Perceived Stigma and Depression among Black Adolescents in Outpatient Treatment

Purpose: According to the U.S. Surgeon General's report on mental health, ethnic minority children are less likely than white children to receive mental health services, and this disparity is particularly pronounced for black children and adolescents (Flisher, Kramer, Grosser, & et al., 1997). It is important to announce the reason for this phenomenon. The stigma of mental illness is the foremost patient level barrier deterring blacks from seeking treatment for mental illness. The low amount of service use is particularly troubling among black children and adolescents in need of treatment (U. S. Public Health Service, 2001; USDHHS, 2003). Scant scientific attention has been given to the relationship between specific stigma and mental health disorders, particularly the severity of depression among adolescents. The purpose of this study was to explore the relationship between adolescents' perceived stigma and being in outpatient mental health treatment and their current level of depression severity.

Methods: Face-to-face interviews were conducted with a convenience sample of adolescent referred for mental health services at an outpatient mental health clinic (n =108) participating in prospective pilot study on adolescents' patterns of mental health service use. Depression severity was measured using the well established 30 item Reynolds Adolescent Depression Scale 2nd edition (RADS;Reynolds, 1987)which was developed to evaluate the severity of depressive symptoms in adolescents' ages 12 through 18 years (á =.90). Stigma was measured using the 5-item Stigma Scale for Receiving Psychological Help modified for depression treatment (Komiya, 2000 ). Statistical analyses included Spearman correlation and multivariate regression.

Results: Adolescents with more severe depression are more likely to not remain in treatment. In the correlation analysis, being in treatment with depression compared with never experiencing depression was associated with significantly higher levels of perceived stigma (p <.001). In separate multivariate models controlling for significant univariate correlates, greater depression severity (p < .001) and meeting criteria for current major depression (p < .001) were significant predictors of perceived stigma. Greater depression severity appears to be a strong predictor of perceived stigma.

Implications: Overall, this exploratory study supports the hypothesis that depression severity is positively associated with greater perceived stigma among black adolescents in outpatient treatment. It is important to understand the relationship between depression and perceived stigma because stigma may act as a barrier to the initiation and maintenance of depression treatment among adolescents patients who are in particular need of mental health treatment. These results are interpreted in relation to previous literature, and limitations and directions for future research are discussed.