Stigma as a barrier to recognizing personal mental illness and seeking help: a prospective study among untreated persons with mental illness

Background: It is unclear to what extent failure to recognize symptoms as potential sign of a mental illness is impeding service use, and how stigmatizing attitudes interfere with this process. Methods: In a prospective study, we followed a community sample of 188 currently untreated persons with mental illness (predominantly depression) over 6 months. We examined how lack of knowledge, prejudice and discrimination impacted on self-identification as having a mental illness, perceived need, intention to seek help, and help-seeking, both with respect to primary care (visiting a general practitioner, GP) and specialist care (seeing a mental health professional, MHP). Results: 67% sought professional help within 6 months. Fully saturated path models accounting for baseline depressive symptoms, previous treatment experience, age and gender showed that self-identification predicted need (beta 0.32, p<0.001), and need predicted intention (GP: beta 0.45, p<0.001; MHP: beta 0.38, p<0.001). Intention predicted service use with a MHP after 6 months (beta 0.31, p<0.01; GP: beta 0.17, p=0.093). More knowledge was associated with more self-identification (beta 0.21, p<0.01), while support for discrimination was associated with lower self-identification (beta -0.14, p<0.05). Blaming persons with mental illness for their problem was associated with lower perceived need (beta -0.16, p<0.05). Our models explained 37% of the variance of seeking help with a MHP, and 33% of help-seeking with a GP. Conclusions: Recognizing one’s own mental illness and perceiving a need for help are impaired by lack of knowledge, prejudice, and discrimination. Self-identification is a relevant first step when seeking help for mental disorders.