Self Stigma and Its Correlates among Adolescents with Mental Disorders: The Role of Parents' and Adolescents' Illness Attributions

Background and Purpose: Youth evidencing mental disorders are stigmatized in our society. Still, little is known about their subjective experiences with mental illness stigma, particularly self-stigma, defined as the application of negative stereotypes about people with mental illness toward oneself in a way that undermines self-esteem and self-efficacy. The purpose of this study was to examine the extent to which adolescents and their parents experience stigma, and explore the illness attributions that relate to adolescents' self-stigma. Illness attributions relating to perceived controllability of symptoms, anticipated chronicity, and causal factors are interesting to investigate in relation to self-stigma given their consistent role in determining public stigmatization of individuals with mental illness. The specific questions guiding this inquiry are: (1) What are adolescents' and parents' perceptions of stigma and attributions toward the adolescent's mental health problems? and (2) What stigma perceptions (parents') and attributions (adolescents' and parents') relate to child's sense of self-stigma?

Methods: Data was elicited from in-home interviews conducted with a convenience sample of 60 adolescents (aged 12-18) receiving wraparound services and their parent/caregiver (total of 120 interviews). Participating youth were diagnosed with multiple disorders and had been receiving extensive MH services for several years.

I adapted widely used and validated measures of stigma and illness attributions for the study population. Associations between self-stigma and correlates were tested using hierarchical linear regression. Statistically significant bivariates were regressed on self stigma in three sequences: adolescent correlates, parent correlates and combined.

Results: About 23% of adolescents reported experiencing self-stigma “frequently” or “very often”. The average parent did not report a high level of shame or desire to conceal their child's problems, yet parents reported that they are often stigmatized by others, and that families of youth with MH problems are generally devalued. In terms of illness attributions, over 50% of adolescents and parents indicated believing that the adolescents can ‘control' their negative emotions and behaviors. More adolescents than parents expressed optimism in regards to the child's future without mental health problems (58% vs. 30%). In terms of causal attributions, adolescents most commonly endorsed their personality/characteristic way of thinking (62%), while parents most commonly endorsed biological/genetic factors (70%).

The four factors that emerged in the regression analysis as most significant correlates of adolescents' self-stigma included: adolescents' causal attributions related to social problems and a history of trauma, parents' inclination to conceal their child's mental health problems from others and the parent's perception of others' stigmatizing behavior toward their child. These factors accounted for 60% of the variance of youths' self stigma and remained significant (p<.001) when controlling for clinical and demographic factors.

Implications: This study points to the potential importance of youths' causal explanations for their problems as well as parents' stigma reactions as factors contributing to youths' self-stigma or sense of shame or embarrassment secondary to having MH problems. If such factors are borne out in future research with larger samples, social work interventions addressing youths' and parents' cognitive appraisals are promising avenues for stigma-reduction among adolescent mental health consumers.