Mental illness stigma and treatment-seeking willingness in Japan: a national survey study

Abstract Background Japanese adults report high mental illness stigma and low treatment use, yet the specific public stigma beliefs and attitudes associated with Japanese treatment seeking remain unclear. This study had three aims: (1) describe public stigma in a national Japanese sample and compare these patterns descriptively with U.S. public stigma, (2) examine which Japanese public stigma components independently predicted Japanese treatment-seeking willingness, and (3) examine the effects of the potential facilitators of mattering and prior treatment experience on Japanese treatment-seeking willingness. Methods Data were collected from a geographically representative national online sample of 1,012 Japanese adults, assessing treatment-seeking willingness and vignette-based measures of public stigma involving perceived seriousness and treatability, causal attributions, desired social distance, and perceived dangerousness. Japanese participants were compared with U.S. adults from the 2018 U.S. General Social Survey. Linear regression examined public stigma predictors and potential facilitators (e.g., mattering) of Japanese treatment-seeking willingness. Results Only 54% of Japanese participants reported treatment-seeking willingness, with low perceived treatment need. In descriptive cross-national comparisons, Japanese participants reported significantly lower rates of perceived mental disorder seriousness, lower beliefs in treatment effectiveness/recovery, and fewer neurobiological attributions, with higher desired social distance but lower perceived dangerousness than U.S. adults. Within the Japanese sample, believing treatment would improve mental disorders, greater mattering, and prior treatment experience independently predicted greater treatment-seeking willingness, while believing disorders would improve without treatment and greater desired social distance predicted lower willingness. Conclusions Findings revealed a pattern of Japanese public stigma marked by high social distancing and treatment/recovery pessimism that may contribute to low treatment-seeking willingness and unmet mental health need. Positively, mattering emerged as a possible treatment-seeking facilitator. Public stigma and mattering may therefore represent potentially modifiable treatment-seeking barriers and facilitators, respectively, with implications for supporting mental health equity in Japan and addressing Japan’s treatment gap.