2012. Vol.3, No.10, 892-898
Published Online October 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.310134
Copyright © 2012 SciRes.
Reducing Stigma Barriers to Help-Seeking Behaviors
among College Students
Pennsylvania State University, University Park, USA
Received July 18th, 2012; revised August 19th, 2012; accepted September 21st, 2012
College students suffer disproportionately from depression, an illness with significant consequences that,
untreated, escalates in severity. A review of literature reveals that seeking help for this health issue is of-
ten stigmatized, reducing the likelihood of treatment. While the literature identifies the types of stigma,
less is known about the communicative processes involved in stigma coping. This paper applies Meisen-
bach’s (2010) Theory of Stigma Management Communication (SMC) to this issue, suggested strategies
researching depression stigma coping as well as new and promising intervention strategies to increase
help seeking rates among college students.
Keywords: Depression; Stigma Management Communication; College Students; Help Seeking
Depression, the most common psychiatric disorder and
among the top causes of mortality worldwide, begins prior to
age 24 in three fourths of all lifetime cases (Gladstone et al.,
2011; Richards, 2011; Eisenberg et al., 2007). These observa-
tions are especially relevant to students attending college, as
over one third of the United States college student population
report depressive symptoms that, at the very least, interferes
with their relationships, well-being, and school work (Zivin et
al., 2009; Michael et al., 2006; NIMH; CDC, 2011; Eisenberg
et al., 2007). Suicidal risk, the third leading cause of death for
15- to 24-year olds, is increased by depression and the rates of
suicidal thoughts on college campuses range between 2.5% and
9% (CDC, 2011; Eisenberg et al., 2007; Klein et al., 2011).
While depression is among the most treatable mental illnesses,
college students are the demographic most in need of help, but
are the least likely to seek it, with only 3% - 12% doing so
(Gladstone et al., 2011; Ting, 2011; Richards, 2011; Zivin et al.,
2009; Eisenberg et al., 2007; Michael et al., 2006; Rickwood,
2007).Instead most ignore the symptoms and rely on harmful
self-medicating behaviors such as alcohol and drug use, all of
which only increase symptom severity (Gladstone et al., 2011;
Ting, 2011; Cassano & Fava, 2002; Michael et al., 2006; Zivin
et al., 2009; Rickwood, 2007; Klein et al., 2011). One might
ask: why would one ignore symptoms with such severe poten-
tial consequences when proven treatment options are available
through college campuses without any financial or accessibility
obstacles? Most people are able to correctly identify symptoms
of depression; therefore this disproportion in help seeking rates
cannot be explained by lack of information (Elwy et al., 2011).
The answer, it appears, is at least in part due to the stigma asso-
ciated with depression status. Stigmastrongly correlates with
decreased willingness to seek help and disclose information in
the general population regardless of depression status, but par-
ticularly so for the college demographic(Schomerus et al.,
2009b; Ting, 2011; Barney et al., 2011).Exploring stigma com-
munication and possible responses to stigma is beneficial for
affected individuals, health professionals, and the college popu-
lation because it allows for recognition of stigma as a legitimate
resource or hindrance to seeking help for depression, and how
these issues can be addressed to improve help seeking rates
(Boardman et al., 2011). Thus, it is imperative to consider
stigma reduction programs and research and this involves a
focus on how stigma is communicated. A literature review was
conducted to elucidate the processes involved in help seeking,
depression, and stigma among college students. Research pub-
lished within the past decade was given priority and recom-
mendations are then offered. The discussion starts with the
concept of stigma.
To say that depression and/or depression treatment are stig-
matized means that there is a socially constructed, simplified,
and standardized image used to mark those seeking treatment as
“not normal” (Smith, 2007a; Goffman, 1963). Creation, per-
petuation, and maintenance of this stigma depends on a com-
municative process involving cues (marks, responsibility, group
labels, and peril) that serve to distinguish, categorize, blame,
and link peril to the targeted group (Smith, 2007a). These cues
dictate who is stigmatized, why they are stigmatized, and what
constitutes stigmatization. They are commonly relied upon in
communicative exchanges because of the accessibility and
emotional arousing qualities that are useful for bonding and
increasing popularity (Smith, 2007a).
The main normative factors influencing communication
about depression stigma are public stigma, self-stigma and
social distance. Public, or perceived, stigma is an individual’s
perception of what the general population believes about a
stigmatized topic (Yap et al., 2011).
Self-stigma, the second factor, is an individual’s application
of public stigma to the self (Yap et al., 2011). One example of
depression self-stigma is the perception that a mental illness
signifies a personal weakness rather than an illness, and is
found to decrease help seeking rates (Yap et al., 2011). In addi-
tion to being associated with low help seeking rates, high self-
stigmatization is also associated with decreased self-efficacy,
decreased functioning, and increased hospitalization rates (Ev-
ans-Lacko, 2011). Finally, social distance is defined as the ex-
tent to which other individuals avoid contact with a stigmatized
individual based on the stigmatized conception that depression
is due to weakness of character (Yap et al., 2011; Jorm & Grif-
There is a complex relationship between and among these
factors. Public stigma does not directly influence help seeking
decisions for depression but informs self-stigma and social
distance that are both strongly related to help seeking intentions
(Yap et al., 2011; Barney et al., 2006). Social distancing cli-
mates are associated with higher levels of self-stigma, suggest-
ing that targeting social distance may be the most efficient way
to combat depression stigma (Evans-Lacko et al., 2011; Scho-
merus et al., 2009b; Yap et al., 2011). The complexity of inter-
actions between self-stigma and social distance along with con-
textual factors such as mental illness type, and demographic
renders the task of studying coping with stigma a challenging
one, but recent developments in stigma communication offer
promising suggestions for where to begin and how to utilize
current research to improve help-seeking rates.
A Model of Stigma Communication
Research has begun to identify strategies for coping with
perceptions of stigma that can be applied to depression stigma
(Meisenbach, 2010). Meisenbach’s (2010) Theory of Stigma
Management Communication (SMC) utilizes stigma attitudes
from an individual as they apply to the self (the degree of self-
stigma) and as the individual accepts or challenges the public’s
understanding of the stigma (relating to social distance).These
two planes provide a framework for mapping stigma manage-
ment in order to quantify and qualify efficacy in a systematic
way that has not been possible before. However, the process is
complex, with the model acknowledging that stigma statuses
can vary across perceptions, discourse, time, and severity, and
because of this fluidity the origin of the stigma under examina-
tion must be specified (Meisenbach, 2010).
SMC divides responses to stigma into four categories that re-
flect the degree to which an individual internalizes the stigma
(self acceptance) as well as the degree to which they agree with
the public stigma messages (public acceptance). In other words
they can either accept or challenge stigma internally as well as
the public perception resulting in four over-arching categories
or quadrants reflected in Figure 1 (e.g., accept internally/accept
publicly; accept internally/challenge publicly; challenge inter-
nally/accept publicly; and challenge both internally and pub-
licly). SMC then describes six main coping strategies for these
four situations (see Figure 1 for more detail): accepting, avoid-
ing, evading responsibility, reducing disgust, denying, and ig-
noring (Meisenbach, 2010).
Quadrant 1: Accept Internally/Accept Publicly
When stigma is accepted both internally and publicly the in-
dividual can accept the stigma through submissive means or in
an active manner with humor, displaying, disclosing, apologiz-
ing, blaming, isolation, or bonding with other stigmatized indi-
Quadrant 2: Challenge Internally /Accept Publicly
Here stigma is internally challenged but publicly accepted by
distancing the self in various ways from anything attributable to
the stigma whether through hiding, denial, avoidance, stopping
behaviors, distancing, or making favorable comparisons.
Quadrant 3: Accept Internally/Challenge Publicly
Strategies falling in this quadrant accept the applicability of
the stigma to the self but challenge the public’s perception
through strategies that shift agency away from the self or aim to
change the public perception.
Quadrant 4: Challenge Internally/Challenge Publicly
When stigma is challenged in both dimensions the two avail-
able coping strategies include denial, which is divided into
simple denial and logical denial (further divided into discredit-
ing, providing evidence, or highlighting fallacies), and ignoring
Stigma Application to the Self
Accept Internally Challenge Internally
Quadrant 1 Quadrant 2
Accept Publicly Accept Stigma
Quadrant 3 Quadrant 4
Public Understanding of Stigma
○ Bolster alternative identity
○ Minimize effects
Adapted from Meisenbach’s (2010) model of stigma management communication (SMC).
Copyright © 2012 SciRes. 893
Factors Impacting Strategy Choice
Like stigma itself, decisions about coping are complex.
However, research suggests that one of the keys to this process
is the degree to which individuals accept personal responsibility
for the stigma. People who accept personal responsibility have
internalized public and social stigma cues that communicate
blame towards stigmatized individuals. This, in turn, decreases
help seeking intentions, and decreases empathy towards other
group members (Smith, 2007a; Rickwood, 2007; Chang, 2008).
Responsibility is broken into choice and control, one being the
individual’s responsibility in the onset of the stigmatized condi-
tion, the other being the amount of control an individual has
over eliminating the condition (Smith, 2007a). Illnesses such as
depression are stigmatized in both ways but are especially
branded as more manageable than physical illness and will
eventually go away if the individual takes control of the symp-
toms (Chang, 2008). The amount and type of responsibility that
a stigmatized depressed person feels, therefore, impacts their
coping strategy decision. For example, strong feelings of con-
trol responsibility correspond to an acceptance of the public
understanding of depression stigma, therefore, depending on
how the individual accepts or challenges that public under-
standing internally the coping strategy could result in either
accepting or avoiding. The opposite would then be challenging
the public perception, and depending on the acceptance/denial
to the self, an individual could use evading responsibility or
Unfortunately, there is very little research regarding what
coping methods are effective in increasing help seeking for
depression, but what little there is has focused on the use of
evading responsibility through defeasibility and provocation.
Evading responsibility in SMC results from an acceptance of
the stigma to the self but challenges the public understanding of
stigma and is done through provocation, defeasibility, or unin-
tentional means (Meisenbach, 2010). Defeasibility as applied to
depression stigma relates directly to relinquishing control re-
sponsibility through admission that the individual could not
avoid this stigma and that this strong need assume responsibil-
ity for their recovery simply is not a viable option (Meisenbach,
2010).Using defeasibility has not only been found effective, but
also integral to increasing help-seeking intentions (Boardman et
al., 2011). Having a strong sense of control responsibility is
described as a cage that prevents help-seeking behaviors be-
cause holding onto the responsibility does not carry the risk of
being personally scrutinized by the self and others as letting go
does (Boardman et al., 2011).
Cause responsibility can be evaded from depression stigma
through the use of provocation, or the reasoning that predeter-
mined factors provoked the stigmatized state independent of the
stigmatized individual’s responsibility (Meisenbach, 2010).
One way to employ provocation is through the use of scientific
evidence such as biological information and, when applied to
depression stigma, has been found to increase help-seeking
intentions in college student populations (Han et al., 2006).
Additionally, this strategy is thought to be effective for percep-
tions of depression because evidence is perceived as physical,
more empirical, and less questionable (Han et al., 2006). Brain
imaging scans are one useful tool for demonstrating the physi-
cal nature of depression because they visually demonstrate
reward-related areas of the brain such as the amygdala, the
mesolimbic dopamine system, the prefrontal cortex, and the
striatum differing in reward sensitivity in depressed compared
to nondepressed individuals (NIMH, 2011; Forbes & Dahl,
2012; Hankin, 2006). Biological information such as brain im-
aging scans take cause responsibility away from the stigmatized
individual and instead focus it on predetermined factors, such
as brain chemistry, to demonstrate that depression is often pro-
voked by risk factors that are often out of the individuals con-
Ineffective strategies also have been documented. In SMC
decreasing the degree of disgust attached to a stigma is a gen-
eral strategy choice that results from an acceptance of the
stigma applicability to the self, but challenges the public under-
standing of that stigma (Meisenbach, 2010). There are three
ways to reduce disgust including bolstering an alternative iden-
tity, minimizing the effects, and transcending (Meisenbach,
2010). Transcendence describes a strategy of highlighting and
reframing how a stigma attribute can lead to a higher purpose
and a positive result (Meisenbach, 2010). In depression this
strategy has been termed resilience, and it has been found to be
ineffective, even harmful, to help-seeking intentions (Boardman
et al., 2011). The problematic nature of this strategy choice is
not only that it is common among college students, as they are
in an environment which encourages the pursuit of autonomy
and independence, but also that it is derived directly from de-
pression stigma itself (Boardman et al., 2011; Rickwood, 2007;
Han et al., 2006).
Other SMC centered research not exclusive to depression
stigma also has identified ineffective and effective methods,
however since stigma vary dramatically according to type of
stigma and the context in which it is expressed, these results
must be only very tentatively applied to depressive stigma. This
related research suggests that blaming the stigma for unpleasant
outcomes has been found to protect the stigmatized individual’s
self-esteem while bonding with other stigmatized individuals is
thought to improve mentoring and peer support (Meisenbach,
2010). Blaming an employer because of the lack of depression
awareness could be an example of blaming the stigma, while
bonding could involve attending group counseling sessions.
Passive acceptance, however, is discouraged (Meisenbach,
2010). Applied to depression, passive acceptance could de-
scribe a stigmatized individual not saying anything in a discus-
sion where it is stated that people who are depressed just need
to be more positive.
Suggestions for Future Research
SMC, especially when applied to depression stigma, is still in
its infancy and much research is needed to know more about
coping strategies. In a general sense, little is known about how
the mechanisms in each process works, if different stigma types
generate specific strategies, how successful or unsuccessful
each strategy is, and how the strategies operate when combined
(Meisenbach, 2010). Relevant questions for future research will
inquire as to the effectiveness of each response, if the effec-
tiveness is context specific, such as interacting with health pro-
fessionals versus peers, etc., and if it is identifying what con-
texts (Barney et al., 2011).
A line of qualitative research, such as narrative inquiry, is
needed to begin describing crucial elements of the stigmatized
Copyright © 2012 SciRes.
experience and how interactions and identities are shaped by
SMC (Meisenbach, 2010). Narratives, or stories, are a commu-
nicative tool with means for cognitively organizing and inter-
preting culturally grounded knowledge, experiences, and events
(Larkey & Hecht, 2010; Hecht & Miller-Day, 2009). It is im-
portant to base research on actual experiences, such as those
expressed in narratives, in order to more completely understand
what coping strategies are used, for what reasons, and with
what effects. Narrative inquiry allows for a starting point to
base future research directions on that is grounded on the actual
experiences of stigmatized individuals. Effectiveness of the
strategies can be examined through factors such as subsequent
self-esteem and health outcomes (Meisenbach, 2010). In any
case, the SMC model and existing research sets a baseline for
intervention integration and therefore recommendations for
effective implementation are addressed in the next section.
Suggestions for Program Implementation
Implementing SMC strategies into anti stigma and help-
seeking focused programs for depression in college students is
a promising tool for utilizing the barriers that stigma poses to
help-seeking intentions and behaviors (Boardman et al., 2011).
Simply integrating the strategies, however, is not enough. Sev-
eral aspects are to be considered for successful SMC strategy
dissemination including the transportation, audience, demo-
graphic, and platform of the implementation. The first is the
issue of transportation, and the most effective way to commu-
nicate strategy information. Informational approaches on their
own have not been proven to be as effective in stigma reduction.
As a result, we turn to other methods, such as narrative strate-
gies, which are perceived to be more realistic and easier to re-
late to (Chang, 2008; Feely et al., 2006).
Communicating about health requires strategy analysis of
effective modes for transferring information. Narrative use is
efficacious particularly for health messages involving stigma.
Narratives are memorable, efficient, chronologically ordered
messages that humans learn at a young age to use to communi-
cate a relationship between events and integrate with previous
conceptions in order to form new understandings (Chang, 2008;
Kopfman et al., 1998). Narrative health promotion messages
allow the experiences of those affected to be expressed in a
powerful story format (Hopfer & Clippard, 2011; Larkey &
Hecht, 2010) that are more effective than other message forms
for engaging resistant audiences (Hopfer & Clippard) such as
those involved with stigmas.
Several health initiatives utilize narrative theory and are
prime examples for future programs to be modeled after. The
practice of narrative competence, otherwise referred to as nar-
rative medicine, among physicians has allowed for increased
effectiveness and understanding of medical practice and treat-
ment (Charon, 2001). Motivational interventions, a type of
counseling that changes behavior with empathy and reflective
listening, have been shown to be successful in decreasing binge
drinking among college students and were rated as very favor-
able among the participants (Borsari & Carey, 2000). Applied
to depression stigma, similar methods may be implemented in a
variety of ways, for example, to improve stigma literacy in
medical settings or improve coping mechanisms among at-risk
Narrative engagement theory suggests that it is important to
build curricula from narratives, instead of adapting narratives
into new settings (Larkey & Hecht, 2010; Miller-Day & Hecht,
in press). Eliciting narratives is beneficial both for practical and
scholarly aim, but only when done correctly. The main princi-
ple of narrative elicitation is that the interview processes should
focus on encouraging the interviewee to tell a story, not engage
in a discourse (Larkey & Hecht, 2010). Hopfer and Clippard’s
(2011) study, involved with the cultural and social framework
employed by college aged women in HPV vaccination deci-
sions, followed this principle well and used open ended base
questions to encourage story telling (Hopfer & Clippard, 2011).
Another study exploring help-seeking intentions of African
American male adolescents employed a similar methodology of
interviewing participants who were in treatment and not in
treatment about their decisions to seek help in order to gain
insight into what factors influences their decisions (Lindsey et
al., 2006). Finally, narratives were collected about the social
processes of drug offers and became the centerpiece for keepin’
it REAL, the most widely disseminated school-based substance
abuse curriculum in the world (Miller-Day & Hecht, in press;
Colby et al., in press). All of these provide models for collect-
ing narratives in order to design narrative interventions.
Recipient Considerations: Depressive Status
Using the SMC framework and related research to develop
interventions first requires an acknowledgement of the recipi-
ents of the program. Stigma reduction programs typically
choose to focus either on nonstigmatized or stigmatized indi-
viduals but rarely both. This author argues against an either-or,
stigmatized-nonstigmatized mentality and in its place an inclu-
sive perspective that views everyone as potentially stigmatized.
This is a powerful intervention strategy because depressive
symptoms exist on a spectrum from mild to severe and stigma
is constructed along a two-category system of difference and
normalcy. This is complicated by the stigma associated with
obtaining treatment for depression, which may be at least partly
independent of the stigma attached to the disease. In other
words, one might envision a situation in which depression,
itself, is not highly stigmatized (i.e., many people are sad) but
seeking treatment is stigmatized as a sign of weakness. This is
because one key function of stigma messages is to distinguish
between group members and nonmembers through the use of
group labels and marks (Smith, 2007b). Labels and marks can
be as explicit as “crazy” or “emo”, but they can also be institu-
tionalized, such as correctly labeling the symptoms of depres-
sion or even those who seek treatment (Evans-Lacko et al.,
2011). Of course, the opposite situation (stigmatized disease,
not treatment) is also possible and presents different challenges.
No matter the form, however, the use of marks and labels in-
crease stigmatizing attitudes (Evans-Lacko et al., 2011). As a
result, programs that target the “general population” or “nonde-
pressed” individuals in an effort to educate them about depres-
sive illnesses may only reinforce the very stigma construction
they are trying to fight. In addition, targeting certain popula-
tions based on depressive status often has no impact on actual
help-seeking attitudes (Schomerus et al., 2009a).
Combatting stigma and avoiding the use of marks requires
elimination of the marks in order to promote inclusion for eve-
ryone regardless of depressive status. One strategy for accom-
Copyright © 2012 SciRes. 895
plishing this is promoting face-to-face and mediated social
contact among stigmatized and non-stigmatized individuals.
This strategy has been shown to significantly decrease stigma-
tized attitudes in other domains (Schulze et al., 2003; Evans-
Lacko et al., 2011; Klin & Lemish, 2008; Chang, 2008). This
strategy requires that individual contact not be written off as
unique (i.e., the attribution of the person as an atypical member
or even an exception who does not completely belong to the
stigmatized group), as often occurs with contact and racial
stereotyping, but at the same time must refute stigmatized as-
pects of depression (Hecht, 1998). An inclusive approach not
only relieves the burden (or even stigma) of being the target of
prosocial messages but, at the same time including stigmatizing
people and stigma targets reduces social distance and increases
the likelihood that at-risk, asymptomatic people will seek help
should they develop symptoms (Schomerus et al., 2009a).
Demogra phic Considerations: R a ce and Gender
Despite the fact that the rate of mental illness is the same for
Americans regardless of race non-white individuals have sig-
nificantly lower help seeking and detection rates than their
white non-Hispanic counterparts (Barney et al., 2011; Schome-
rus et al., 2009b; Rickwood, 2007; Klein et al., 2011; Kranke et
al., 2012; Lindsey et al., 2006). Stigma is a substantial cause of
these differences because stigma differs depending on the cul-
ture, from health promotion behavior being regarded as a
“white” behavior to attitudes that medication is for “crazy peo-
ple,” all of which are informed and reinforced by peers, family,
culture, the media, and even the medical community (Kranke et
al., 2012; Lindsey et al., 2006; Oyserman et al., 2007). Racial
exclusion is even evident in the DSM-IV, which does not dif-
ferentiate between symptoms specific to various cultures other
than that of the dominant white culture, resulting in mis- and
under diagnosis among nonwhite patients (Lindsey et al., 2007;
Klein et al., 2011; Warren et al., 2010). This tendency is not
limited to Black Americans, as Asian Americans also have
higher stigmatized perceptions than white Americans with only
3.5% Chinese Americans willing to seek help and Japanese
American students more likely to equate their symptoms with
“weak-mindedness” (Han et al., 2006; Chang, 2008). Despite
the fact that race is a significant factor in help-seeking rates,
culturally grounded psychoeducation models for African Ame-
ricans are very rare (Rickwood, 2007; Kranke et al., 2012).
Gender must also be considered. Depression has historically
been a stigmatized as a biologically female illness and this
stigma as persisted to present times in media analysis, diagnosis
rates, and manifestation of symptoms (Johansson et al., 2009;
Klin & Lemish, 2008). In addition to perceptions of differences
between men and women regarding depression, actual mani-
festation of symptoms are different with men exhibiting an
increase of risk behaviors such as drug and alcohol abuse, and
developing antisocial and narcissistic personality traits com-
pared to women who report emptiness and guilt (NIMH, 2011;
Michael et al., 2006). While the causes, origins, and validity of
these differences are unknown, it remains that the DSM-IV
does not classify differing depressive symptoms according to
gender thus revealing a gap in diagnostic criteria, public under-
standing of the criteria, or both.
The effects of the gap includes differences in symptom rec-
ognition (men are less likely to recognize depressive symp-
toms), help seeking rates (men have lower rates), diagnosis
(men are less likely to be diagnosed), self-stigmatizing views
regarding personal responsibility (men have higher levels), and
suicide completion rates (higher for men; Barney et al., 2011;
Schomerus et al., 2009b; Rickwood, 2007; Lawlor et al., 2008;
Klein et al., 2011; Michael et al., 2006; Elwy et al., 2011;
Richards, 2011). These differences are especially relevant to the
college student demographic, where in many samples gender
differences disappear and even reverse with men in this age
group from all ethnic groups more frequently reporting depres-
sive symptoms, but still reluctant to seek help (Eisenberg et al.,
2007; Klein et al., 2011; Cassano& Fava, 2002; Richards,
Fortunately, while messages are never culture neutral, ac-
knowledging difference by including culturally grounded narra-
tives is effective for culturally diverse groups with various
identities that span across gender, age, ethnicity, etc. (Larkey &
Hecht, 2010; Hecht et al., 2003; Oyserman et al., 2007). When
the identities embodied the narratives are important to the indi-
vidual, the health messages endorse behaviors that are not only
beneficial to the individual, but also define (or redefine) that
individual’s identity through social group membership (Oyser-
man et al., 2007). Depression programs require culturally
grounded efforts because depression has historically, socially,
and medically been stigmatized as a white woman’s illness.
Therefore it is important to give voices to those who do not fit
into that archetype yet still have depression and narrative health
messages provide a promising strategy for accomplishing this
In addition to narrative strategies, recent studies have shown
that an Internet platform, accessible by smart phones, is an
effective medium to distributing program content, particularly
in the case of depression stigma. Among the benefits of an
online medium include relevance to the college student demo-
graphic, personalization, interaction, anonymity, social prolif-
eration, inexpensively, and efficiency (Morgan et al., 2011; Oh
et al., 2009; Lawlor et al., 2008; Rickwood, 2007; Larkey &
Hecht, 2010). Online dissemination has been shown to be ef-
fective in improving a variety of health behaviors (Morgan et
al., 2011). In 2011 there were over 211 million internet users
and the most prevalent users of the Internet are people 25 years
old and younger who will first search the internet for health
questions (Nielsen, 2011; Oh et al., 2009; Rickwood, 2007). In
addition, the internet has been shown to be the ideal medium to
reach individuals of various genders, races, and socioeconomic
status (Warren et al., 2010). Men favor in person services less
favorably than online services and African American students
have been found to use the internet for health information more
than whites as long as the information is culturally relevant (Oh
et al., 2009; Warren et al., 2010).
Online services have also been found to be at least as effec-
tive as in person services for symptom reduction, treatment, and
counseling (Klin & Lemish, 2008; Christensen et al., 2004). In
an evidence-based review of online mental health programs, six
out of the eight online interventions specific to depression were
effective at reducing symptoms (Griffiths et al., 2010). One of
these programs is the beyond blue campaign, an Australian
funded non-profit organization dedicated to the improvement of
public perceptions of depression through awareness, support,
and destigmatization (Jorm et al., 2006). The program has been
Copyright © 2012 SciRes.
found to result in higher mental health literacy, more help-
seeking intentions, and higher awareness of discrimination (Oh
et al., 2009; Jorm et al., 2006). The prospect of adapting or
modeling Depression SMC interventions after campaigns such
as beyond blue is promising for depression stigma reduction
and increased help seeking behaviors.
In conclusion, communication perspectives offer promising
directions in understanding and influencing health decisions,
especially those impacted by stigma such as depression and
help seeking in college. While some studies show that strategies
such as evading responsibility through provocation and defea-
sibility can be effective, or reducing disgust through transcen-
dence as ineffective, much of how SMC strategies implicate
depression stigma and help seeking rates have not been studied.
Narrative inquiry is a promising strategy to begin this much
needed research. Prevention programs are strongly urged to
incorporate context- and culture-specific SMC because teaching
effective personal strategies unrestrained by the depressed/non-
depressed binary may increase help-seeking behaviors. Online
distribution of the curriculum through narratives allows for
fluidity and flexibility in addressing context and culture of the
recipients in a way that mimics how stigma function. Utilizing
and expanding on all of these findings is promising for the fu-
ture of stigma reduction and increasing help seeking behavior
among depressed individual’s in the college student demo-
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