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Abstract

Stigma related to mental health and its treatment can thwart help-seeking. The current study assessed college athletes’ personal and perceived public mental illness stigma and compared this to nonathlete students. Athletes (N = 304) were National Collegiate Athletic Association (NCAA) Division I athletes representing 16 teams. Results indicated that athletes reported greater perceived public stigma than personal stigma. Athletes reported significantly higher levels of stigma compared to nonathlete peers (n = 103). Accordingly, athletes may benefit from education that can reduce the stigma of mental illness and reduce prejudices toward those who are seeking treatment. Additional implications for improving access to care are discussed.
October 2015 vol 56 no 7 735October 2015 vol 56 no 7 735
Jan Arminio & Robert D. Reason, associate editorsResearch in Brief
Perceptions of Mental Illness Stigma:
Comparisons of Athletes to Nonathlete Peers
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Stigma related to mental health and its treatment
can thwart help-seeking. The current study
assessed college athletespersonal and perceived
public mental illness stigma and compared this
to nonathlete students. Athletes (N = 304) were
National Collegiate Athletic Association (NCAA)
Division I athletes representing 16 teams.
Results indicated that athletes reported greater
perceived public stigma than personal stigma.
Athletes reported signicantly higher levels of
stigma compared to nonathlete peers (n = 103).
Accordingly, athletes may benet from education
that can reduce the stigma of mental illness and
reduce prejudices toward those who are seeking
treatment. Additional implications for improving
access to care are discussed.
One in four Americans has a diagnosable
mental disorder, most of which onset by age
24 (Kessler etal., 2005). College athletes are
a vulnerable group because of cumulative
stresses related to competitive sport (e.g.,
Papanikolaou, Nikolaidis, Patsiaouras &
Alexopoulos, 2003). In addition to extensive
sport-related time demands, sport-related
travel translates into being academically
disadvantaged due to lost classroom and
laboratory instructional time. Furthermore,
sport-related injuries often increase time
demands because of the added commitment
of physical therapy and rehabilitation.
Few studies have compared rates of
psychopathology between college athletes
and nonathletes. Storch, Storch, Killiany, and
Roberti (2005) found that female athletes
reported lower levels of social support and
greater levels of depressive and social anxiety
symptoms than did female nonathletes;
however, there were no dierences between
athletes and nonathletes in rates of clinical
mental health problems. Approximately
10–15% of college athletes experience issues
Emily Kaier is a student member of e University of Tulsa Institute of Trauma, Adversity and Injustice, and a
doctoral candidate of Psychology at e University of Tulsa. Lisa DeMarni Cromer is Codirector at e University
of Tulsa Institute of Trauma, Adversity and Injustice and Associate Professor of Psychology at e University of Tulsa.
Mitchell D. Johnson graduated with his Bachelor’s of Science in Psychology at e University of Tulsa. Kathleen
Strunk is Cofounder and Codirector at e University of Tulsa Institute of Trauma, Adversity and Injustice and
a Clinical Associate Professor in the School of Nursing at e University of Tulsa. Joanne L. Davis is Cofounder
and Codirector at e University of Tulsa Institute of Trauma, Adversity and Injustice and Associate Professor of
Psychology at e University of Tulsa. e authors wish to acknowledge the Athletics Department at e University
of Tulsa for their cooperation and assistance with this research as well as the athletes who took time out of already
busy schedules to complete measures.
736 Journal of College Student Development
Research in Brief
736 Journal of College Student Development
Research in Brief
signicant enough to warrant psychological
services (Ferrante, Etzel, & Lantz, 1996;
Parham, 1993; Watson, 2006).
Despite potential elevated risk, college
athletes underutilize psychological services
(Watson, 2006). is may be a corollary of
athletics culture that emphasizes self-reliance
(Etzel, Ferrante, & Pinkney, 1991) and
prioritizing the team over self. Additionally,
athletes are often well known on campus and,
hence, may not have privacy if seen walking
into campus counseling (Etzel etal., 1991).
Individuals seen at a mental health clinic may
be labeled as mentally ill and stigmatized
(Corrigan, 2004). According to the National
Institute of Mental Health, stigma is the
primary impediment to seeking treatment for a
mental illness (U.S. Department of Health and
Human Services, 1999). Mental illness stigma
could contribute to athletes’ underutilization
of services and less positive attitudes toward
help-seeking (Watson, 2006).
Stigma can be public or personal. Public
stigma is a belief about others’ perceptions, and
personal stigma is one’s own beliefs (Corrigan,
Watson, & Barr, 2006). Corrigan (2004)
suggested that stigmas develop sequentially,
rst by recognizing public or peer group stigma,
then by forming one’s own personal stigma.
Perceived public stigma (PPS) may prevent
an individual from seeking psychological
help for fear of peers’ negative judgments,
and personal stigma may harm self-esteem
when one sees oneself as part of a stigmatized
group (Corrigan, 2004). e idea that PPS
might prevent an individual from seeking
psychological services is consistent with
empirical data. A survey of undergraduates
found that students who reported higher
mental illness stigma were less likely to seek
psychological help (Cooper, Corrigan, &
Watson, 2003). In a college sample, Eisenberg,
Downs, Golberstein, and Zivin (2009) found
that PPS was considerably higher than personal
stigma and that higher levels of personal stigma
were associated with less help-seeking.
The current study examined PPS and
personal stigma about mental health help-
seeking in a sample of college athletes and
a comparison sample of nonathletes. We
hypothesized that: (a)personal stigma and
PPS about mental illness would be positively
correlated, (b)PPS would be significantly
higher than personal stigma, and finally,
(c)athletes would experience higher personal
and PPS than would a group of nonathletes. e
ultimate goal of exploring these questions was
to provide feedback to athletic administration
at the present university.
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There were 304 athlete participants (129
women and 175 men) from 16 NCAA
Division I teams with an average age of 20
(SD = 1.36). Ethnicity was: Caucasian (68%),
African American (20%), American Indian
(1%), Hispanic, Latino or Spanish (4%), and
other (7%). Nonathletes (n = 103) consisted
of 72 women and 31 men, with average age of
21 (SD = 4.33) years. Nonathletes’ ethnicity
was: Caucasian (62.7%), African American
(6.9%), Hispanic, Latino or Spanish (6.9%),
American Indian (4.9%), other (17.6%), and
one who declined to say (1%).
>*13)@8*)
Athlete data collection was conducted in
conjunction with practices and team meetings.
Participation was voluntary. A comparison
sample of nonathletes was recruited through
an online human subjects pool (HSP). Because
the HSP was small at this university, the
comparison sample was smaller than the
athlete sample. Any participants enrolled in
Psychology classes were given research credit;
the rest volunteered without compensation.
October 2015 vol 56 no 7 737
Research in Brief
October 2015 vol 56 no 7 737
Research in Brief
.)(,8*),
e Perceived Discrimination–Devaluation
(PDD) Scale measures mental illness stigma
(Link, 1987). e PDD has 12 items that
assess agreement with statements about how
most people view psychiatric patients. e
PDD queries personal stigma and public
stigma. An example of a personal stigma
item is: “I would willingly accept someone
who has received mental health treatment as
a close friend. Public stigma refers to peer
groups (Eisenberg etal., 2009). For example,
for athletes a public stigma item is: “Most
of my fellow student athletes would willingly
accept someone . . .”; whereas for nonathletes
the item would query: “Most of my fellow
students would willingly accept someone . .
.”. Responses were given on a 6-point Likert-
type scale from 0 (strongly agree) to 5 (strongly
disagree), and scores were averaged. Higher
values reected more stigma. In the current
sample, the full scale Cronbachs alpha was .78.
A!7B+;7
Consistent with previous research (Eisenberg
etal., 2009), among athletes we found
a significant positive correlation between
personal and perceived stigma (r = .29,
p < .0001), and it was a medium eect size
(Cohen, 1988). This finding supports the
notion that more PPS is associated with higher
personal stigma about mental illness. A paired-
samples t-test revealed that PPS (M = 2.38)
was signicantly higher than personal stigma
(M = 2.19), t(278) = 4.52, p < .001.
To explore if athletes experienced
higher personal and PPS than a comparison
group of students, a multivariate analysis of
variance (MANOVA) with student status
(athlete or nonathlete) as the independent
variable and personal and PPS scores as
the dependent variables was conducted.
The omnibus MANOVA was significant,
F(2,372) = 174.53, p < .001, Wilks’s
lambda = .52, partial η2 = .48. e univariate
analyses between group dierences for both
personal and PPS resulted in the following,
F(1, 373) = 23.11, p < .001, partial η2 = .06
and F(1,373) = 349.77, p < .001, partial
η2 = .48, respectively. Athletes had higher
levels of personal stigma (M = 2.18, SD = 0.70)
than did nonathletes (M = 0.65, SD = 0.66)
and higher PPS (M = 2.38, SD = 0.47) than
did nonathletes (M = 2.05, SD = 0.80).
Post hoc mean levels of personal stigma
and PPS from this study were compared to that
of Eisenberg etal.’s (2009) sample of college
students (N = 5,555). We examined whether
the group of athletes in the present study
diered from a larger population of students.
A one-sample t-test revealed that, compared
to Eisenberg and colleagues’ study, athletes
in the current sample reported more personal
stigma, t(284) = 28.12, p < .001; however,
the athletes’ level of PPS was not dierent
from that in Eisenberg and colleagues’ study,
t(277) = –1.94, p = .05.
-C70B77C=D
Relative to peers, college athletes underutilize
mental health services (Watson, 2006).
Previous research has demonstrated that
negative attitudes toward mental health can be
an encumbrance to help seeking. e current
study examined stigmatized attitudes toward
mental illness that could deter athletes from
help seeking (U.S. Department of Health and
Human Services, 1999). Based on previous
research, we postulated that stigma could be
heightened because of athletes’ celebrity status
on campus (Etzel etal., 1991). Because athletes
are in the public eye, they could experience
less privacy, which could then make them
more vulnerable to fears of mental ill stigma
(Corrigan, 2004).
Predictions were partially supported.
738 Journal of College Student Development
Research in Brief
738 Journal of College Student Development
Research in Brief
College athletes’ personal stigma was cor-
re lated with higher PPS, and athletes
reported greater PPS than personal stigma.
ese ndings suggest that athletes may be
internalizing prejudices (personal stigma)
about mental illness.
e current study extended ndings by
Eisenberg etal. (2009), who found high levels
of PPS among college students. However,
we caution that we used a modied (albeit
recommended) version of the measure. In
the current study we modified “public”
to reference participants’ peer group, i.e.,
fellow athletes. is modication was based
on Eisenberg etal.’s recommendations for
future study. ey noted that the term “most
people” was ambiguous and recommended
that future research specify the reference
group. Thus, when we compared the data
and found that the athletes’ mean level of
PPS was signicantly less than the Eisenberg
etal. sample, this could be an artifact of how
the reference group was operationalized. It is
important to note that the current sample had
signicantly higher personal stigma than did
the Eisenberg etal. sample.
Limitations of the study include the self-
report nature of the measures and potential
social desirability bias. We also note that
dierences between athlete and nonathlete
means may be an artifact of the data collection
method. Almost all of the athletes completed
the measures in a paper and pencil format and
in a room with other participants. In contrast,
nonathletes completed measures online.
Additionally, the study adapted the modied
terminology used by Eisenberg and colleagues
(2009) in describing mental illness patients.
e wording of the PDD measure former
mental patient” was changed to “a person who
has received mental health treatment.” e less
stigmatized language could have inuenced
participants’ responses.
As pointed out by an anonymous reviewer,
another potential limitation is that we directed
athletes to reference their own peer group
(i.e., fellow student athletes), not the entire
student body. The athlete population is a
small subgroup of the student body and, as
such, athletes may naturally see themselves
as more similar to one another in contrast
to nonathletes who compared themselves
a larger group (i.e., entire student body).
Consequently, the dierences in PDD wording
may have been a factor in the differences
between the personal and PPS for athletes as
opposed to the nonathlete group. As such,
future research could explore whether these
ndings replicate when athletes are asked to
reference the entire student body.
The current study findings were dis-
seminated on the campus where we collected
the data and have had a positive impact. We
presented ndings in an annual report to the
athletic director and head coaches, and they
expressed a desire to address the problem. We
developed a collaborative relationship between
athletics and the campus counseling center
and arranged a position in which a clinical
psychologist is holding walk-in consulting
and referral service hours in the athletics
building. We also developed psychoeducation
workshops for athletes, tailored to their
interests and needs. ese workshops helped
improve athletes’ attitudes toward psychology
as evidenced by enthusiastic evaluations
following the workshops (Kaier, Cromer,
Strunk, & Davis, 2013).
e current study is important for under-
standing the nature and extent of mental illness
stigma among NCAA athletes. Future research
should investigate what levels of mental
illness stigma are great enough to inuence
an individual’s decision not to seek treatment.
It also would be helpful to understand what
aspects of athletic culture may be prohibitive
for individuals seeking treatment. Implications
of the current study suggest that athletes and
October 2015 vol 56 no 7 739
Research in Brief
October 2015 vol 56 no 7 739
Research in Brief
college students in general could benet from
education that reduces both the stigma of
mental illness and prejudices towards those
who are seeking treatment.
Correspondence concerning this article should be addressed
to Lisa DeMarni Cromer, Psychology Department, e
University of Tulsa, 800 S. Tucker Drive, Tulsa, OK
74104–9700; lisa-cromer@utulsa.edu
A!E!A!D0!7
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... Similar relationships between these variables (i.e., stigma and attitudes toward counseling) have been identified in samples of SAs (Bird et al., 2018;Hilliard et al., 2019). Since stigma accounts for approximately 66% of the variance in attitudes toward help-seeking among SAs experiencing a mental health issue (Wahto et al., 2016), interventions designed to reduce stigma toward people with mental illness are needed (Kaier et al., 2015). Researchers have recently begun to implement and quantitatively evaluate the effectiveness of programs aimed toward this goal (e.g., Chow et al., 2020;Kern et al., 2017). ...
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Evidence-based stigma reduction interventions for student-athletes exist, but researchers have focused on assessing their effectiveness with little attention paid to understanding how participants experience such programs. The current study aimed to qualitatively evaluate a mental illness destigmatization intervention delivered to 35 National Collegiate Athletic Association Division I student-athletes. The program consisted of four weekly 1 hr empirically based sessions. Program-level results showed that participants increased their understanding of student-athlete mental health and identified actionable ways to combat stigma. Session-level results revealed intervention components impacted knowledge and application consistent with their theoretical underpinnings (i.e., mental health literacy). Practical guidelines based on the findings suggest stigma reduction interventions aimed at student-athletes should provide information specific to the athletic context (i.e., common symptoms experienced by athletes), consider content that moves beyond mental health literacy (e.g., contact-based interventions), and present opportunities for participants to apply what they have learned (i.e., roll play displaying empathy).
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Purpose This study aims to examine the relationship between teacher ideals and attitudes toward peers with autism spectrum disorder (ASD) among teacher college students, and the effect of knowledge of ASD identification on this relationship. Design/methodology/approach This study used a quantitative approach and included 341 teacher college students. A vignette was used to assess social and professional attitudes toward peers with ASD. The participants were divided into identification and nonidentification groups based on how accurately they identified the peer depicted in the vignette as having ASD. A teacher ideals questionnaire consisting of two subscales indicating different ideal teachers − a dedicated/engaging teacher (e.g. a teacher who can work with enthusiasm) and a skillful teacher (e.g. a teacher who is knowledgeable) − was developed and administered to evaluate the participants’ teacher ideals and self-perceptions of a teacher. Findings In the nonidentification group, ideals of a skillful teacher were significantly correlated with social attitudes toward peers with ASD. The identification group exhibited no significant correlations between ideals and social attitudes. Furthermore, the self-perceptions of being a dedicated/engaging teacher was significantly correlated with professional attitudes toward peers with ASD in the identification group. Originality/value To the best of the authors’ knowledge, this study is the first to examine the relationship between teacher ideals and attitudes toward peers with ASD. Teacher ideals were related to negative social attitudes toward peers with ASD. While knowledge of ASD identification weakens this relationship, it may drive the relationship between self-perceptions of a teacher and professional attitudes toward peers with ASD. Therefore, ASD education is important for reducing the stigma toward ASD in teacher education.
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Prevalence studies on depressive symptoms in collegiate athletes have yielded varied estimations, which may be due, in part, to survey administration privacy. However, the influence of survey administration privacy (i.e., anonymous and confidential) on depressive symptom disclosure remains unknown in sport. The purposes of the current study, therefore, were twofold: (a) compare depressive symptoms reported under high- and low-privacy conditions and (b) examine factors associated with underreporting (i.e., social desirability). College athletes ( N = 123) were randomly assigned to high- and low-privacy conditions. Results indicated no significant difference, F (1, 120) = 0.59, p = .446, between the prevalence of depressive symptoms reported across conditions when controlling for sex, and no significant correlation between depressive symptoms and social desirability ( r = −.01, p = .886). Taken together, results indicated that survey administration privacy did not impact depressive symptom disclosure in the current sample.
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Mental illness stigma has been identified by national policy makers as an important barrier to help seeking for mental health. Using a random sample of 5,555 students from a diverse set of 13 universities, we conducted one of the first empirical studies of the association of help-seeking behavior with both perceived public stigma and people's own stigmatizing attitudes (personal stigma). There were three main findings: (a) Perceived public stigma was considerably higher than personal stigma; (b) personal stigma was higher among students with any of the following characteristics: male, younger, Asian, international, more religious, or from a poor family; and (c) personal stigma was significantly and negatively associated with measures of help seeking (perceived need and use of psychotropic medication, therapy, and nonclinical sources of support), whereas perceived stigma was not significantly associated with help seeking. These findings can help inform efforts to reduce the role of stigma as a barrier to help seeking.
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Many people who would benefit from mental health services opt not to pursue them or fail to fully participate once they have begun. One of the reasons for this disconnect is stigma; namely, to avoid the label of mental illness and the harm it brings, people decide not to seek or fully participate in care. Stigma yields 2 kinds of harm that may impede treatment participation: It diminishes self-esteem and robs people of social opportunities. Given the existing literature in this area, recommendations are reviewed for ongoing research that will more comprehensively expand understanding of the stigma-care seeking link. Implications for the development of antistigma programs that might promote care seeking and participation are also reviewed.
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This article will highlight some of the special challenges that confront the 1990s inter collegiate student-athlete. Ways in which student-athletes respond differentially to these challenges, which are over and above those that non-student-athletes face, will also be highlighted. Finally, suggestions will be offered for how counseling psychologists can lend their expertise and talents in helping student-athletes to enrich their overall collegiate experience.
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Athletic participation adds additional challenges above and beyond the normal developmental challenges faced by college students. Despite these added demands, student-athletes traditionally do not utilize counseling and support services. Previous researchers have hypothesized reasons why student-athletes might be resistant to treatment. This study examines the results of a survey of 267 undergraduates comprised of student-athletes and non-athletes in which their attitudes toward seeking counseling services were addressed. Results partially support previous findings, suggesting that the perceptions of counseling services held by student-athletes might be changing. Time management continues to be a factor in not seeking counseling help for many student-athletes while perceptions of others and social stigma appear to be less important factors for student-athletes than they may have been in the past. Possible explanations for the findings and implications for counseling and support personnel on college and university campuses are provided. (PsycINFO Database Record (c) 2012 APA, all rights reserved)