Effects of mental health stigma on loneliness, social isolation, and relationships in young people with depression symptoms

Abstract

Background Major depressive disorder (MDD) is the most prevalent affective disorder and the leading cause of illness and disability among young people worldwide. Besides being more susceptible to the onset of depression, young people have a higher risk of loneliness, and their personal and social development is impacted by social relationships during this time. It is thought that mental health stigma can undermine both help-seeking and longer-term outcomes for disorders like depression in young people. However, how stigma (i.e., related to depression) might affect young people’s feelings of loneliness, social isolation, and relationships is unclear. Using qualitative research methods, this study aimed to explore the subjective experiences of public and internalized stigma and its effects on loneliness, social isolation, and relationship quality in young people with depression symptoms. Methods We carried out in-depth, semi-structured interviews with N = 22 young people aged 17–25 (Mage = 22 years) who reported high symptoms of depression (Mood and Feelings Questionnaire (MFQ) score > 27) (i.e., community sample, N = 9) or had been previously diagnosed with depression by a medical professional (i.e., clinical sample, N = 13). Data were analysed using thematic analysis. We explored the subjective effects of depression stigma on loneliness, social isolation, and relationships. Results Participants described both public stigma (i.e., initiated by others) and internalized stigma (i.e., self-imposed) as disrupting social relationships and eliciting loneliness, isolation, and depressive symptomology. Four main themes about young people's subjective experiences of stigma were identified: 1) Others’ Misunderstanding of Mental Health Disorders and the Impact Misunderstanding has on Relationships; 2) Effects of Stigma on the Self and Wellbeing; 3) Stigma Fosters Secrecy Versus Disclosure; and 4) Stigma Increases Loneliness Driven by Avoidance of Social Contexts. Conclusions Young people's accounts revealed a wide range of consequences beyond their depression diagnosis. Participants often felt discriminated against, misunderstood, and judged by others as a result of public stigma; they discussed internalizing these attitudes. They suggested that a lack of understanding from others, for example from their partners, family, and peers, and unreliable and/or absent support systems resulted in increased feelings of loneliness and social isolation and reduced the quality and quantity of relationship formation, social bonds, and interactions. Stigma also reduced their self-esteem and confidence, which in turn fostered secrecy and a reluctance to disclose their depression. Despite depression's stigma, most participants reported having long-term goals and aspirations to reconnect with others. These goals stood in contrast to feeling hopeless and unmotivated during periods of depression. Overall, we reveal how stigma can impact feelings of loneliness, social isolation, and relationships among young people with depression, which could lead to targeted interventions to lessen the impact of stigma in this population.

Experience of naturally occurring peer support among people using psychiatric day-care in China: an interpretative phenomenology approach

“…This may be due to a desire to avoid revealing vulnerabilities, causing concern, or disrupting the soothing nature of their interactions. Our findings align with previous studies that suggest individuals with depression may be hesitant to acknowledge their condition due to the guilt and stigma surrounding it ( 25 ). While keeping secrets can provide protection against stigma, it may ultimately result in negative consequences such as social isolation and loneliness ( 32 ).…”

“…Social support from peers has been linked to adaptive functioning and is recommended as an intervention target to increase hope, reduce self-stigma, and combat loneliness (2,23). Previous studies have shown that stigma can increase loneliness by leading to avoidance of social situations (24,25).…”

The moderating role of stigma in the relationship between depression and resilience: results of a cross-sectional study in university students

“…When considering the role of stigma, our findings are consistent with the literature suggesting that higher levels of stigma may be associated with more severe depressive symptoms ( Musa et al, 2020 ; Prizeman et al, 2023 ). A critical aspect appears to be the significant moderating role that stigma plays between depression and resilience.…”

A modified persian version of the self-stigma of depression scale among the Iranian population: a methodological study in 2023

“…Severe disorders in social functioning are complications of depression disorders [ 54 ]. In a qualitative study by Prizeman et al, youths with depression described self-stigma as a factor that disrupts social relationships and provokes symptoms of depression, isolation and loneliness [ 55 ]. As a result, SSDS can be helpful in measuring social inadequacy.…”