RIVERSIDE, Calif. -- A UC Riverside-led study of mental health stigma in Japan has found a striking gap between the need for treatment and people's willingness to seek it, with high levels of social distancing toward people with mental illness serving as a potential barrier.
Motivated by concerns about Japan's current mental health crisis, Andrew Subica , a professor of social medicine, population, and public health in the UC Riverside School of Medicine , and Shinichi Nagata , an associate professor at the University of Tsukuba in Japan, surveyed 1,012 Japanese adults using a geographically representative national online sample. They examined several dimensions of public stigma, including perceptions of the seriousness and treatability of mental illness, beliefs about its causes, perceived dangerousness, and desired social distance. Subsequently, they compared their Japanese data with nationally representative U.S. data from the 2018 General Social Survey, a long-running survey of American attitudes and behaviors.
Published in the International Journal for Equity in Health, their study found that only about 54% of Japanese participants reported being willing to seek mental health treatment for serious emotional problems, compared with about 70% of U.S. participants. Japanese participants were also more likely than their U.S. counterparts to want to socially distance themselves from people with mental disorders (about 84% versus 28% for depression), although they were less likely to view those individuals as dangerous.
Moreover, the study found that Japanese participants were less likely than U.S. participants to believe that mental disorders could improve with treatment. For major depression, about 78% of Japanese participants believed treatment would help, compared with approximately 95% of U.S. participants.
"These findings show that mental health stigma can take different forms across cultures and nations," Subica said. "You can't simply take an intervention that works in one country and assume it will work for people somewhere else."
That difference has implications for public health efforts. In the United States, anti-stigma campaigns have often sought to address perceptions that people with mental illness are dangerous. The study findings suggest that reducing social distance may be a more relevant target in Japan.
The study's most unexpected finding involved "mattering" — whether people believe they are important to and cared about by others. Subica and Nagata found a stronger sense of mattering was associated with greater willingness to seek treatment in Japan. Prior treatment experience and stronger beliefs that mental illness can improve with treatment were also associated with greater treatment-seeking willingness. In contrast, greater desire for social distance and the belief that mental disorders would improve without treatment were associated with lower willingness to seek care.
Subica said the role of mattering was not something he and Nagata expected to emerge so prominently.
"We weren't expecting mattering to have such a strong connection with treatment seeking," he said. "But even in a highly stigmatizing environment, people who feel that they matter to others appear to be more willing to seek treatment for their mental health problems."
Subica cautioned that the finding does not establish that increasing people's sense of mattering will cause them to seek treatment. However, it provides a basis for further research into social connection and mattering as potentially modifiable factors in promoting treatment engagement, he said.
The findings come amid broader concern about mental health in Japan, including depression, anxiety, loneliness, and suicide. Despite extensive health care resources, mental health treatment remains underused in Japan, creating a gap between people's needs and their willingness to obtain care.
Subica said cultural context is essential to understanding that gap. He explained that mental illness has historically been hidden from public view in Japan, and concerns about family reputation and social standing can influence how mental illness is perceived and disclosed.
"In some cultures, mental illness isn't seen simply as something that affects one person," Subica said. "It can be seen as something that affects the family's status and reputation. The biggest lesson is that culture matters. We need to understand the specific cultural factors affecting stigma and treatment seeking and design interventions around those factors."
Subica has a personal connection to the research. His mother is Japanese, and he had not returned to Japan for many years before beginning this work.
"My research has consistently shown me that the culture and communities we live in strongly matter when it comes to people's mental health and physical health in the U.S.," he said. "I wanted to understand whether similar cultural factors were at play in Japan, and what we could learn about helping people overcome barriers to care."
The title of the paper is "Mental illness stigma and treatment-seeking willingness in Japan: a national survey study."
| The University of California, Riverside is a doctoral research university, a living laboratory for groundbreaking exploration of issues critical to Inland Southern California, the state and communities around the world. Reflecting California's diverse culture, UCR's enrollment is more than 27,000 students. The campus opened a medical school in 2013 and has reached the heart of the Coachella Valley by way of the UCR Palm Desert Center. The campus has an annual impact of more than $2.7 billion on the U.S. economy. To learn more, visit www.ucr.edu . |
