Stigma Among Historically Marginalized Young Adults With Serious Mental Illnesses: A Mixed Methods Study

Stigma of mental illness is a significant barrier to mental health service use and recovery. Yet, few studies have examined stigma among marginalized young adults with serious mental illnesses (SMI). This convergent mixed methods study builds knowledge surrounding stigma among a sample of young adults of color with SMI (n = 113). The study progressed in two phases. First, a multivariable regression model was estimated to identify factors associated with anticipated stigma. Results indicated that (a) more severe depression symptoms were associated with higher levels of anticipated stigma and (b) more positive treatment beliefs were associated with lower levels of anticipated stigma. Level of education was trending toward significance, suggesting that young adults with higher levels of education experience more anticipated stigma. The second phase focused on qualitative interview data from a subset of young adults (n = 57). Analysts used grounded theory coding techniques and constant comparison to evolve a set of themes that describe stigma experiences. Three themes emerged, namely perceptions of the self, societal views of people with SMI, and the impact of stigma on life. Analytic matrices were developed to merge quantitative data on education, depression symptoms, and treatment beliefs with qualitative data to examine convergence and divergence. The density and content of statements on stigma differed by education and depression, further validating quantitative results. These findings suggest that young adults with more severe depression symptoms and negative treatment beliefs may be more likely to experience stigma as they navigate adult systems of care.Clinical Impact StatementThis study unpacked stigma experiences among minoritized and low-income young adults living with serious mental illnesses. Clinical interventions focused on addressing stigma throughout the treatment experience may be critical to young adult engagement in care and overall treatment success, particularly among low-income, minoritized young adults. Findings reveal that young adults of color with more severe depression symptoms and negative treatment beliefs may experience more anticipated stigma, for example, negative beliefs about themselves, as they navigate adult systems of care.