Children and adolescents treated for mental illness typically become outsiders at school, overmedicated, and "zombie"-like.

At least that's what many adults in the United States believe, according to a multidimensional analysis of the 2002 National Stigma Study—Children (NSS—C) survey published in the May Psychiatric Services in a special section titled "Culture, Children, and Mental Health Treatment."

Conducted between February and June 2002, this is the "first large-scale, nationally representative survey of public knowledge, attitudes, and beliefs on children's mental health," reported Bernice Pescosolido, Ph.D., an Indiana University sociology professor and lead investigator of the five-member survey research team.

The other team members were Brea Perry, M.A., Jack Martin, Ph.D., and Jane McLeod, Ph.D., of Indiana University's Department of Sociology, and Peter Jensen, M.D., of the Center for the Advancement of Children's Mental Health at Columbia University in New York City.

The survey's findings have serious public health implications for one of this country's most vulnerable populations.

"The general stigma attached to mental health treatment and specific concerns about the use of psychiatric medications for children challenge clinicians' efforts to provide appropriate and effective treatment to children and adolescents," the researchers wrote. As previously reported in the literature, "services cannot be effective for families concerned about stigma because these families are unlikely to access available resources or accept recommended treatment options."

The results of the 15-minute, face-to-face query of nationally representative samples of people (from the initial 1,393 noninstitutionalized individuals viewed) are contained in four companion analyses briefly summarized below. (See end of article for study methodology.)

This is "'a snapshot' of American views," wrote Psychiatric Services editorial board member Bonnie Zima, M.D., M.P.H., in a commentary that accompanies the special section. "The [NSS-C] survey indicates that the public perceives disturbingly high rates of overmedication and stigma" affecting children and adolescents.

According to Pescosolido, in the article introducing the special section, much is empirically known about the attitudes, knowledge, and prejudices that Americans have about mentally ill adults. But far less is known about how society "views" its mentally ill children and adolescents or of the attitudes held by adults about the treatment options available to them. And yes, that's true, despite growing public interest in mental health news involving children ranging from deadly school violence to the pro and con debate about the safety of psychotropic medications for children and adolescents.

"We have known more," she wrote, "about the stigma surrounding the occurrence of leprosy, diabetes, epilepsy, and developmental disabilities among children than we have about serious emotional disorders [among children.]"

The 2002 NSS-C Survey received project support from the National Science Foundation to the National Opinion Research Center, Eli Lilly and Co., the Office of the Vice President for Research at Indiana University, the National Institutes of Health, and National Institute of Mental Health.

The reports in the Psychiatric Services' "Special Section on the National Stigma Study-Children" can be accessed from the table of contents of the May issue at<http://ps.psychiatryonline.org>.

The 15-minute, 2002 National Stigma Study—Children (NSS—C) survey was incorporated into one of two national samples of the 90-minute, face-to-face General Social Survey (GSS), thought to be the "longest running monitor of American opinions."

The authors of the analyses, which was published in a special section in the May Psychiatric Services noted that "an institutional review board approval for [the GSS] was provided by the University of Chicago, and approval for the secondary analysis was given by Indiana University."

A total of 1,393 noninstitutionalized U.S. adult residents participated in the survey, for a response rate of 70 percent (margin of error ±3.5 percent). Of these, wrote the researchers, "78% of respondents were white, 15% were African American, and 7% reported belonging to another racial or ethnic category (such as Asian American). Respondents' mean±SD age was 46±17.2 years. They had slightly more than a high school education (13.4 years) and a family income of $50,000±$39,500. Married individuals constituted 48% of the sample, 50% of the sample worked full-time, and 71% of respondents were parents. With the exception of the slight overrepresentation of women (59%), the sample mirrored the U.S. population profile within sampling error."

The respondents were randomly asked to answer questions about a short written vignette on one of four topics, an NSS—C-specific technique developed by psychiatrist Peter Jensen, M.D., a study-team member.

Two vignettes described a subject who met DSM-IV diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) or major depression. The other two "control" vignettes described a subject with asthma or a nebulous, subclinical condition called "daily troubles."

The subject in each vignette was variously described as male or female, white or black, or age 8 or 14.

In the end, 24 percent of respondents (340 participants) were assigned to the ADHD vignette group, and 27 percent (374) were assigned to the depression vignette group. In the survey control groups, 23 percent of respondents (327) were assigned to the asthma vignette group, and 25 percent (352) were assigned to the daily troubles vignette group.

The reports in the Psychiatric Services' "Special Section on the National Stigma Study—Children" can be accessed from the table of contents of the May issue at<http://ps.psychiatryonline.org>.▪