A mixed-methods study on depression self-stigma among young Chinese people with parental depression

Abstract

Major depressive disorder remains one of the most prevalent mental disorders both worldwide and in China, profoundly affecting patients’ health and mental well-being. Self-stigma, which entails feelings of shame and endorsement of negative societal stereotypes on depression, hinders help-seeking behaviors and affects recovery and quality of life. A considerable proportion of individuals with depression report a family history, with parental depression being particularly influential. The role of parents is critical in shaping offspring’s psychological development and their subsequent social adaptation and mental health into adulthood. However, there has been limited research concerning the impact of parental depression on offspring’s stigma internalization. In this thesis, three studies were designed to address the identified research gaps. Study One is a systematic review and meta-analysis that aims to summarize and synthesize global evidence on depression self-stigma. After searching four online databases, fifty-six studies involving a total of 11,549 samples were included in the final meta-analysis. This study reports the global prevalence of depression self-stigma (29%) and its protective and risk factors at demographic, clinical, and psychosocial levels. Study Two is a qualitative study that aims to 1) explore familial factors associated with self-stigma among people growing up with parental depression; and 2) construct an explanatory model of depression self-stigma in a Chinese context. Essential principles of the constructivist grounded theory approach were adopted to collect data through in-depth interviews with 27 participants aged 13-30 during September to November 2022. This study summarizes the cognitive, emotional, and behavioral manifestations of self-stigma among individuals with depression and with parental depression. A family-individual model was proposed to illustrate the direct and indirect effects of parental depression on offspring’s self-stigma. Subsequently, Study Three is a quantitative study that aims to 1) examine whether parental depression is associated with offspring’s self-stigma; and 2) validate the proposed model. An online survey was conducted between May and October 2023, involving 1,012 Chinese participants aged 13-30 and diagnosed with depression. Structural equation modeling (SEM) was employed to validate the proposed model. According to the survey’s results, the group with parental depression reported significantly poorer family relationships, less parental care, and higher parental overprotection than those without parental depression. The group also reported higher self-stigma, perceived stigma, and introversion, as well as lower self-esteem, resilience, and social functioning. Six serial mediation paths linked parental depression to offspring’s self-stigma through familial and individual factors showed significant positive indirect effects. This study suggests that parental depression is associated with higher self-stigma in offspring, mediated by poorer family interactions and individual difficulties. The Results further indicate that negative family dynamics, such as increased conflicts and parental overprotection, significantly exacerbate offspring’s self-stigma. Findings from both qualitative and quantitative studies suggest that cultural values of collectivism and familism further influence family dynamics. Thus, effective interventions should be culturally tailored and address both familial and individual factors to mitigate self-stigma. Public awareness campaigns, supportive parenting practices, and enhancing personal traits such as self-esteem and social functioning are essential for reducing self-stigma among people growing up with parental depression. (500 words)