Online supplement 4 Characteristics of included studies



Online supplement 4 Characteristics of included studies

Quantitative studies (association and barriers)

|Reference |Study design |Method of data |Country |Condition that was|Sample |Help-seeking measure (chosen for |Stigma Scale / Stigma barriers measure(s) |

| | |collection | |focus of study | |analysis) | |

|Adams et al., |Cross sectional |Postal questionnaire|UK |Depression |1265 GPs and psychiatrists |Question: If you felt your health might|Twelve statements adapted from published measures to |

|20102 |survey | | | | |be suffering due to strain or stress, |assess stigma (Chung, 2010, Link et al., 1991, |

| | | | | | |what sources of help would you turn to?|Ritsher et al., 2003) |

|Al-Krenawi & |Cross-sectional |Self-complete |Israel |None specified |195 Arab university students |Recognition of personal need subscale |Treatment stigma subscale of ATSPPH (Fischer and |

|Graham, 20111 |survey |questionnaire | | | |of ATSPH (Fisher and Turner 1970) |Turner, 1970) (help-seeking attitudes) |

|Alvidrez & Azocar,|Cross-sectional |Interview |USA |None specified |104 Women attending public-care|  |Question 'Are any of the following reasons why you |

|19992 |survey | | | |women's clinic who reported | |would not come to these classes or groups' followed |

| | | | | |current psychological distress | |by list of potential barriers used in previous study|

| | | | | | | |(Sussman et al., 1987). |

|Alvidrez et al., |Prospective |Interview |USA |Mixed |42 Black mental health clients |Treatment engagement (attended 4+ |Perceived Devaluation and Discrimination Scale (Link |

|20101 | | | |non-psychotic | |psychotherapy sessions) |et al., 1989) |

| | | | |illnesses | | | |

|Aromaa et al., |Cross-sectional |Postal questionnaire|Finland |Depression |507 Adults with diagnostic |Sought help for mental health problem |‘Depression is a matter of will' subscale and |

|20111 |survey | | | |levels of major depression by |in past 12 months |'desire for social distance' subscale of Attitudes |

| | | | | |self-report on CIDI-SF | |connected with depression scale (Aromaa et al., 2010)|

|Bambauer & |Cross-sectional |Interview |USA |Compli-cated grief|135 Bereaved older persons |Question: 'During the past 60 days, |Stigma Receptivity Scale (Reaction subscale) |

|Prigerson, 20061 |survey | | | | |have you gone to any hospital, or |(Pridgerson and Jacobs, 2003) |

| | | | | | |clinics, or talked with a doctor, nurse| |

| | | | | | |or counsellor, or other health | |

| | | | | | |professional for help with a | |

| | | | | | |psychological or emotional problem?' | |

|Belloch et al., |Cross-sectional |Interview |Spain |Obsessive |26 Outpatients of mental health| |Open ended question on patient’s reason for delaying |

|20092 |survey | | |compulsive |clinic | |treatment seeking |

| | | | |disorder | | | |

|Boey, 1998a2 |Cross-sectional |Interview |China |None specified |205 Adolescent patients |  |Question about feeling on seeking psychiatric |

| |survey | | | |attending psychiatric | |treatment(7 categories) |

| | | | | |outpatient clinic in Shanghai | | |

|Boey, 1998b2 |Cross-sectional |Interview |China |None specified |1297 Adults attending |  |Open ended questions on barriers to seeking treatment|

| |survey | | | |psychiatric outpatient clinic | | |

| | | | | |(new patients) | | |

|Boey, 19992 |Cross-sectional |Self-complete |China |None specified |466 Undergraduate students from| |Reasons for not seeking psychiatric care (categorised|

| |survey |questionnaire | | |two universities | |from open-ended question) |

|Brown et al., |Cross sectional |Interview |UK |  |74 Women (white and black |  |Open ended question: “Why would you NOT seek |

|20112 |survey | | | |ethnicity) | |help/advice from GP for these difficulties” |

|Bruffaerts et al.,|Cross sectional |Interview |Six continents |Suicidal behaviour|1170 Suicidal in the past year |  |A list of reasons for not seeing a professional(14 |

|20112 |survey | | | |and did not receive treatment | |items) |

|Chandra & |Cross-sectional |Self-complete |USA |None specified |274 8th grade adolescent school|Vignette in which they confronted a |Stigma Scale for Receiving |

|Minkovitz, 200612 |survey |questionnaire | | |children |personal mental health problem for over|Psychological Help (Komiya et al., 2000), modified to|

| | | | | | |one month. Respondents were asked to |make it suitable for 8th grade students. Barriers: |

| | | | | | |indicate their willingness to use |List of possible barriers to obtaining mental health |

| | | | | | |mental health services (dichotomised to|services. |

| | | | | | |very/somewhat willing and not willing) | |

|Conner et al., |Cross-sectional |Telephone |USA |Depression |248 African American and White |Attitudes Toward Seeking Mental Health |1. Perceived Devaluation and Discrimination Scale |

|2010a1 |survey |questionnaire | | |older adults with depression |Treatment developed by authors, adapted|(Link, 1982) |

| | | | | |(PHQ>9) |from ATSPPH (Fisher and Turner 1970) |2. Internalised Stigma of Mental Illness (Ritsher et |

| | | | | | | |al., 2003) |

|Conner et al., |Cross-sectional |Self-complete |USA |None specified |101 African American and White |Attitudes Toward Seeking Mental Health |1.Perceived Devaluation and Discrimination Scale |

|20091 |survey |questionnaire | | |older adults (aged 55+) living |Treatment developed by authors, adapted|(Link, 1982) |

| | | | | |in community-based independent |from ATSPPH (Fischer and Turner, 1970) |2.Internalised Stigma of Mental Illness Scale adapted|

| | | | | |living facilities | |to 'if you were diagnosed with a mental illness' |

| | | | | | | |(Ritsher et al., 2003) |

|Cooper et al., |Cross-sectional |Self-complete |USA |None specified |79 Students at a local |Attitudes Toward Seeking Professional |Attribution Questionnaire with eight factors for |

|20031 |survey |questionnaire | | |community college |Psychological Health Fischer and |pity, anger, help, danger, fear, social avoidance and|

| | | | | | |Farina, 1995) |treatment coercion (Corrigan et al., 2003a) |

|Corrigan et al., |Cross-sectional |unclear |USA |Depression |230 Community dwelling older |Question: Have you and a physician |Tells others about treatment, sum of 5 yes/no items |

|2003b1 |survey | | | |adults in Chicago |discussed depression?' |about talking family, friends and others |

|David, 20101 |Cross-sectional |Online survey |USA |None specified |118 Filipino Americans |Help-seeking propensity subscale of |Indifference to stigma subscale of Inventory of |

| |survey | | | | |Inventory of Attitudes toward Seeking |Attitudes toward Seeking Mental Health Services |

| | | | | | |Mental Health Services (Mackenzie et |(Mackenzie et al., 2004) |

| | | | | | |al., 2004), | |

|Deane & |Cross-sectional |Self-complete |New Zealand |None specified |263 University students |Question 'If you did have a personal |1.Image Concerns subscale of the Thoughts About |

|Chamber-lain, |survey |questionnaire | | | |problem, how likely is it that you |Psychotherapy Scale (TAPS) (Kushner and Sher, 1989) |

|19941 | | | | | |would seek help from a professional | |

| | | | | | |psychologist or counsellor?' on 9 point|2. Social Stigma Concerns scale (developed for the |

| | | | | | |scale |study) |

|Eaton et al., |Cross-sectional |Self-complete |USA |None specified |74 Spouses of military service | | Barriers items based on previous research (Hoge et |

|2008) 2 |survey |questionnaire | | |members | |al., 2004) |

|Eisenberg et al., |Cross-sectional |Self-complete |USA |None specified |5555 Undergraduate and |Any therapy of counselling or |1. Perceived Devaluation and Discrimination Scale |

|2009)1 |survey |questionnaire | | |postgraduate college students |psychotropic medication for mental or |(Link et al., 1987) adapted |

| | |(online) | | | |emotional health in past 12 months |2. Perceived Devaluation and Discrimination Scale |

| | | | | | | |(Link et al., 1987; adapted) ‘most people’ changed to|

| | | | | | | |‘I’ to measure “personal stigma”. |

|Elhai et al., |Cross-sectional |Self-complete |USA |None specified |89 Medical patients in clinic |Attitudes Toward Seeking Professional |Stigma Scale for Receiving Psychological Help (Komiya|

|2008)1 |survey |questionnaire | | |waiting rooms |Psychological Help Short Form (Fischer |et al., 2000) |

| | | | | | |and Farina, 1995) | |

|Ey et al., 20001,2|Cross-sectional |Self-complete |USA |None specified |315 Medical and dental students|Currently receiving help for mental |Concerns about the Student Counseling Center: |

| |survey |questionnaire | | |in South Carolina |health treatment (self report) |Sigma/confidentiality subscale. (Developed by |

| | | | | | | |authors) |

|Fikretoglu et al.,|Cross-sectional |Face-to-face |Canada |None specified |1220 Active members of military|  |List of barriers created by authors based on previous|

|20082 |survey |interviews | | |services | |research  |

|Givens et al., |Cross-sectional |Self-complete |USA |Depression |490 African American and White | |Barriers list from Treatment stigma scale developed |

|20072 |survey |questionnaire | | |primary care patients | |for the study (4 items) |

|Golberstein et |Cross-sectional |Self-completed |USA |None specified |2782 Undergraduate and graduate|Two questions: used any psychotropic |Stigma Scale for Receiving Psychological Help (Komiya|

|al., 20081 |survey |questionnaire | | |university students |medication or received any |et al., 2000) adapted |

| | | | | | |counselling/therapy in the last 12 | |

| | | | | | |months (responses combined into any | |

| | | | | | |treatment) | |

|Golberstein et |Prospective cohort |Self-completed |USA |None specified |732 Undergraduate and graduate |Whether had used any psychotropic |Stigma Scale for Receiving Psychological Help (Komiya|

|al., 20091 | |questionnaire | | |university students |medication or psychotherapy in previous|et al., 2000) adapted |

| | | | | | |two years | |

|Goodman, 20092 |Cross-sectional |Self-complete |USA |Perinatal |509 Pregnant women | | List of stigma barriers (developed by authors) |

| |survey |questionnaire | |depression | | | |

|Gorman et al., |Cross sectional |Self-complete |USA |No |332 National Guard members |  |Questions assessing perceived barriers adapted from |

|20112 |survey |questionnaire | | |returning from combat | |previous research (Hoge et al., 2006) |

|Gould et al., |Cross sectional |Self-complete |US, UK, Australia,|  |1249 Military persons returning|  | Barriers adapted from previous research (Hoge et |

|20102 |survey |questionnaire |New Zealand | |from service or about to end | |al., 2004) |

| | | | | |service | | |

|Gum et al., |Cross sectional |Interview |USA |No |142 Adults aged 60 years or |On psychotropic medication |Devaluation and Discrimination Scale (Link et al., |

|20101,2 |survey | | | |older receiving home based case| |1989) |

| | | | | |management (aging network | | |

| | | | | |agencies) | | |

|Hackler et al., |Cross-sectional |Self-complete |USA |Eating disorders |145 University students with |ATSPPH-Short Form (Fischer and Farina, |Self-Stigma Scale of Seeking Help (Vogel et al., |

|20101 |survey |questionnaires | | |disordered eating (20+ on |1995) |2006b) |

| | | | | |EAT-26) | | |

|Halter, 20041 |Cross-sectional |Self-complete |USA |Depression |117 Patients and companions in |Attitudes Toward Seeking Professional |Attribution questionnaire (Corrigan et al., 2001) |

| |survey |questionnaire | | |waiting rooms of a primary care|Psychological Help Scale- Short Form | |

| | | | | |office and adult health clinic |(Fischer and Farina, 1995) adapted | |

|Hammer & Vogel, |Cross-sectional |Online questionnaire|USA |Depression |1397 Men who were depressed |ATSPPH-Short Form (Fischer and Farina, |Self-Stigma of Seeking Help Scale (Vogel et al., |

|20101 |survey | | | |(CES-D 16+) and had not |1995) |2006b) |

| | | | | |previously sought help for | | |

| | | | | |depression | | |

|Hoge et al., 20042|Cross-sectional |Self-complete |USA |None specified/ |6201 US soldiers and Marines |  |List of possible barriers to seeking mental health |

| |survey |questionnaire | |Depression, |before or after deployment to | |services (13 items) |

| | | | |Anxiety, PTSD, and|Iraq or Afghanistan | | |

| | | | |alcohol misuse | | | |

|Interian et al., |Cross-sectional |Face-to-face |USA |Depression |200 Latino primary care |Currently taking antidepressants |1. Perceived Devaluation and Discrimination Scale |

|20101 |survey |interview | | |patients with depression (PHQ | |(Link, 1982) 2. Stigma Concerns about Mental Health |

| | | | | |3+) | |Treatment (developed by authors) |

| | | | | | | |3.Social Distance Scale (Link et al., 1987) |

| | | | | | | |4.Latino Scale for Antidepressant Stigma (developed |

| | | | | | | |by authors based on qualitative work) |

|Iversen et al., |Cross sectional |Telephone interview |UK |None specified |821 UK service men and women in|  |Expanded version of a previous scale (Hoge et al., |

|20112 |survey | | | |the military both deployed and | |2004) |

| | | | | |not deployed at Iraq. | | |

|Kanter et al., |Cross-sectional |Self-complete |USA |Depression |391 Undergraduate university |Questions on whether have ever been in |Depression Self Stigma Scale |

|20081 |survey |questionnaire | | |students and community members |therapy for depression or taken |(secrecy, public stigma, general self-stigma, |

| | | | | | |medication for depression |treatment stigma, stigmatising experiences subscales)|

| | | | | | | |developed in the study |

|Kessler et al., |Cross-sectional |Interview |USA |Serious mental |474 Adults (age 18-54) in | |List of reasons for not seeking treatment (15 items) |

|20012 |survey | | |illness |National Comorbidity Survey | | |

| | | | | |with serious mental illness | | |

|Kim et al., 20102 |Cross sectional |  |USA |  |2520 Active duty and national | | Barrier items from previous research (Hoge et al., |

| |survey | | | |guard soldiers | |2004) |

|Kim et al., |Cross-sectional |Self-complete |USA |None specified |881 Soldiers deployed to |Treatment utilisation in past 3 months|Barriers and Association: Stigma scale developed by |

|20111,2 |survey |questionnaires | | |Afghanistan and Iraq who report|for stress, emotional alcohol or family|authors from previous research (4 items) (Hoge et |

| | | | | |mental health problems |problem (include all mental health and |al., 2004 Britt et al., 2008, Mackenzie et al., 2004)|

| | | | | | |medical plus chaplain / clergy but | |

| | | | | | |latter were rarely used) | |

|Komiti et al., |Cross-sectional |Self-report |Australia |None specified |300 Random sample from |Question: 'Have you ever sought help |Perceived Stigma Scale (Wrigley et al., 2005) |

|20061 |survey |questionnaire | | |community survey stratified by |from General Practitioner for | |

| | | | | |town size |psychological or mental health | |

| | | | | | |problems?' | |

|Komiya et al., |Cross-sectional |Self-complete |USA |None specified |311 Undergraduate psychology |Attitudes Toward Seeking Professional |Stigma Scale for Receiving Psychological Help (Komiya|

|20001 |survey |questionnaire | | |university students |Psychological Help Scale - Short Form |et al., 2000) |

| | | | | | |(Fischer and Farina, 1995) | |

|Langston et al., |Cross sectional |Interview / |UK |"Stress-related |1131 UK Royal Navy personnel |  |A list of internally stigmatizing beliefs (one belief|

|20102 |survey |Self-complete | |problems" | | |was an explicit barrier) |

|Lee et al., 20111 |Prospective |Self-complete |USA |Bipolar disorder |43 Adults with bipolar disorder|Treatment adherence with family |Internalized Stigma of Mental Illness Scale (Ritsher |

| | |questionnaires | | |in tertiary outpatient family |treatment in 3 months post initial |et al., 2003) |

| | | | | |treatment (caregivers also in |assessment (not defined, classified as | |

| | | | | |sample but excluded from |adherent or not) | |

| | | | | |review) | | |

|Leong & Zachar, |Cross-sectional |  |USA |None specified |290 Undergraduate psychology |Attitudes Toward Seeking Professional |Opinions about Mental Illness scale (Cohen and |

|19991 |survey | | | |students |Psychological Help Scale (Fischer and |Struening, 1965) |

| | | | | | |Turner, 1970) | |

|Loya et al., 20101|Cross-sectional |Online questionnaire|USA |None specified |128 White or South Asian |Inventory of Attitudes Towards Seeking |1. Social Distance Scale (Link et al., 1987) |

| |survey | | | |university students |Mental Health Services, adaptation of |2.Perceived Devaluation and Discrimination Scale |

| | | | | | |ATSPPH (Fischer and Turner, 1970), |(Link et al., 1987) |

| | | | | | |excluded indifference to stigma | |

| | | | | | |subscale (Mackenzie et al., 2004) | |

|Marques et al., |Cross sectional |Self-complete |USA |  |175 Persons with OCD |  |Barriers to treatment questionnaire (Cachelin et al.,|

|20102 |survey |questionnaire | | | | |2001) |

|Marques et al., |Cross sectional |Self-complete |USA |  |401 Persons with Body |  |Barriers to treatment questionnaire (Cachelin et al.,|

|20112 |survey |questionnaire | | |Dysmorphic Disorder | |2001) |

|Masuda et al., |Cross-sectional |Self-complete |USA and Japan |None specified |600 Japanese undergraduate |Question: 'Have you ever sought help |Stigma tolerance subscale of Attitudes Toward Seeking|

|20051 |survey |questionnaire | | |students in Japan and US |from a psychological professional, such|Professional Psychological Help Scale (Fischer and |

| | | | | |undergraduates in USA |as a psychiatrists, psychologist or |Turner, 1970), modified |

| | | | | | |counsellor for a personal problem’ | |

|Meltzer et al., |Cross-sectional |Self-complete |UK |Neurotic disorders|1387 Adults in National Survey | |Responses to open-ended question about barriers to |

|20032 |survey |questionnaire | | |of Psychiatric Morbidity with a| |help-seeking categorised by authors |

| | | | | |research-identified diagnoses | | |

| | | | | |of a neurotic disorder | | |

|Menke & Flynn, |Cross-sectional |Self-complete |USA |Depression |1013 Adults in primary care |Current treatment for depression |1. Link Stigma Scale – secrecy subscale (Link et al.,|

|20091 |survey |questionnaire | | |waiting rooms |(therapy or medication) |1997) |

| | | | | | | |2. Link Stigma Scale- Devaluation and Discrimination |

| | | | | | | |subscale (Link et al., 1997) |

|Meredith et al., |Prospective cohort |Telephone interview |USA |Depression |184 Depressed teenagers aged | |List of barriers developed by authors (7 items) |

|20092 |study | | | |13-17 and their parents | | |

|Meyer, 20012 |Cross-sectional |Self-complete |USA |Eating disorders |38 High school students (age |  |List of barriers developed by authors (7 items) |

| |survey |questionnaire | | |15-19) | | |

|Nadeem et al., |Cross-sectional |Interview |USA |Depression |15383 Low-income women | |List of barrier adapted from previous research |

|20072 |survey | | | |attending women, infant and | |(Sussman et al., 1987) (8 items) |

| | | | | |children clinics and family | | |

| | | | | |planning clinics | | |

|Nadeem et al., |Cross-sectional |Interview |USA |Depression |1893 Women in women, infant, |  | List of stigma barrier adapted from previous |

|20082 |survey | | | |children and family planning | |research (Sussman et al., 1987) (3 items) |

| | | | | |clinics who reported a mental | | |

| | | | | |health problem in past 12 | | |

| | | | | |months and had perceived need | | |

| | | | | |for care | | |

|Nguyen & Anderson,|Cross-sectional |Self-complete |USA |None specified |148 Vietnamese Americans |Attitudes toward Seeking Professional |Scale constructed by authors comprising |

|20051 |survey |questionnaire | | | |Psychological Health scale- Confidence |Devaluation-Discrimination Scale (Link et al., 1989) |

| | | | | | |in mental health practitioner subscale |and 11 supplemental items from community informants. |

| | | | | | |(Fischer and Turner, 1970) and | |

| | | | | | |supplementary questions from | |

| | | | | | |consultation with community informants.| |

|Ojeda & |Cross-sectional |Interview |USA |None specified |2680 General adult national |  |List of barriers (9 items) |

|Bergstresser, |survey | | | |survey respondents | | |

|20082 | | | | | | | |

|Okazaki, 20001 |Cross-sectional |Interview |USA |Psychotic |102 Asian and Asian-American |Treatment delay using the Interview for|Stigma Module of the Family Experiences Interview |

| |survey | | |disorders |outpatients with psychosis and |the Retrospective Assessment of the |Schedule (Tessler and Gamache, 1994) |

| | | | | |their relatives |Onset of Schizophrenia (Hafner et al., | |

| | | | | | |1992) | |

|Olfson et al., |Cross-sectional |Self-complete |USA |Social anxiety |6130 Adults with social anxiety|  |List of barriers (8 items) |

|20002 |survey |questionnaire | | |who participated in National | | |

| | | | | |Anxiety Disorders Screening Day| | |

|Olmsted et al., |Cross-sectional |Self-complete |USA |None specified |1286 Army soldiers |Received treatment (including |Stigma subscale created on the basis of previous |

|20111 |survey |questionnaires | | | |counselling) for mental health or |literature (Hoge, 2004) barriers scale, created by |

| | | | | | |substance abuse problem in past 12 |authors via factor analysis |

| | | | | | |months | |

|Pederson & Vogel, |Cross-sectional |Self-complete |USA |None specified |575 Male psychology |Intention to Seek Counselling Inventory| Self-Stigma of Seeking Help scale (Vogel et al., |

|20071 |survey |questionnaire | | |undergraduates |(Cash et al., 1975) |2006b) |

| | | | | | | | |

|Rojas-Vilches et |Cross-sectional |Self-complete |USA |None specified |128 Puerto Rican and Cuban |ATSPPH-Short Form (Fischer and Farina, |1.Self Stigma of Receiving Psychological Help (Vogel |

|al., 20111 |survey |questionnaires | | |young adults (parent sample |1995) |et al., 2006b) |

| | | | | |too, not used in this review) | | |

| | | | | | | |2. Beliefs Towards mental Illness dangerousness |

| | | | | | | |subscale, incurability subscale and poor social |

| | | | | | | |skills subscale (Hirai and Clum, 2000). |

|Rusch et al., |Cross-sectional |Self-complete |USA |Depression |92 African Americans with |Whether had previously received |Depression Self Stigma Scale, 32 items, 5 subscales |

|20081 |survey |questionnaire | | |self-reported depressed mood |psychotherapy of antidepressant |(Secrecy, public stigma, general self-stigma, |

| | | | | | |medication |treatment stigma, stigmatising experiences) (Kanter |

| | | | | | | |et al., 2008) |

|Rusch et al., |Prospective study |Unspecified |USA |Schizo-phrenia, |75 Outpatients with |Use of psychotherapy/counselling, |1.Self-esteem decrement subscale of Self-Stigma of |

|20091 | | | |schizo-affective |schizophrenia, schizoaffective |mutual help/peer-support groups and |mental Illness Scale (Corrigan et al., 2006) |

| | | | |and affective |and affective disorders |hospitalisation during 6 months |2.Perceived Discrimination-Devaluation Questionnaire |

| | | | |disorders | | |(Link et al., 1987) |

| | | | | | | |3.Perceived legitimacy of discrimination (Schmader et|

| | | | | | | |al., 2001) adapted |

|Saldivia et al., |Cross-sectional |Interview |Chile |None specified |2987 Participants in Chile | |List of barriers to seeking help |

|20042 |survey | | | |Psychiatric Prevalence Survey | | |

| | | | | |(national household survey) | | |

|Sareen et al., |Cross-sectional |Interviews |USA, Canada and |Non-psychotic |751 Adults participants in |  |List of barriers to seeking help |

|20072 |survey | |Holland |disorders |household surveys (NCS, OHS and| | |

| | | | | |NEMESIS), focus on those with | | |

| | | | | |any non-psychotic disorder and | | |

| | | | | |perceived need for treatment | | |

|Shechtman et al., |Cross-sectional |Self-complete |Israel |None specified |307 University students |Intention to Seek Counselling Inventory|1.Perceived Devaluation and Discrimination Scale |

|20101 |survey |questionnaires | | | |- Psychological and Interpersonal |(Link et al., 1989) |

| | | | | | |Concerns subscale (Cash et al., 1975) |2.Self-Stigma of Seeking Help Scale (Vogel et al., |

| | | | | | | |2006b) |

|Schomerus et al., |Cross-sectional |Interviews |Germany |Depression |2303 Adults in population |Recorded vignette of person with major |1.Anticipated discrimination when seeing a |

|20091 |survey | | | |telephone survey |depression symptoms, asked to imagine |psychiatrist developed by authors (subscales: |

| | | | | | |they had problems in vignette and had |anticipated discrimination, anticipated job problems,|

| | | | | | |seen GP for problem, how likely to |anticipated shame) |

| | | | | | |comply with referral to psychiatrist |2. Social Distance Scale (Link et al., 1987) adapted |

| | | | | | |for major depression (7 point scale) | |

|Schwenk et al., |Cross-sectional |Self-complete |USA |Depression |1154 Practicing physicians with| |Questions on the effect of being depressed on mental |

|20082 |survey |questionnaire | | |moderate to severe depression | |healthcare-seeking behaviours (stigma barriers and |

| | | | | | | |behaviour) |

|Sheffield et al., |Cross-sectional |Self-complete |Australia |None specified |254 Secondary school students |Question 'If in the next 12 months you |Opinions about Mental Illness scale (Cohen and |

|20041 |survey |questionnaire | | |aged 15-17 |were to experience a mental illness, |Struening, 1965), adapted. |

| | | | | | |how likely are you to seek help from | |

| | | | | | |formal sources listed as any of the | |

| | | | | | |following: school counsellor, | |

| | | | | | |psychologist, psychiatrist, doctor, | |

| | | | | | |crisis hotline (11 point scale) | |

|Sirey et al., |Prospective cohort |Self-complete |USA |Depression |92 New patients attending a |Treatment continuation or |Stigma Coping Scale (perceived stigma subscale) (Link|

|20011 |study |questionnaire | | |psychiatric outpatients clinic |discontinuation (discontinued treatment|et al., 1989) |

| | | | | |for depression |and did not seek it elsewhere) during 3| |

| | | | | | |month follow-up period, based on | |

| | | | | | |self-report and chart review | |

|Soheilian and |Cross-sectional |Self-complete |USA |None specified |102 Middle Eastern- American |Attitudes Toward Seeking Professional |Perceived Devaluation-Discrimination scale (Link et |

|Inman, 20091 |survey |questionnaire | | |university students |Psychological Help - Short Form |al., 1987); Self-Stigma of seeking Help scale (Vogel |

| | | | | | |(Fischer and Farina, 1995) |et al., 2006b) |

|Stefl & Prosperi, |Cross-sectional |Interview |USA |None specified |209 Adults participating in | |List of barriers (8 items) |

|19852 |survey | | | |community survey on mental | | |

| | | | | |health need | | |

|Takeuchi et al., |Cross-sectional |Interview |USA |None specified |774 Caucasian, Filipino, |  |Barriers grouped by authors from participants’ |

|19882 |survey | | | |Japanese and Native Hawaiian | |responses (?) |

| | | | | |adults participating in | | |

| | | | | |state-wide survey in Hawaii | | |

|Tang et al., 20072|Cross-sectional |Interview |China |Schizo-phrenia |120 Inpatients with |  |Stigma barriers for reasons for not seeking care |

| |survey | | | |schizophrenia | |directly from a psychiatric hospital (as opposed to |

| | | | | | | |non-psychiatric facilities including traditional |

| | | | | | | |Chinese medicine , qigong and general hospitals) |

| | | | | | | |categorised by authors (unclear). |

|Ting & Hwang, |Cross-sectional |Self-complete |USA |None specified |107 Asian American college |Attitudes Toward Seeking Professional |Stigma tolerance subscale of original ATSPPH (Fischer|

|20091 |survey |questionnaire | | |students |Psychological Help - Short Form |and Turner, 1970) scale adapted |

| | | | | | |(Fischer and Farina, 1995) | |

|Tsang et al., |Cross-sectional |Face-to-face |China |Schizo-phrenia |105 Service users with |Psychosocial Treatment Compliance Scale|1.Chinese Self Stigma of Mental Illness Scale |

|20101 |survey |interview | | |schizophrenia using |(Attendance and Participation |(stereotype agreement, self concurrence, and |

| | | | | |community-based services |subscales) (Tsang et al., 2010) |self-esteem decrement subscale) ( Fung et al., 2007) |

|Van Hook, 19962 |Cross-sectional |Self-complete |USA |Depression |53 Women in rural primary care |  |Barriers: Which issues make it difficult to discuss |

| |survey |questionnaire | | |clinics | |depression with primary care doctor or nurse (unclear|

| | | | | | | |how this was measured) |

|Van Hook, 19992 |Cross-sectional |Self-complete |USA |Depression |56 Women in primary care |  |Barriers Which issues make it difficult to discuss |

| |survey |questionnaire | | |clinics in a low income area | |depression with primary care doctor or nurse 'Worried|

| | | | | | | |what they would think of me' 'I did not want this |

| | | | | | | |information on my record' |

|Vogel et al., |Cross-sectional |Self-complete |USA |None specified |491 University students |ATSPPH (Fisher & Farina 1995) adapted |1.Perceived Devaluation and Discrimination Scale |

|20101 |survey |questionnaires | | | |for group therapy |(Link et al., 1989) |

| | | | | | | |2.Self Stigma of Seeking Help (Vogel et al., 2006b) |

| | | | | | | |adapted |

|Vogel et al., |Cross-sectional |Self-complete |USA |None specified |354 Undergraduate students |Intention to seek counselling inventory|Stigma Scale for Receiving Psychological Help (Komiya|

|20051 |survey |questionnaire | | | |(Cash et al., 1975) |et al., 2000) |

|Vogel et al., |Cross-sectional |Self-complete |USA |None specified |271 Undergraduate students |Intentions to Seek Counselling |1.Self-Stigma of Seeking Help scale (developed by |

|2006a |survey |questionnaire | | | |Inventory (Cash et al 1975) |authors in this study), |

|Study 41 | | | | | | |2.Stigma Scale for Seeking Psychological Help (Komiya|

| | | | | | | |et al., 2000) |

|Vogel et al., |Prospective Study |Self-complete |USA |None specified |655 Undergraduate students |Question: 'Have you sought help from a |1.Self-Stigma of Seeking Help scale (developed by |

|(2006) |(study 5) |questionnaire | | | |mental health professional over the |authors in this study) |

|Study 51 | | | | | |past two months |2.Stigma Scale for Seeking Psychological Help (Komiya|

| | | | | | | |et al., 2000) |

|Vogel et al., |Cross-sectional |Self-complete |USA |None specified |676 Undergraduate students |Intentions to Seek Counselling |1.Self-Stigma of Seeking Help scale (Vogel et al., |

|20071 |survey |questionnaire | | | |Inventory (Cash et al., 1975), |2006b), |

| | | | | | | |2.Stigma Scale for Seeking Psychological Help (SSRPH)|

| | | | | | | |(Komiya et al., 2000) |

|Vogel et al., |Cross-sectional |Self-complete |USA |None specified |369 Undergraduate students |Intentions to Seek Counselling |Stigma Scale for Receiving Psychological Help (Komiya|

|20081 |survey |questionnaire | | | |Inventory (Cash et al., 1975), |et al., 2000) |

|Wade et al., 20111|Cross-sectional |Self-complete |USA |None specified |263 University students |Intention to Seek Counselling Inventory|Self-Stigma of Seeking Help scale (Vogel et al., |

| |survey |questionnaires | | | |- Psychological and Interpersonal |2006b), |

| | | | | | |Concerns subscale (Cepeda-Benito and | |

| | | | | | |Short, 1998) | |

|Wallace & |Cross-sectional |Self-complete |USA |None specified |251 African American |Attitudes Toward Seeking Professional |Stigma Scale for Receiving Psychological Help (Komiya|

|Constantine, 20051|survey |questionnaire | | |undergraduate and graduate |Psychological Help - Short Form |et al., 2000) |

| | | | | |students |(Fischer & Farina, 1995) | |

|Ward & Heidrich, |Cross-sectional |Self-complete |USA |None specified |185 African American women |Treatment seeking subscale of |Stigma subscale of Professional Help Use scale |

|20091 |survey |questionnaire | | | |Professional Help Use scale (Neighbors |(Neighbors and Jackson, 1996) |

| | | | | | |and Jackson, 1996) adapted | |

|Warner et al., |Cross-sectional |Self-complete |USA |None specified |2678 Soldiers (pre-deployment) |  |Barriers questions (Hoge et al., 2004) (8 items) |

|20082 |survey |questionnaire | | | | |adapted |

|Weinberger et al.,|Cross sectional |Self-complete? |USA |  |35 Men with prostate cancer |  | List of barriers |

|20112 |survey | | | | | | |

|Wells et al., |Cross-sectional |Interview |USA and New |None specified |504 Regional household survey |  |List of barriers |

|19942 |survey | |Zealand | |of adults (reported not having | | |

| | | | | |sought help in help in the past| | |

| | | | | |when would have needed it) | | |

|Wrigley et al., |Cross-sectional |Self-complete |Australia |None specified |142 Adults in household survey |Contact Experience Questionnaire, |Perceived Stigma Scale, developed for this study, |

|20051,2 |survey |questionnaire | | |in rural town |developed for this study. How helpful |based on Devaluation and Discrimination Scale (Link |

| | | | | | |believed GP would be in the treatment |et al., 1987) adapted |

| | | | | | |of mental health problems | |

|Yakunina et al., |Cross-sectional |Self-complete |USA |Suicidal ideation |321 University students |General Help-seeking Questionnaire - |1.Stigma Scale for Receiving Psychological Help |

|20101 |survey |questionnaires | | | |formal subscale (Wilson et al., 2005) |(Komiya et al., 2000) |

| | | | | | | |2.Self Stigma Scale for Receiving Help (Vogel et al.,|

| | | | | | | |2006b) |

| | | | | | | |3.Stigma of Suicide Scale (developed by authors) |

|Yakunina & |Cross-sectional |Online questionnaire|USA |None specified |295 Asian international |Intentions to Seek Counselling Scale |Perceptions of Stigmatizations by Others for Seeking |

|Weigold, |survey | | | |University students |(Cash et al., 1975) |Help Scale (Vogel et al., 2009) |

|20111_ENREF_111_EN| | | | | | | |

|REF_109 | | | | | | | |

|1=Study exploring an association between stigma and help-seeking |

|2=Study exploring stigma barriers |

Qualitative process studies

|Reference |Sample |Country |Condition(s) that was |Method of data collection |Analysis method |

| | | |focus of study | | |

|Abrams et al 2009 |25 low-income ethnic minority mothers with and without self-reported |USA |Postpartum depression |In-depth interviews and focus |Grounded theory |

| |postpartum depression symptoms | | |groups | |

|Ahmed et al 2008 |10 immigrant women who screened positive for postpartum depression |Canada |Postpartum depression |Semi-structured telephone |Constant comparative approach |

| | | | |interviews | |

|Aisbett et al 2007 |3 adolescents aged 15-17 attending a rural Child and Adolescent Mental |Australia |Adolescent mental health |Serial interviews (x3) |Interpretive phenomenological |

| |Health Service | |problems | |analysis |

|Ayalon & Alvidrez 2007; Alvidrez |34 Black adults attending a community mental health service |USA |Mental disorder |Interviews |Thematic analysis and grounded|

|et al 2008a | | | | |theory approach |

|Barney et al 2009 |23 adults who had a current or past diagnosis of major depression or |Australia |Depression |Focus groups |Thematic analysis |

| |would have done if had accessed services | | | | |

|Becker et al 2010 |32 ethnic minority and Caucasian adults reporting past or current' |USA |Eating disorders |Telephone semi-structured |Thematic analysis (secondary |

| |concerns, symptoms or problems' regarding eating or weight | | |interviews |analysis) |

|Biddle et al 2006 |23 young people aged 16-24 |UK |None specified |Interviews |Thematic analysis |

|Bilszta et al 2010 |40 women with in treatment or support groups for postnatal depression |Australia |Postpartum depression |Focus groups |Interpretive phenomenological |

| | | | | |analysis |

|Boyd et al 2007 |6 undergraduates who had sought help for a mental health problem during|Australia |Adolescent mental health |Interviews |Thematic analysis with |

| |adolescence and living in a rural area when at school | |problems | |constant comparative method |

|Brown et al 2011b |74 Black African and White British women aged 18 - 45 reporting previous|UK |Depression |Written responses to open-ended|General inductive approach, |

| |experience of depression and that would not seek GP | | |questions |which combines elements of |

| | | | | |grounded theory |

|Burke et al 2008 |18 male school students aged 15-18 |Ireland |None specified |Focus groups |Thematic analysis |

|Carptenter-Song et al 2010 |25 African American, Latino, and Euro-American inner-city residents |USA |Severe mental illness |Ethnographic observations and |Iterative analysis within an |

| |diagnosed with severe mental illness | | |conversations |ethnographic framework |

|Chandra & Minkovitz 2007 |57 8th grade school students |USA |None specified |Interviews |Grounded theory approach |

|Chew-Graham et al 2003 |22 medical students in years 3-5 |UK |None specified |Interviews |Constant comparative method |

|Chung 2010 |31 Chinese immigrants with a history of mental illness and suicide |USA |Deliberate self harm |In depth narrative interviews |Thematic analysis |

| |attempts | | | | |

|Connor et al 2010b |42 African Americans aged 55+ who had a recent self-identified |USA |Depression |Focus groups |Thematic analysis |

| |depressive episode | | | | |

|Connor et al 2010c |37 African Americans aged 60+ with depressive symptoms |USA |Depression |Semi-structured interviews |Content analysis |

|Cruz et al 2008 |43 depressed African Americans in psychotherapy attending a community |USA |Depression |Interviews |Thematic analysis |

| |mental health clinic | | | | |

|Dinos et al 2004 |46 adults with a psychiatric diagnosis |UK |Mental disorder |Narrative interviews conducted |Thematic and content analysis |

| | | | |by service users | |

|Donnelly et al 2011 |10 Chinese and Sudanese refugee and immigrant women with mental illness |Canada |Mental disorder |In-depth interviews |Thematic analysis from |

| | | | | |post-colonial feminist |

| | | | | |perspective |

|Flynn et al 2010 |23 pregnant / postpartum women who screened positive for depression or |USA |Perinatal depression |Interviews |Thematic analysis based on |

| |reported past or current major depression | | | |grounded theory principles |

|Fortune et al 2008 |2954 secondary school students age 15-16 |UK |Deliberate self-harm |Written responses to open-ended|Thematic analysis utilising |

| | | | |questions |some grounded theory |

| | | | | |principles |

|Gibbs et al 2011 |270 Army soldiers |USA |Mental disorder (including|Focus groups |Content analysis |

| | | |alcohol abuse) | | |

|Hepworth & Paxton 2007 |63 women with past or present bulimic behaviours |Australia |Bulimia nervosa and binge |Semi-structured interviews |Concept mapping |

| | | |eating | | |

|Hines-Martin et al 2003a |24 African American low-income adults in inpatient or outpatient care in|USA |Mental disorder |Semi-structured interviews |Thematic analysis |

| |past 12 months | | | | |

|Howerton et al 2007 |35 male offenders in prison (interviewed pre- and post-release) flagged |UK |Deliberate self harm |Serial in-depth interviews (x2)|Thematic analysis with a |

| |as at risk for self-harm or suicide | | | |grounded theory approach |

|Jesse et al 2008 |21 pregnant or recently pregnant African American and Caucasian women in|USA |Depression in pregnancy |Focus groups and |Content analysis |

| |rural area | | |semi-structured interviews | |

|Kadir & Bifulco 2010 |61 Malaysian Muslim mothers who screened positive for depression |Malaysia |Depression |Semi-structured interviews |Thematic analysis |

|Kodandzic et al 2011 |92 adults from 'hard to reach' groups with experience of common mental |UK |Common mental illness |Secondary analysis of interview|Interpretative, case oriented,|

| |illness | | |data |comparative analysis informed |

| | | | | |by narrative approaches |

|Langston et al 2010b |374 Naval personnel |UK |Stress and stress-related |Interviews |Grounded theory / thematic |

| | | |problems | |analysis |

|Lazear et al 2008 |138 low-income ethnic minority mothers with a child up to aged 7 or |USA |Depression |Focus groups |Unspecified |

| |under | | | | |

|Lee et al 2009 |17 Asian American young adults aged 18-30 |USA |None specified |Focus groups |Thematic analysis |

|Lindsey et al 2010 |18 African American boys aged 13-18 who screened positive for depression|USA |Depression |Interviews |Thematic analysis |

|McCarthy & McMahon 2008 |15 women who had received community mental health services for |New Zealand |Postpartum depression |Interviews |Modified analytic induction |

| |postpartum depression | | | |method |

|Mishra et al 2009 |42 African American adults |USA |None specified |Focus groups |Thematic analysis |

|Nicolaidis et al 2010 |30 low-income African American women with major depressive disorder and |USA |Depression |Focus groups |Thematic analysis consistent |

| |histories of violence victimization. | | | |with grounded theory |

|Polyakova & Pacquiao 2006 |33 elder immigrants from the Former Soviet Union |USA |None specified |Participant observation and |Thematic analysis |

| | | | |semi-structured interviews | |

|Prior et al 2003 |127 adults from primary care practice registers and from community |UK |Depression and anxiety |Focus groups |Unspecified |

| |groups | | | | |

|Quinn et al 2009 |17 university students, some using student counselling services |UK |None specified |In-depth interviews, |Thematic analysis |

| | | | |interactive web space and focus| |

| | | | |group | |

|Reiling 2002 |50 'Old Order' Amish adults |USA |Depression |In-depth interviews and |Grounded theory approach |

| | | | |observation | |

|Reitmanova & Gustafson 2009 |8 'Visible' immigrants to Canada |Canada |None specified |Semi-structured interviews |Thematic analysis |

|Sadavoy et al 2004 |50 Chinese and Tamil seniors, age 65+/55+ and families of seniors |Canada |None specified |Focus groups |Grounded theory approach |

|Stecker et al 2007 |20 veterans who served in Iraq and screened positive for mental disorder|USA |Mental disorder |Semi-structured interviews |Thematic analysis |

|Strike et al 2006 |15 men with a history of suicide attempts and a diagnosis of borderline |Canada |Deliberate self harm |Semi-structured interviews |Iterative inductive analysis |

| |or antisocial personality disorder | | | | |

|Teasdale et al 1987 |21 clients of psychiatric day care centre |UK |Severe mental illness |Semi-structured interviews |Grounded theory |

|Thompson et al 2004 |201 African Americans adults |USA |None specified |Focus groups |Thematic analysis |

|Timlin-Scalera et al 2003 |22 white male high school students aged 14-18 |USA |None specified |Semi-structured interview |Grounded theory |

|Vetter 1989 |7 school children aged 9 - 13 referred for behavioural problems or |Germany |Behavioural problems or |Semi-structured individual |Not specified |

| |learning difficulties | |learning difficulties |in-depth interviews | |

|Visco 2009 |170 post-deployment air force personnel |USA |None specified |Qualitative telephone |Content analysis |

| | | | |interviews | |

|Walsh et al 2011 |6 young offenders aged 13 - 17 attending a Youth Offending Service |UK |None specified |Interviews |Thematic analysis |

|Ward et al 2009b |15 African American women |USA |None specified |Semi-structured interviews |Dimensional analysis |

a Two papers from one study

b The Brown et al (2011) and Langston et al (2010) papers also contribute data to the barriers studies

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