Stigma of Children's Mental Disorders in the United States: A Systematic Literature Review

Background and Purpose: Stigma is a pervasive barrier that prevents many children and families from engaging in mental health care. Stigma refers to a set of negative attitudes and beliefs that motivate individuals to fear, reject, avoid, and discriminate against people with mental illness. U.S. population-based studies have examined the public's stigma toward mental disorders among children. This literature review aims to: (1) evaluate methods used to study the public's stigma toward mental disorders among children (2) summarize stigma findings focused on the public's knowledge, causal attributions, attitudes toward treatments and help-seeking in relation to children's mental disorders; and (3) draw conclusions for reducing stigma and barriers to care for children with mental disorders.

Methods: Electronic bibliographic databases and manual searches were used to identify relevant articles. Published articles in peer review journals were chosen if they met the following criteria: (1) used probability U.S. national samples of non-institutionalized adults or children and (2) reported findings relevant to stigma of mental disorders among children. Two reviewers working independently coded studies' aims, sampling techniques, measures, results, and implications. Reviewers met to discuss and come to a consensus of their analyses.

Results: Nine articles met selection criteria. All studies were cross-sectional and most used vignette methodology. Seven studies asked adults about perceptions of mental illness among children, two studies asked children about perceptions of mental illness among children, and one study compared adults' perceptions of mental illness among adults and children. Low levels of knowledge and recognition of common mental disorders among children (e.g., depression) were reported. Respondents were equally likely to label adult and childhood depression a mental illness. However, childhood depression was seen as more serious and dangerous than adult depression. Biological and non-biological causes of mental illness in children were endorsed by adults and children. Family and individual-level causal attributions were associated with greater social distance. Stigma toward children's mental illness was prevalent and associated with greater perceptions of dangerousness, social distance, and help-seeking. Perceptions of violence and antisocial behaviors among children were high for ADHD and depression. Perceptions of dangerousness were associated with increased desire for social distance, viewing the problem as serious, and greater support for coerced treatment. Positive contact with someone with mental illness reduced desire for social distance. The public's help-seeking preferences for children with mental illness are complex. The public remains wary of giving psychiatric medications to children. Respondents endorsed most forms of help seeking for depression more for children than for adults. Perceptions of greater severity of mental health problems were associated with greater help-seeking. Among adults, sociodemographic characteristics were not associated with stigma. Among children, sociodemographic characteristics, particularly race/ethnicity and gender, were associated with stigmatization, causal beliefs, and attitudes towards treatment.

Conclusions and Implications: Stigma and low levels of recognition and knowledge of children's mental disorders were widespread. These findings can inform interventions to reduce stigma by increasing the public's knowledge of childhood mental disorders and enhancing positive social contact with people with mental illness. Such interventions should target children and families.