Conceptualizing Adolescent Mental Illness Stigma: Youth Stigma Development and Stigma Reduction Programs
The majority of mental illnesses develop during the teenage years, and such mental health conditions can significantly derail psychosocial development. However, many adolescents are reluctant to pursue mental health services or do not know how to help their peers who may be struggling. Stigma and low mental health knowledge have been identified as leading barriers to such mental health help-seeking. In response, there has been increasing interest in understanding the development of stigma among youth and evidence-base interventions to reduce stigma. The focus of this narrative review was to summarize findings from the adolescent mental illness stigma literature and to link findings to a multidimensional and theoretical model of stigma and adolescent development, with the goals of informing future research and evidence-based stigma reduction practices. Existing evidence suggests that stigma is well-documented among adolescents, but that little consensus exists regarding how to implement successful adolescent-focused mental illness stigma reduction programs. Suggestions for improvement include evaluating the multiple dimensions of mental illness stigma when conducting research, considering the impact of adolescent development on program development and evaluation, using reliable and valid outcome measures, and employing strong research designs (e.g., randomized trials with fidelity checks and long-term follow-ups) to evaluate standardized programs.
KeywordsAdolescence Youth Mental illness Mental health Stigma
This review benefitted from conversations and feedback from Drs. Philip T. Yanos, Maureen A. Allwood, Kevin L. Nadal, and Roger J. R. Levesque, as well as two anonymous reviewers.
This study did not receive funding.
Compliance with ethical standards
Conflicts of interest
The author reports no conflicts of interest.
This article did not make use of participants or a research design. No ethical approval or informed consent were required.
- Allport, G. W. (1954). The nature of prejudice. New York: Doubleday Anchor Books.Google Scholar
- Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge: Harvard University Press.Google Scholar
- Campbell, J. D., Trapnell, P. D., Heine, S. J., Katz, I. M., Lavallee, L. F., & Lehman, D. R. (1996). Self-concept clarity: Measurement, personality correlates, and cultural boundaries. Journal of Personality and Social Psychology, 70, 141–156. https://doi.org/10.1037/0022-35188.8.131.524.CrossRefGoogle Scholar
- Cauce, A. M., Domenech-Rodríguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebnik, D., & Baydar, N. (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70, 44–55. https://doi.org/10.1037//0022-006X.70.1.44.CrossRefPubMedGoogle Scholar
- Centers for Disease Control and Prevention (2013). Children’s mental health: Report on data. Retrieved from https://www.cdc.gov/ncbddd/childdevelopment/documents/CMH-feature-2013-05-16-updated.pdf.
- Christiana, J. M., Gilman, S. E., Guardino, M., Mickelson, K., Morselli, P. L., Olfson, M., & Kessler, R. C. (2000). Duration between onset and time of obtaining initial treatment among people with anxiety and mood disorders: An international survey of members of mental health patient advocate groups. Psychological Medicine, 30, 693–703. https://doi.org/10.1017/S0033291799002093.CrossRefPubMedGoogle Scholar
- Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J.S., Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45, 11–27. https://doi.org/10.1017/S0033291714000129.CrossRefPubMedGoogle Scholar
- Coles, M. E., Ravid, A., Gibb, B., George-Denn, D., Bronstein, L. R., & McLeod, S. (2016). Adolescent mental health literacy: Young people’s knowledge of depression and social anxiety disorder. Journal of Adolescent Health, 58, 57–62. https://doi.org/10.1016/j.jadohealth.2015.09.017.CrossRefPubMedGoogle Scholar
- Corrigan, P. W., Lurie, B. D., Goldman, H. H., Slopen, N., Medasani, K., & Phelan, S. (2005). How adolescents perceive the stigma of mental illness and alcohol abuse. Psychiatric Services, 56, 544–550. https://doi.org/10.1176/appi.ps.56.5.544, https://doi.org/10.1093/oxfordjournals.schbul.a007096.
- Corrigan, P. W., Rowan, D., Green, A., Lundin, R., River, P., Uphoff-Wasowski, K., White, K., Kubiak, M. A. (2002). Challenging two mental illness stigmas: Personal responsibility and dangerousness. Schizophrenia Bulletin, 28, 293–309. https://doi.org/10.1093/oxfordjournals.schbul.a006939.CrossRefPubMedGoogle Scholar
- Delgado, M., & Zhou, H. (2008). Youth-led health promotion in urban communities: A community capacity-enhancement perspective. New York: Rowman & Littlefield.Google Scholar
- DeLuca, J. S., Evans, M., Reyes, I., & Yanos, P. T. (2016). An initial evaluation of in our own voice in a diverse high school. Unpublished raw data.Google Scholar
- Divin, N., Harper, P., Curran, E., Corry, D., & Leavey, G. (2018). Help-seeking measures and their use in adolescents: A systematic review. Adolescent Research Review (Advance online publication).Google Scholar
- Erikson, E. (1968). Identity, youth and crisis. New York: W.W. Norton.Google Scholar
- Evans-Lacko, S., Little, K., Meltzer, H., Rose, D., Rhydderch, D., Henderson, C., Thornicroft, G. (2010). Development and psychometric properties of the mental health knowledge schedule. Canadian Journal of Psychiatry, 55, 440–448. https://doi.org/10.1177/070674371005500707.CrossRefPubMedGoogle Scholar
- Evans-Lacko, S., Rose, D., Little, K., Flach, C., Rhydderch, D., Henderson, C., Thornicroft, G. (2011). Development and psychometric properties of the reported and intended behaviour scale (RIBS): A stigma-related behaviour measure. Epidemiology and Psychiatric Sciences, 20, 263–271. https://doi.org/10.1017/S2045796011000308.CrossRefPubMedGoogle Scholar
- Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs: Prentice Hall.Google Scholar
- Heary, C., Hennessy, E., Swords, L., & Corrigan, P. (2017). Stigma towards mental health problems during childhood and adolescence: Theory, research and intervention approaches. Journal of Child and Family Studies. https://doi.org/10.1007/s10826-017-0829-y. Advance online publication.CrossRefGoogle Scholar
- Hughes, D., Rodriguez, J., Smith, E. P., Johnson, D. J., Stevenson, H. C., & Spicer, P. (2006). Parents’ ethnic-racial socialization practices: A review of research and directions for future study. Developmental Psychology, 42, 747. https://doi.org/10.1037/0012-16184.108.40.2067.CrossRefPubMedGoogle Scholar
- Jones, E., Farina, A., Hastorf, A., Marbus, H., Mitler, D., Scott, B., & French, R. (1984). Social stigma: The psychology of marked relationships. New York: Freeman.Google Scholar
- Ke, S., Lai, J., Sun, T., Yang, M. M., Wang, J. C. C., & Austin, J. (2015). Healthy young minds: The effects of a 1-hour classroom workshop on mental illness stigma in high school students. Community Mental Health Journal, 51, 329–337. https://doi.org/10.1007/s10597-014-9763-2.CrossRefPubMedGoogle Scholar
- Kobau, R., DiIorio, C., Chapman, D., & Delvecchio, P. (2010). Attitudes about mental illness and its treatment: Validation of a generic scale for public health surveillance of mental illness associated stigma. Community Mental Health Journal, 46, 164–176. https://doi.org/10.1007/s10597-009-9191-x.CrossRefPubMedGoogle Scholar
- Kuhn, D. (2009). Adolescent thinking. In R. M. Lerner & L. Steinberg (Eds.), Handbook of adolescent psychology, Volume 1: Individual bases of adolescent development (3rd ed.), pp. 152–186). Hoboken: Wiley.Google Scholar
- Lenhart, A. (2015). Teens, social media, and technology. Washington: Pew Research Center. Retrieved from http://www.pewinternet.org/.
- Link, B. G., Yang, L. H., Phelan, J. C., & Collins, P. Y. (2004). Measuring mental illness stigma. Schizophrenia Bulletin, 30, 511–541. https://doi.org/10.1093/oxfordjournals.schbul.a007098.CrossRefPubMedGoogle Scholar
- Lysaker, P. H., Roe, D., & Yanos, P. T. (2007). Toward understanding the insight paradox: Internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophrenia Bulletin, 33, 192–199. https://doi.org/10.1093/schbul/sbl016.CrossRefPubMedGoogle Scholar
- Major, B., & O’Brien, L. T. (2005). The social psychology of stigma. Annual Review of Psychology, 56, 393–421. https://doi.org/10.1146/annurev.psych.56.091103.070137.CrossRefPubMedGoogle Scholar
- Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49, 980–989. https://doi.org/10.1016/j.jaac.2010.05.017.CrossRefPubMedPubMedCentralGoogle Scholar
- Merikangas, K. R., He, J. P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., Georgiades, K., Heaton, L., Swanson, S., Olfson, M. (2011). Service utilization for lifetime mental disorders in US adolescents: Results of the National Comorbidity Survey–Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 50, 32–45. https://doi.org/10.1016/j.jaac.2010.10.006.CrossRefPubMedGoogle Scholar
- Milburn, D. M., Fass, D., & Arseneault, L. (2017). The Prince’s Trust Macquarie youth index 2017 [Brochure]. London: The Prince’s Trust.Google Scholar
- Milin, R., Kutcher, S., Lewis, S. P., Walker, S., Wei, Y., Ferrill, N., & Armstrong, M. A. (2016). Impact of a mental health curriculum on knowledge and stigma among high school students: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 55, 383–391.CrossRefGoogle Scholar
- Miller, P. K., Cuthbertson, C., Skidmore, M., & Loveridge, S. (2017). National mental-health survey finds widespread ignorance, stigma. MSU Today. Retrieved from http://msutoday.msu.edu/news.
- Nam, S. K., Choi, S. I., Lee, J. H., Lee, M. K., Kim, A. R., & Lee, S. M. (2013). Psychological factors in college students’ attitudes toward seeking professional psychological help: A meta-analysis. Professional Psychology Research and Practice, 44, 37–45. https://doi.org/10.1037/a0029562.CrossRefGoogle Scholar
- Newcomb-Anjo, S. E. (2018). Applying what is known about adolescent development to improve school-based mental health literacy of depression interventions: Bridging research to practice. Adolescent Research Review (Advance online publication).Google Scholar
- Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents. JAMA Psychiatry, 70, 300–310. https://doi.org/10.1001/2013.jamapsychiatry.55.CrossRefPubMedGoogle Scholar
- O’Driscoll, C., Heary, C., Hennessy, E., & McKeague, L. (2012). Explicit and implicit stigma towards peers with mental health problems in childhood and adolescence. Journal of Child Psychology and Psychiatry and Allied Disciplines, 53, 1054–1062. https://doi.org/10.1111/j.1469-7610.2012.02580.x.CrossRefGoogle Scholar
- Pachankis, J. E., Hatzenbuehler, M. L., & Starks, T. J. (2014). The influence of structural stigma and rejection sensitivity on young sexual minority men’s daily tobacco and alcohol use. Social Science and Medicine, 103, 67–75. https://doi.org/10.1016/j.socscimed.2013.10.005.CrossRefPubMedGoogle Scholar
- Penn, D. L., Judge, A., Jamieson, P., Garczynski, J., Hennessy, M., & Romer, D. (2005). Stigma. In M. Seligman (Ed.), Treatments for adolescents that work. London: Oxford Press.Google Scholar
- Peplak, J., Song, J. H., Colasante, T., & Malti, T. (2017). Only you can play with me!” Children’s inclusive decision making, reasoning, and emotions based on peers’ gender and behavior problems. Journal of Experimental Child Psychology, 162, 134–148. https://doi.org/10.1016/j.jecp.2017.04.019.CrossRefPubMedGoogle Scholar
- Pescosolido, B. A., Martin, J. K., Long, J. S., Medina, T. R., Phelan, J. C., & Link, B. G. (2010). “A disease like any other?” A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. American Journal of Psychiatry, 167, 1321–1330. https://doi.org/10.1176/appi.ajp.2010.09121743.CrossRefPubMedGoogle Scholar
- Pescosolido, B. A., Medina, T. R., Martin, J. K., & Long, J. S. (2013). The “backbone” of stigma: identifying the global core of public prejudice associated with mental illness. American Journal of Public Health, 103, 853–860. https://doi.org/10.2105/AJPH.2012.301147.CrossRefPubMedPubMedCentralGoogle Scholar
- Pinto, M. D., Hickman, R., Logsdon, M. C., & Burant, C. (2012). Psychometric evaluation of the revised attribution questionnaire (r-AQ) to measure mental illness stigma in adolescents. Journal of Nursing Measurement, 20, 47–58. https://doi.org/10.1891/1061-37220.127.116.11.CrossRefPubMedPubMedCentralGoogle Scholar
- Pinto-Foltz, M. D., Logsdon, M. C., & Myers, J. A. (2011). Feasibility, acceptability, and initial efficacy of a knowledge-contact program to reduce mental illness stigma and improve mental health literacy in adolescents. Social Science and Medicine, 72, 2011–2019. https://doi.org/10.1016/j.socscimed.2011.04.006.CrossRefPubMedGoogle Scholar
- Plemmons, G. (2017). Trends in suicidality and serious self-harm for children 5–17 years at 32 US children’s hospitals, 2008–2015. In: Paper presented at the meeting of the Pediatric Academic Societies Meeting, San Francisco.Google Scholar
- Schachter, H. M., Girardi, A., Ly, M., Lacroix, D., Lumb, A. B., van Berkom, J., & Gill, R. (2008). Effects of school-based interventions on mental illness stigmatization: A systematic review. Child and Adolescent Psychiatry and Mental Health, 2, 1–14. https://doi.org/10.1186/1753-2000-2-18.CrossRefGoogle Scholar
- Sharpe, H., Patalay, P., Vostanis, P., Belsky, J., Humphrey, N., & Wolpert, M. (2017). Use, acceptability and impact of booklets designed to support mental health self-management and help seeking in schools: Results of a large randomised controlled trial in England. European Child and Adolescent Psychiatry, 26, 315–324. https://doi.org/10.1007/s00787-016-0889-3.CrossRefPubMedGoogle Scholar
- Spencer, M. S., Chen, J., Gee, G. C., Fabian, C. G., & Takeuchi, D. T. (2010). Discrimination and mental health-related service use in a national study of Asian Americans. American Journal of Public Health, 100, 2410–2417. https://doi.org/10.2105/AJPH.2009.176321.CrossRefPubMedPubMedCentralGoogle Scholar
- Tajfel, H., & Turner, J. C. (1986). The social identity theory of intergroup behavior. In S. Worchel & W. G. Austin (Eds.), Psychology of intergroup relations (pp. 7–24). Chicago: Nelson.Google Scholar
- Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., Koschorke, M., Shidhaye, R., O’Reilly, C., Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet, 387, 1123–1132. https://doi.org/10.1192/bjp.bp.114.151944.CrossRefGoogle Scholar
- Trump, D. J. (2017). [realDonaldTrump] I heard poorly rated @Morning_Joe speaks badly of me (don’t watch anymore). Then how come low I.Q. Crazy Mika, along with Psycho Joe, came.. [Tweet]. Retrieved from https://twitter.com/realDonaldTrump/status/880408582310776832.
- Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among US adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6, 3–17. https://doi.org/10.1177/2167702617723376.CrossRefGoogle Scholar
- Vogel, D. L., Armstrong, P. I., Tsai, P. C., Wade, N. G., Hammer, J. H., Efstathiou, G., Holtham, E., Kouvaraki, E., Liao, H. Y., Shechtman, Z., Topkaya, N. (2013a). Cross-cultural validity of the Self-Stigma of Seeking Help (SSOSH) scale: Examination across six nations. Journal of Counseling Psychology, 60, 303–310. https://doi.org/10.1037/a0032055.CrossRefPubMedGoogle Scholar
- Vogel, D. L., Wade, N. G., & Ascheman, P. L. (2009). Measuring perceptions of stigmatization by others for seeking psychological help: Reliability and validity of a new stigma scale with college students. Journal of Counseling Psychology, 56, 301–308. https://doi.org/10.1037/a0014903.CrossRefGoogle Scholar
- Wahl, O., Rothman, J., Brister, T., & Thompson, C. (2018). Changing student attitudes about mental health conditions: NAMI ending the silence. Stigma and Health. (Advance online publication).Google Scholar
- Watson, A. C., Miller, F. E., & Lyons, J. S. (2005). Adolescent attitudes toward serious mental illness. The Journal of Nervous and Mental Disease, 193, 769–772. https://doi.org/10.1097/01.nmd.0000185885.04349.99.CrossRefPubMedGoogle Scholar
- Weisz, J. R., Kuppens, S., Ng, M. Y., Eckshtain, D., Ugueto, A. M., Vaughn-Coaxum, R., Weersing, V. R. (2017). What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice. American Psychologist, 72, 79–117. https://doi.org/10.1037/a0040360.CrossRefPubMedGoogle Scholar
- West, J. S., Kayser, L., Overton, P., & Saltmarsh, R. (1991). Student perceptions that inhibit the initiation of counseling. The School Counselor, 39, 77–83. Retrieved from https://www.jstor.org/What is mental health? (n.d.). Retrieved from https://www.mentalhealth.gov/basics/what-is-mental-health/index.html.
- World Health Organization (2005). Atlas: child and adolescent mental health resources: Global concerns, implications for the future [PDF file]. Retrieved from http://www.who.int/mental_health/resources/Child_ado_atlas.pdf.
- Yamaguchi, S., Mino, Y., & Uddin, S. (2011). Strategies and future attempts to reduce stigmatization and increase awareness of mental health problems among young people: A narrative review of educational interventions. Psychiatry and Clinical Neurosciences, 65, 405–415. https://doi.org/10.1111/j.1440-1819.2011.02239.x.CrossRefPubMedGoogle Scholar