki S (2000) Treatment delay among Asian-American patients with severe mental illness. Am J Orthopsychiatry 70:58–64CrossRefPubMedGoogle Scholar
  34. 34.
    Wynaden D, Chapman R, Orb A, McGowan S, Zeeman Z, Yeak S (2005) Factors that influence Asian communities’ access to mental health care. Intern J Ment Health Nurs 14:88–95CrossRefGoogle Scholar
  35. 35.
    Van Voorhees BW, Fogel J, Houston TK, Cooper LA, Wang NY, Ford DE (2005) Beliefs and attitudes associated with the intention to not accept the diagnosis of depression among young adults. Ann Fam Med 3:38–46CrossRefPubMedGoogle Scholar
  36. 36.
    Van Voorhees BW, Fogel J, Houston TK, Cooper LA, Wang NY, Ford DE (2006) Attitudes and illness factors associated with low perceived need for depression treatment among young adults. Soc Psychiatry Psychiatr Epidemiol 41:746–754CrossRefPubMedGoogle Scholar
  37. 37.
    Sartorius N, Schulze H, Global Programme of the World Psychiatric Association (2005) Reducing the stigma of mental illness: a report from a global programme of the World Psychiatric Association. Cambridge University Press, Cambridge, UKGoogle Scholar
  38. 38.
    Jorm AF, Christensen H, Griffiths KM (2006) The public’s ability to recognize mental disorders and their beliefs about treatment: changes in Australia over 8 years. ANZ J Psychiatry 40:36–41Google Scholar
  39. 39.
    Hugo CJ, Boshoff DE, Traut A, Zungu-Dirwayi N, Stein DJ (2003) Community attitudes toward and knowledge of mental illness in South Africa. Soc Psychiatry Psychiatr Epidemiol 38:715–719CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of PsychiatryJohns Hopkins UniversityBaltimoreUSA
  3. 3.BaltimoreUSA

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