Reducing stigma associated with mental health concerns is a key objective of suicide prevention policies. Although the primary aim of these efforts is to promote help-seeking, the problem of stigma does not necessarily end when a person crosses the threshold to treatment. Internalized stigma can affect meanings attached to experiencing a problem or needing help, adding to the burden of mental health difficulties. Perceived stigma by others can inhibit positive social connections and exacerbate social isolation. This article draws on cognitive and relational-cultural theories to discuss psychological and interpersonal consequences of mental illness stigma for depressed and suicidal young adults. Clinical approaches to addressing stigma are illustrated with a case vignette of a 19-year-old male college student.
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References
1.
BanduraA., PastorelliC., BarbaranelliC., & CapraraG. V. (1999). Self-efficacy pathways to childhood depression. Journal of Personality and Social Psychology, 76(2), 258–269.
2.
BaumeisterR. (1990). Suicide as escape from self. Psychological Review, 97(1), 90–113.
3.
BeckA. (1996). Beyond belief: A theory of modes, personality and psychopathology. In SalkovskisP. (Ed.), Frontiers of cognitive therapy (pp. 1–25). New York, NY: Guilford.
4.
BeckA. T., BrownG. K., SteerR. A., KuykenW., & GrishamJ. (2001). Psychometric properties of the Beck self-esteem scales. Behavior Research and Therapy, 39, 115–124.
5.
BoivinJ., PoulinF., & VitaroF. (1994). Depressed mood and peer rejection in childhood. Development and Psychopathology, 7, 483–498.
6.
BrownG. K., BeckA. T., SteerR. A., & GrishamJ. R. (2000). Risk factors for suicide in psychiatric outpatients: A 20-year prospective study. Journal of Consulting and Clinical Psychology, 68(3), 371–377.
7.
BrownG. K., Ten HaveT. T., HenriquesG. R., XieS. X., HollanderJ. E., & BeckA. T. (2005). Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. Journal of the American Medical Association, 294(5), 563–570.
8.
Centers for Disease Control and Prevention. (2009). National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). Retrieved on October 17, 2010 from http://www.cdc.gov/ncipc/wisqars
9.
Cepeda-BenitoA., & ShortP. (1998). Self-concealment, avoidance of psychological services, and perceived likelihood of seeking psychological help. Journal of Counseling Psychology, 45, 58–64.
10.
CooperA., CorriganP. W., & WatsonA. C. (2003). Mental illness stigma and care seeking. Journal of Nervous and Mental Disease, 191, 339–341.
11.
CorriganP. W. (2000). Mental health stigma as social attribution: Implications for research methods and attitude change. Clinical Psychology: Science & Practice, 7, 48–67.
12.
CorriganP. W. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614–625.
13.
CorriganP. W. (2005). Dealing with stigma through personal disclosure. In CorriganP. W. (Ed.), On the stigma of mental illness: Practical strategies for research and social change (pp. 257–280). Washington, DC: American Psychological Association.
14.
CorriganP. W., & CalabreseJ. D. (2005). Strategies for assessing and diminishing self-stigma. In CorriganP. W. (Ed.), On the stigma of mental illness: Practical strategies for research and social change (pp. 239–256). Washington, DC: American Psychological Association.
15.
CorriganP. W., & KleinleinP. (2005). The impact of mental illness stigma. In CorriganP. W. (Ed.), On the stigma of mental illness: Practical strategies for research and social change (pp. 11–44). Washington, DC: American Psychological Association.
16.
CorriganP. W., & MatthewsA. K. (2003). Stigma and disclosure: Implications for coming out of the closet. Journal of Mental Health, 12(3), 235–248.
17.
CorriganP. W., & WatsonA. C. (2002). The paradox of self-stigma and mental illness. Clinical Psychology—Science and Practice, 9, 35–53.
18.
CorriganP. W., WatsonA. C., & BarrL. (2006). The self-stigma of mental illness: Implications for self-esteem and self-efficacy. Journal of Social and Clinical Psychology, 25(8), 875–885.
19.
CramerK. M. (1999). Psychological antecedents to help-seeking behavior: A reanalysis using path modeling structures. Journal of Counseling Psychology, 46(3), 381–387.
20.
DownsM. F. (2011). Pathways to care: Correlates and predictors of help-seeking among suicidal college students. (Unpublished doctoral dissertation). Simmons College, Boston, MA.
21.
DownsM. F., & EisenbergD. (in press). Help-seeking and treatment use among suicidal college students. Journal of American College Health.
22.
DrumD., BrownsonC., DenmarkA. B., & SmithS. (2009). New data on the nature of suicidal crises in college students: Shifting the paradigm. Professional Psychology: Research and Practice, 40(3), 213–222.
23.
EisenbergD., DownsM. F., GolbersteinE., & ZivinK. (2009). Stigma and help-seeking for mental health among college students. Medical Care Research and Review, 66(5), 522–541.
24.
EisenbergD., GolbersteinE., & GollustB. A. (2007). Help-seeking and access to mental health care in a university student population. Medical Care, 45(7), 594–601.
25.
EisenbergD., GollustB. A., GolbersteinE., & HefnerJ. L. (2007). Prevalence and correlates of depression, anxiety and suicidality among university students. American Journal of Orthopsychiatry, 77(4), 534–542.
26.
GallagherR. P. (2009). National Survey of Counseling Center Directors. Arlington, VA: International Association of Counseling Services.
27.
GilchristH., & SullivanG (2006). Barriers to help-seeking in young people: Community beliefs about youth suicide. Australian Social Work, 59(1), 73–85.
28.
GoffmanE. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.
29.
GolbersteinE., EisenbergD., & GollustS. E. (2008). Perceived stigma and mental health care seeking. Psychiatric Services, 59(4), 392–399.
30.
GoldsmithS. K., PellmarT. C., KleinmanA. M., & BunneyW. E. (Eds.). (2002). Reducing suicide: A national imperative. Washington, DC: National Academies Press.
31.
HefnerJ., & EisenbergD (2009). Social support and mental health among college students. American Journal of Orthopsychiatry, 79(4), 491–499.
32.
HolmesP., & RiverL. P. (1998). Individual strategies for coping with the stigma of severe mental illness. Cognitive and Behavioral Practice, 5, 231–239.
33.
JoinerT. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
34.
JordanJ. V. (2000). The role of mutual empathy in relational-cultural theory. JCLP/In Session: Psychotherapy in Practice, 56(8), 1005–1016.
35.
JordanJ. V. (2004). Relational awareness: Transforming disconnection. In JordanJ. V., WalkerM., & HartlingL. M. (Eds.), The complexity of connection (pp. 47–63). New York, NY: Guilford.
36.
JordanJ. V., & HartlingL. M. (2002). New developments in relationalcultural theory. In BallouM. & BrownL. S. (Eds.), Rethinking mental health and disorders: Feminist perspectives (pp. 48–70). New York, NY: Guilford.
37.
JordanJ. V., KaplanA. G., MillerJ. B., StiverI. P., & SurreyJ. L. (Eds.). (1991). Women's growth in connection: Writings from the Stone Center. New York, NY: Guilford.
38.
KadushinG. (2000). Family secrets: Disclosure of HIV status among gay men with HIV/AIDS to the family of origin. The Journal of Health Care Social Work, 30(3), 1–17.
39.
KesslerR. C., BerglundP. A., BruceM. A., KochJ. R., LaskaE. M., LeafP. J., & WangP. S. (2001). The prevalence and correlates of untreated serious mental illness. Health Services Research, 36, 987–1007.
40.
KomiyaN., GoodG. E., & SherrodN. B. (2000). Emotional openness as a predictor of college students’ attitudes toward seeking psychological help. Journal of Counseling Psychology, 47(1), 138–143.
41.
LeafP. J., BruceM. L., & TischlerG. L. (1986). The differential effects of attitudes on the use of mental health services. Social Psychiatry, 21, 197–192.
42.
LinkB. G. (1987). Understanding labeling effects in the area of mental disorders: An assessment of the effects of expectations of rejection. American Sociological Review, 52, 96–112.
43.
LinkB. G., MorotznikJ., & CullenF. T. (1991). The effectiveness of stigma coping orientations: Can negative consequences of mental illness labeling be avoided? Journal of Health and Social Behavior, 32, 302–320.
44.
LinkB. G., & PhelanJ. C. (2002). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385.
45.
LinkB. G., StrueningE. L., Neese-ToddS., AsmussenS., & PhelanJ. C. (2001). The consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Services, 52, 1621–1626.
46.
MacgowanM. J. (2004). Psychosocial treatment of youth suicide: A systematic review of the research. Research on Social Work Practice, 14(3), 147–162.
47.
MillerJ. B. (1986). What do we mean by relationships? (Work in Progress No. 22). Wellesley, MA: Stone Center Working Paper Series.
48.
MillerJ. B. (1988). Connections, disconnections, and violations (Work in Progress, No. 12). Wellesley, MA: Stone Center Working Paper Series.
49.
MillerJ. B., & StiverI. P. (1997). The healing connection: How women form relationships in therapy and in life. Boston: Beacon Press.
50.
MojtabaiR., OlfsonM., & MechanicD. (2002). Perceived need and help-seeking in adults with mood, anxiety or substance use disorders. Archives of General Psychiatry, 59, 77–84.
51.
MoskosM. A., OlsonL., HalbernS. R., & GrayD. (2007). Utah youth suicide study: Barriers to mental health treatment for adolescents. Suicide and Life-Threatening Behavior, 37(2), 179–186.
52.
PachankisJ. E. (2007). The psychological implications of concealing a stigma: A cognitive-affective-behavioral model. Psychological Bulletin, 133, 328–345.
53.
PennebakerJ. W., Kiecolt-GlaserJ. K., & GlaserR. (1988). Disclosure of traumas and immune function: Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, 54, 373–384.
54.
PerkinsD. F., & HartlessG. (2002). An ecological risk-factor examination of suicidal ideation and behavior of adolescents. Journal of Adolescent Research, 17, 3–26.
55.
PescosolidoB. A., MartinJ. K., LongJ. S., MedinaT. R., PhelanJ. C., & LinkB. G. (2010). “A disease like any other”? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. American Journal of Psychiatry, 67, 1321–1330.
56.
PhelanJ. C., LinkB. G., StueveA., & PescosolidoB. A. (2000). Public conceptions of mental illness in 1950 and 1996: What is mental illness and is it to be feared?Journal of Health and Social Behavior, 41(2), 188–207.
57.
RomerD., & BockM (2008). Reducing the stigma of mental illness among young adults: The effects of treatment information. Journal of Health Communication, 13(8), 742–758.
58.
RuddM. D. (2004). Cognitive therapy for suicidality: An integrative, comprehensive and practical approach to conceptualization. Journal of Contemporary Psychotherapy, 34(1), 59–72.
59.
SchwartzA. J. (2006). College student suicide in the United States: 1990-1991 through 2003-2004. Journal of American College Health, 54(6), 341–352.
60.
SheaC. S. (2002). The practical art of suicide assessment: A guide for mental health professionals and substance abuse counselors. Hoboken, NJ: Wiley & Sons.
61.
SilvermanM. M., MeyerP. M., SloaneF., RaffelM., & PrattD. M. (1997). The Big Ten student suicide study: A 10-year study of suicides on midwestern university campuses. Suicide and Life- Threatening Behavior, 27(3), 285–303.
62.
SireyJ. A., BruceM. L., AlexopoulosG. S., PerlickD. A., RaueP., FriedmanS. J., & MeyersB. S. (2001). Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression. American Journal of Psychiatry, 52, 1615–1620.
63.
Substance Abuse and Mental Health Services Administration. (2008). National Registry of Evidence-Based Programs and Practices (NREPP). Retrieved July 16, 2008, from http://www.nrepp.samsha.gov
64.
Van VorheesB. W., FogelJ., HoustonT. K., CooperL. A., WangN-Y & FordD. E. (2005). Beliefs and attitudes associated with intention to not accept the diagnosis of depression among young adults. Annals of Family Medicine, 3(1), 38–46.
65.
WalkerM. (2004). How relationships heal. In WalkerM. & RosenW. (Eds.), How connections heal: Stories from relational-cultural therapy (pp. 3–21). New York, NY: Guilford Press.
66.
WangP. S., BerglundP., OlfsonM., PincusH. A., WellsK. B., & KesslerR. C. (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 603–613.
67.
WatsonA. C., & RiverL. P. (2005). A social-cognitive model of personal responses to stigma. In CorriganP. W. (Ed.), On the stigma of mental illness: Practical strategies for research and social change (pp. 145–164). Washington, DC: American Psychological Association.
