Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2026 Jul 21.
Published before final editing as: Stigma Health. 2025 Jul 21:10.1037/sah0000658. doi: 10.1037/sah0000658

Stigma Affects How Parents Respond to their Children’s Mental Health, But Does Child Gender Complicate the Story?

Alice P Villatoro a, Melissa J DuPont-Reyes b, Jo C Phelan c, Bruce G Link d
PMCID: PMC12453056  NIHMSID: NIHMS2091052  PMID: 40989504

Abstract

Parents are influential gatekeepers to mental health services for children struggling with mental health issues, and their stigmatizing attitudes and behaviors towards mental illness may hinder help-seeking. Parents’ gendered expectations throughout the help-seeking process may influence whether they pursue formal or informal support for their children. We advance stigma research by examining how stigma affects a parent’s decision to seek formal and informal mental health support for their child depending on the child’s gender. Using longitudinal data from a school-based anti-stigma intervention study among sixth-grade students, we analyzed the subsample of children who reported high mental health symptoms (n=217). Regression models assessed the role of parental stigmatizing attitudes and behaviors and child gender on parental formal and informal help-seeking, including the child’s use of psychiatric medications. To examine gendered patterns to stigma and help-seeking, we tested interactions between parental stigmatizing attitudes and the child’s self-reported gender on help-seeking behaviors. Mental health labeling and literacy were associated with proactive parental help-seeking behaviors, while discriminatory stigma dimensions like social distance decreased help-seeking. These stigma effects varied by child gender, particularly when it came to formal avenues of care: Labeling enhanced parental help-seeking for girls in formal settings, while social distance deterred medication use among girls. The results of the study suggest that effective interventions targeting mental illness and help-seeking must actively incorporate parental perspectives, address gender biases in mental health, and consider the nuanced ways in which gender may complicate stigma processes when it comes to help-seeking decisions.

Keywords: stigma, gender, help-seeking behaviors, parents, children

Psychiatric epidemiology studies have long documented gendered patterns of mental illness in children and adolescents (hereafter children; Costello et al., 2003; Merikangas et al., 2022). Yet, evidence on gendered differences in mental health services use in these populations is mixed. Some studies suggest girls1 use more services than boys (Haavik et al., 2017) due to gender stereotypes around help-seeking (Courtenay, 2000; Pattyn et al., 2015), while others show boys more frequently using psychotherapy and psychotropic medications than girls (Olfson et al., 2014; Olfson et al., 2015). This latter pattern may be due to perceptions of their symptoms being more severe or problematic than girls, particularly in school settings (Green et al., 1996). In adulthood, gendered patterns in help-seeking are more consistent, with women engaging in services at higher rates than men (Olfson et al., 2014; Pattyn et al., 2015), which are often attributed to masculine norms that motivate unhealthy behaviors (Courtenay, 2000). Across developmental stages, gender likely influences how mental health is recognized and addressed. This study takes a closer look into how gender may affect the ways parents respond to their children’s mental health when stigmatization processes occur.

The roots of gender disparities in mental health help-seeking may emerge early in life as parents and guardians (hereafter parents) are influential gatekeepers on the frontlines of children’s mental health. Children vary in their ability to make autonomous healthcare decisions and rely on the help of proximal gatekeepers to access specialty mental health services (Cauce et al., 2002; Villatoro et al., 2018). Yet, parents possess their own knowledge, attitudes, and biases towards mental illness and their treatment that may encourage or deter help-seeking. Child gender may further complicate these actions. This raises key questions: How do parents contribute to gender differences in childhood mental health help-seeking? And what role does stigma play?

Gender Influencing Mental Health Help-Seeking

Gender is a complex construct. Gender represents the manner in which societal structures and cultural representations formulate gender identity, through the way individuals portray their appearance, demeanor, and behaviors to the consolidation of these patterns in society (Butler, 1988). Gender also reflects how societies perceive, receive, and treat individuals with specific gender identities (Goffman, 1976). For example, gendered expectations and norms concerning what it means to be a woman are qualitatively different from those related to a man. Gender constructions are not static (Butler, 1988). Actions, behaviors, and roles ascribed to women in the early 20th century are not necessarily the same in contemporary times. While some gendered expectations remain static (e.g., women are to be mothers), women have gained more economic, social, and cultural capital over time and have become active participants in higher education and the formal workforce, which was not necessarily the norm in the early 1900s. Some of this progress, however, has been challenged more recently with the rollback of reproductive rights in the United States (Gostin & Reingold, 2022). Moreover, our understanding of gender has also evolved to extend beyond binary categories. There has been recognition of more-inclusive gender identities such as transgender, nonbinary, and three-spirit persons; yet, this nuanced understanding of gender has not come without backlash (e.g., current executive orders in the US mandate that federal agencies recognize only biological sex at birth; The White House, 2025). Gender expressions become ritualized, and as such, the meanings behind their expressions are interpreted by society which in turn influence how individuals react to people with different gender identities (Goffman, 1976). In the case of parents, the gender expressions of their children can very well shape how they respond to their children’s mental health needs.

People of all genders experience mental illness, yet these outcomes and help-seeking practices are gendered (Addis & Mahalik, 2003; Pattyn et al., 2015). First, internalizing problems such as depression or anxiety are more common among girls compared to externalizing problems like conduct disorder or attention deficit hyperactive disorder (ADHD) which are more prevalent among boys (Costello et al., 2003; Merikangas et al., 2022). Gendered patterns in mental health outcomes may influence how parents label mental illness in their children, an important predictor to help-seeking (Villatoro et al., 2018). For instance, externalizing problems in boys may reflect expressions of male social deviance (e.g., disruptive classroom behavior), difficulty concentrating, and expressing frustrations towards authority, which tends to be interpreted as “boys will be boys.” In this context, symptoms may be perceived as typical for boys. In contrast, reactions to these same symptoms in girls may be interpreted as deviancy in need of “fixing.” The threshold of parents perceiving and responding to mental health problems in their children may be lower for girls than boys. In such cases, girls can be found to use mental health services more often than boys (Haavik et al., 2017; Velasco et al., 2020).

Second, help-seeking in childhood may, in part, be influenced by gender socialization and expectations around help-seeking more generally. The low help-seeking observed among some boys may result from masculine gender-role socialization—the learned values, norms, attitudes, and behaviors about what it means to be male vs female (Addis & Mahalik, 2003). Parents may reinforce these expectations or “do gender” by modeling and reproducing social transactions that emphasize conventional values and norms about femininity and masculinity (Courtenay, 2000; West & Zimmerman, 1987). Thus, society may perceive help-seeking as acceptable for girls as they are traditionally perceived as the “weaker” and “nurturing” gender, but males, often believed as the “strong” gender, may be expected to “toughen up” and face problems on their own (Pattyn et al., 2015).

Third, level of mental health impairment may influence gendered patterns in help-seeking. Epidemiological evidence suggests that boys with mental health problems have more prevalent severe mental impairment than girls (Olfson et al., 2015), thereby increasing their need for mental health services. Although the threshold for problematic mental health symptoms may be perceived to be lower for female than male children, once symptoms are labeled as a mental illness, parents may be more responsive to the mental health of young males than females if these symptoms are believed to be, and in actuality are, serious or interfere with daily functioning.

Stigma May Complicate Gendered Help-Seeking

Still, exhibiting a symptomatic need for mental health services does not definitively determine help-seeking. Mental illness stigma may act as a barrier to parents seeking help for their children (Clement et al., 2015; Dempster et al., 2015; Gonzalez et al., 2011; Mojtabai et al., 2016; Velasco et al., 2020). Stigma is a multi-component construct that can influence help-seeking decisions and behaviors in distinct ways. The propensity to label symptoms as part of an underlying mental health condition can promote help-seeking; however, labeling can also unlock opportunities for stigmatization, including stereotyping, discrimination, and status loss (Link & Phelan, 2013). Mental illness stereotypes are closely related to mental health literacy as it influences cognitive knowledge structures about when, where, and how individuals seek help for mental health problems (Link et al., 2004). Thus, the more knowledge and positive attitudes towards mental health someone possesses, the less likely they are to believe negative stereotypes about mental illnesses, the more willing they are to seek help, and the more likely they are to engage services (Mojtabai et al., 2016; Wong et al., 2018). Nevertheless, negative attitudes may disrupt help-seeking by increasing exposure to stigmatizing experiences like discrimination. As such, the act of not seeking help may be a protective strategy for avoiding stigma (Thoits, 2011, 2016). It is conceivable to expect parents to react similarly to stigma when making help-seeking decisions for their children. For example, labeling a child with a mental illness or engaging them in formal services may stigmatize parents because society may blame them for their child’s mental health struggles (Hinshaw, 2005). Thus, stigma experienced by children would not only impact them, but stigma’s negative consequences may also extend to immediate family members by mere association with the child (Corrigan & Miller, 2004).

Despite advances in our understanding of stigma, only two percent of stigma research has explored adult perspectives of stigma towards children (Angermeyer & Schomerus, 2017). The limited research suggests that stigmatizing attitudes toward mental illness in children may be pervasive among adults, especially considering the influence of familial transmission in help-seeking (DuPont-Reyes et al., 2024). Nearly one in five adults report desiring their families or children to be socially distant towards other children who demonstrate symptoms aligned with major depression or attention deficit hyperactivity disorder; these attitudes are more likely to occur among male versus female adults (Martin et al., 2007). However, it is unclear how stigma may impact gendered patterns of childhood help-seeking behaviors, especially when parents are involved as gatekeepers to services.

Purpose of Study

Gender may shape how mental illness is perceived and how responses to childhood mental health issues are formulated. However, the intersection of gender and stigma remains largely unexplored, particularly in the context of parents’ pivotal role as gatekeepers to help-seeking for their children. This study addresses this gap by examining how these dynamics influence parental decisions in help-seeking among children with mental health problems. Our investigation examines how stigma influences a parent’s decision to seek mental health support among children currently experiencing mental distress. Specifically, it investigates how the gender of their child modifies the relation between stigma and help-seeking, an innovation to stigma research. The following hypotheses were tested:

Hypothesis 1:

Overall, parents will be more likely to engage in help-seeking behaviors for girls with mental health problems compared to boys.

Hypothesis 2:

Stigma dimensions will affect parental help-seeking for their children in distinct ways. (a) Labeling mental illness in children and mental health knowledge/positive attitudes will increase parental help-seeking for children experiencing mental health issues. (b) In contrast, negative attitudes towards mental illness will deter parents from seeking help for their children struggling with mental health concerns.

Hypothesis 3:

The role of labeling, knowledge/positive attitudes, and negative attitudes towards mental illness in affecting parental help-seeking will vary by the child’s gender.

Methods

Data

Longitudinal data were gleaned from a school-based anti-stigma intervention among sixth-grade students (Link et al., 2020; Painter et al., 2017). All students and their parents from socioeconomically and racially/ethnically diverse schools (14 schools) from an urban/suburban school district in Texas were invited to participate (60% response rate). The children sampled were similar to the 2011 Texas public school population in terms of race/ethnicity (Texas Education Agency, 2011): Latino/Hispanic (44% sampled; 50% Texas-wide), non-Latino Black/African American (22% sampled; 13% Texas-wide), and non-Latino white/White (23% sampled; 32% Texas-wide).

Schools were randomized to receive none, one, or a combination of three interventions: (1) an anti-stigma teacher-led curriculum; (2) contact with two young adults who described their experiences with bipolar disorder; and/or (3) supplemental materials with anti-stigma messaging. The study included an in-class pre/post-test evaluation (2011–2012) and longitudinal in-home follow-up assessments every six months. These occurred at six-, 12-, 18-, and 24-months post-intervention (2012–2015). Parents/guardians (hereafter parents) were not exposed to the interventions and were only invited to participate in longitudinal in-home assessments (n=484). Informed consent and assent of the parents and their child were obtained after procedures were explained. The study was approved by the IRBs of Columbia University and My Health, My Resources (MHMR) of Tarrant County.

Sample

The current study uses panel data of the parent sample (n=432); analyses were restricted to parents with children reporting high mental health symptoms (n=243) because they likely had a need for mental health services. Table 1 provides a descriptive summary of the study sample. Parents were in their late 30s (M=38.62, SD=6.54), identified as female (85%), and a biological parent (93.1%, not shown in Table 1). Few fathers were in the study because parents who were the primary caregiver were invited to participate. Three-quarters of parents identified as belonging to a racial/ethnic minority group. Nearly three-in-five reported household incomes under $40,000. In 2011, the national household income median was $50,502, comparable to the Texas household median of $49,392 (Noss, 2012). While the majority of parents were employed, one-fifth were not actively in the workforce. About one-quarter had a high school education and nearly 60% had at least some college education or more.

Table 1.

Demographic characteristics of the total longitudinal sample of parents and children and subsample of children with high mental health symptoms; Texas Stigma Study (2011–2015).

Total Sample (n = 380) High-Symptom Subsample (n = 217)
M (SD) or % (n) M (SD) or % (n)
Family Characteristics
Parent Age 38.62 (6.54) 38.56 (6.87)
Parent Gender (n = 372)*
 Female 84.96% (322) 82.95% (180)
 Male 15.04% (57) 17.05% (37)
Parent Race/Ethnicity
 Non-Minority 28.68% (109) 31.34% (68)
 Minority 71.32% (271) 68.66% (149)
Parent Educational Attainment
 Less than high school 15.53% (59) 14.29% (31)
 High School diploma or equivalent 25.26% (96) 22.58% (49)
 Some college 37.37% (142) 41.94% (91)
 Bachelor’s or Graduate Degree 21.84% (83) 21.20% (46)
Household Income
 Under $40k 59.47% (226) 58.53% (127)
 $40k or more 40.53% (154) 41.47% (90)
Parent Employment Status
 Employed 73.68% (280) 77.88% (169)
 Unemployed 5.26% (20) 5.07% (11)
 Not in the labor force 21.05% (80) 17.05% (37)
Family History of Mental Illness 53.42% (203) 60.83% (132)
Family Cohesion (Range: 1–5) 4.00 (0.63) 3.98 (0.65)
Child Self-Reported Gender
 Female 55.79%. (212) 57.14% (124)
 Male 44.21% (168) 42.86% (93)
Child Self-Reported MH Symptoms
 Bottom-Tertile 8.68% (33) ---
 Middle-Tertile 34.21% (130) ---
 High-Tertile 57.11% (217) ---
Parental Stigma Dimensions
 Labeled MH Problem in Child 40.79% (155) 44.70% (97)
 MH Literacy (Range: 1–5) 3.80 (0.37) 3.85 (0.35)
 Positive MH Actions (Range: 0–9) 2.99 (2.09) 3.19 (2.12)
 Social Distance (Range: 1–4) 1.90 (0.64) 1.82 (0.59)
 Any Avoidance 63.16% (240) 62.67% (136)
Parental Help-Seeking
 Formal MH Services (n = 377)* 34.48% (130) 40.28% (87)
 Child Took Medications (n = 377)* 19.36% (73) 23.61% (51)
 Informal Help-Seeking 39.47% (150) 43.78% (95)
Open in a new tab
*

Sample size is slightly smaller due to missing data on the respective variable.

NOTE: MH = mental health

Measures

Parental Help-Seeking.

Starting at the 6-month follow-up assessment and continuing every follow-up assessment thereafter, parents reported whether they personally sought formal (i.e., saw a doctor or therapist) or informal (i.e., talked to their partner, friend, or clergy) help to discuss their child’s mental health. Separate formal and informal use variables were created to specify engagement in help-seeking for their child (0=No, 1=Yes). At each follow-up assessment, parents also reported whether their child was taking psychiatric medications (0=No, 1=Yes). Medication use was excluded from the formal help-seeking variable because it required the child’s participation, while the formal help-seeking variable focused solely on parental involvement, which may or may not involve the child.

Parental Stigma.

Multiple stigma dimensions were measured at each assessment. Labeling mental health problems in children was measured by a single item: “Was there a time in the past six months, when your child seemed to have an emotional or behavioral problem like being anxious, depressed, hyperactive, withdrawn, or always getting into trouble?” (0=No, 1=Yes). This item was developed for the study to assess global subjective mental health status, as this perception signals need and action for mental health help-seeking.

Two measures assessed negative aspects of stigma. Social distance, validated by and adapted from Wahl et al. (2011), assessed the parent’s willingness for their child to interact with individuals with a mental illness in six situations (e.g., have as a friend.; 1=Definitely yes to 4=Definitely no). Mean scores were computed (alpha=0.95). Higher scores suggest greater social distance. Additionally, parents completed a six-item scale assessing whether they personally avoided persons with mental health problems in the last six-months (0=No, 1=Yes). A sum score was created that counted the number of items that were endorsed; higher scores indicated greater avoidance (alpha=0.65).

Finally, positive attitudes towards mental illness were measured. A 24-item instrument assessed mental health knowledge and positive attitudes towards persons with a mental illness, validated by and adapted from Wahl et al. (2012). Knowledge was assessed by factual statements (“A mental illness is caused by something genetic or hereditary”); attitudes were assessed by opinion statements (“A person with a mental illness is able to be a good friend”). Parents indicated the degree to which they agreed with each statement (1=Strongly disagree to 5=Strongly agree). Items where correct knowledge/positive attitudes reflected disagreement were reverse coded. Exploratory factor analyses were conducted to examine the measure’s psychometric properties in this sample. Results showed that the data best fit a one-factor scale; an overall mean score was calculated (alpha=0.81) where higher scores represented greater knowledge/positive attitudes. Lastly, validated and adapted from the Actions Relating to Mental Illness instrument (Painter et al., 2017; Wahl et al., 2011), parents were asked nine items about positive mental health actions they may have engaged in to help someone in need of mental health support (e.g., “I encouraged a friend or relative to speak to a mental health counselor or therapist;” 0=No, 1=Yes). All items were summed with higher scores indicative of more positive mental health actions (alpha=0.80).

Child Gender.

During the pre-test assessment, child participants were asked to self-identify their gender. While three gender categories were presented of ‘male’, ‘female’, and ‘other: fill-in-the-blank;’ all participants identified as male or female (reference group).

Mental Health of Children.

Mental health symptoms were assessed via parents and children using a 22-item symptoms screen (0=No, 1=Yes). A credentialed mental health social worker created the screener using gate questions from the Major Depressive Episode, Anxiety Disorders, Attention-Deficit/Hyperactivity Disorder, and Whole Life modules from the Diagnostic Interview Schedule for Children, Version IV, a validated structured interview for assessing childhood mental disorders (DISC-IV; Shaffer et al., 2000). The screen was developed for administration within the time constraints of the survey. Parent items were adapted from the child survey, but only the children’s self-reported symptoms (alpha=0.92) were used in this study. This approach was selected because children’s self-reports may provide a more sensitive measure of mental health (Van Roy et al., 2010), thereby permitting us to estimate how parents might respond (or not) to their children’s mental health needs. Child symptom self-reports were completed during the pre-test, post-test, 18-, and 24-month assessments; 6- and 12-month follow-up assessments excluded the checklist due to survey time constraints. Previously conducted exploratory factor analyses of the symptoms checklist (Link et al., 2020; Villatoro et al., 2022), revealed a unidimensional structure, supporting the use of global symptom scale. For each assessment period, summed scores were calculated and transformed into tertile symptoms categories assessing level of mental health symptoms (0=Low, 1=Moderate, 2=High). On average, those in the high-symptom subsample endorsed over nine and three times as many symptoms (M=9.72, SD=5.98) as those in the bottom- (M=0.50, SD=0.70) and middle-tertiles (M=3.12, SD=2.58), respectively. The screening tool cut-offs used in the study demonstrated good construct validity as the experiences of the high-symptom group (i.e., top-tertile) have been shown to strongly coincide with those of people with mental illness (e.g., high help-seeking behaviors, violence victimization; DuPont‐Reyes et al., 2021; Link et al., 2020; Villatoro et al., 2022).

Control Variables.

The analyses controlled for several family, parent, and child characteristics collected at pre-test. An indicator variable captured family history of mental illness—a family member ever had or showed signs of depression, anxiety, substance use problems, or other mental health problems (0=No, 1=Yes). Parent characteristics included: race/ethnicity (non-minority—referent vs. minority) and household income (0=Under $40K—referent, 1=$40K or more). Characteristics of the children included family cohesion and intervention assignment. Family cohesion was measured using a 10-item instrument (Olson, 1986) that assessed the extent of the family’s communication about problems/troubles, reliance for support/help, etc. (1=Not very often to 4=Always; alpha=0.88). Although parents were not exposed to the interventions, analyses control for their child’s assigned intervention group (None—referent, Materials; Contact; and Curriculum) to adjust for possible spillover effects on parental stigma.

Data Analysis

Analyses were restricted to the subsample of children who reported high mental health symptoms (n=248). The independent effects of stigma on parental formal and informal help-seeking as well as the child’s use of medications were examined using multivariable logistic regressions, resulting in three separate models (one per help-seeking outcome; see Models A1, A2, and A3 in Table 2). All analyses controlled for: child reports of mental health symptoms, the parent’s familiarity with and family history of mental illness, parent/family characteristics (race/ethnicity and household income), child characteristics (family cohesion), child intervention assignment, and time of the follow-up assessments (6-month follow-up reference group). Sensitivity analyses were conducted with adolescent age as a covariate, but it was not statistically associated with any of help-seeking outcomes and did alter any of the findings. For parsimony, presented models exclude age. To examine gendered patterns in stigma and help-seeking, we tested interactions between the stigma variables and child’s self-reported gender for all outcomes. Only statistically significant interactions are presented (see Models B1 and B2 in Table 2). Because the data included repeated observations of parents over time, we use generalized estimating equations to assess the role of stigma and mental health problem perceptions on parental help-seeking. The models also used robust standard errors to reflect the clustering of students within schools.

Table 2.

Logistic regression models examining the role of parental stigma attitudes and child gender on mental health help-seeking of parents with children with high mental health symptoms; Texas Stigma Study (2011–2015).

Formal Help-Seeking (n = 216) Child Took Medications (n = 216) Informal Help-Seeking (n = 217)
Model A1 Model B1 Model A2 Model B2 Model A3
OR [95% CI] OR [95% CI] OR [95% CI] OR [95% CI] OR [95% CI]
Stigma Dimensions
 Labeled MH Problem 3.47*** [2.28, 5.29] 4.86*** [2.80, 8.42] 3.12*** [1.99, 4.88] 3.03*** [1.97, 4.66] 3.16*** [2.09, 4.77]
 MH Literacy 2.36* [1.13, 4.95] 2.35* [1.12, 4.95] 0.82 [0.38, 1.77] 0.78 [0.37, 1.63] 1.90 [0.93, 3.90]
 Positive MH Actions 1.29*** [1.18, 1.41] 1.28*** [1.17, 1.39] 1.07 [0.98, 1.17] 1.07 [0.98, 1.17] 1.23*** [1.13, 1.34]
 Social Distance 1.04 [0.68, 1.58] 1.01 [0.66, 1.55] 0.52** [0.33, 0.83] 0.35*** [0.20, 0.62] 0.83 [0.55, 1.26]
 Any Avoidance 1.09 [0.73, 1.61] 1.08 [0.72, 1.60] 0.79 [0.53, 1.18] 0.77 [0.52, 1.13] 1.49* [1.01, 2.19]
Child Self-Reported Gender
 Female 1.00 1.00
 Male 0.64 [0.36, 1.11] 0.92 [0.47, 1.80] 0.87 [0.45, 1.70] 0.19* [0.05, 0.76] 0.94 [0.56, 1.58]
Family History of MI 1.33 [0.70, 2.52] 1.36 [0.72, 2.59] 0.96 [0.44, 2.10] 1.00 [0.45, 2.20] 1.11 [0.61, 2.01]
Parent Race/Ethnicity
 Non-Minority 1.00 1.00
 Minority 0.81 [0.43, 1.52] 0.81 [0.43, 1.52] 0.60 [0.29, 1.26] 0.59 [0.28, 1.26] 0.51* [0.28, 0.91]
Family Cohesion 0.79 [0.52, 1.19] 0.78 [0.52, 1.18] 0.73 [0.45, 1.19] 0.76 [0.46, 1.25] 0.79 [0.53, 1.17]
Household Income
 Under $40k 1.00 1.00
 $40k or more 1.00 [0.55, 1.82] 0.97 [0.53, 1.78] 1.14 [0.55, 2.35] 1.19 [0.57, 2.49] 0.92 [0.52, 1.62]
Intervention Assignment
 No Intervention 1.00 1.00
 Curriculum 0.79 [0.43, 1.47] 0.80 [0.43, 1.49] 0.96 [0.46, 2.01] 1.03 [0.48, 2.20] 1.00 [0.56, 1.78]
 Contact 1.67 [0.95, 2.92] 1.68 [0.96, 2.95] 1.47 [0.75, 2.90] 1.57 [0.79, 3.13] 1.47 [0.87, 2.50]
 Materials 0.60 [0.32, 1.09] 0.58 [0.32, 1.07] 0.60 [0.28, 1.28] 0.65 [0.30, 1.38] 0.73 [0.41, 1.29]
Follow-Up Assessment
 6-Month Follow-Up 1.00 1.00
 12-Month Follow-Up 1.50 [1.00, 2.26] 1.47 [0.97, 2.22] 1.34 [0.89, 2.01] 1.34 [0.91, 1.96] 1.42 [0.94, 2.14]
 18-Month Follow-Up 1.03 [0.67, 1.60] 0.98 [0.63, 1.53] 1.15 [0.75, 1.77] 1.14 [0.76, 1.71] 1.08 [0.70, 1.68]
 24-Month Follow-Up 1.29 [0.83, 2.01] 1.23 [0.79, 1.94] 1.20 [0.78, 1.86] 1.23 [0.81, 1.85] 1.30 [0.84, 2.04]
Interactions with Child Gender
 Labeled Problem --- --- 0.44* [0.19, 0.99] --- --- --- --- --- ---
 Social Distance --- --- --- --- --- --- 2.72* [1.26, 5.87] --- ---
Open in a new tab

NOTE: MH = mental health; MI = mental illness

*

p < 0.05

**

p < 0.01

***

p < 0.001

Approximately 13% of the high-symptom subsample are missing on one or more of the covariates and outcomes. Most of the missing data comes from variables collected at pre-test: household income, family history of mental illness, and family cohesion (reported by child participants). There was little missing on the follow-up assessment variables. Examination of the missing data revealed evidence consistent with observations being missing at random given that few characteristics (e.g., symptoms, mental illness exposure) were associated with missingness. Longitudinal data from the pre-, post-, 6-, 12-, 18-, and 24-month assessments were used to impute missing values on the parent and child variables previously mentioned. Using STATA SE 17’s multiple imputation chained procedures (StataCorp, 2017), 15 data sets were imputed and combined according to Rubin’s rules (Rubin, 1987). Complete and imputed case analyses resulted in similar patterns of results. For parsimony, complete case analyses are presented.

Results

Gender Differences in Help-Seeking

Overall, most parents with children experiencing high mental health symptoms did not engage in help-seeking on behalf of their children. Only two in five parents sought formal mental health care or informal support (see Table 1); one in four indicated their child was taking medications for a mental health problem. Table 2 presents results from the logistic regression models. Controlling for stigma and the model covariates, there were no differences between boys and girls in their parents’ use of formal and informal help-seeking to support their child’s mental health (see Models A1-A3 in Table 2). No child gender differences were observed in the parents’ report of their children using psychiatric medications.

Stigma’s Influence on Parental Help-Seeking Behaviors

The role of labeling, mental health knowledge and positive attitudes, and negative mental health attitudes (i.e., social distance and avoidance) on parental help-seeking were assessed. On average, parents did not label their children’s symptoms as a mental health problem (55.3%; Table 1). Despite holding moderate levels of mental health knowledge (M=3.85, SD=0.35), parents demonstrated low levels of positive attitudes towards mental health actions (M=1.82, SD=0.59). Additionally, parents reported moderate desirability for their children to socially distance themselves from other children with mental health issues (M=1.82, SD=0.59) and nearly two-thirds of parents purposely avoided people with mental illness.

Labeling and positive attitudes towards mental health actions were associated with increased odds of help-seeking for parents. Specifically, parents who expressed high levels of mental health knowledge and held positive attitudes about mental health actions were 2.36 and 1.29 times more likely, respectively, to engage in formal help-seeking on behalf of their child (Model A1, Table 2); positive beliefs about help-seeking actions were also associated with informal help-seeking by parents (Model A3, Table 2). The most consistent predictor of parental help-seeking was labeling of a mental health problem in their child. Parents who labeled their child’s symptoms as indicative of an underlying mental health problem compared to those who did not were generally three times more likely to seek formal or informal help on behalf of their child and report their child taking psychiatric medications.

Negative attitudes were not associated with parental help-seeking, with few exceptions. Higher levels of social distancing attitudes were significantly related with increased odds of the child taking medications for a mental health problem (Model A2, Table 2). Finally, parents who purposely avoided people with a mental illness were more likely to participate in informal help-seeking for their children than parents who did not engage in avoidance. Social distance and avoidance were not related to parental formal help-seeking.

Child Gender Moderates Stigma’s Influence on Parental Help-Seeking

For two of the three outcomes, the impact of stigma on parental help-seeking varied by child gender (see Models B1-B2 in Table 2). Specifically, gender moderated the role of labeling (p<0.05) and social distance (p<0.05) on parental formal help-seeking and child medication use, respectively. Although parents are more likely to engage in formal help-seeking when they label their child’s symptoms as a mental health problem, parents are more responsive to this labeling among girls compared to boys (see Figure 1a). On average, parents who label girls’ symptoms as a mental health problem had a 47.6% predicted probability of engaging in formal help-seeking relative to only 23.0% predicted probability for boys with a labeled problem. Gendered stigma effects were also different for medications use (see Figure 1b). Parents with higher versus lower social distance desirability for their children were less likely to report medication use; however, this deterrence to medication use was only observed for girls (p<0.001). Social distance was not significant for boys (p=0.86).

Figure 1.

Figure 1.

Open in a new tab

Predicted probabilities of parental help-seeking for children with high mental health symptoms across child gender and stigma dimensions of labeling (a) and social distance (b); Texas Stigma Study (2011-2015).

Sensitivity analyses were performed to assess gender and stigma interactions for an outcome that combined parental formal help-seeking with child medication use (not shown). The gender interaction with labeling persisted, but the gender by social distance interaction was not statistically significant. These results suggest that gendered social distance effects may be more relevant to medication use among children specifically rather than overall formal help-seeking.

Discussion

As gatekeepers to mental health services, parents represent an entryway for children in seeking support for their mental health struggles. Effective help-seeking requires parents to label their children’s problems as a mental health issue, possess knowledge about mental illnesses, and hold positive attitudes towards treatment. The current study demonstrates how stigma dimensions affect parental engagement in mental health help-seeking for their children. However, these dimensions did not uniformly influence parental help-seeking across child gender, particularly when it came to formal avenues of care. As suggested by Butler (1988) and Goffman (1976), meanings of gender are socially constructed, and these meanings can influence how individuals are perceived and treated in society. Thus, in the context of help-seeking, it is not unusual to observe gendered expectations in what are acceptable forms of support. The results of the study suggest that effective interventions targeting mental illness and help-seeking in children must actively incorporate parental perspectives and consider the nuanced ways in which gender may complicate stigma processes when it comes to help-seeking decisions.

Child Gender Differences in Parental Help-Seeking

There were no gender differences in parental help-seeking for children with high mental health symptoms, not supporting Hypothesis 1. Although the pattern was in the expected direction (parents of boys had lower help-seeking than parents of girls), the difference was not statistically significant. This could be due to the modest sample size (n=217). Approximately 57% of girls self-reported high symptoms versus 43% of boys. Parents also were slightly more likely to label the symptoms of girls as a mental health problem (46%) compared to boys (43%). Additionally, few parents indicated that their child used psychiatric medications (23%). The absence of significant gender differences in help-seeking could also be due to the measurement of the outcomes as (with the exception of medication use) they reflected parental behaviors that may or may not involve the participation of their children. Parents may find it useful to speak to mental health professionals or seek informal support without their child’s engagement in the process as this may reflect initial information gathering and trust building before their children co-participate in more proactive forms of help-seeking.

Stigma and Help-Seeking among Parents

There was some support for Hypothesis 2. Parents who labeled their child’s symptoms had three times the odds of formal and informal help-seeking than those who did not. Likewise, parents with high versus low proactive help-seeking attitudes had 1.3 times the odds of both formal and informal help-seeking. These patterns are consistent with prior research in adults (Cheng et al., 2018; Corrigan et al., 2014), pointing towards the salience of labeling as a predictor of parental help-seeking in all settings. Practical mental health knowledge and holding positive attitudes towards help-seeking in general may support navigation of formal services for parents, especially when treatment for their children may involve use of medications. Furthermore, labeling a child’s symptoms provides opportunities to a variety of help-seeking options including informal support. Mental health literacy may facilitate parental labeling of mental health issues in children, but prior work has shown no relationship between the two (Villatoro et al., 2018). Except for labeling, knowledge/positives attitudes were not associated with informal help-seeking, likely because the risk of stigma is lower when accessing these types of services. Informal support may be perceived as more discreet and trustworthy as it involves reaching out to trusted individuals, such as a spouse/partner, clergy, or close friend, who may be less likely to stigmatize the child and/or parent (McKeague et al., 2022).

The role of stigma discrimination on help-seeking was less clear. Parents who desired their children to engage in greater socially distancing practices had half the odds of their child using psychiatric medications. In contrast, parents who avoided people with a mental illness had 1.5 times increased odds of informal help-seeking compared to those who did not report avoidance. Psychiatric medications may be more stigmatized among children than adults (Pescosolido et al., 2007), with social distance likely reflecting poor mental health literacy, which in turn would further contribute to help-seeking barriers. However, our results suggest that social distance remains a statistically significant barrier over and above mental health knowledge. Additionally, parents’ personal experiences with mental health systems for their own concerns may influence their decisions to seek or avoid help for their child, acting as a push or pull factor in the help-seeking process (Hinshaw, 2005). Alternatively, social distance may suggest a concern for courtesy stigma (dosReis et al., 2010; McKeague et al., 2022). If their children interact with peers with a mental illness, it may increase exposure to stigma for both the child and parent (Hinshaw, 2005; McKeague et al., 2022). Interestingly, stigma dimensions do not always act as a deterrent in the context of informal support. It may be more fruitful to engage in informal help-seeking as it may minimize risk of stigmatization towards the child and courtesy stigma towards the parent.

Gendered Stigma and its Influence on Help-Seeking

Support for Hypothesis 3 was mixed. There were clear gender differences in how stigma affected formal help-seeking among parents of children with high symptoms. First, the proactive influence of labeling on formal help-seeking significantly impacted both genders in the sample but more so for girls. Parents were more likely to label girls’ symptoms as a problem compared to boys, which mirror gendered patterns in mean symptom levels (girls: M=8.01, SD=6.12; boys: M=5.79, SD=4.56) and prevalence of high symptoms (57% girls; 41% boys). Parents in the sample may be more sensitive to identifying and responding to mental health symptoms in girls than boys, which contradicts prior research on adolescent use of mental health services (Olfson et al., 2015). We note, however, that parent formal help-seeking assessed in the study may be more aligned with information gathering, care navigation, and preliminary steps for seeking help for children. Except for medication use, parents were not asked about the child’s direct engagement with formal and informal help-seeking. Lastly, social distance only hindered medication use for girls, not boys. Social norms often regard specialty services as more appropriate and acceptable for female than male children (Courtenay, 2000; Pattyn et al., 2015), but the possible threat of discrimination for having a mental health problem may weaken this gender pattern. From these data, it is unclear whether the gendered stigma patterns in child medication use are associated with parents’ decisions to allow their children to take these medications, differences in prescribing practices by physicians, or a combination of both factors. Nevertheless, these findings allude to stigma having a stronger influence on parental help-seeking for girls compared to boys, furthering gender stereotypes that “boys can safeguard themselves” but “girls need protection.”

Gender expressions and performance may shape how society perceive and respond to specific gender identities (Butler, 1988; Goffman, 1976). Society may then impose norms and stereotypes that dictate acceptable help-seeking across genders, often expecting these behaviors more from females than males (Courtenay, 2000; Pattyn et al., 2015). In applying Link & Phelan’s (2013) conceptualization of stigma, we can further infer that stigma processes on help-seeking could be more influential for the gender that conforms to these stereotypes, as observed in the current study (albeit in limited ways). Prior research highlights how stigmatizing attitudes, beliefs, and experiences vary by gender (DuPont-Reyes et al., 2020). For instance, parents might be more attuned to labeling cues when their daughters display mental health symptoms because of the societal expectation that girls are more vulnerable and in need of mental health care.

Conclusion

The findings have important implications for theory and practice. First, anti-stigma interventions should target both labeling and mental health knowledge. Labeling is a critical gateway to initiating care, as recognizing a problem is often a prerequisite for seeking help. However, specific types of knowledge, particularly those related to understanding mental health etiology, treatment services, and care navigation may further support help-seeking behaviors. Future research is needed to clarify which forms of knowledge are most effective in driving parental engagement in mental health services. Second, stigma theory would be enriched by extending an intersectional lens of mental illness and gender among children to their parents. The intersection of gender and mental illness can produce unique experiences, some of which may intensify stigma consequences experienced by children and shape the attitudes and actions of parents. Third, there are, in some cases, gendered dimensions to stigma, particularly in how parents respond to child mental health according to gender. Thus, there is a need for stigma reduction strategies that not only improve labeling of mental health problems and general/practical mental health knowledge among parents but also address the gendered dimensions of stigma that may inhibit help-seeking. Yet, more research is required before we can get there. Finally, public health policies should consider integrating these insights into broader mental health promotion and education efforts, ensuring that interventions are inclusive and sensitive to the diverse experiences of children across gender. These anti-stigma strategies can also extend to clinicians and providers to address gender bias in treatment practices and engagement in children.

The current findings should be interpreted in light of measurement and analytic limitations. Although child participants were given the option to identify with various genders, gender identities in the sample were ultimately categorized as binary. However, gender identities and expressions are more complex in the real world, encompassing non-binary, transgender, gender fluid, etc.. The diversity in gender appears to hold greater prominence among younger generations than previous ones (Meerwijk & Sevelius, 2017). Moreover, gender non-conforming youth are at higher risk of poor mental health than their cis-gendered counterparts (Price-Feeney et al., 2020). We could expect stigma to negatively impact help-seeking processes for gender minority groups in similar ways as other stigmatized identities (Lucas & Phelan, 2012), but further research is warranted. Relatedly, the study assumed parents’ perceptions of their child’s gender aligned with the child’s self-reported gender; this assumption could not be examined further with the available data. While the children in the study were provided with other options for describing their gender, the sample may have been too young to comprehend or articulate their gender identity at the time (M=11.94, SD=0.66). Furthermore, gender was only measured during the baseline assessment, so it is conceivable that a child’s gender identity may have evolved as the study progressed. The study also prioritized child symptom self-reports over parent reports to identify adolescents with potential need for mental health services. These considerations suggest that our results may underestimate parents’ likelihood of seeking help given they observe their children’s reported symptoms. Thus, our analysis can be considered a conservative test of the stigma, gender, and help-seeking relationship.

Limitations in the analytical approaches may also affect interpretation of the findings. Structural equation modeling (SEM) approaches were not used to account for potential shared variance across the different help-seeking outcomes. There were conceptual and behavioral distinctions between the help-seeking outcomes (i.e., formal, informal, and medication use), particularly the different roles of parental and child involvement, that made this approach unsuitable for the current study. The help-seeking behaviors examined reflect different entry points and mechanisms for care engagement and are likely to be influenced by stigma in different ways, as illustrated in our results. We suggest future studies consider using SEM approaches to better capture the interrelationships among different help-seeking behaviors. Our study was a first step in exploring gendered stigma influences in parental help-seeking behaviors for adolescents. Future studies also should explore the temporal dynamics between stigma, symptom recognition, and help-seeking across child gender using causal modeling techniques. Finally, additional limitations included the modest sample size and the omission of unmeasured confounders in the analyses (e.g., insurance status and availability of mental health services) due to survey length constraints. However, the analysis did include proxy variables such as household income that correlate with access to mental health services.

Despite these limitations, the study has several strengths, including the use of panel data, which allowed for examination of changes over time, the use of robust measures that captured multiple stigma dimensions, and the inclusion of parental perspectives, which are crucial for understanding the role of gatekeepers in children’s mental health. More importantly, our understanding of gender was informed by theoretical perspectives that describe gender as a social construct, which guided our empirical approach and interpretation of the data. As scholars, we were cognizant of the power dynamics at play in this work and aimed to conduct this study with an awareness of our own gender, race, and socioeconomic positionalities.

Future research should investigate why these gender patterns exist, particularly for labeling and social distance. Larger samples are needed to assess diverse gender identities and how they intersect with stigma to shape parental and child help-seeking. We note, however, that this line of inquiry may be particularly challenging at this time given current policies on gender definitions in the US (The White House, 2025). Additionally, the role of parent gender requires further examination. Our sample of parents was mostly female, raising questions about the influence of fathers and other gender-minority parents, and whether parent gender matching the child’s gender impacts gender-stigma help-seeking. Addressing these questions will ensure that anti-stigma interventions and mental health services are inclusive and accessible.

In conclusion, this study contributes to the growing body of research on gender, stigma, and help-seeking by highlighting the nuanced ways in which gender and stigma processes influence parental mental health help-seeking decisions of children. We explored gender differences across several stigma dimensions (i.e., labeling, knowledge, and discrimination), finding that gender matters contingently. Labeling significantly amplified parental help-seeking for girls with high symptoms but not for boys. In contrast, social distance deterred parental help-seeking for girls but did not have the same effect for boys. This work addresses an important gap in the literature, as gender and stigma dynamics in help-seeking have not been previously explored. This work provides critical insights into the intersection of gender and stigma in shaping mental health help-seeking, offering a foundation for advancing both theory and practice.

Health Impact Statement.

The study provides new insights into how gender and mental illness stigma may influence parental decisions to seek mental health support for their children. By highlighting the intersection of stigma processes with gender, the study underscores the need for greater attention to gender among interventions that reduce stigma and promote parental mental health help-seeking for their children. Such efforts would help address possible gender-specific barriers to help-seeking and promote mental wellbeing.

Acknowledgments

The study was support by grant #R01MH095254 from the National Institute of Mental Health (NIMH) and by the Latino Research Institute at The University of Texas at Austin. The authors thank Mental Health Connection of Tarrant County, the project staff, and the youth and parents who participated in the study. As scholars, we recognize the influence of our own social locations on our research processes. Our understanding of gender in this manuscript was informed by theoretical perspectives that describe gender as a social construct, which guided our empirical approach and interpretation of the data. We were cognizant of the power dynamics at play in this work and aimed to conduct this study with an awareness of our own gender, race, and socioeconomic positionalities.

Footnotes

1

The terms “girl/woman” and “boy/man” are used to describe the cultural and structural construction of gender identity. In contrast, “female” and “male” are used to denote biological sex.

References

  1. Addis ME, & Mahalik JR (2003). Men, Masculinity, and the Contexts of Help Seeking. American Psychologist, 58(1), 5–14. [DOI] [PubMed] [Google Scholar]
  2. Angermeyer MC, & Schomerus G (2017). State of the art of population-based attitude research on mental health: A systematic review. Epidemiology and Psychiatric Sciences, 26, 252–264. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Butler J (1988). Performative acts and gender constitution: An essay in phenomenology and feminist theory. Theatre Journal, 40(4), 519–531. [Google Scholar]
  4. Cauce AM, Domenech-Rodríguez M, Paradise M, Cochran BN, Shea JM, Srebnik D, & Baydar N (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70(1), 44–55. [DOI] [PubMed] [Google Scholar]
  5. Cheng H-L, Wang C, McDermott RC, Kridel M, & Rislin JL (2018). Self-stigma, mental health literacy, and attitudes toward seeking psychological help. Journal of Counseling & Development, 96, 64–74. [Google Scholar]
  6. Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, Morgan C, Rüsch N, Brown JSL, & Thornicroft G (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27. [DOI] [PubMed] [Google Scholar]
  7. Corrigan PW, Druss BG, & Perlick DA (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37–70. [DOI] [PubMed] [Google Scholar]
  8. Corrigan PW, & Miller FE (2004). Shame, blame, and contamination: A review of the impact of mental illness stigma on family members. JOurnal of Mental Health, 13(6), 537–548. [Google Scholar]
  9. Costello EJ, Mustillo S, Erkanli A, Keeler G, & Angold A (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry, 60(8), 837–844. [DOI] [PubMed] [Google Scholar]
  10. Courtenay WH (2000). Constructions of masculinity and their influence on men’s well-being: A theory of gender and health. Social Science & Medicine, 50(10), 1385–1401. [DOI] [PubMed] [Google Scholar]
  11. Dempster R, Davis DW, Jones VF, Keating A, & Wildman B (2015). The role of stigma in parental help-seeking for perceived child behavior problems in urban, low-income African American parents. J Clin Psychol Med Settings, 22, 265–278. [DOI] [PubMed] [Google Scholar]
  12. dosReis S, Barksdale CL, Sherman A, Maloney K, & Charach A (2010). Stigmatizing experiences of parents of children with a new diagnosis of ADHD. Psychiatric Services, 61(8), 811–816. [DOI] [PubMed] [Google Scholar]
  13. DuPont-Reyes MJ, Villatoro AP, Phelan JC, Painter K, & Link BG (2020). Adolescent views of mental illness stigma: An intersectional lens. American Journal of Orthopsychiatry, 90(2), 201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. DuPont-Reyes MJ, Villatoro AP, Phelan JC, Painter K, & Link BG (2024). Familial transmission of mental health help-seeking: Does it “run in the family”? SSM-Population Health, 27(1), 101695. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. DuPont‐Reyes MJ, Villatoro AP, Phelan JC, Painter K, Barkin K, & Link BG (2021). School Mental Health curriculum effects on peer violence victimization and perpetration: a cluster‐randomized trial. Journal of school health, 91(1), 59–69. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Goffman E (1976). Gender Display. Studies in the Anthropology of Visual Communication, 3, 69–77. [Google Scholar]
  17. Gonzalez JM, Alegría M, Prihoda TJ, Copeland LA, & Zeber JE (2011). How the relationship of attitudes toward mental health treatment and service use differs by age, gender, ethnicity/race and education. Social Psychiatry and Psychiatric Epidemiology, 46, 45–57. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Gostin LO, & Reingold RB (2022). Ending the constitutional right to abortion in the United States. In (Vol. 378): British Medical Journal Publishing Group. [DOI] [PubMed] [Google Scholar]
  19. Green MT, Clopton JR, & Pope AW (1996). Understanding gender differences in referral of children to mental health services. Journal of Emotional and Behavioral Disorders, 4(3), 182–190. [Google Scholar]
  20. Haavik L, Joa I, Hatloy K, Stain HJ, & Langeveld L (2017). Help-seeking for mental health problems in an adolescent population: The effect of gender. JOurnal of Mental Health, 467–474. 10.1080/09638237.2017.1340630 [DOI] [PubMed] [Google Scholar]
  21. Hinshaw SP (2005). The stigmatization of mental illness in children and parents: Developmental issues, family concerns, and research needs. Journal of Child Psychology and Psychiatry, 46(7), 714–734. [DOI] [PubMed] [Google Scholar]
  22. Link BG, DuPont-Reyes MJ, Barkin K, Villatoro AP, Phelan JC, & Painter K (2020). A school-based intervention for mental illness stigma: A cluster randomized trial. Pediatrics, 145(6). [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Link BG, & Phelan JC (2013). Labeling and stigma. In Aneshensel CS, Phelan JC, & Bierman A (Eds.), Handbook of the Sociology of Mental Health (2nd ed., pp. 525–541). Springer. [Google Scholar]
  24. Link BG, Yang LH, Phelan JC, & Collins PY (2004). Measuring mental illness stigma. Schizophrenia Bulletin, 30, 511–541. [DOI] [PubMed] [Google Scholar]
  25. Lucas JW, & Phelan JC (2012). Stigma and status: The interrelation of two theoretical perspectives. Social Psychology Quarterly, 75(4), 310–333. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Martin JK, Pescosolido BA, Olafsdottir S, & McLeod JE (2007). The construction of fear: Americans’ preferences for social distance from children and adolescents with mental health problems. Journal of Health and Social Behavior, 48, 50–67. [DOI] [PubMed] [Google Scholar]
  27. McKeague L, Hennessy E, O’Driscoll-Lawrie C, & Heary C (2022). Parenting an adolescent who is using a mental health service: A qualitative study on perceptions and management of stigma. Journal of Family Issues, 43(9), 2317–2338. [Google Scholar]
  28. Meerwijk EL, & Sevelius JM (2017). Transgender population size in the United States: A meta-regression of population-based probability samples American Journal of Public Health, 107(2), e1–e8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Merikangas KR, Makamura EF, & Kessler RC (2022). Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience, 11(1), 7–20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Mojtabai R, Evans-Lacko S, Schomerus G, & Thornicroft G (2016). Attitudes towards mental health help-seeking as predictors of future help-seeking behavior and use of mental health treatments. Psychiatric Services, 67, 650–657. [DOI] [PubMed] [Google Scholar]
  31. Olfson M, Blanco C, Wang S, Laje G, & Correll CU (2014). National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA Psychiatry, 71(1), 81–90. [DOI] [PubMed] [Google Scholar]
  32. Olfson M, Druss BG, & Marcus SC (2015). Trends in mental health care among children and adolescents. The New England Journal of Medicine, 372(21), 2029–2038. [DOI] [PubMed] [Google Scholar]
  33. Painter K, Phelan JC, DuPont-Reyes MJ, Barkin KF, Villatoro AP, & Link BG (2017). Evaluation of antistigma interventions with sixth-grade students: A school-based field experiment. Psychiatric Services, 68(4), 345–352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Pattyn E, Verhaeghe M, & Bracke P (2015). The gender gap in mental health service use. Social Psychiatry and Psychiatric Epidemiology, 50, 1089–1095. [DOI] [PubMed] [Google Scholar]
  35. Pescosolido BA, Perry BL, Martin JK, McLeod JD, & Jensen PS (2007). Stigmatizing attitudes and beliefs about treatment and psychiatric medications for children with mental illness. Psychiatric Services, 58(5), 613–618. [DOI] [PubMed] [Google Scholar]
  36. Price-Feeney M, Green AE, & Dorison S (2020). Understanding the mental health of transgender and nonbinary youth. Journal of Adolescent Health, 66(6), 684–690. [DOI] [PubMed] [Google Scholar]
  37. Shaffer D, Fisher P, Lucas CP, Dulcan MK, & Schwab-Stone ME (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child & Adolescent Psychiatry, 39(1), 28–38. [DOI] [PubMed] [Google Scholar]
  38. Texas Education Agency. (2011). Snapshot 2011: State Totals. https://rptsvr1.tea.texas.gov/perfreport/snapshot/2011/state.html [Google Scholar]
  39. The White House. (2025). Defending women from gender ideology extremism and restoring biological truth to the federal government. https://www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/ [Google Scholar]
  40. Thoits PA (2011). Resisting the stigma of mental illness. Social Psychology Quarterly, 74(11), 6–28. [Google Scholar]
  41. Thoits PA (2016). “I’m not mentally ill”: Identity deflection as a form of stigma resistance. Journal of Health and Social Behavior, 57(2), 131–151. [DOI] [PubMed] [Google Scholar]
  42. Van Roy B, Groholt B, Heyerdahl S, & Clench-Aas J (2010). Understanding discrepancies in parent-child reporting of emotional and behavioural problems: Effects of relational and socio-demographic factors. BMC Psychiatry, 10(1), 56. 10.1186/1471-244X-10-56 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Velasco AA, Cruz ISS, Billings J, Jimenez M, & Rowe S (2020). What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review. BMC Psychiatry, 20(293), 1–22. 10.1186/s12888-020-02659-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Villatoro AP, DuPont-Reyes MJ, Phelan JC, & Link BG (2022). “Me” versus “them”: How mental illness stigma influences adolescent help-seeking behaviors for oneself and recommendations for peers. Stigma and health, 7(3), 300. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Villatoro AP, DuPont-Reyes MJ, Phelan JC, Painter K, & Link BG (2018). Parental recognition of preadolescent mental health problems: Does stigma matter? Social Science & Medicine, 216, 88–96. 10.1016/j.socscimed.2018.09.040 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Wahl O, Susin J, Lax A, Kaplan L, & Zatina D (2012). Knowledge and attitudes about mental illness: A survey of middle school students. Psychiatric Services, 63(7), 649–654. [DOI] [PubMed] [Google Scholar]
  47. Wahl OF, Susin J, Kaplan L, Lax A, & Zatina D (2011). Changing knowledge and attitudes with a middle school mental health education curriculum. Stigma Research and Action, 1(1), 44–53. 10.5463/sra.v1i1.17 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. West C, & Zimmerman DH (1987). Doing Gender. Gender & Society, 1(2), 125–151. [Google Scholar]
  49. Wong EC, Collins RL, Breslau J, Burnam MA, Cefalu M, & Roth EA (2018). Differential association of stigma with perceived need and mental health service use. The Journal of Nervous and Mental Disease, 206(6), 461–468. [DOI] [PMC free article] [PubMed] [Google Scholar]

RESOURCES