When Depression Runs in Families: A Qualitative Study on Self-Stigma Among People Living with Depression

Background and Purpose: Self-stigma is detrimental to psychosocial wellbeing and recovery journey among people living with depression (PLWD). Less research has explored stigma internalization experience when depression runs in PLWD’s families. Drawing from the Social Cognitive Model of Self-stigma and Family Systems Theory, this study sought to 1) characterize manifestations of self-stigma among PLWD whose parent(s) also lived with depression; and 2) explore potential mechanisms underlying the impacts of parental depression on self-stigma among PLWD.

Methods: Following grounded theory approach, data were collected through in-depth interviews with 27 participants diagnosed with depression, aged 15-30, living in Mainland China, and with a parent(s) diagnosed with depression. Constant comparison was used to analyze the data to extract themes.

Results: Many participants perceived depression that run in family as an endless disaster and incurable illness, and PLWD as worthless. These cognitions further led to stigmatizing affection (i.e., oppression, anger, and guilt) and behaviors (i.e., concealment and social withdrawal). Results also identify multiple paths through which parental depression impacted the entire family and offspring’s stigma internalization. Participants highlighted ambivalent intergenerational relationships, tense family atmospheres, lower parental emotional involvement, and a lack of family flexibility because of parental depression. Moreover, parental depression was involved in participants’ self-stigma by interfering with family relationships, family functioning, and parenting styles and shaping their perceptions of family, illness attribution, and public stigma. Parental depression was also cited as influential on participants’ social functioning, self-esteem, and personality, heightening their proneness to self-stigma.

Conclusions and Implications: This study highlights the pivotal role family could play in PLWD’s stigma internalization. Parental depression was implicated in family interaction and individual development, shaping PLWD’s thoughts, affection, and behavior towards their own experience and view of depression.

Helping professionals need to address the self-stigma issue among patients with familial mental illness and respond to the role of family interactions when developing intervention strategies to reduce self-stigma.