Comparison of Public Attributions, Attitudes, and Stigma in Regard to Depression Among Children and Adults

Table 1 indicates that more respondents believed that childhood depression is a very serious problem in comparison with adult depression, that it is not simply a response to the normal "ups and downs" of children's lives, and that it will not improve on its own. However, the respondents were equally likely to label adult and child depression as a mental illness.

Nearly all respondents attributed depression among adults and children to stress. However, more respondents attributed childhood depression to a genetic problem, a chemical imbalance, or the way the child was raised. Further, significantly more respondents believed that children with depression are more likely than adults with depression to be violent toward others. They were equally likely to see adults and children with depression as potentially dangerous to themselves.

Almost all respondents recommended that adults with depression talk to family and friends about their problem; however, only three-quarters of respondents recommended this strategy for children's caregivers. More respondents recommended almost all other sources of help for children with depression than they recommended for adults, including visiting physicians or psychiatrists and psychiatric hospitalization. Seeing therapists and counselors was the only exception, which respondents recommended for both age groups. Finally, more respondents were willing to force a child with depression to receive treatment from a mental health clinic or a physician.

On the basis of these findings, we ran additional analyses (controlling for gender, age, race, and years of schooling) to examine the potentially "contaminating" role of perceptions of dangerousness. These post-hoc analyses suggested that these perceptions drive most other public attitudes toward childhood depression (results available on request). Specifically, those who believed that children with depression are likely to be violent toward others were two to four times more likely to consider the problem serious rather than the normal ups and downs of life; to recommend seeking treatment from physicians, psychiatrists, and psychiatric hospitals; and to be willing to coerce a child with depression into treatment.

Our analysis raises important concerns about the challenges facing families and providers confronting depression among children and adults. That almost half of respondents did not perceive depression among adults as a serious problem suggests a lack of "mental health literacy" about adult depression and its consequences. The findings for children, however, are both encouraging and discouraging. When respondents' attitudes toward adult and childhood depression were compared, more respondents viewed depression among children and adolescents as serious and in need of formal treatment. This finding may reflect the acceptance of contemporary psychiatric thinking about childhood depression; alternatively, as post-hoc analyses implied, it may signal an underlying fear and desire for threat reduction.

Overall, these results suggest that children with depression and their families may be more vulnerable than adults to stigmatization. Most problematic is the belief in children's greater potential for violence against others. Further, the greater willingness to mandate treatment for children is out of step with current psychiatric research and efforts of advocacy organizations. Finally, many people in the United States embrace popular representations of childhood depression as resulting from poor parenting—an attitude that stigmatizes families and creates barriers to care ( 5, 8 ). This conclusion is only reinforced by the greater numbers of respondents unwilling to talk to friends and family about children's mental health problems compared with adults' problems.

Public knowledge and attitudes may rely on sensationalized media reports or direct-to-consumer advertising for information, as well as "commonsense" (but typically uninformed) inferences. In particular, the greater prevalence of beliefs that children with depression are likely to be violent toward others may reflect media attention to the role of mental disorders in the 1999 shootings at Columbine High School and other instances of youth violence. Despite research conclusions that "mental illness cannot be viewed as a straightforward predictor of a school shooting rampage" ( 9 ), many media accounts have emphasized mental health treatment that teen perpetrators had received and have quoted "experts" who have contended that there has been a "social epidemic" of violence among children and adolescents ( 10 ).

The inclusion of suicidal ideation in the child vignette might have skewed respondents' assessments. Ironically, however, this variation produced only a small, nonsignificant difference in evaluation of "danger to self" (less than 5% difference), whereas the difference for "danger to others" was double (more than 10% difference). Also, because data were collected six years apart, it is possible that findings reflect a broader trend toward increasing stigmatization of mental disorders rather than differing attitudes toward children and adults. Although this possibility seems unlikely to be true, given the relatively short period between waves, a design that planned a direct comparison within one survey would have been preferable.

This study represents only a first step in understanding the challenges that mental health providers and families face. Examining the full spectrum of mental health problems and the reasons underlying different responses to adult and child problems would offer additional guidance for treatment and for educational and antistigma campaigns.

Although adult mental disorders have long been misunderstood and stigmatized by the general public ( 4, 8 ), childhood mental health problems have been shown here to receive a complicated public response. More recognition of the problem of depression and recommendations for help seeking were coupled with greater prejudice regarding some treatment and community responses. Stigma has been shown to have devastating effects on the psychological, emotional, and social development of children with mental disorders, significantly diminishing their life chances as adults ( 5, 8 ). Without efforts to promote the understanding and acceptance of youths with mental disorders, stigma will continue to challenge children, families, and providers confronted by depression ( 5 ). Unless these efforts counter the public attitudes we document here that, for example, exaggerate violence, suggest secrecy among family members and friends, and affirm coercive societal response, stigma will continue to challenge children, families, and providers confronted by depression ( 5 ).

The authors acknowledge project support by the National Science Foundation to the National Opinion Research Center; Eli Lilly and Company; the Office of the Vice President for Research, Indiana University; and grant K02-MH-012989 from the National Institutes of Health and National Institute of Mental Health to Dr. Pescosolido, principal investigator. The authors thank Tom Smith and staff members of the Indiana Consortium for Mental Health Services Research, Schuessler Institute for Social Research, Indiana University.

The authors report no competing interests.

Ms. Perry, Dr. Pescosolido, Dr. Martin, and Dr. McLeod are affiliated with the Department of Sociology, Indiana University, 1020 E. Kirkwood Ave., Ballantine Hall 744, Bloomington, IN 47405 (e-mail: [email protected]). Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Columbia University, New York City. This article is part of a special section of reports based on the 2002 National Stigma Study-Children, for which Dr. Pescosolido served as guest editor.