Multi-Level Stigma, Discrimination, and Mental Health Care Barriers Among Brazilian Youth: A Scoping Review

Background/Objectives: To map mental illness-related stigma and identity-based stigma and discrimination in relation to depression, anxiety, and mental health care processes among Brazilian youth. Methods: This scoping review followed PRISMA-ScR guidelines and the Arksey and O’Malley framework. PubMed/MEDLINE, Scopus, SciELO, LILACS, and CAPES were searched for studies examining stigma in relation to depression, anxiety, mental health outcomes, or care-related processes among Brazilian children and adolescents. Mixed adolescent and young-adult samples were included when they contained adolescents within the target age range. Results: Seven studies met the inclusion criteria. Stigma was identified across four domains: public, structural, self-, and courtesy stigma. Perceived discrimination was associated with major depression (aPR = 2.00, 95% CI 1.37–2.97) and severe depressive symptoms (aOR = 1.71, 95% CI 1.23–2.38) in studies examining racial discrimination and discrimination affecting sexual and gender minority youth. These estimates were derived from samples that included young adults. Qualitative evidence linked stigma to symptom concealment, barriers to help-seeking and diagnostic processes, and difficulties engaging with care. Evidence was limited by predominantly cross-sectional and qualitative designs, uneven geographic representation across Brazil, and a lack of culturally validated stigma measures. Conclusions: Stigma appears to be a multi-level factor associated with adverse mental health outcomes and with reported barriers across the mental health care pathway among Brazilian youth. Stigma-informed approaches may support earlier engagement with care among marginalized youth, but their effectiveness remains to be evaluated.