The Role of Continuum Conceptualisations of Mental Illness on Adolescent Mental Health Stigma and Intentions to Seek and Provide Help

The promotion of adolescent mental health has been identified as a global health priority. Despite the significant negative impacts of mental illness, many young people do not seek help. Stigma has been identified as one of the key barriers to help-seeking among adolescents and remains a widespread experience for individuals experiencing mental health difficulties. There has been growing interest in determining whether continuum conceptualisations of mental illness may be capable of combatting stigma among adults. It has been proposed that continuum conceptualisations of mental illness may decrease stigma by dissolving ‘us’ vs. ‘them’ distinctions which are considered a component of the stigma generation process. Recent findings among adults suggest that continuum conceptualisations of mental illness show promise in reducing stigma. However, there has been minimal research on the link between continuum beliefs and adolescents’ stigmatising attitudes towards both other adolescents and people in general who have mental health difficulties. Likewise, there is a lack of research into the potential relationships between continuum beliefs and important outcomes of mental health promotion such as intentions to seek and provide help. The purpose of this thesis is to examine the links between continuum beliefs and stigma, help-seeking and help-providing intentions in adolescents.

Study 1 involved a systematic review of 92 Australian mental health webpages to determine how mental health, mental illness, depression, and schizophrenia were conceptualised. Across all webpage foci, there was a greater prevalence of webpages implying continuum rather than categorical conceptualisations. Yet only a minority of webpages explicitly presented continuum conceptualisations. Webpages for both depression and schizophrenia implied many mixed conceptualisations including both continuum and categorical messaging. Finally, all webpages targeting young people included continuum messaging.

Study 2 investigated the links between continuum and categorical beliefs, stigma, and intentions to seek and provide help after participants had reviewed vignettes of depression and schizophrenia. One hundred and ninety-three adolescents aged between 13 and 18 years participated. For the depression vignette, continuum beliefs were not related to stigma, help-seeking or help-providing intentions. Conversely, categorical beliefs about depression positively predicted social distance, dangerousness stereotyping, avoidance, and fear. Continuum beliefs regarding the schizophrenia vignette negatively predicted prognostic pessimism, social distance, and stigmatising attitudes, whereas categorical beliefs were positively associated with these variables. Interestingly, continuum beliefs predicted greater intentions to not seek help for schizophrenia.

Study 3 extended on prior findings by investigating the relationships between continuum beliefs about mental illness as a general construct, stigma, and intentions to seek and provide help . Mediation analyses allowed the exploration of indirect paths between continuum beliefs and help-seeking and help-providing intentions via stigma. Participants were 591 adolescent males. Continuum beliefs were found to indirectly predict intentions to seek help via decreased social distance, albeit with effects of very small magnitude. There was also a direct negative association between continuum beliefs and intentions to not seek help. Lastly, continuum beliefs predicted intentions to provide help both directly and indirectly via social distance.

Study 4 aimed to clarify some of these inconsistent findings through a novel experimental manipulation of continuum and categorical beliefs about schizophrenia in a convenience sample of 271 adults. Two of seven stigma variables were reduced in the continuum belief condition, specifically prognostic pessimism and dangerousness/unpredictability stereotypes. Prognostic pessimism increased in the categorical condition. Help-seeking intentions increased across conditions and there was no change to help-providing intentions. There was no difference between conditions on a novel measure of prosocial behaviour.

Overall, these studies show that among adolescents the relationships between continuum beliefs and stigma, help-seeking and help-providing intentions can vary across different types of mental illnesses. Continuum beliefs inversely predicted stigma variables for schizophrenia and general mental illness but not depression. Categorical beliefs consistently predicted greater stigma across both schizophrenia and depression. The findings also suggest that there is a very weak relationship between continuum beliefs and intentions to seek and provide help. These findings provide some support for the use of continuum as opposed to categorical conceptualisations within adolescent mental health promotion. However, there is not sufficient evidence to suggest continuum beliefs should be a primary target to improve help-seeking or help-providing outcomes in either adults or adolescents.