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Association between mental health-related stigma and active help-seeking: Systematic review and meta-analysis

  • Nina Schnyder (a1), Radoslaw Panczak (a2), Nicola Groth (a3) and Frauke Schultze-Lutter (a3)

Mental disorders create high individual and societal costs and burden, partly because help-seeking is often delayed or completely avoided. Stigma related to mental disorders or mental health services is regarded as a main reason for insufficient help-seeking.


To estimate the impact of four stigma types (help-seeking attitudes and personal, self and perceived public stigma) on active help-seeking in the general population.


A systematic review of three electronic databases was followed by random effect meta-analyses according to the stigma types.


Twenty-seven studies fulfilled eligibility criteria. Participants' own negative attitudes towards mental health help-seeking (OR = 0.80, 95% CI 0.73–0.88) and their stigmatising attitudes towards people with a mental illness (OR = 0.82, 95% CI 0.69–0.98) were associated with less active help-seeking. Self-stigma showed insignificant association (OR = 0.88, 95% CI 0.76–1.03), whereas perceived public stigma was not associated.


Personal attitudes towards mental illness or help-seeking are associated with active help-seeking for mental problems. Campaigns promoting help-seeking and fighting mental illness-related stigma should target these personal attitudes rather than broad public opinion.

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Corresponding author
Nina Schnyder, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Haus A, 3000 Bern 60, Switzerland. Email:
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Association between mental health-related stigma and active help-seeking: Systematic review and meta-analysis

  • Nina Schnyder (a1), Radoslaw Panczak (a2), Nicola Groth (a3) and Frauke Schultze-Lutter (a3)
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Programmes which reduce public stigma can combat social exclusion and promote social participation of people with mental illness

Sara Evans-Lacko, Associate Professorial Research Fellow / Senior Lecturer, London School of Economics and Political Science / King's College London, Institute of Psychiatry, Psychology and Neuroscience
Brandon Kohrt, Assistant Professor of Psychiatry, Global Health, and Cultural Anthropology, Duke University
Claire Henderson, Clinical Senior Lecturer, King's College London, Institute of Psychiatry, Psychology and Neuroscience
Graham Thornicroft, Professor of Community Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience
14 June 2017

In their systematic review and meta-analysis on the association between mental health-related stigma and active help-seeking, Schnyder et al find that negative help-seeking attitudes and personal stigma are associated with less actual help-seeking. The authors connect these findings to a recommendation for anti-stigma campaigns to “target these personal attitudes rather than broad public opinion.” However, this recommendation cannot be extrapolated from the types of studies they reviewed. Moreover, it over-emphasises help-seeking as the key outcome and does not adequately consider the importance of changing wider social acceptance in broader domains related to, for example, disclosure at work or support from family and friends.

Schynder et al. reviewed studies evaluating the association between stigma and actual help-seeking at the individual level. They did not assess how public-level attitudes correlated with actual help-seeking in the population, which would have required cluster-level analyses. Their individual stigma-to-help-seeking association is different from concluding that campaigns targeting the general public are not helpful to improve help-seeking at a population level. Because Schnyder and colleagues did not include evaluations of broad public anti-stigma campaigns on care seeking, their recommendation against such efforts risks misleading policy makers, health care practitioners, researchers and advocates.

In contrast to Schnyder et al.’s recommendation against targeting public opinion, our work has shown that investment in population level anti-stigma programmes can address several important challenges. Low levels of public knowledge, negative attitudes and discriminatory behaviour have significant consequences for people with mental illness. Our evaluation of the Time to Change anti-stigma campaign in England1,2 has demonstrated improvements in mental health-related attitudes and intended behaviour at the population level and among specific target groups and this is supported by further reviews of anti-stigma interventions. These changes can foster a positive social context which is more supportive of people with mental illness.

Moreover, Schnyder et al.’s finding that self-stigma and stigma against other persons with mental illness associated with limited help-seeking is likely influenced by community level stigma. Individuals with mental illness internalise the broad socio-cultural environment in which they reside and may experience more discrimination when living in a high stigma community. Individuals with mental illness and sexual minorities residing in communities with higher public stigma have greater self-stigma, lower empowerment, lower chances of employment and greater risk of mortality3–5.

Programmes which reduce public stigma could combat social exclusion and promote social participation of people with mental illness across several important life domains. Moreover, targeted anti-stigma interventions which improve attitudes of key groups, such as employers, peers at work, law enforcement officers, and healthcare practitioners could foster support for individuals with mental illness and make a significant impact on quality of life. Improving public attitudes, therefore, can also create a virtuous cycle.

Ultimately, the most effective approaches require multi-sectorial strategies incorporating persons with mental illness, the general public, and key stakeholders. Extrapolating recommendations against public anti-stigma campaigns from studies only assessing associations between stigma and help-seeking at the individual level risks deterring investment from evidence-based approaches.


Sara Evans-Lacko

Brandon Kohrt

Claire Henderson

Graham Thornicroft

1 Henderson C, Robinson E, Evans-Lacko S, Corker E, Rebollo-Mesa I, Rose D, et al. Public knowledge, attitudes, social distance and reported contact regarding people with mental illness 2009-2015. Acta Psychiatr Scand 2016; 134: 23–33.

2 Henderson, C.; Robinson, E; Evans-Lacko, S; Thornicroft G. Relationships between anti-stigma programme awareness, disclosure comfort and intended help-seeking regarding a mental health problem. (In press, Br J Psychiatry).

3 Evans-Lacko S, Brohan E, Mojtabai R, Thornicroft G. Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries. PsycholMed 2012; : 1–13.

4 Evans-Lacko S, Knapp M, McCrone P, Thornicroft G, Mojtabai R. The mental health consequences of the recession: economic hardship and employment of people with mental health problems in 27 European countries. PLoS One 2013; 8: e69792.

5 Hatzenbuehler ML, Bellatorre A, Lee Y, Finch BK, Muennig P, Fiscella K. Structural stigma and all-cause mortality in sexual minority populations. Soc Sci Med 2014; 103: 33–41.

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Conflict of interest: SEL and CH have received consulting fees from Lundbeck. SEL currently holds a Starting Grant from the European Research Council. GT has received grants for stigma-related research in the past five years from the National Institute for Health Research, and has acted as a consultant to the UK Office of the Chief Scientist.

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