The Effect of Social Stigma Associated with Mental Illness on Help-Seeking Behaviors and the Use of Mental Health Services

Abstract

This study aimed to explain how individuals experiencing mental health problems perceive social stigma and how such stigma influences their decisions to seek help, select sources of support, and continue using professional mental health services. This qualitative study was conducted using a conventional content analysis approach. The participants were 24 adults residing in Tehran who had experienced a mental health problem, received a psychiatric or psychological diagnosis, or perceived a need for professional mental health care. Purposive sampling with maximum variation was used to achieve diversity in gender, age, marital status, educational level, employment status, clinical experiences, and patterns of service use. Data were collected exclusively through individual semi-structured interviews lasting between 45 and 85 minutes. All interviews were audio-recorded with consent, transcribed verbatim, and analyzed concurrently with data collection. Theoretical saturation was reached during the twenty-first interview, followed by three confirmatory interviews. Data were managed and analyzed using NVivo 14 through repeated reading, identification of meaning units, initial coding, comparison of codes, development of subcategories, and abstraction of the main categories. Credibility was enhanced through member checking, peer review, independent coding of selected interviews, maximum variation, reflexive documentation, and maintenance of an audit trail. Five main categories were identified: “fear of judgment and disclosure of a vulnerable identity,” “internalized stigma and compulsory self-reliance,” “protection of family reputation and diversion of help-seeking pathways,” “institutional stigma and discontinuous service use,” and “reconstruction of help-seeking through support and mental health literacy.” Most participants described anticipating labels such as “crazy,” “weak,” “unstable,” or “untrustworthy.” These concerns contributed to concealment of symptoms, delayed professional consultation, reliance on relatives or nonprofessional sources, presentation of distress as physical complaints, selective disclosure, and premature treatment discontinuation. Confidential and respectful care, supportive family members, positive contact with recovered individuals, and improved mental health literacy facilitated professional help-seeking. Social stigma influenced help-seeking through interconnected interpersonal, intrapersonal, familial, cultural, and institutional mechanisms. Stigma reduced service utilization not only by generating fear of external discrimination but also by becoming internalized as shame, inadequacy, and failure of self-control. Reducing the mental health treatment gap therefore requires multilevel interventions, including public education, contact-based stigma reduction, family engagement, provider training, confidentiality safeguards, culturally responsive communication, and integration of mental health services into primary and general health care.