Public Stigma and Self-Stigma Toward Mental Health Treatment in China

Background: Mental health problems are considered to be one of the leading causes of disability in China, yet mental health treatment service utilization by individuals experiencing mental health problems remains very low. Stigma acts as a barrier to mental health treatment. The current study explores two types of stigma, specifically self-stigma and public stigma toward mental health care among adults within the Chinese context. The study investigated which participant characteristics affect stigma toward mental health treatment, and whether participant exposure to mental health problems moderates the relationship between participant characteristics and stigma toward mental health.

Methods: This study uses cross-sectional data from a community-based survey conducted in Shanghai, China in 2018 (N=500). Convenience sampling was used to recruit participants in public spaces across the Shanghai metropolitan area, such as shopping malls, libraries, public parks, and commuter bus terminals. Participants completed a survey that included questions on participant demographics and standardized measures related to attitudes and beliefs about mental health and mental health treatment. Following examination of measurement models for latent variables, we conducted a series of regression models examining predictors of stigma. The first series of analyses focused on public stigma; the second series concentrated on self-stigma.

Results: Findings indicate that knowing someone with a mental health problem moderates the relationship between participant characteristics and stigma. For public stigma, no predictors achieved statistical significance among those who did not know anyone with mental health problems; however, for those who did know someone with mental health problems, females scored higher on public stigma compared with males. Furthermore, a Wald test indicated an interaction effect between knowing someone with mental health problems and gender: χ²(1)=7.687, p=.006. Self-stigma models showed that older respondents expressed higher self-stigma. Additionally, respondents who were employed full-time tended to express higher self-stigma than non-full-time workers. Wald tests indicated knowing someone with mental health problems moderated the association of age and self-stigma, χ²(1)=4.910, p=.027, but the difference in slopes for the full-time employment indicator was not significantly different across groups: χ²(1)=0.874, p=.350.

Conclusions: This study highlights that gender and proximity together influence public stigma, most notably the closeness of the relationship rather than the presence of knowing someone seems to be driving this relationship. Findings may support the inclusion of family in the treatment of mental illness at a clinical practice level in China, and also inform the targeting of anti-stigma interventions and public awareness campaigns at a policy level. Findings also indicate that as the age of participants increased their public stigma decreased. While other research has found the association of age and stigma mixed, results may highlight that public stigma is a more nuanced phenomenon that may be influenced by experience and tolerance. The study found that participants who were employed full-time expressed higher self-stigma. Consequently, interventions designed to address public stigma and self-stigma and to overcome the barrier to stigma to engaging and accessing mental health treatment may need to be more nuanced across demographics, such as age, gender, and employment.