Double stigma and help-seeking barriers among Blacks with a behavioral health disorder.

Abstract

Objective: There is considerable evidence that racial stigma and stigma due to mental illness or addiction are each independently a barrier to help-seeking for Black adults. The present study examines empirically the "double stigma" of discrimination, marginalization, and exclusion due both to a behavioral health disorder and to race among Black adults. Method: Interviews were conducted with 176 Black adults with a diagnosed behavioral health disorder-a mental health disorder (mental illness), a substance abuse disorder (addiction), or both-who enrolled in behavioral health treatment in a northeastern U.S. city. Measures assessed racial stigma, self-stigma due to mental illness or addiction, depressive symptoms, and helpseeking barriers. Serial mediation analyses were conducted to examine hypothesized relationships among variables. Results: The results demonstrate the potential impact of double stigma on help-seeking among Black adults with a behavioral health disorder. Serial mediation analyses show that there is a significant positive relationship between racial stigma and help-seeking barriers, and this relationship is partially mediated by internalized self-stigma and depressive symptoms. Conclusions and Implications for Practice: This is the first study to show a serial mediation effect for double stigma among Black adults with a behavioral health disorder. The results build on previous research on stigma and race to illustrate how experiences of racial stigma are integral to understanding how mental illness or addiction intersect with depressive symptoms and help-seeking behavior. Implications are discussed for research and practice to reduce help-seeking barriers for adults who experience double stigma. Impact and ImplicationsBlack adults with a mental illness or addiction experience barriers to seeking help for their disorder because of internalized self-stigma and racial stigma, a combination known as "double stigma." We describe processes underlying the relationship of double stigma to help-seeking and discuss practice implications for counteracting double stigma.

Community member attitudes and understanding of “serious mental illness”: A mixed-method study.

“…Factors such as race may be more strongly linked to diagnostic base rates and how mental health is perceived, understood, and discussed in some communities. For instance, practitioners are up to 4 times more likely to diagnose Black patients with psychotic disorders (Schwartz & Blankenship, 2014) and the subjective experience, projection, and impact of stigma may differ across Black individuals and those of other racial groups (Budhwani & De, 2019; Rao et al, 2007; Yu et al, 2022). Our sample was only 5% Black or African American, and their underrepresentation in this study is a marked limitation.…”

The mental health climate and mental health-related academic help seeking on U.S. college campuses.

“…In addition to stigma, other social factors impact help-seeking behavior. People of disadvantaged racial and ethnic groups often face additional barriers when seeking help related to mental health, such as encountering mental health care service that (a) fails to be sensitive to diverse cultural backgrounds and (b) features underrepresentation within the mental health care field (Gary, 2005; Leath & Jones, 2021; Misra et al, 2021; Yu et al, 2021). For example, Black college students, in comparison to their White counterparts, are less likely to seek treatment, reporting additional barriers related to stigma (e.g., Masuda et al, 2012; Williams et al, 2023).…”

There is no such a thing as a ‘biological’ basis for cancer disparities: A call to end misreporting of the ultimate determinants of health outcomes

“…16,17 Double stigma is common in those communities with poor access to healthcare, experiencing increased risk and more adverse outcomes. 18 As such, reporting data across ethnical groups to infer inferior oncological outcomes is commonly biased, confused and can perpetuate double stigma in selected populations.…”