Health experts agree that reducing the stigma associated with adolescent mental illness is an essential step toward increasing the number of teenagers who seek the help they need.
But, say researchers at Case Western Reserve in the Journal of Nursing Measurement, the relative dearth of data regarding stigma in this age group makes tackling the topic particularly tough. Not only is adolescent mental health stigma rarely studied, but even less is known about the accuracy of measures used to assess it.
Explained Melissa Pinto, KL2 Clinical Research Scholar and instructor of nursing at the Frances Payne Bolton School of Nursing: “We need to find a reliable and valid way to measure the presence of stigma associated with mental illness among adolescents.”
Pinto and her colleagues sought to begin that process by testing an existing measure among more than 200 teenagers in the southern United States. Their article about the assessment, “Psychometric Evaluation of the Revised Attribution Questionnaire (r-AQ) to Measure Mental Illness Stigma in Adolescents,” appears in the year’s first issue of the journal. Based on this first sample, the authors concluded that this questionnaire can be considered reliable and valid for this age group. Still, they urge additional assessments among more diverse groups located throughout the country.
Determining the true value of such measures in advance, the researchers argue, is a key first step in acting to help teens understand the wisdom of seeking assistance when troubled by mental illness. Research has shown that young people in these straits often are so concerned about the perceptions of peers and others important in their social network that they forgo treatment that is beneficial.
Young people pick up cues about what is acceptable and unacceptable from those around them, Pinto said. If teens believe friends will distance themselves if their struggles with mental illness become known, they will endure the consequences and risks of disease without asking for assistance. But if peers seem accepting, then chances increase that teens with mental illness will seek help.
The researchers administered the self-report survey to 210 students between the ages of 13 and 18 from southern public and private high schools. The survey measured an important component of stigma, the emotional reaction to a person with mental illness. This is important because emotional reactions to persons with mental illness are associated with how easy or difficult it is to socially interact with others and discriminating behaviors. Administering the survey again, the results were validated with another group of students.
“The Revised Attribution Questionnaire was found to be a reliable and valid measure among this group of adolescents. Having measures of that reliability and validity give us confidence when we do interventions with teens to decrease stigma that changes we are see are actually changes and not an artifact of the measure. Specifically, this measure holds promise to be used in intervention studies to determine if our interventions work,” Pinto said.
She added that it is the first time the Revised Attribution Questionnaire is found to be both reliable and valid in assessing stigma associated with mental illness in adolescents.
The idea behind changing attitudes about mental illness is to get teens help they need. “If untreated, illnesses, like depression and mood disorders, tend to reoccur and become chronic,” Pinto said.
The onset of a mental illness often comes before the age of 25. Hiding the disease, adolescents suffer negative consequences for their silence, including delinquency from school, substance abuse problems, unwanted pregnancies, struggles at work and suicide.
“Mental illness is like other diseases—with treatment, people can recover. Creating a social culture where people feel comfortable getting treatment and talking about the illness with others who can support them is a vital initial step that can help people get better,” Pinto said.