Stigma starts early: Gender differences in teen willingness to use mental health services



      To explore gender differences and the role of stigma in teen willingness to use mental health services.


      Self-administered, written questionnaires were conducted with 274 eighth graders in a suburban community in a mid-Atlantic state. Teens reported on social support for emotional concerns, mental health experience and knowledge, and stigma and barriers associated with mental health service use. Data analysis included chi-square statistics and analysis of variance (ANOVA) to examine associations between gender and independent variables of interest. Logistic regression analyses assessed the relationship of gender, stigma, and willingness to use mental health services, adjusting for race and receipt of mental health services.


      More girls than boys turned to a friend for help for an emotional concern, whereas more boys turned to a family member first. Boys had less mental health knowledge and experience and higher mental health stigma than girls. In adjusted analyses, girls were twice as likely as boys to report willingness to use mental health services (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.20–4.99). Parental disapproval and perceived stigma helped to explain the relationship between gender and willingness to use mental health services (OR 1.65, 95% CI .72–3.77).


      Gender differences in negative mental health attitudes and willingness to use mental health services are present early in adolescence. Enhanced mental health education and services in middle school may reduce gender disparities by incorporating stigma reduction efforts that actively involve parents and address differences in knowledge and exposure to mental health issues.


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        • U.S. Surgeon General
        Mental Health. U.S. Government Printing Office, Washington, DC1990
        • Costello E.J.
        • Angold A.
        • Burns B.J.
        • et al.
        The Great Smoky Mountains Study of Youth.
        Arch Gen Psychiatry. 1996; 53: 1137-1143
        • U.S. Surgeon General
        Mental Health: Culture, Race, and Ethnicity. A Supplement to Mental Health: A Report of the Surgeon General. U.S. Government Printing Office, Washington, DC2001
        • Leaf P.J.
        • Alegria M.
        • Cohen P.
        • et al.
        • Mental health service use in the community and schools: results from the four-community MECA Study
        Methods for the Epidemiology of Child and Adolescent Mental Disorders Study.
        J Am Acad Child Adolesc Psychiatry. 1996; 35: 889-897
        • Rickwood D.J.
        • Braithwaite V.A.
        Social-psychological factors affecting help-seeking for emotional problems.
        Soc Sci Med. 1994; 39: 563-572
        • Flisher A.J.
        • Kramer R.A.
        • Grosser R.C.
        • et al.
        Correlates of unmet need for mental health services by children and adolescents.
        Psychol Med. 1997; 27: 1145-1154
        • Barnett M.A.
        • Sinisi C.S.
        • Jaet B.P.
        Perceived gender differences in children’s help-seeking.
        J Genet Psychol. 1990; 151: 451-460
        • Garland A.F.
        • Zigler E.F.
        Psychological correlates of help-seeking attitudes among children and adolescents.
        Am J Orthopsychiatry. 1994; 64: 586-593
        • Cuffe S.P.
        • Waller J.L.
        • Cuccaro M.L.
        • et al.
        Race and gender differences in the treatment of psychiatric disorders in young adolescents.
        J Am Acad Child Adolesc Psychiatry. 1995; 34: 1536-1543
        • Bland R.C.
        • Newman S.C.
        • Orn H.
        Health care utilization for emotional problems.
        Can J Psychiatry. 1990; 35: 397-400
        • Schonert-Reichl K.A.
        • Muller J.R.
        Correlates of help-seeking in adolescence.
        J Youth Adolesc. 1996; 25: 705-729
        • Leong F.T.
        • Zacher P.
        Gender and opinions about mental illness as predictors of attitudes toward seeking professional psychological help.
        Br J Guid Couns. 1999; 27: 123-132
        • Leaf P.J.
        • Bruce M.L.
        Gender differences in the use of mental health-related services.
        J Health Soc Behav. 1987; 28: 171-183
        • Temkin-Greener H.
        • Clark K.
        Ethnicity, gender, and utilization of mental health services in a Medicaid population.
        Soc Sci Med. 1990; 26: 989-995
        • Gallo J.J.
        • Marino S.
        • Ford D.
        • et al.
        Filters on the pathway to mental health care, II. Sociodemographic factors.
        Psychol Med. 1995; 25: 1149-1160
        • Boldero J.
        • Fallon B.
        Adolescent help-seeking.
        J Adolesc. 1995; 18: 193-209
        • Blazina C.
        • Watkins E.C.
        Masculine gender role conflict.
        J Couns Psychol. 1996; 43: 461-465
        • Kessler R.C.
        • Brown R.L.
        • Broman C.L.
        Sex differences in psychiatric help-seeking.
        J Health Soc Behav. 1981; 22: 49-64
        • Saunders S.M.
        • Resnick M.D.
        • Hoberman H.M.
        • Blum R.W.
        Formal help-seeking behavior of adolescents identifying themselves as having mental health problems.
        J Am Acad Child Adolesc Psychiatry. 1994; 33: 718-728
        • Timlin-Scalera R.M.
        • Ponterreto J.G.
        • Blumberg F.C.
        • et al.
        A grounded theory study of help-seeking behaviors among White male high school students.
        J Couns Psychol. 2003; 50: 339-350
        • Nunnally J.C.
        Popular Conceptions of Mental Health. Holt, Rinehart and Winston, New York, NY1961
        • Link B.G.
        • Struening E.
        • Cullen F.T.
        • et al.
        A modified labeling theory approach to mental disorders and empirical assessment.
        Am Sociol Rev. 1989; 54: 400-423
        • Dubin R.J.
        • Fink W.R.
        Effects of stigma on psychiatric treatment.
        in: Fink P.J. Tasman A. Stigma and Mental Illness. American Psychiatric Press, Washington, DC1992: 1-7
        • Hinshaw S.P.
        • Cicchetti D.
        Stigma and mental disorder.
        Dev Psychopathol. 2000; 12: 555-598
        • Roeloffs C.
        • Sherbourne C.
        • Unutzer J.
        • et al.
        Stigma and depression among primary care patients.
        Gen Hosp Psychiatry. 2003; 25: 311-315
        • Adler A.K.
        • Wahl O.F.
        Children’s beliefs about people labeled mentally ill.
        Am J Orthopsychiatry. 1998; 68: 321-326
        • Sirey J.A.
        • Bruce M.L.
        • Alexopoulos G.S.
        • et al.
        Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression.
        Am J Psychiatry. 2001; 158: 479-481
        • Lauber C.
        • Nordt C.
        • Falcato L.
        • Rossler W.
        Factors influencing social distance toward people with mental illness.
        Community Ment Health J. 2004; 40: 265-274
        • Mann C.E.
        • Himelein M.J.
        Factors associated with stigmatization of persons with mental illness.
        Psychiatr Serv. 2004; 55: 185-187
        • Seiffge-Krenke I.
        Causal links between stressful events, coping style, and adolescent symptomatology.
        J Adolesc. 2000; 23: 675-691
        • Weist M.D.
        • Christodulu K.V.
        Expanded school mental health programs.
        J Sch Health. 2000; 70: 195-200
        • Komiya N.
        • Good G.E.
        • Sherrod N.B.
        Emotional openness as a predictor of college students’ attitudes toward seeking psychological help.
        J Couns Psychol. 2000; 47: 138-143
        • Barrett A.E.
        • White H.R.
        Trajectories of gender role orientation in adolescence and early adulthood.
        J Health Soc Behav. 2002; 43: 451-468
        • Liben L.S.
        • Bigler R.S.
        The developmental course of gender differentiation.
        Monogr Soc Res Child Dev. 2002; 67 (discussion 148–83): 1-147
        • Jessor R.
        • Turbin M.S.
        • Costa F.M.
        Protective factors in adolescent health behavior.
        J Pers Soc Psychol. 1998; 75: 788-800
        • Resnick M.D.
        • Bearman M.S.
        • Blum R.W.
        • et al.
        Protecting adolescents from harm.
        JAMA. 1997; 278: 823-832
        • Browne G.
        • Gafni A.
        • Roberts J.
        • et al.
        Effective/efficient mental health programs for school-age children.
        Soc Sci Med. 2004; 58: 1367-1384
        • Pescosolido B.A.
        Illness careers and network ties.
        Adv Med Sociol. 1991; 2: 161-184
        • Stiffman A.R.
        • Striley C.
        • Horvath V.E.
        Organizational context and provider perception as determinants of mental health service use.
        J Behav Health Serv Res. 2001; 28: 188-204
        • Ellickson P.L.
        • Hawes J.A.
        An assessment of active versus passive methods for obtaining parental consent.
        Eval Rev. 1989; 13: 45-55
        • Unger J.B.
        • Gallaher P.
        • Palmer P.H.
        • et al.
        Characteristics of adolescents who provide neither parental consent nor refusal for participation in school-based survey research.
        Eval Rev. 2004; 28: 52-63
        • Dent C.W.
        • Galaif J.
        • Sussman S.
        • et al.
        Demographic, psychosocial and behavioral differences in samples of actively and passively consented adolescents.
        Addict Behav. 1993; 18: 51-56