The Contextual Weight of Mental Health Stigma: Its Role in Suicidal Ideation, Planning, and Attempts

Background

Mental health stigma is a critical factor contributing to suicidal thoughts and behaviors, including ideation, attempts, and planning among young adults in the U.S. Mental health stigma consists of perceived stigma—societal discrimination and negative stereotypes against individuals with mental health conditions—and personal stigma, where individuals internalize these negative beliefs. Prior research has examined the impact of perceived stigma on personal stigma. Yet, little is known about how this impact can affect suicidal thoughts and behaviors and how these effects differ across racial and ethnic groups. Guided by Goffman’s Stigma Theory and Crenshaw’s Intersectionality Theory, this study examines how personal stigma mediates the relationship between perceived stigma and suicide-related outcomes and whether this pathway varies across racial and ethnic groups.

Methods

Data were drawn from the 2023–2024 National Mental Health Survey, with a sample of 89,010 young adults (ages 18-29). Perceived and personal stigma were assessed using two Mental Health Stigma Scale subscales. Suicidal ideation, suicide attempts, and suicide planning were assessed as three separate binary outcomes. Race and ethnicity categories included White, Black, Asian, Hispanic/Latino, and AIAN/NHPI (American Indian/Alaska Native or Pacific Islander). Covariates included sex at birth, education level, depression severity, and LGBTQ identity. Moderated mediation analysis was conducted using SPSS PROCESS Macro, with confidence intervals estimated through bootstrapping (10,000 samples).

Results

Perceived stigma significantly increased suicide-related risks. A one-unit increase in perceived stigma was associated with higher odds of suicidal ideation (logit = 0.28, 95% CI [0.23, 0.32], p < .001), suicide planning (logit = 0.30, 95% CI [0.24, 0.36], p < .001), and suicide attempts (logit = 0.48, 95% CI [0.37, 0.59], p < .001). Perceived stigma was negatively associated with personal stigma (logit = -0.17, CI [–0.19, –0.14], p < .001), and this effect was stronger among Hispanic (logit = -0.22, 95% CI [–0.24, –0.19]]) than Black (-logit = 0.17, 95% CI [–0.19, –0.14]). The indirect effect of personal stigma is significant in the relationship between perceived stigma and suicidal attempts across groups but not ideation or planning. Personal stigma did not mediate the effects on ideation or planning, but significantly mediated suicide attempts across groups: Hispanic (0.0397, CI [0.0220, 0.0571]), Asian (0.0578, CI [0.0321, 0.0821]), White (0.0306, CI [0.0164, 0.0449]), and AIAN/NHPI (0.0336, CI [0.0188, 0.0475]). Moderated mediation analyses indicated that the indirect effect of perceived stigma on suicide attempts through personal stigma was stronger for Hispanic individuals (index = 0.01, 95% CI [0.002, 0.019]) compared to Black individuals (index = 0.03, 95% CI [0.01, 0.04]). Personal stigma was also negatively associated with suicide attempts (logit = -0.18, CI [–0.26, –0.11], p < .001). CIs reported at 95%.

Conclusion

This study investigates the roles of perceived and personal stigma in suicide-related behaviors. Perceived stigma was linked to all outcomes, while personal stigma uniquely mediated the effect on suicide attempts. Racial and ethnic differences suggest disproportionate vulnerability to stigma’s effects. Future qualitative research should examine group-specific stigma perceptions to inform culturally tailored and policy-relevant suicide prevention efforts.