Objective: Despite considerable policy interest in the association between perceived public stigmatization of mental illness and use of mental health services, limited empirical evidence, particularly from longitudinal data, documents this relationship. This study used longitudinal data to estimate the association between perceived public stigmatization and subsequent mental health care seeking. Methods: A Web-based survey was used to collect data from a random sample of undergraduate and graduate students at a university at baseline and two years later (N=732). Logistic regression models assessed the association between students' perceived public stigma at baseline and measures of subsequent help seeking for mental health problems (perceived need for help and use of mental health services) at follow-up. Results: No significant associations were found between perceived public stigma and help-seeking behavior over the two-year period. Conclusions: In this population of college students, perceived stigma did not appear to pose a substantial barrier to mental health care. (Psychiatric Services 60:1254-1256, 2009)

Reducing stigma is one of the major policy approaches proposed to reduce levels of unmet need for mental health services (1). This policy focus is understandable for two reasons. First, the stigma that the public associates with mental illness has remained persistent, with no apparent improvements over the past ten years (2). Second, it seems logical that individuals who believe that the public stigmatizes mental illness or mental health services might forgo treatment in order to avoid being labeled as a member of a stigmatized group (3).

Despite these compelling reasons to consider stigma an important barrier to mental health care, there is limited empirical evidence that stigma actually affects use of mental health services (4). In this report we focus on perceived public stigma, one of multiple dimensions of stigma (3). Perceived stigma was associated with lower medication adherence in a longitudinal study of a clinical sample, but less is known about the association between perceived stigma and use of mental health services in nonclinical samples (5). Prior research addressed this topic using cross-sectional data from a representative sample of students at a large public university (4). Among students under age 22, higher levels of perceived stigma was associated with a lower probability of perceiving a need for help, but no significant association was found between perceived stigma and perceived need for help among older students, nor were there any significant associations for any student group between perceived stigma and actual service use.

In that study's cross-sectional analysis, however, the relationship between perceived stigma and service use was likely to reflect not only the effect of perceived stigma on service use but also the reverse, the effect of service use on perceived stigma. In this study, we improved upon prior research by using longitudinal data to test for an association between perceptions of stigma and subsequent help-seeking behavior.