Why depression carries social stigma

The reason for this difference may be the difference in how the question was presented between the studies. The previous study asked about people described in a vignette about depression, whereas our study asked about a case specified as depression.

However, in an Australian study based on a vignette, Recognition of the effectiveness of antidepressants has not spread to the public in Japan, suggesting that public awareness-raising activities on treatment methods are necessary. Several other findings are described below.

Among the public, Japanese government statistics show that the number of people diagnosed with depression in recent years has increased greatly.

This increase in the number of opportunities to be in contact with people diagnosed with depression may be one reason for increased understanding.

In addition, respondents may have understood the character of people who try to avoid behaviors that make others uncomfortable. However, according to a survey, the Japanese public recognized that people with depression have a mental health problem, but tended not to recognize that it was a disease named depression [ 29 ].

Further research is required to understand reasons why Japanese people are unlikely to notice depression in other people. In multivariate analysis, health literacy was associated only with an appropriate belief about the effectiveness of pharmacotherapy. Health literacy examined in this study consisted of the ability to collect information and critically examine it.

Health literacy plays a role in successful self-management of chronic disease [ 32 ]. However, general health literacy alone might not be sufficient to improve mental health literacy. One reason is that mental health literacy may be affected by culture. Even among countries with high education standards, there is a large difference in beliefs about the causes of mental illness, attitudes about seeking help [ 22 , 33 , 34 ].

For all four beliefs, a higher proportion of women than men had appropriate responses. The association between knowledge and sex did not reach statistical significance in previous studies [ 35 , 36 ].

A previous study of Japanese high school students also showed that females were less likely to stigmatize depression as a sign of personal weakness [ 25 ]. However, in a review about stigma towards mental disorders, there were no clear associations between stigma and sex [ 37 , 38 ]. Regarding knowledge and stigma about depression, it is difficult to state a universal relationship based on sex, because the associations between sex and social situations are complex and vary from region to region.

Young people, with the exception of beliefs about the efficacy of pharmacotherapy, were more likely to have appropriate beliefs in three categories. This result is consistent with the results of previous studies showing that younger adults have more appropriate knowledge and attitudes towards depression and mental illness [ 39 , 40 ]. Although not significant in the other three beliefs, there was a possibility that the analysis was underpowered because there were only a few participants with a history of depression.

Being employed and higher educational background were associated with some beliefs, but the strength of the associations was low. This study had several limitations. First, because we attempted to narrow down the questions, an exhaustive survey of beliefs about depression was not made. However, we carefully selected survey items that were supposed to be important for each step necessary to minimize disability due to depression.

Second, questions explicitly named the disease as depression; therefore, it was unknown whether the respondents understood how depression is diagnosed. Regardless of the ability to identify depression, public beliefs about depression could be investigated. Third, this survey was targeted at people receiving an annual health checkup; therefore, there is a possibility that they had more awareness of health issues. Fourth, this survey was conducted in a limited geographic area; therefore, it was hard to generalize it to the entire Japanese population.

Although general health literacy was associated with beliefs about the effectiveness of pharmacotherapy, this alone might not improve knowledge and reduce stigma about depression.

An educational intervention or campaign to reduce stigma toward depression and improve knowledge about treatment of depression is needed. The authors have no conflict of interest to disclose with respect to this study. National Center for Biotechnology Information , U. J Clin Med Res. Published online Jan Author information Article notes Copyright and License information Disclaimer. Email: pj. Received Nov 26; Accepted Dec Copyright , Yokoya et al.

This article has been cited by other articles in PMC. Methods A self-administered questionnaire was distributed to participants receiving an annual health checkup. Results Among 1, respondents Conclusions Thirty percent of participants had the stigmatizing belief that a weak personality causes depression and only Keywords: Depression, Mental health, Help-seeking behavior, Medication adherence, Health knowledge, Social stigma, Health literacy, Cross-sectional studies, Surveys and questionnaires.

Introduction Depression is a highly prevalent mental illness [ 1 , 2 ]. Materials and Methods Participants Participants were citizens aged 18 and over receiving annual health checkups provided by the city of Kamisu, located km east of Tokyo. Design This study was conducted as part of a cross-sectional survey of health literacy and knowledge regarding common diseases.

Statistical analysis Subjects with no missing data in the items about beliefs regarding depression, health literacy scores, and age were included in the analysis. Results Subject characteristics A total of 1, citizens participated in the survey.

Open in a separate window. Beliefs regarding depression Figure 1 shows public beliefs regarding depression. Figure 1. Association between beliefs regarding depression and various factors Table 2 shows the results of univariate analysis on the association between beliefs regarding depression and various factors.

Factors independently associated with beliefs regarding depression Table 3 shows the results of multivariate logistic regression analysis on beliefs regarding depression and total health literacy score, age group, sex, employment status, educational background, regularly visiting an outpatient clinic, and history of depression. Discussion This survey evaluated knowledge and stigma towards depression in a large number of citizens.

You may even experience internalised stigma, where you come to believe the negative messages or stereotypes about yourself. Nearly nine out of ten people with mental health problems say that stigma and discrimination have a negative effect on their lives.

We know that people with mental health problems are among the least likely of any group with a long-term health condition or disability to:. Social isolation, poor housing, unemployment and poverty are all linked to mental ill health. So stigma and discrimination can trap people in a cycle of illness.

You may face more than one type of stigma: for example, you may also be stigmatised because of your race, gender, sexuality or disability. This can make life even harder. Time to Change campaigned to change the way people think and act about mental health problems. The campaign has now closed, but there is still plenty of useful information on their website about challenging stigma and discrimination when you see, hear or experience it.

They also have resources for your workplace or school if you want to help others understand mental health and challenge stigma. In Scotland, the anti-stigma organisation See Me has ideas on challenging stigma and discrimination. They also have resources and activities you could use at work.

If you want to do more campaigning around mental health issues, you could join OPEN , our personal experience network. Mental illness stigma and ethnocultural beliefs, values, and norms: an integrative review. Clinical Psychology Review , Fighting stigma and discrimination in fighting for mental health. Canadian Public Policy , S The World Health Report Geneva: World Health Organization. Indigenous perspectives on depression in rural regions of India and the United States. Transcultural Psychiatry , 48 5 : Eugenics, genetics, and mental illness stigma in Chinese Americans.

Soc Psychiatry Psychiatr Epidemiol. I hope I would now handle it better but it would still not be easy. There can be no doubt that there is considerable stigma associated with depression. I am repeatedly congratulated for being so brave, even courageous, in talking so openly about my depression.

I, in fact, am a 'performer' and there is no bravery, but these comments show how others view depression and that it is highly stigmatised. An example of how stigma can present a particularly difficult problem for sportsmen is provided by the case of a professional footballer, Stan Collymore 2 who played for England.

He had a severe depression and his career went into a rapid decline. He says that he can never forgive the Aston Villa manager for the way he reacted to his depression. He told him to pull his socks up and that his idea of depression was that of a woman living on a 20th floor flat with kids.

The Sun newspaper said that he should be kicked out of football as how could anyone be depressed when he is earning so much money. He bitterly remarks that if you suffer from an illness that millions of others suffer from, but it is a mental illness which leads many to take their own lives, then you are called spineless and weak.

Just as important, perhaps more so, is the self stigmatisation of those with depression as it can have serious effects on how individuals deal with their illness. My experience in talking to others who have had a depression has provided me with numerous accounts of just how much those with depression see it as something to be ashamed of, and so kept secret 3.

One young woman cannot even tell her father who is a psychiatrist and another woman could not confide in her brother or sister who knew nothing of her suicide attempts. While I have no difficulty talking about my depression when I have recovered, when I am in it I must admit I hesitate. One reason is that whoever you tell is embarrassed and does not know quite what to say.

There is also a sense of failure in not having handled it. That is why depressives can talk so openly to each other about their experience. The shame and stigma associated with depression can prevent those with the illness admitting they are ill.

It is remarkable how it is sometimes possible to conceal one's depression. It was chilling to hear a mother relate to me how she could talk cheerfully to her son while at the same time composing, in her own mind, the suicide note that she would leave him. There is also the stigma of taking antidepressant medication which is perceived as mind altering and addictive. Stigma may also cause somatic symptoms as it is more acceptable to talk of stomach ache and fatigue than mental problems.

A major difficulty in overcoming stigma, and indeed probably one of the causes, is that it is very hard, perhaps impossible, for those who have not experienced depression to understand what the individual with depression is experiencing.

I have colleagues who openly admit that they just cannot understand what I am talking about. The experience is almost impossible to describe and the situation is not helped by the almost total absence of good descriptions of depression in English novels — I know of none. Writers have described their own depression but none in novels; Virginia Woolf, herself a depressive, never does. Perhaps it is just too difficult. It may be that if you can describe your severe depression you have not really had one.

In more general terms, there are many attempts to account for stigmatisation of mental illnesses. Mental illnesses are perceived as different as they express themselves through those very characteristics that make us human — cognitive and affective and behavioural — and thus differ from physical illnesses 5. Mental illness is thus seen as embodying the core of the person and not just affecting some organ like the heart or lungs. But different mental illnesses each have their own characteristics in relation to stigma.

For example, unlike depression, people with schizophrenia or addictions are perceived as being dangerous. But depressives are seen as unpredictable people who, if they really tried, could pull themselves together.