The association of depression stigma with barriers to seeking mental health care: a cross-sectional analysis.

Stigma is one of several barriers to seeking mental health care. However, few studies have examined how stigma relates to other common barriers (e.g. attitudes about treatment, cost, time). This study investigated whether depression stigma (internalized or perceived) was related to other treatment-seeking barriers (attitudinal, structural) and whether depression severity influenced the strength of the association. We used multivariable-adjusted linear regression to model barrier outcomes as a function of internalized and perceived stigma in an undergraduate population (=2551). We evaluated potential effect modification by depression severity using likelihood-ratio tests. Internalized stigma displayed a stronger association with overall barriers to care (including perceived need, negative treatment expectations, and structural barriers) than did perceived stigma. Higher internalized stigma predicted a stronger emphasis on each barrier to treatment measured. Sub-components of internalized stigma (e.g. alienation, stereotype endorsement) uniquely predicted a greater emphasis on distinct barriers. Internalized stigma is strongly linked to greater perception of barriers to mental health care. It may be necessary to address stigma and barriers concurrently rather than independently.