Parental Perceptions of Child Mental Health Stigma: Mixed-Method Study

This study considered three main aims of (1) developing and validating a tool to measure parental perceived child mental health (MH) stigma, (2) determining whether perceived stigma levels corresponded in any way to parental identities, and (3) producing a decision-making process flow identifying where barriers such as perceived child MH stigma may affect families dealing with child MH issues. Recruitment of parents/guardians (18 years or older) with children (under the age of 18 years) was done through convenience and respondent-driven sampling in Phoenix, Arizona. A 44-prompt MH stigma tool was developed and validated (N=65, Cronbach's alpha 0.89) prior to utilizing (N=623) it to measure levels of perceived child MH stigma in the community. Analysis of variance showed potential significant (p<.005) interactions among education, income, and race/ethnicity (white, non-Hispanic/Latinx and Hispanic/Latinx) and levels of stigma. Specifically, higher education and lower income among the Hispanic/Latinx population in Phoenix showed a greater likelihood for higher levels of perceived child MH stigma. Factor analysis yielded three underlying factors of this stigma: interaction with MH, discrimination, and positive aspects. Content and thematic analysis of free response questions in the survey conveyed parents talk about MH diagnoses differently between general MH and child MH (e.g., child MH included ADD/ADHD while general MH included anxiety and schizophrenia). Fifteen, one hour-long, semi-structured interviews were completed, transcribed, and analyzed using narrative analysis to develop a parental decision-making process flow. The resulting flow showed parents went through informal methods of accessing MH care (e.g., research, awareness of MH issue) prior to formal methods such as seeking medical experts or school support. While the study was able to address these three aims, a significant shift in the landscape of MH occurred with the COVID-19 pandemic, increasing child MH risk and decreasing care access. This study developed a tool and set of methods that may be applied to identify changes in perceived child MH stigma and in how parents make decisions to access child MH care.