Downloaded from http://journals.lww.com/co-psychiatry by BhDMf5ePHKbH4TTImqenVA+lpWIIBvonhQl60EtgtdlLYrLzSPu+hUapVK5dvms8 on 11/02/2020 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. C URRENT O PINION The role of stigma in children and adolescents with mental health difficulties Laurence Telesia a,b , Anya Kaushik a , and Marinos Kyriakopoulos a,b Purpose of review Children and adolescents with mental health difficulties, and people associated with them, can experience stigma as a result of these difficulties. This article aims to provide an update on the literature pertaining to mental health-related stigma in children and adolescents. Recent findings Recent studies have investigated public stigma, self-stigma and affiliate stigma related to child and adolescent mental health difficulties. Research has typically employed a cross-sectional design. Significant variation was identified in both study methodology and study findings. Qualitative studies offer a unique perspective of stigma from the point of view of the stigmatized individual. Significantly, quantitative analysis has found different variables to be associated with stigma in different geographical locations, even when similar measures are used. Summary Stigma can have a significant detrimental impact on the quality of life for those affected. Careful attention should therefore be paid to stigma in the assessment and treatment of children and adolescents with mental health difficulties. Furthermore, its impact on their caregivers should not be overlooked. Further research is needed to understand the role of social and cultural factors in the development and impact of stigma, and may aid production of antistigma interventions. Keywords affiliate stigma, child and adolescent, mental health, self-stigma, stigma INTRODUCTION Stigma has been defined as a ‘deeply discrediting attribute’, which ‘reduces the bearer from a whole and usual person to a tainted, discounted one’ [1]. Corrigan and Watson [2] outlined a tripartite model of stigma. First, widespread negative beliefs about certain groups may be present within a society (stereotype). Second, negative emotional reactions such as fear or anger can arise within people who endorse the stereotypes (prejudice). Finally, individ- uals alter their behavior to avoid or reject the indi- vidual about whom the prejudice is held (discrimination). When stigma is held by the gen- eral population (i.e. nonstigmatized individuals) it is known as public stigma. Stigmatized individuals may also internalize the process, agreeing with negative stereotypes about themselves and changing their own behaviors in response; they may isolate themselves, or avoid applying for opportunities such as jobs or promo- tions. This form of stigma is known as self-stigma [2]. In addition, people associated with a stigmatized individual, such as friends and family, can attract a secondary stigma known as courtesy stigma or asso- ciative stigma [1,3,4]. When this secondary stigma is internalized it is known as affiliate stigma [5]. Stigma has been studied in a wide range of medical presentations [6–9] and can affect all age groups [10,11]. Within the field of psychiatry, Thor- nicroft et al. [12] reviewed the literature evaluating a Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust and b Department of Child and Adoles- cent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK Correspondence to Marinos Kyriakopoulos, MD, PhD, FRCPsych, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, P066, De Cres- pigny Park, London SE5 8AF, UK. Tel: +44 203 228 4521; e-mail: marinos.kyriakopoulos@kcl.ac.uk Curr Opin Psychiatry 2020, 33:571–576 DOI:10.1097/YCO.0000000000000644 0951-7367 Copyright ß 2020 Wolters Kluwer Health, Inc. All rights reserved. www.co-psychiatry.com REVIEW