Double Stigma and Help-Seeking Barriers Among Blacks With a Behavioral Health Disorder

Impact and Implications Black adults with a mental illness or addiction experience barriers to seeking help for their disorder because of internalized self-stigma and racial stigma, a combination known as "double stigma." We describe processes underlying the relationship of double stigma to help-seeking and discuss practice implications for counteracting double stigma. Objective: There is considerable evidence that racial stigma and stigma due to mental illness or addiction are each independently a barrier to help-seeking for Black adults. The present study examines empirically the "double stigma" of discrimination, marginalization, and exclusion due both to a behavioral health disorder and to race among Black adults. Method: Interviews were conducted with 176 Black adults with a diagnosed behavioral health disorder-a mental health disorder (mental illness), a substance abuse disorder (addiction), or both-who enrolled in behavioral health treatment in a northeastern U.S. city. Measures assessed racial stigma, self-stigma due to mental illness or addiction, depressive symptoms, and help-seeking barriers. Serial mediation analyses were conducted to examine hypothesized relationships among variables. Results: The results demonstrate the potential impact of double stigma on help-seeking among Black adults with a behavioral health disorder. Serial mediation analyses show that there is a significant positive relationship between racial stigma and help-seeking barriers, and this relationship is partially mediated by internalized self-stigma and depressive symptoms. Conclusions and Implications for Practice: This is the first study to show a serial mediation effect for double stigma among Black adults with a behavioral health disorder. The results build on previous research on stigma and race to illustrate how experiences of racial stigma are integral to understanding how mental illness or addiction intersect with depressive symptoms and help-seeking behavior. Implications are discussed for research and practice to reduce help-seeking barriers for adults who experience double stigma.