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).

Rural parents’ perceived stigma of seeking mental health services for their children: Development and evaluation of a new instrument.

“…Stigma is purported to be a significant barrier to such service seeking (Jameson & Blank, 2007; Mukolo et al, 2010); however, little empirical evidence for perceived stigma of service seeking exists among parents of children in rural areas of the U.S. As the first step in understanding stigma among parents of children with psychosocial concerns, this study sought to examine the score interpretations of an instrument developed to assesses parents’ perceived public and self stigma of seeking mental health services for their children living in rural communities. In assessing perceived stigma, we focused on parents from rural Appalachia whose children were experiencing psychosocial concerns because, for these parents, stigma as a potential barrier to service seeking may be particularly relevant.…”

“…Recently, more attention has been focused on perceptions of stigma about children’s mental illness and mental health services (see Mukolo et al, 2010 for a review). In particular, the National Stigma Study – Children (NSS-C) provided the first nationally representative, large-scale survey of adults’ public knowledge and beliefs about child mental health concerns.…”

“…Access to effective treatments is particularly limited in rural areas, where several hypothesized barriers have been implicated including: financial concerns including inadequate insurance coverage (U.S.D.H.H.S., 1999), problems with travel and transportation (Fox, Merwin, & Blank, 1995), and beliefs about the relevance and need for (Girio-Herrera, Owens, & Langberg, 2013) or appropriateness of mental health treatment such as the stigma associated with it (Jameson & Blank, 2007; Mukolo, Heflinger, & Wallston, 2010). Further, recent evidence suggests that in rural areas parents of children at risk for behavioral difficulties are more likely to seek help from informal (e.g., spouse, family) than formal systems (e.g., medical professionals) for problems with their children (Girio-Herrera et al, 2013).…”

Stigma Scale for Receiving Psychological Help (SSRPH)

“…To date, most conceptual frameworks of stigma have been developed for adults and used in child and adolescent populations (Corrigan et al, 2007; Mukolo et al, 2010); there has been little attention to the conceptualization of stigma among adolescents. Transfer of adult frameworks to adolescent populations without sufficient evidence is problematic for two reasons.…”

“…Despite this large number of interventions, the evidence base to support anti-stigma interventions for adolescents is not well established. Specifically, scientific progress has been hindered because studies overall have lacked experimental design, are low rigor, have have poor reporting quality of findings; in addition, studies do not consistently use validated instruments to measure stigma (Mukolo, Heflinger, & Wallston, 2010; Schachter et al, 2008). There are limited data on reliability and validity of stigma measures in adolescents (Schachter et al, 2008).…”