The Stigma of Childhood Mental Disorders: A Conceptual Framework

Abstract

Objective-To describe the state of the literature on stigma associated with children's mental disorders and highlight gaps in empirical work.Method-We reviewed child mental illness stigma articles in (English only) peer-reviewed journals available through Medline and PsychInfo. We augmented these with adult-oriented stigma articles that focus on theory and measurement. 145 articles in PsychInfo and 77 articles in MEDLINE met search criteria. The review process involved identifying and appraising literature convergence on the definition of critical dimensions of stigma, antecedents, and outcomes reported in empirical studies.Results-We found concurrence on three dimensions of stigma (negative stereotypes, devaluation and discrimination), two contexts of stigma (self, general public), and two targets of stigma (self/ individual, family). Theory and empirics on institutional and self stigma in child populations were sparse. Literature reports few theoretic frameworks and conceptualizations of child mental illness stigma. One model of help-seeking (the FINIS) explicitly acknowledges the role of stigma in children's access and utilization of mental health services.Conclusions-Compared to adults, children are subject to unique stigmatizing contexts that have not been adequately studied. The field needs conceptual frameworks that get closer to stigma experiences that are causally linked to how parents/caregivers cope with children's emotional and behavioral problems such as seeking professional help. To further research in child mental illness, we suggest an approach to adapting current theoretical frameworks and operationalizing stigma highlighting three dimensions of stigma, three contexts of stigma (including institutions), and three targets of stigma (self/child, family and services).

Factors Associated with Attributions About Child Health Conditions and Social Distance Preference

“…In line with a broader research endeavor to examine geographic disparities in child mental health (Heflinger and Christens 2006;Mukolo et al 2010), we were particularly interested in the role of rurality in attributions and stigma. In addition, we proposed recognition of ''stigma by association'' that applies to parents of children with mental illness (Mukolo et al 2010), such as preference for social distance from families of children with mental disorders. In this study we also examined attributions that implicate parents for their children's mental illness as well as those about biologic/genetic causes of child mental illness.…”

“…Our categorization schema is similar to other studies that have explored attributions from GSS data (Schnittker et al 2000). However, we subdivided the unhealthy upbringing group into 'child is to blame' (1 item) and 'parent is to blame' (3 items) subgroups in line with our conceptual model for the stigmatization of children's emotional and behavioral disorders (Mukolo et al 2010). Initially, we analyzed the factor structure of these attributions based on principal components analysis, varimax rotation with Kaizer Normalization and obtained two components: all the unhealthy upbringing items clustered together (Cronbach's a = .78) and the biology items clustered with the environmental stress item (Cronbach's a = .68).…”

Symptoms of psychiatric diseases in a pediatric neurology department

“…However, the reason for remaining without the proper medical care or prolonging the time before the first consultation with a psychiatrist is very often a desire to avoid the stigmatization with a mental illness. The problem of stigmatization of patients with mental disorders is a key issue, whereas understanding the psychological aspect of the resistance to consult a psychiatrist and the fear of mental illness enables one to better understand the families of children and adolescents with signs of psychiatric problems and to accept their attitudes [27]. Nevertheless, this does not change the fact that the attitude of "dodging" or resisting treatment increases the risk of unwanted complications and exposes the patient to persistent psychological distress.…”

Stigma in Child and Adolescent Mental Health Services Research: Understanding Professional and Institutional Stigmatization of Youth with Mental Health Problems and their Families

“…Yet, to provide understanding of the role of professional/institutional stigma and its impact on youth with mental health problems and service delivery, the FINIS model needs further explication. A recent paper (Mukolo et al 2010) presented needed expansions in order to make stigma theory more relevant to the experiences of youth and to link stigma directly to service use. In our limited space herein, we focus on (a) stigma by association and (b) the linkage between stigma and service use.…”