Stigma Experience Among Adolescents Prescribed Psychiatric Medications

Purpose: This study examines adolescent experience of mental health stigma. Minimal research has been conducted on adolescent experience of stigma (Hinshaw, 2007). Stigma is of concern for at least three reasons. First, adolescents are being diagnosed and prescribed psychiatric medication at much higher rates than ever before (Moreno et al, 2007; Thomas et al, 2006). Second, the Surgeon General (2000) approximated that between six and nine million children who have DSM-IV diagnoses are not receiving proper treatment for their condition. Research shows that stigma acts as a barrier to receiving proper treatment in children (Owens et al., 2002). Third, during adolescence, developmental theory suggests that individuals form an identity, engage in peer relations outside the family, and use the school environment as a site for developing a sense of self-esteem, independence, and self-efficacy (Brockman, 2003). Thus, by having to live with the effects of stigma while adjusting to developmental needs, negative stigma effects could be more harmful and longer lasting on youth than on adults.

Methods: Forty-two adolescents, ages 12-17, who currently meet DSM IV criteria for a psychiatric illness (assessed by the K-SADS research diagnostic interview) and who were currently being prescribed a psychiatric medication were enrolled in a NIMH funded, IRB approved study. A semi-structured interview instrument was used to query adolescents about: (1) illness representations; (2) perceptions of medication; (3) parent and adolescent interaction regarding medication management; (5) illness and medication stigma; (6) adolescent and school interactions regarding medication management; and (7) adolescent and peer interactions regarding medication management. Respondent answers were recorded as audio wav files, transcribed, and the resulting written narratives transferred to a computer software program, Atlas.ti. Using the constant comparative method, coders selected quotations that referenced stigma feelings, thoughts, and behavior and then coded (often with the respondent's own words) the quotations. These codes were sorted by shared thematic content. Coding reliability and validity was established by independent coding procedures.

Results: Adolescents reported at least one of the following stigma themes: 1) secrecy-adolescents were embarrassed and did not want to inform peers about their illness and use of medication; 2) withdrawal-adolescents limited their interactions to those peers they trusted, to those who knew about their illness, or had a similar condition; 3) shame-adolescents felt they were different and abnormal from peers who did not have the same condition. Many participants reported all three stigma themes.

Conclusion and Implications: This study provides descriptive data suggesting that adolescents do experience the effects of stigma and labeling: secrecy, shame, and withdrawal. The long-term effects of mental illness stigma on adolescents may include the formation of an ‘illness/stigmatized' identity, reduced or limited career opportunities, and diminished independent living skills, mostly negative and documented with adult populations. Thus, more stigma research is needed and more psychoeducational programs are needed for prevention and amelioration of youth stigmatization effects. Concern over stigma is particularly heightened now given that in the last two decades, increasing numbers of adolescents are being diagnosed with mental illnesses and increasing numbers are being prescribed medication.