top of page
Search

How Does Mental Health Stigma Impact Treatment Outcomes?

ree

While society has become more open in discussing and treating mental health, there continues to be a persistent stigma surrounding mental illness (Canadian Mental Health Association, 2024.). Mental health stigma involves any negative attitudes that are associated with mental illness (American Psychiatric Association, 2024). Stigma manifests in several ways, including, negative attitudes people hold toward their own mental health (internalized stigma) and the negative attitudes people expect from other (anticipated stigma) (American Psychiatric Association, 2024). The stigma around mental health has serious consequences on peoples’ lives. Stigma can lead to the loss of crucial support systems like friends and family. Those seeking treatment may become targets for judgment and they could face discrimination and be denied basic needs like housing and work (Dobransky, 2020). With such negative consequences, it can be hard to want to seek mental health treatment. This article will focus on the ways stigma manifests and how stigma has an impact on people’s attitudes toward mental health treatment.

Deciding whether to seek treatment can be influenced by several distinct factors. A 2018 study conducted by Fox et al. examined 9/11 veterans with depression and what factors affected their choice to seek mental health treatment. The study found that anticipated stigma, internalized stigma, and the severity of their symptoms impacted whether these veterans pursued mental health care (Fox et al., 2018). Specifically, the researchers found that veterans who had anticipated that others around them would treat them poorly because of their mental illness would then internalize these negative thought patterns (Fox et al., 2018). Research on veterans has shown that veteran anticipated stigma stems from a fear of being seen as weak and the fear of being treated differently by their superiors (Sharp et al., 2015). As a result, these veterans would hold negative attitudes toward their mental illness, self-image, and were less likely to seek treatment (Fox et al., 2018).The internalized stigma these veterans experienced was a key factor in their reluctance to seek help. Reluctance to seek help due to internalized stigma was shown through self-assessment reports where veterans were assessed on their feelings towards their mental illness, anticipated stigma, and their severity of their depression. Veterans answered questions on a five-point scale ranging from strongly agree to strongly disagree (Fox et al., 2018). Veterans who scored high in having anticipated and internalized stigma in their self-reports were found to be less likely to seek mental health treatment (Fox et al., 2018). Fox et al.’s findings demonstrate the impact internalized stigma has on treatment outcomes.


Further, another key factor contributing to reluctance to seek mental health treatment was the veteran’s severity in mental illness symptoms (Fox et al., 2018). In this study, symptom severity was measured through self-assessment reports, where veterans with more symptoms were considered to have severe depression (Fox et al., 2018). Fox et al. found that veteran’s severity of symptoms can either decrease or increase anticipated stigma, overall impacting treatment seeking. Veterans with more depressive symptoms were more likely to anticipate stigma from their peers and consequently less likely to seek treatment. Conversely, veterans who had fewer depressive symptoms were less likely to anticipate stigma from their peers and did not impact them from seeking treatment. It is unclear why symptom severity impacts anticipated stigma and treatment seeking; however, it could be because individuals with milder symptoms are driven to seek help earlier to avoid the stigma around their mental illness (Fox et al., 2018). On the other hand, those who have severe symptoms might expect more intense stigma due to their symptom severity (Fox et al., 2018). The fear of being seen as someone who needs treatment may prevent people with more severe symptoms from seeking treatment altogether.

Although the fear of stigma has a large impact on one’s reluctance towards treatment seeking, initiating treatment for a mental illness can help reduce one’s internalized stigma. In 2017, Pearl et al. conducted a study that investigated patients enrolled in a brief, twelve-day psychiatric treatment program, focusing on whether there were any changes in the patient’s internalized stigma. Patients in this study had various mental illnesses including depression and anxiety (Pearl et al., 2017). Using self- assessment reports to monitor symptoms and internalized stigma, the study found that patients had a decrease in both internalized stigma and symptom severity because of treatment provided (Pearl et al., 2017). Further after treatment, patients reported in self-assessment reports that they had better quality of life due to reduced symptoms and reduced negative self-stigma (Pearl et al., 2017). Pearl et al.’s study demonstrates that even undergoing treatment for a short period of time has beneficial outcomes in internalized stigma and symptom severity.

Further, additional research around the effects of anticipated and internalized stigma across a variety of symptom severity levels and types of mental illnesses is needed to create strategies that help reduce mental health stigma. For instance, research has not considered several factors related to stigma that can affect treatment outcomes. For example, the first study cited explored veterans with solely depressive symptoms. This is a niche population, meaning that the results are less generalizable.


Both anticipated and internalized stigma surrounding mental health, as seen from the cited studies, can act as a barrier towards treatment seeking; however, undergoing treatment can alleviate internalized stigma and overall alleviate mental illness symptoms. Creating strategies to decrease mental health stigma can allow individuals with mental illnesses to receive the treatment they need without fear of judgment (Pearl et al., 2017). Although stigma creates a boundary toward treatment seeking, finding help is essential in improving mental health outcomes and fostering better attitudes toward our own mental health.


References

American Psychiatric Association. (n.d.). Stigma, prejudice and discrimination against people with

Annie B. Fox, Brian N. Smith, Dawne Vogt. (2018). How and when does mental illness stigma

impact treatment seeking? Longitudinal examination of relationships between anticipated and

internalized stigma, symptom severity, and mental health service use. Psychiatry Research,

Canadian Mental Health Association. (n.d.). Stigma and Discrimination.

Kerry M. Dobransky. Reassessing mental illness stigma in mental health care: Competing stigmas

and risk containment. Social Science & Medicine.

Pearl, R. L., Forgeard, M. J. C., Rifkin, L., Beard, C., & Björgvinsson, T. (2017). Internalized

stigma of mental illness: Changes and associations with treatment outcomes. Stigma and

Health, 2(1), 2 –15. https://doi.org/10.1037/sah0000036

Sharp, M., Fear, N., Rona, R., Wessley, S., Greenberg, N., Jones, N., Goodwin, L. (2015).

Stigma as a barrier to seeking health care among military personnel with mental health

problems, Epidemiological Reviews, 37 (1), 144-162.

 
 
 

Comments

bottom of page