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
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
"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
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
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
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>.▪