Mental Illness, Problem, Disorder, Distress: Does Terminology Matter When Measuring Stigma?

It has become commonplace to adapt the terminology used to reference mental illness in stigma measures to avoid further stigmatizing people who have experienced a mental health problem. However, to our knowledge, no study has examined the effect of modifying terminology in stigma measures on levels of stigma endorsement or on the relationship between measured stigma and important outcomes. We surveyed 3,367 people with a current or past history of a mental illness using Amazon MTurk and randomly assigned them to one of five labeling conditions: "Mental Illness (MI)," "Mental Health Problem (MH)," "Psychological Disorder (PD)," "Emotional Distress (ED)," and "Choose Your Own Term (OL)." Participants completed measures of personal, perceived, and internalized stigma, their mental health history, attitudes toward mental illness treatment, self-stigma of seeking help, and intentions to seek treatment. The terms referring to mental illness within each stigma measure were adapted to reflect the condition to which participants had been assigned. Results demonstrated no differences in the level of stigma endorsement across the MI, MH, PD, and OL conditions. However, participants in the ED condition reported significantly higher personal, perceived, and internalized stigma compared to the other conditions. Despite differences in levels of endorsement, there was no effect of labeling condition on the relationship between mental illness stigma and important outcomes. Based on these findings, we recommend researchers studying the experiences of people with mental illnesses use terminology that most appropriate for their measurement context, using a term that is socially acceptable for their local, cultural, and historical context.