IntroductionOne in ten children and adolescents experience mental health difficulties at any given time, yet only one third of those suffering access treatment. Untreated mental illness predisposes to longstanding individual difficulties, and presents a great public health burden. Large scale initiatives to reduce stigmatization of mental illness in children and adolescents, identified as a key deterrent to treatment, have had limited success, and research is scarce.AimsTo gain a better understanding of the stigma experienced by children and adolescents with mental health difficulties.ObjectivesWe conducted a systematic review of the literature examining stigma and self-stigma towards children and adolescents with mental health difficulties, in order to better understand the extent and type of discrimination directed towards this particularly vulnerable group.MethodsFollowing PRISMA guidelines, the databases Pubmed, PsychINFO and Cochrane were searched for original research published between 1980 and 2014, assessing public stigma (i.e. the reaction of the general public) and self-stigma (i.e. internalized public stigma) towards children and adolescents with mental health difficulties.ResultsThirty-seven studies were identified, confirming that stigmatization towards children and young people suffering mental health difficulties is a universal and disabling problem. There was some variation by diagnosis and gender, and stigmatization was for the most part unaffected by labelling. Self-stigmatization led to more secrecy and avoidance of interventions.ConclusionsThe findings confirm that stigmatization of mental illness is poorly understood due to a lack of evidence and methodological discrepancies. Implications of the findings are discussed, and suggestions made for future research.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Background: Research on the impact of stigma associated with mental illness in

Background: Children in mental health inpatient care require multiple treatments. There is not a comprehensive instrument to assess perceived helpfulness of this combination of interventions. Aims: To develop and evaluate the psychometric properties of the What was Helpful Questionnaire (WHQ), a tool designed to capture parental perceived helpfulness of the multidimensional management approach used in inpatient children's units. Methods: A total of 73 inpatients and their families were included in this study. The WHQ consists of six items exploring the perceived helpfulness of different aspects of care. Demographic and clinical variables were collected on admission and discharge. An exploratory factor analysis using polychoric correlations was performed to assess the item structure of the scale and the Cronbach's alpha coefficient was used for internal reliability. Associations were assessed using regressions models. Results: WHQ is a unidimensional scale with an internal reliability of 0.77. No associations were identified between WHQ total score and age, gender, and Children's Global Assessment Scale scores change. A strong relationship between the WHQ total score and parental Acorn Satisfaction Questionnaire total score was found. Conclusions: Results add evidence for the validity and the reliability of the WHQ to measure parental perceived helpfulness of interventions offered in inpatient children's units.

Mental health-related stigma is poorly understood, and minimal research has focused on the experience of stigma from children’s perspectives. We sought to investigate whether children treated as inpatients and outpatients had different experiences of stigma over time and whether stigma is linked to global functioning cross-sectionally and longitudinally. Children, aged 8–12 years, receiving treatment within a national specialist mental health inpatient unit were matched for age, gender and diagnosis with children receiving outpatient treatment (N = 64). Validated measures of stigma, global functioning and symptom severity were collected at the start of treatment and upon discharge from the ward for inpatients, and a similar timeframe for their individually matched outpatients. Latent change score models and partial correlation coefficients were employed to test our hypotheses. No differences in most aspects of stigma between children treated as inpatients and outpatients were observed, except for personal rejection at baseline and self-stigma at follow-up favouring outpatients. A reduction in stigma was observed in societal devaluation, personal rejection and secrecy for inpatients, and self-stigma and secrecy for outpatients between the two assessments. Societal devaluation declined at a higher rate among inpatients compared to outpatients, albeit reductions in stigma were comparable for all remaining measures. No association was found between the change in stigma and change in global functioning. Future research may offer further insights into the development and maintenance of stigma and identify key targets for anti-stigma interventions to reduce its long-term impact.

No abstract