Mental Health Literacy and Stigma Among Salvadorian Youth: Anxiety, Depression and Obsessive-Compulsive Related Disorders

Abstract

This study examined (1) adolescent mental health literacy (MHL) and stigma for depression, anxiety and obsessive-compulsive and related disorders (OCRDs), and (2) demographic moderators. Participants were 383 high school students (50.9% boys) aged 11–18 years (M = 14.12, SD = 1.91) in El Salvador. Participants read vignettes of adolescents with mental health problems and reported on their beliefs about (1) what was wrong with the young person, (2) expected recovery time, (3) help-seeking beliefs and recommendations, and (4) stigma and preferred social distance associated with each condition. Results suggested that recognition of mental health conditions, especially anxiety disorders and OCRDs, was limited, although one third could recognize depression in a peer. Help-seeking attitudes were favorable. Adolescents were only somewhat willing to be affiliated with someone experiencing a mental health problem. Girls showed better MHL and lower stigma than boys. Stigma was lower among those with exposure to mental health problems.

Disorder Vignettes

Disorder	Vignette
Generalized Anxiety Disorder	Leo is a 14 year-old boy, who worries all the time. He is constantly worried about his schoolwork, whether his classmates at school like him, his health (such as whether he will catch a cold or whether his headaches are signs of a more serious illness), the health of his grandfather—who is a smoker—and family issues (whether his family has enough money to pay the bills and if his parents might get a divorce). Leo cannot seem to stop worrying about these things, no matter how hard he tries. When Leo is worried, he becomes very restless, has a hard time getting to sleep, and has difficulty concentrating on things.
Depression	Amelia is in Year 12. She and her friend, Mariana, have been planning to go away together during school break with a group of other girls and boys from their local area. Mariana and Amelia had been planning their trip for a while now, ever since Amelia’s older sister had gone on a similar trip. Lately, however, Mariana has noticed that Amelia hasn’t been so excited about the trip—in fact, she has noticed that over the past month—maybe longer—Amelia hasn’t really been very interested in anything very much, has lost her characteristic spark and energy, and has regularly appeared to be sad and tearful. To make matters worse, Amelia has forgotten to call the travel agent on the allocated day to confirm their tickets, and has cost them both an extra $50 in failed ‘confirmation fees’. Amelia has been very apologetic to Mariana, but nothing Mariana has said has seemed to cheer Amelia up. Amelia just keeps saying that she is ‘useless’ and ‘good for nothing’, and that ‘she might as well just not go because no-one would care if she wasn’t there’.
Social Anxiety Disorder	Sophia is a 12-year old girl, who has always felt nervous in social situations and when she has to perform in front of others. She feels uncomfortable talking to new kids and speaking to adults. She often avoids making eye contact when talking to others and speaks with a soft voice in short sentences. Sophia becomes very nervous when teachers in school call on her to answer questions in class, because she fears that she will give the wrong answer and other students will laugh at her. She is often absent on days where she is expected to read in front of the class or give an oral report. Sophia is very shy and only has a few friends even though she wants to have more. She does not belong to any school clubs or does not participate in any team sports. Sophia used to take piano lessons after-school, but stopped going because she was expected to perform in recitals and was too afraid of “messing up” and being embarrassed.
OCD—Contamination	José is a 13-year old boy, who is constantly worried about dirt and germs. He is particularly concerned about getting an illness or getting sick. He washes his hands multiple times throughout the day, and has very elaborate bathroom/cleaning routines that he must follow each time, or else he’ll feel very nervous and will have to start the routine all over again. José will often refuse to do things like play basketball because he does not want to touch anything he thinks is dirty. José’s worries about getting germs on him make him avoid lots of activities that he otherwise would enjoy doing.
Bereavement	Nicholas and Sara have been friends for over 3 years and would often meet at the train station after school for a coffee and a chat. When Nicholas didn’t turn up one day, Sara decided to call him at home. Nicholas sounded upset, so Sara asked him what was wrong. Nicholas explained that his grandmother had just passed away, and then he burst into tears. After a long silence, Nicholas explained that his grandmother had moved back to Greece about 5 years ago, and had been diagnosed with cancer a year ago. Nicholas’s father received a phone call in the middle of the night last night, and told Nicholas the news first thing that morning. Although he hadn’t seen his grandmother very much in the last 5 years, Nicholas still felt really upset and felt he couldn’t cope with going to school that day. He spent the day lying in bed and looking through some old family photo albums that had pictures of him and his grandmother on a family beach holiday when he was 9.
Trichotillomania	Marisol is a 15-year old girl who pulls the hair out from the top of her head and arms on a daily basis. She began pulling about a year ago, first starting on her head and eventually moving to her eyebrows and eyelashes. Marisol is dealing with a lot of stress in her family and at school, and she pulls her hair as a way to get rid of her anxiety and/or stress. When she feels the urge to pull, she has to immediately give in to that urge and does not stop until it “feels right”. After she stops pulling, her anxiety/stress is relieved for a short time; however, she is left feeling shameful, guilty, and embarrassed. The spots where Marisol pulls are visible and she now has to wear her hair a certain way or put on makeup to cover up the bald patches. Additionally, she is reluctant to engage in social activities because she is worried someone may notice.
Body Dysmorphic Disorder	Santiago is a 16-year old male who is bothered by the way his nose and complexion look. Even though he looks normal compared to others and people tell him he has nothing to worry about, he constantly worries about his appearance and feels that he looks ugly. Santiago tends to keep his head down when around others people in order to hide what he calls “flaws” and tries to wear a hat whenever possible. More often than not, every time he looks at his facial complexion, he tends to pick at it to remove blemishes. He carries a mirror around with him at school to constantly check if he looks ok—if he sees something that he thinks looks off, he will stop and try to fix it by picking. Santiago’s worries about his appearance make it difficult for him to concentrate at school and at work. On occasions, he has even pretended to be sick because he thinks his skin looks really bad. Despite reassurance from others saying that he looks fine, Santiago has difficulty believing them.
OCD—Harm	Maria is a 17-year old girl, who has thoughts of accidentally running someone over with her car even though she is a very safe driver and doesn’t want to harm anyone. These thoughts are causing her a lot of anxiety and she tries to get rid of them whenever she has the thought. In her mind, Maria keeps visualizing the situation of harming someone with her car over and over again. Even though she doesn’t want to have them, she has a really hard time getting rid of these thoughts and is so overwhelmed with the anxiety of maybe hurting someone that she has stopped driving completely. Her parents now have to drive her everywhere, while she sits in the back seat. Maria is no longer able to do things like pick up her little sister from soccer practice or go hang out with her friends.