The Stigmatization of Depression

From UBC Wiki

Depression stigma is the negative sentiments that surface against those with depression. An illness such as depression becomes stigmatized when negative attitudes regarding depressives "make depressives seem unattractive and unreliable,"[1] thus hindering those diagnosed with depression from fulfilling meaningful social interactions because they become tinted with the negative stigma. Major depression is a type of invisible disability that can easily go unnoticed in society. Without any physical evidence of an illness, depressives become socially stigmatized. As an example of the general negative connotations on depression, reports have claimed that one out of four people see depression as a "sign of personal weakness and would not employ a person with depression"[2]. The stigmatization of depression puts a burden on all aspects of the life of a depressed individual. In fact, it is said that "the stigma and discrimination associated with depression may be worse than the illness itself"[3].

Depression as a Mental Illness

There is often confusion or misunderstandings about the term depression. Depression goes further from being a mood when it significantly affects a person's personal life, relationships, and overall health[4]. Major depressive disorder, or clinical depression, is a mental disability that can physically hinder someone from functioning normally[4]. The effects of a depressive disorder become cyclical, as the individual feels even more guilt or shame because he or she is depressed[5]. Depression impedes on the individual's life, keeping him or her from even doing regular daily tasks. However, it has only been since the early 1950s that the medical community started to recognize depression as a mental disease[6]. Likely because of this relatively new classification, there still exists a large stigma attached to depression, with many still associating depression to a merely weak personality or bad mood. In reality, the stigma of depression alone "prevents society from accepting it as a valid ailment worth of recognition"[7].

Types of Depression

DSM

The Diagnostic and Statistical Manual of Mental Disorders sets certain criteria for different types of mental illnesses. The DSM provides definitions for several types of depression, which will be discussed below. It is important to clarify that this manual changes over time to reflect the differences in cultural perceptions of mental health[8]. Because of this, the DSM may be viewed as a guideline for mental illness criteria rather than a final categorization of different disorders.

Major Depression

Major Depression is characterized by a depressed mood for most or all of the day, which results in a loss of motivation and interest in many things that once used to be pleasurable. In fact, it is often that things which once made someone happy can conversely make them feel depressed. Symptoms of major depression may include suicidal ideation, insomnia (not being able to sleep) or hypersomnia (excessive sleeping) most days, which is very often accompanied by fatigue, significant fluctuations in weight, feelings of restlessness, feelings of worthlessness or guilt present at most times, and a marked decrease in otherwise typically interesting activities and relationships. In order to meet the threshold to be diagnosed with Major Depressive Disorder according to the DSM-5, at least 5 of the above symptoms must be present every day for a two week period, with one of them having to be either depression and/or diminished interest in daily activities. Furthermore, these symptoms must "cause clinically significant distress or impairment in social, occupational or other important areas of functioning", and the symptoms must not be a function of another physical disorder or due to physiologically altering substances (such as narcotics). [9]

There are many subtypes of Major Depressive Disorder, which have the same symptomatology but different diagnostic criteria including: Psychotic Depression, Postpartum Depression, and Seasonal Affective Disorder.

Persistent Depressive Disorder/Dysthymia

For adults to be diagnosed with Persistent Depressive Disorder symptoms must be present for almost every day for a minimum of two years, and for children and adolescents it is a one year minimum. The mood is generally considered to be depressed or down and is accompanied by a minimum of two other symptoms, which can include low self-esteem and feelings of worthlessness, insomnia or hypersomnia, which is often accompanied by fatigue, lack of concentration and/or diminished cognitive abilities, weight fluctuations, and difficulty with making decisions. [10]

It is important to note that although many symptoms are the same as symptoms from Major Depressive Disorder, they are two different disorders. Major depressive disorder often precedes the onset of Persistent Depressive Disorder, and sometimes can be present during Persistent Depressive Disorder – Double Depression. Additionally, Persistent Depressive Disorder cannot be diagnosed if there were any instances of mania or Cyclothymic Disorder. [11]

Seasonal Affective Disorder

Seasonal affective disorder is a combination of biologic and mood disturbances with a seasonal pattern, typically occurring in the autumn and winter with remission in the spring or summer [12], but it does not always occur in those specified seasons. However, the pattern an individual has for Seasonal Affective Disorder remains the same for them throughout the years.

Seasonal affective disorder is a subtype of Major Depressive Disorder that has been found in over 10% of those with Major depression [13]. Symptoms of Seasonal Affective Disorder include those that of Major Depressive disorder: feelings of depression almost every day, feelings of low self esteem or worthlessness, feelings of hopelessness, having suicidal ideation or thoughts about death, sleep difficulties and fatigue, and weight fluctuation.

Postpartum Depression

Postpartum Depression is considered another subtype of Major Depressive Disorder with the same symptomology according to the DSM-5. The diagnostic material is different from Major Depressive Disorder in that one must be experiencing these symptoms for 4 weeks after giving birth. The DSM-V states that a small percentage of postpartum depressives may experience symptoms before giving birth. Additionally, the risks of women experiencing postpartum with a psychotic feature ([delusions, hallucinations, disorganized thinking, grossly disorganized or abnormal motor behaviour, and negative symptoms) raise substantially if they have previously experienced postpartum depression. [14]

Bipolar Disorder

Bipolar Disorder, once referred to as Manic-Depressive Disorder, is a neurological disorder with very severe symptoms. These symptoms vary depending on the subtype of the disorder, but each are characterized by mood episodes, including manic episodes, mixed state episodes, and depressive episodes.

Mania includes mood changes (extremely elevated mood/euphoria or extreme irritability), which are consequently accompanied by behavioural changes. The depressive episodes include mood changes (long-lasting feelings of depression and loss of interest in once-pleasurable daily activities), and are also accompanied by behavioural changes. Mixed state episodes involve both aspects of mania and depression. These mood and behaviour changes are extremely severe and can destroy an individual's relationships, career, and other aspects life. Fortunately it is treatable.

There are two major subtypes, which are Bipolar I and Bipolar II. Bipolar I is characterized by one full blown manic episode that either required hospitalization or had a minimum duration of one week (usually longer). One may be diagnosed with Bipolar I if they experience a mixed episode. Bipolar II is characterized by many depressive episodes and hypomanic episodes (an episode not as full blown as a manic episode), but neither mixed episodes nor manic episodes may be involved to be diagnosed with Bipolar II. Two less common subtypes are Cyclothymic Disorder, which is a minor form of bipolar disorder II and symptoms have had to have been present for two years, and Bipolar Not Specified, where a person presents disruptive behaviours and mood changes in line with Bipolar disorder but can not quite meet the criteria. [15]

Why People Stigmatize

Most people believes about the nature and course of mental illness such as depression and treatment come from media reports, from personal contact with people who have these illness and from knowledge about the mental health care system. In addition, according to attribution theory, behaviour is determined by a cognitive - emotional process: person make attribution about the cause and controllability of a person’ less that lead to inferences about responsibility. These inference lead to emotional reaction such as anger or pity that affect the likelihood of helping or punishing behaviour. The common fear that people with mental illness are “Dangerous.” This is due to four dimension of stigmatiza about depression. First, conceivability which refer to factor when symptoms of depression are not apparent on the surface, leading to anxiety about whether or not to reveal the condition. Second, the chronicity of the condition, leading to far greater likelihood that it will be stigmatized. Third, perceived dangerous, accosted with depression primary through the risk of suicide, and lastly, controllability, the belief that people can contour their sumo a life that often diminish compassion and leads to blame and anger.[16]

Depressive Disorders in the Media

Depression widely goes unnoticed until it is somehow represented in the media. In particular, the issue of depression is not addressed until an A-list celebrity confesses his or her fight with clinical depression or even goes as far as committing suicide. Or, moreover, suicide may only presented in the media when or if the victim of depression was being bullied or harassed for being different (i.e. in terms of sexual orientation, race, gender identification, etc.). But, even in the latter case, suicide is only presented in the media to show the effects of bullying and to prevent bullying; the primary focus is not to spread the awareness of depressive disorders. Without this preventative element, depressives are stigmatized to be viewed as 'weak' and 'unnatural'.

Stigma in the Media

Infanticide is often a product of postpartum depression-psychosis (but the majority with postpartum depression usually do not become violent), and as such is widely represented in the media throughout news outlets. Stories of mothers who had killed their children such as Felicia Boots, Natasha Sultan, and Inakesha Armour had quickly spread throughout media outlets with the headlines "_______ had postpartum depression". Although this is a sad reality of those who experience a very severe form of postpartum depression, or those who pretend they have a mental illness to avoid prosecution, it contributes to the stigma about the realities of postpartum depression. Ten to fifteen percent of the Canadian mothers who gave birth 2009 to 2011 were diagnosed with postpartum depression, most of whom did not have postpartum psychosis, and if they did, they were not violent as can be perpetuated in the media. [17] Media can also fight against the stigma, with prominent celebrities and public figures speaking openly about their experiences with postpartum depression and creating a more inclusive and fuller picture of the disorder that many women experience in their lifetime. Some celebrities who have shared their stories include: Brooke Shields, Amanda Peet, Valerie Wilson, Courteney Cox, Kendra Wilkinson, and Gwyneth Paltrow.

Famous celebrities who suffer from forms of depression are often made into entertainment as the ill suffer in the public eye. This is a result of the stigma surrounding mental illness and a misunderstanding of how serious the illness really is. Two recent and notable cases are that of Charlie Sheen, who many experts believed had bipolar (manic-depressive) disorder despite his denial of any mental illness, and Amanda Bynes who was diagnosed with many mental disorders in court and publicly stated that she had been diagnosed with bipolar disorder. The stories of these celebrities grew in popularity and were smeared throughout headlines amidst their struggles.

Many celebrities share their stories in dealing with depression to help reduce the stigma. Demi Lovato is an advocate for mental health treatment after having been forced into treatment for bipolar disorder as well as an eating disorder. Other celebrities include Jan Hamm who has been open about his experiences with depression, Ashley Judd who had a memoir (All That is Bitter is Sweet discussing her experiences with depression, Catherine Zeta Jones who has been open about her experiences with Bipolar II disorder, and Winona Ryder who has spoken about life with anxiety and depression, among many others.

Suicide

Every year, over 3,500 Canadians commit suicide[18]. Due to strict media guidelines, suicides are seldom reported in the press. This is because there are "often copycat attempts in the wake of a [suicide]"[19]. In particular, "when a famous person commits suicide, teen suicide rises on a national level"[19]. Seeing celebrities commit suicide almost triggers the underlying symptoms of depression to surface in individuals. If depressives see that even celebrities lose the battle against depression, there seems almost no hope for them. They start to think that they are "just like" others who suffer from depression and commit suicide, driving them to take their own lives as well[19]. According to a study, "media reporting of celebrity suicides increase suicidal behaviors and associated risk factors among depressive patients"[6]. This adds to the stigma of depression, with victims of depression feeling hopeless and like they are not able to seek help.

Robin Williams

The suicide of Robin Williams came as a shock to much of North America. Responses to his death ranged variously from negative to positive. To many individuals who were already battling depression and suicidal thoughts, the intense coverage of Robin William's suicide actually made their conditions worse[20]. Williams, being an icon and idol, had a large impact on the lives of many. However, also because of this, his death "helped bring mental health issues into the spotlight and increased the understanding of [depression]"[21]. To others, the death of Williams opened a door to a world of conversations about depression and mental illnesses, but that does not mean it is all of a sudden easier for someone to talk about his or her depression[22]. The stigma of depression still exists, and the case of Robin Williams has helped to make society realize that it does.

Challenging the Stigma

Using the media in an informed way could help to ease the stigma associated with depression. As seen with the case of Robin Williams, social media platforms can be used to spread the awareness of depression as a mental disorder[21]. Instead of using the media to announce suicides and spread the risk of "copycat attempts," the media can just as easily be used to spread awareness of the challenges that depression entails.

The media can also be used to "encourage public discussions about treatment for depression and other mental illnesses, and to remove the stigma of seeking help"[6]. Movements such as Bell Let's Talk have proven to use social media as an effective platform for mental health awareness. In one day alone in January 2015, there were "more than 122 million tweets, texts, calls and social media shares" related to the Bell Let's Talk initiative. Bell donated 5 cents to mental health initiatives for each "share" on social media, which resulted in a donation of over $6.1 million[23].

According to a review of 144 studies, individuals refrained from seeking help from health services because of the stigma attached to mental illness[22]. To ease the stigma of help-seeking, the media can be used to convey messages to the public about the symptoms and effects of depressive disorders, and show that depression is not just a mood or a weakness. Resources are easily accessible if more people are aware of them, which social media has the power of doing.

On a personal level, people can do many things individually to challenge the stigma around depression. If friends of an individual are suffering from depression, challenging the stigma can be as simple as asking how those suffering are doing, or what the individual can do to help. It is important to listen non-judgementally if a depressed individual chooses to share something, as well as respect their right to privacy if they do not want to talk about their condition. Finally, it is crucial to remind a friend or family member suffering from depression that help is always readily available, and to continue to socially interact with them regardless of their apparent lack of interest.

Differences of Stigma of Depression in Gender

Men and women have different attitudes and belief toward mental illness such as depression. In the general population, the prevalence of depression is higher in women than in men. Being a female is a risk factor for depressive illness because their gender role in society is associated with role overload, lack of job satisfaction, and inequality at work and in the home.[24] The influences of ethnicity on women’s mental health and self stigmatizing beliefs appears primarily to be socially mediated by racial prejudice, social barriers to treatment, health care disparities, health care cost, immigration status, language barriers and symptom recognition. [25] Men may have less exposure to depression than women. However, compared to women, men have less knowledge and more misconceptions about depression in terms of its risk factors, leading to a higher degree of stigma. [26]This highlights the importance of mental health education and promotion to clarify misunderstandings about depression, especially in men. In addition, study showed that contacts with persons with depression might reduce stigma among women, but not in men. In this case, the rates of suicide are three to four times higher in men than women. [27] Women with depression are more likely than men to seek help from friends, family and health services [28]It is understandable that in society, male gender role are considered to be a strong because many men have placed a premium on self-control, thinking it’s “unmanly” to express feelings and emotions and Men may avoid getting the help they need because they are worried that the stigma of depression could damage their career and cause family and friends to lose respect for the them. [29]

Stigma of Depression in Asian Culture

People from ethnic minority group who suffer from depression often bear a triple burden of stigma, stereotype, prejudice and discrimination. There is stigma associated with mental illness because revealing problem by seeking professional help is a sign of personal immaturity, weakness, and lack of self-discipline.[30] Due to high cultural bias and stigma, Asians tend to view depression as a personal weakness or moral failing. There are great stigma and shame about mental health problems such as depression and about receiving treatment for them. [31] Asian parent feel strongly stigmatized if their children have depression because they feel that it’s challenging to their heritage by reflecting family dysfunction or weakness or by reflecting their poor parenting skills. There is a belief that mental illness can affect a family’s good name for generation and that an individual with mental illness causes the entire family to “lose face” and be shamed.[32] Due to the fact that asian parent worry too much about their child’s success, they have a strong belief that depression may threaten a child’s future and if outsiders see the mental illness as heritage, child might face poor marriage prospects [33]

Causal Explanations of Depression in the Context of Stigma

Biomedical Explanation

Biomedical explanation stated that depression in an illness caused by biological factors that operate outside of an individual's control including genetic vulnerability, the sensitivity of the stress response system, the influence of neurotransmitter and decreased activity in the prefrontal cortex. A biomedical application of depression may result in less public stigma because it suggest that people with depression cannot control the cause of the disorder. [34]The belief in biomedical model lead to decreased in public stigma and reduced blame but it can lead people to displayed less self efficacy for dealing with depression without the help of antidepressants. decreased willingness to interact with a depressed individual when their illness was attributed to genetics [35]

Contextual Explanation

Contextual explanation stated that depression is an illness caused by environmental influence and these influence are normally outside personal control. Contextual explanation was associated with less public stigma than the control condition supports the initial hypothesis that is consistent with prior research. This is due to the fact that one’s environment can usually be altered, hope for recovery from depression remains which is successful and effective in reducing public stigma [36]

Cognitive explanation

A cognitive explanation is often not considered a viable model for reducing public stigma because it emphasize the role of distorted thinking in depression. People with depression often show a number of negative distortion (biases against themselves) in interpreting event such as minimising positive accomplishment, magnifying personal failures, and personalizing neutral events and statement. The finding that a cognitive distortion explanation was associated with less public stigma compared with a control condition was unexpected since internal causes that are believed to be under an individual's control would be expected to be more stigmatizing than other cause of explanation. Distorted thinking and other cognitive factors and usually believed to be under a person's control and that seeing such factors as a cause of depression is associated with increased stigma and blame and result in increased anger toward that person. [37]

Cognitive Schema explanation

The presentation of a cognitive schema explanation as also associated with a reduction in public stigma compared with a the control condition. The cognitive schema explanation introduce extenuating circumstances that were absent from cognitive distortion explanation. These schemas are believed to originate in childhood at a time when the individual is not cognitively mature enough to challenge the accuracy of his or her own thought and the representation made by others. Person who is faced with failure at work may experience a number thoughts related to worthlessness, hopelessness, and lack of efficacy. Schema explanation suggest that depressed individual are not directly respond for their distorted thinking but can test and modify these negative belief. [38]

Effect of Stigmatization

Stigmatization of Depression and Discrimination

Discrimination against people with mental illness such as depression form a large portion of main effect of stigmatization. Stigmatization has a dramatic bearing on the distribution of life chances in such areas as earning, housing, criminal involvement, health and life itself. [39] The most common forms of discrimination due to depression is withholding responsibility, assuming that people won’t be able to handle stress, questioning their qualification, considering their options less valid because of the depression or terminating their employment. The loss of meaningful opportunities for education, employment, financial security and housing can also exacerbate the feelings of hopelessness, helplessness and worthlessness endeared by depression. [40]

Stigmatization and effect of help-seeking behaviour

Depressed people may believe that others will view and respond negatively to them if they seek help. Study shows that 26% of people who had not sought treatment for mental illness cited the stigma associated with the conditions as one of the main reason for that decision[41] Sufferers may be concerned about responses of the professionals from whom they seek help, the responses of other people who are aware of the help seeking, or both. In addition, due to self stigma people may perceive depression as being due to a weak personality. Such stigmatizing views may impact on help-seeking because sufferers do not wish to show their ‘weaknesses’ to others. Perceptions that others may respond negatively may lead to help-seeking avoidance, somatization and misdiagnosis, and treatment discontinuation. Many people believe those with depression are hard to talk to, unpredictable and threatening to others, and consider medical treatment for depression to be unnecessary. Other research has found that people seeking psychological counselling are viewed as being defensive, awkward, insecure, sad, cold and unsociable, and that people with depression who seek help from mental health professionals are seen as more unstable than those who do not. [42] People with depression have reported concerns that others would see them as being lazy, weak, incapable of coping with life, and inferior. Moreover, people with a mental illness may fear being treated differently, even with care and support, because it can be perceived as reflecting over concern and underlying views of incompetence. Lastly, the stigma concerning the dimension of repellence relate to perceptions that others do not find them pleasant to be around and either have avoided or will eventually give up on them and the label of depression itself may be sufficient to cause withdrawal and social distance from depressed person. [43]

See also

References

  1. ↑ Wolpert, Lewis. "Stigma of depression - a personal view" (2001). Depression, 57 (1): 221-224. http://bmb.oxfordjournals.org/content/57/1/221.full
  2. ↑ "What is stigma?" (2010). Government of Australia Mental Health Commission. http://www.mentalhealth.wa.gov.au/mental_illness_and_health/mh_stigma.aspx
  3. ↑ "Stigma and discrimination associated with depression and anxiety" (August 2012). Beyondblue. http://www.beyondblue.org.au/docs/default-source/policy-submissions/bw0080-position-statement---stigma-and-discrimination-associated-with-depression-and-anxiety.pdf?sfvrsn=2
  4. ↑ 4.0 4.1 National Institute of Mental Health. Depression (2008). http://web.archive.org/web/20110727123744/http://www.nimh.nih.gov/health/publications/depression/nimhdepression.pdf
  5. ↑ "Overcoming the Stigma of Depression" (2012). Healing From Depression. http://www.healingfromdepression.com/stigma.htm
  6. ↑ 6.0 6.1 6.2 Stresing, Diane. "Depression in the Media" (May 2010). Everyday Health. http://www.everydayhealth.com/depression/depression-in-the-media.aspx
  7. ↑ Charron, Sandra. "Let's Bring an Ice-Bucket Level of Awareness to Depression, Too" (August 2014). Huffington Post Canada. http://www.huffingtonpost.ca/sandra-charron/depression-awareness_b_5698658.html
  8. ↑ Rosenthal, Richard N. Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery (2008). Treatment Improvement Protocol (TIP) Series 48. Substance Abuse and Mental Health Services Administration. http://www.ncbi.nlm.nih.gov/books/NBK64057/pdf/TOC.pdf
  9. ↑ ,J., & Mineka, S.(2013). Abnormal psychology (15th ed.). Boston: Pearson. DSM depression
  10. ↑ Central. (2014). Persistent Depressive Disorder (Dysthymia) Symptoms. Psych Central.
  11. ↑ , M., Kocsis, J., & Thase, M. (n.d.). Dysthymic Disorder and Other Chronic Depressions. FOCUS: The Journal of Lifelong Learning in Psychiatry, 422-422.
  12. ↑ Kurlansik, S. (2013). Seasonal Affective Disorder. Indian Journal of Clinical Practice
  13. ↑ AJ, Boyle MH, Joffe RT, Baumal Z. (2003). Estimated prevalence of the seasonal subtype of major depression in a Canadian community sample, Canadian Journal of Psychiatry, 45(7), 650-654.
  14. ↑ Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association. 186-187.
  15. ↑ Müller-Oerlinghausen, MD, B., Berghöfer, MD, A., & Bauer, MD, M. (2002). Bipolar Disorder. The Lancet, 241-247.
  16. ↑ Woll, P. (2007). Healing the Stigma of Depression: A Guide for Helping Professionals.
  17. ↑ Lanes, A., Kuk, J., & Tamim, H. (2011). Prevalence and characteristics of Postpartum Depression symptomatology among Canadian women: A cross-sectional study. BMC Public Health, 302-302.
  18. ↑ Ladouceur, Roger. "Suicide among men" (February 2011). Canadian Family Physician 57 (2): 148. http://171.66.125.180/content/57/2/148.full
  19. ↑ 19.0 19.1 19.2 Blues, Chelsea. "Suicide and the Media" (n.d.). Teen Ink.
  20. ↑ Martin, Michael G. "The media’s obsession with Robin Williams’ death made my own depression worse" (August 2014). Salon. http://www.salon.com/2014/08/22/the_medias_obsession_with_robin_williams_death_made_my_own_depression_worse/
  21. ↑ 21.0 21.1 Jameson, Ella. "Sidestepping Depression Stigma" (October 2014). PsychCentral. http://psychcentral.com/blog/archives/2014/10/12/sidestepping-depression-stigma/
  22. ↑ 22.0 22.1 Etchells, Pete. "Mental health stigma hasn't gone away" (August 2014). The Guardian. http://www.theguardian.com/science/head-quarters/2014/aug/28/mental-health-stigma-depression
  23. ↑ "Bell Let's Talk breaks records, raises more tan $6M for mental health" (January 2015). CTV News. http://www.ctvnews.ca/health/bell-let-s-talk-breaks-records-raises-more-than-6m-for-mental-health-1.2211607
  24. ↑ Oakley, L. D., Kanter, J. W., Taylor, J. Y., & Duguid, M. (2012;2011;). The self-stigma of depression for women. International Journal of Social Psychiatry, 58(5), 512-520. doi:10.1177/0020764011409820
  25. ↑ Wang, J., Fick, G., Adair, C., & Lai, D. (2007). Gender specific correlates of stigma toward depression in a canadian general population sample. Journal of Affective Disorders, 103(1), 91-97. doi:10.1016/j.jad.2007.01.010
  26. ↑ Bjerkeset, O., Romundstad, P., & Gunnell, D. (2008). Gender differences in the association of mixed anxiety and depression with suicide. The British Journal of Psychiatry, 192(6), 474-475. doi:10.1192/bjp.bp.107.045203
  27. ↑ Bjerkeset, O., Romundstad, P., & Gunnell, D. (2008). Gender differences in the association of mixed anxiety and depression with suicide. The British Journal of Psychiatry, 192(6), 474-475. doi:10.1192/bjp.bp.107.045203
  28. ↑ Wang, J., Fick, G., Adair, C., & Lai, D. (2007). Gender specific correlates of stigma toward depression in a canadian general population sample. Journal of Affective Disorders, 103(1), 91-97. doi:10.1016/j.jad.2007.01.010
  29. ↑ Male Depression and Stigma. (2014, December 1). Retrieved November 11, 2015, from http://fromshame-tohealing.com/this-illness/depression-during-pregnancy/male-depression/
  30. ↑ Fogel, J., & Ford, D. E. (2005). Stigma beliefs of asian americans with depression in an internet sample. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 50(8), 470.
  31. ↑ Kam, K. (2013). Cultural Stigma Hurts Asian American Teens with Depression - New America Media. Retrieved November 10, 2015.
  32. ↑ Kam, K. (2013). Teenager sensing the stigma will start denying the illness and leaving them untreated can cause adverse effect such as school failure or even suicidal.
  33. ↑ Kam, K. (2013). Teenager sensing the stigma will start denying the illness and leaving them untreated can cause adverse effect such as school failure or even suicidal.
  34. ↑ Botha, F. B., & David J A Dozois. (2015). The influence of emphasizing psychological causes of depression on public stigma. Canadian Journal of Behavioural Science, 47(4), 313.
  35. ↑ Cook, T. M., & Wang, J. (2011). Causation beliefs and stigma against depression: Results from a population-based study. Journal of Affective Disorders, 133(1), 86-92. doi:10.1016/j.jad.2011.03.030
  36. ↑ Botha, F. B., & David J A Dozois. (2015). The influence of emphasizing psychological causes of depression on public stigma. Canadian Journal of Behavioural Science, 47(4), 313.
  37. ↑ Botha, F. B., & David J A Dozois. (2015). The influence of emphasizing psychological causes of depression on public stigma. Canadian Journal of Behavioural Science, 47(4), 313.
  38. ↑ Botha, F. B., & David J A Dozois. (2015). The influence of emphasizing psychological causes of depression on public stigma. Canadian Journal of Behavioural Science, 47(4), 313.
  39. ↑ Woll, P. (2007). Healing the Stigma of Depression: A Guide for Helping Professionals.
  40. ↑ Woll, P. (2007). Healing the Stigma of Depression: A Guide for Helping Professionals.
  41. ↑ Barney, L. J., Griffiths, K. M., Jorm, A. F., & Christensen, H. (2006). Stigma about depression and its impact on help-seeking intentions.Australian and New Zealand Journal of Psychiatry, 40(1), 51-54. doi:10.1080/j.1440-1614.2006.01741.x
  42. ↑ Barney, L. J., Griffiths, K. M., Christensen, H., & Jorm, A. F. (2009). Exploring the nature of stigmatising beliefs about depression and help-seeking: Implications for reducing stigma. BMC Public Health, 9(1), 61-61. doi:10.1186/1471-2458-9-61
  43. ↑ Barney, L. J., Griffiths, K. M., Christensen, H., & Jorm, A. F. (2009). Exploring the nature of stigmatising beliefs about depression and help-seeking: Implications for reducing stigma. BMC Public Health, 9(1), 61-61. doi:10.1186/1471-2458-9-61
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