Adolescents’ stigmatizing attitudes and social distance toward peers with depression: The role of social background, familiarity with mental health difficulties and causal attributions.

Mental health stigma poses a significant burden on affected individuals, particularly adolescents, who are especially vulnerable to its consequences. However, the processes and predictors of adolescent mental health stigma remain underexplored. Guided by the Etiology and Effects of Stigma model, this study examines a broad range of factors that shape mental health stigma in this population. Data were drawn from the Red Noses Culturally Sensitive Stigma Survey, a cross-sectional study involving 4,752 final-grade students across 38 secondary schools in Flanders, Belgium. Stigmatizing attitudes and social distance were assessed using a vignette describing a peer with depressive symptoms. Stepwise multilevel linear regression models revealed key differences in stigma based on social background and elucidated the nuanced roles of familiarity and causal attributions. Notably, a dissonance emerged between stigmatizing attitudes and social distance, suggesting that endorsing stereotypes does not necessarily translate into discriminatory behavior. Furthermore, our findings diverge from previous research on the Etiology and Effects of Stigma model in adults, indicating that while contact-based and attributional factors significantly influence stigma, they do not fully explain variations across social backgrounds. These findings underscore the complex and multifaceted nature of adolescent mental health stigma and highlight the limitations of interventions that focus solely on altering attributions to mitigate stigma.