Adolescents’ stigma attitudes toward internalizing and externalizing disorders: Cultural influences and implications for distress manifestations

This study examined predictors of stigma attitudes toward common youth emotional behavioral problems to test the hypothesis that interdependent cultural values would be associated with differential stigma toward externalizing versus internalizing disorders. Furthermore, we examined whether problem-specific stigma attitudes would predict adolescents’ own self-reported manifestations of distress. A total of 1,224 Vietnamese American and European American adolescents completed measures of social distance stigma attitudes in response to vignettes depicting youth with internalizing (depression, social anxiety, somatization) and externalizing (alcohol use, aggressive behaviors, delinquency) disorders. A subset of 676 youth also provided self-reports on their own adjustment prospectively over 6 months. Measurement models revealed clear separation of negatively correlated factors assessing stigma toward externalizing versus internalizing problems. Values related to family interdependence were significantly associated with greater tolerance of internalizing disorders and lower tolerance of externalizing disorders. Stigma toward internalizing disorders was associated with lower concurrent self-reported internalizing symptoms, whereas stigma toward externalizing symptoms was associated with lower concurrent externalizing symptoms and greater decreases in externalizing symptoms over time. The results of the study suggest that stigma attitudes are differentiated by problem type and may represent one cultural factor shaping distress manifestations.