Personal Stigma and Use of Mental Health Services Among People with Depression in a General Population in Finland

Esa Aromaa; Asko Tolvanen; Jyrki Tuulari; Kristian Wahlbeck


BMC Psychiatry. 2011;11 

In This Article


Unfortunately, only a minority of those who would benefit from professional treatment for depression actually seek it and many discontinue treatment prematurely. Only 34% of people with major depression in Finland seek professional help.[1] Similar results from other countries in Europe and the United States reveal the problem to be global.[2,3]

Descriptive models, which try to explain service use in terms of the combined effects of socio-demographics (age, gender, education), access (income, insurance, availability of services) and severity of illness, have only modest power to predict the help-seeking of people with mental conditions.[4] Theoretical models on help-seeking behavior suggest that individual progress through several stages before seeking mental health treatment. They experience symptoms, try to evaluate their significance, assess if they can manage them by themselves or if treatment is required, assess the feasibility of and options for treatment, and decide whether to seek treatment.[5] Health belief theorists have shown that a rational consideration of the costs and benefits of participating in specific treatments may be an important factor when an individual decides to use services.[6] One such perceived cost to engaging in mental health services may be the risk of stigma. It has been suggested that many people hesitate to use mental health services because they do not want to be labeled a "mental patient" and want to avoid the negative consequences connected with stigma.[7] Among people with serious mental illnesses as well as nonpsychotic mental disorders, who perceived a need for help, the most commonly reported reasons for not seeking treatment were a will to solve the problem on their own and a hope that the problem would get better by itself.[8,9]

There is conflicting empirical data about the effects of stigmatizing beliefs on seeking help from professionals for depression. Some studies have found a connection,[10–13] while others have not.[14–16]

One explanation for this could be the complexity of the concept of stigma and thus differences in measuring it. It has been demonstrated that some dimensions of stigma connected with mental illness were associated with potential care-seeking while others were not.[13,17,18] Another explanation for the mixed results may be different samples. Some studies use only people with depression in their samples while others take their samples from the general population.

Stigma related to mental health problems can be divided into perceived public stigma/stereotype awareness (participants' beliefs that in general people with mental illness are stigmatized in society), personal stigma/stereotype agreement (participants' personal beliefs about mental illness) and self-stigma (participants' view of their own mental illness).[19–21] In particular, perceived stigma and self-stigma have relevance in the context of help-seeking. In many cases, they seem to interact.[7,22] Some authors differentiate a perceived public stigma associated with seeking professional services from the perceived public stigma associated with mental illness[22] and have developed scales to measure specifically this stigma component.

An issue closely related to attitudes towards people with psychiatric conditions, mental health professionals and the service system, is people's knowledge about mental disorders, remedies and services. In a review about public beliefs regarding treatment of depression as well as on other psychiatric conditions, psychosocial interventions were predominantly perceived as favorable, while negative views prevailed about pharmacological treatments.[23] In general, without psychiatric treatment, the course of schizophrenia is seen more pessimistically than in the case of depression. Conversely, as long as appropriate treatment is provided, the prognosis for both disorders is assessed as quite optimistic.[23] Given that evidence exists of possibilities to improve people's awareness and knowledge about depression, public beliefs may over time move closer to those of health professionals.[24] Nevertheless, it is still an open question if this would lead to an increase in actual help-seeking on a population level.

So far only a few studies have explored the connection between depression-related attitudes and actual help-seeking. Usually respondents have been asked about their intentions to seek professional help. Another methodological limitation has been the use of small student samples, with large population samples lacking.

In this paper our first aim was to look at whether people with depressive symptoms in a general population carry different kinds of stigmatizing attitudes compared with non-depressive respondents. Our second aim was to study if there is any connection between attitudes and the actual use of mental health services among those with depression.