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

Background: 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).Aims: 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.Methods: We used multivariable-adjusted linear regression to model barrier outcomes as a function of internalized and perceived stigma in an undergraduate population (N = 2551). We evaluated potential effect modification by depression severity using likelihood-ratio tests.Results: 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.Conclusions: 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.