{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T01:58:36Z","timestamp":1781661516788,"version":"3.54.5"},"reference-count":73,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T00:00:00Z","timestamp":1665014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["729101011"],"award-info":[{"award-number":["729101011"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Little is known about factors contributing to perceived stigma in parents of children and adolescents with behavioral and emotional problems in outpatient mental healthcare. We aimed to identify the most relevant factors related to perceived parental stigma using least absolute shrinkage and selection operator (LASSO) regression including a broad range of factors across six domains: (1) child characteristics, (2) characteristics of the primary parent, (3) parenting and family characteristics, (4) treatment-related characteristics, (5) sociodemographic characteristics, and (6) social\u2013environmental characteristics. We adapted the Parents\u2019 Perceived Stigma of Service Seeking scale to measure perceived public stigma and affiliate stigma in 312 parents (87.8% mothers) during the first treatment year after referral to an outpatient child and adolescent clinic. We found that the six domains, including 45 individual factors, explained 34.0% of perceived public stigma and 19.7% of affiliate stigma. Child and social\u2013environmental characteristics (social relations) explained the most deviance in public stigma, followed by parental factors. The strongest factors were more severe problems of the child (especially callous\u2013unemotional traits and internalizing problems), mental healthcare use of the parent, and lower perceived parenting competence. The only relevant factor for affiliate stigma was lower perceived parenting competence. Our study points to the multifactorial nature of perceived stigma and supports that parents\u2019 perceived public stigma is susceptible to social influences, while affiliate stigma relates to parents\u2019 self-evaluation. Increasing parents\u2019 perceived parenting competence may help mitigate perceived stigma. Future studies should explore how stigma relates to treatment outcomes.<\/jats:p>","DOI":"10.3390\/ijerph191912767","type":"journal-article","created":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T22:19:27Z","timestamp":1665267567000},"page":"12767","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Factors Related to Perceived Stigma in Parents of Children and Adolescents in Outpatient Mental Healthcare"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5127-3357","authenticated-orcid":false,"given":"Halewijn M.","family":"Drent","sequence":"first","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, 9723 HE Groningen, The Netherlands"},{"name":"Accare Child Study Center, 9723 HE Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9570-9976","authenticated-orcid":false,"given":"Barbara","family":"van den Hoofdakker","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, 9723 HE Groningen, The Netherlands"},{"name":"Accare Child Study Center, 9723 HE Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8288-7757","authenticated-orcid":false,"given":"Jan K.","family":"Buitelaar","sequence":"additional","affiliation":[{"name":"Department of Cognitive Neuroscience, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, 6525 AJ Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1018-9954","authenticated-orcid":false,"given":"Pieter J.","family":"Hoekstra","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, 9723 HE Groningen, The Netherlands"},{"name":"Accare Child Study Center, 9723 HE Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2538-6136","authenticated-orcid":false,"given":"Andrea","family":"Dietrich","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, 9723 HE Groningen, The Netherlands"},{"name":"Accare Child Study Center, 9723 HE Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.childyouth.2017.03.013","article-title":"Parent-reported stigma and child anxiety: A mixed methods research study Denise","volume":"76","author":"Chavira","year":"2017","journal-title":"Child Youth Serv. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1176\/ps.2010.61.8.811","article-title":"Stigmatizing experiences of parents of children with a new diagnosis of ADHD","volume":"61","author":"DosReis","year":"2010","journal-title":"Psychiatr. Serv."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1007\/s10803-015-2637-9","article-title":"Understanding the Experience of Stigma for Parents of Children with Autism Spectrum Disorder and the Role Stigma Plays in Families\u2019 Lives","volume":"46","author":"Kinnear","year":"2016","journal-title":"J. Autism Dev. Disord."},{"key":"ref_4","unstructured":"Goffman, E. (1963). Stigma: Notes on the Management of Spoiled Identity, Prentice Hall."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/1529100614531398","article-title":"The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care","volume":"15","author":"Corrigan","year":"2014","journal-title":"Psychol. Sci. Public Interest"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3109","DOI":"10.1007\/s10826-016-0459-9","article-title":"Failing to Meet the Good Parent Ideal: Self-Stigma in Parents of Children with Mental Health Disorders","volume":"25","author":"Eaton","year":"2016","journal-title":"J. Child Fam. Stud."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s10880-015-9433-8","article-title":"The Role of Stigma in Parental Help-Seeking for Perceived Child Behavior Problems in Urban, Low-Income African American Parents","volume":"22","author":"Dempster","year":"2015","journal-title":"J. Clin. Psychol. Med. Settings"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.eurpsy.2005.04.004","article-title":"Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma","volume":"20","author":"Angermeyer","year":"2005","journal-title":"Eur. Psychiatry"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1111\/j.1468-3148.2008.00426.x","article-title":"Affiliate stigma among caregivers of people with intellectual disability or mental illness","volume":"21","author":"Mak","year":"2008","journal-title":"J. Appl. Res. Intellect. Disabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1080\/15374416.2012.700504","article-title":"The Role of Stigma in Parental Help-Seeking for Child Behavior Problems","volume":"42","author":"Dempster","year":"2013","journal-title":"J. Clin. Child Adolesc. Psychol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1111\/j.1469-7610.2005.01456.x","article-title":"The stigmatization of mental illness in children and parents: Developmental issues, family concerns, and research needs","volume":"46","author":"Hinshaw","year":"2005","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s12402-012-0085-3","article-title":"Stigma in attention deficit hyperactivity disorder","volume":"4","author":"Mueller","year":"2012","journal-title":"ADHD Atten. Deficit Hyperact. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1007\/s00787-016-0930-6","article-title":"What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies","volume":"26","author":"Reardon","year":"2017","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s10488-010-0294-z","article-title":"Stigma in child and adolescent mental health services research: Understanding professional and institutional stigmatization of youth with mental health problems and their families","volume":"37","author":"Heflinger","year":"2010","journal-title":"Adm. Policy Ment. Health Ment. Health Serv. Res."},{"key":"ref_15","first-page":"182","article-title":"Engaging Families into Child Mental Health Treatment: Updates and Special Considerations","volume":"19","author":"Gopalan","year":"2010","journal-title":"J. Can. Acad. Child Adolesc. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jad.2016.02.026","article-title":"Barriers to access and participation in community mental health treatment for anxious children","volume":"196","author":"Salloum","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1007\/s12671-016-0675-9","article-title":"Trait Mindfulness Attenuates the Adverse Psychological Impact of Stigma on Parents of Children with Autism Spectrum Disorder","volume":"8","author":"Chan","year":"2017","journal-title":"Mindfulness"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1080\/09638237.2018.1521944","article-title":"The role of mothers\u2019 affiliate stigma and child\u2019s symptoms on the distress of mothers with ADHD children","volume":"28","author":"Charbonnier","year":"2019","journal-title":"J. Ment. Health"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Chang, C.-C., Chen, Y.-M., Hsiao, R.C., Chou, W.-J., and Yen, C.-F. (2021). Affiliate Stigma in Caregivers of Children with Attention-Deficit\/Hyperactivity Disorder: The Roles of Stress-Coping Orientations and Parental Child-Rearing Styles. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18179004"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.jad.2020.09.121","article-title":"Association between affiliate stigma and depression and its moderators in caregivers of children with attention-deficit\/hyperactivity disorder","volume":"279","author":"Chen","year":"2021","journal-title":"J. Affect. Disord."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e122","DOI":"10.1016\/j.pedn.2022.04.019","article-title":"Self-esteem and family functioning mediates the association of symptom severity and parental affiliate stigma among families with children with ASD","volume":"66","author":"Lyu","year":"2022","journal-title":"J. Pediatr. Nurs."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ridd.2019.03.001","article-title":"Stigma experienced by families of individuals with intellectual disabilities and autism: A systematic review","volume":"89","author":"Mitter","year":"2019","journal-title":"Res. Dev. Disabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1080\/15374416.2014.888665","article-title":"Implications of Parental Affiliate Stigma in Families of Children with ADHD","volume":"44","author":"Mikami","year":"2015","journal-title":"J. Clin. Child Adolesc. Psychol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.socscimed.2018.09.044","article-title":"Health of parents of individuals with developmental disorders or mental health problems: Impacts of stigma","volume":"217","author":"Song","year":"2018","journal-title":"Soc. Sci. Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Chang, C.-C., Chen, Y.-M., Liu, T.-L., Hsiao, R.C., Chou, W.-J., and Yen, C.-F. (2020). Affiliate Stigma and Related Factors in Family Caregivers of Children with Attention-Deficit\/Hyperactivity Disorder. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17020576"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.psychres.2018.09.055","article-title":"Caregivers\u2019 characteristics and family constellation variables as predictors of affiliate stigma in caregivers of children with ASD","volume":"270","author":"Lovell","year":"2018","journal-title":"Psychiatry Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1037\/fsh0000004","article-title":"Shared decision-making, stigma, and child mental health functioning among families referred for primary care\u2013located mental health services","volume":"32","author":"Butler","year":"2014","journal-title":"Fam. Syst. Health"},{"key":"ref_28","first-page":"92","article-title":"The Stigma of Childhood Mental Disorders: A Conceptual Framework","volume":"49","author":"Mukolo","year":"2010","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4103","DOI":"10.1016\/j.ridd.2013.08.029","article-title":"Subjective well-being among family caregivers of individuals with developmental disabilities: The role of affiliate stigma and psychosocial moderating variables","volume":"34","author":"Werner","year":"2013","journal-title":"Res. Dev. Disabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1037\/a0036571","article-title":"Rural parents\u2019 perceived stigma of seeking mental health services for their children: Development and evaluation of a new instrument","volume":"26","author":"Williams","year":"2014","journal-title":"Psychol. Assess."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1111\/1467-9566.ep11343802","article-title":"Perceptions of stigma: The parents of autistic children","volume":"15","author":"Gray","year":"1993","journal-title":"Sociol. Health Illn."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2045","DOI":"10.1016\/j.socscimed.2010.02.023","article-title":"Internalization of stigma for parents of children with autism spectrum disorder in Hong Kong","volume":"70","author":"Mak","year":"2010","journal-title":"Soc. Sci. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1016\/j.comppsych.2014.03.003","article-title":"Parents of adolescents with psychiatric disorders: Insight into the disorder, self-stigma and parental stress","volume":"55","author":"Gaziel","year":"2014","journal-title":"Compr. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.psychres.2018.03.071","article-title":"Affiliate stigma and depression in caregivers of children with Autism Spectrum Disorders in China: Effects of self-esteem, shame and family functioning","volume":"264","author":"Zhou","year":"2018","journal-title":"Psychiatry Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.apnu.2019.08.012","article-title":"Affiliate stigma, perceived social support and perceived stress in caregivers of children with autism spectrum disorder: A multiple mediation study","volume":"33","author":"Lovell","year":"2019","journal-title":"Arch. Psychiatr. Nurs."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/j.2517-6161.1996.tb02080.x","article-title":"Regression shrinkage and selection via the Lasso","volume":"1","author":"Tibshirani","year":"1996","journal-title":"J. R. Stat. Soc. Ser. B Methodol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1007\/s00787-019-01391-9","article-title":"Factors related to parental pre-treatment motivation in outpatient child and adolescent mental health care","volume":"29","author":"Drent","year":"2019","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Frick, P.J. (2004). Inventory of Callous-Unemotional Traits, University of New Orleans.","DOI":"10.1037\/t62639-000"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1177\/1073191109344153","article-title":"Assessing the affective features of psychopathy in adolescence: A further validation of the inventory of callous and unemotional traits","volume":"17","author":"Roose","year":"2010","journal-title":"Assessment"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"(1997). Goodman, R, The Strengths and Difficulties Questionnaire: A research note. J. Child Psychol. Psychiatry, 38, 581\u2013586.","DOI":"10.1111\/j.1469-7610.1997.tb01545.x"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/00005650-199102000-00008","article-title":"Performance of a five-item mental health screening test","volume":"29","author":"Berwick","year":"1991","journal-title":"Med. Care"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1080\/10401230600801077","article-title":"Validity of Pilot Adult ADHD Self-Report Scale (ASRS) to Rate Adult ADHD Symptoms","volume":"18","author":"Adler","year":"2006","journal-title":"Ann. Clin. Psychiatry"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1017\/S0033291704002892","article-title":"The World Health Organization adult ADHD self-report scale (ASRS): A short screening scale for use in the general population","volume":"35","author":"Kessler","year":"2005","journal-title":"Psychol. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1207\/s15374424jccp2503_8","article-title":"Assessment of parenting practices in families of elementary school-age children","volume":"25","author":"Shelton","year":"1996","journal-title":"J. Clin. Child Psychol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s10826-006-9036-y","article-title":"Psychometric properties of the Alabama Parenting Questionnaire","volume":"15","author":"Essau","year":"2006","journal-title":"J. Child Fam. Stud."},{"key":"ref_46","unstructured":"Van Lier, P.A.C., and Crijnen, A.A.M. (2022, July 17). Alabama Parenting Questionnaire, Nederlandse Vertaling [Alabama Parenting Questionnaire, Dutch Translation]. Erasmus MC: Unpublished Manuscript. Available online: https:\/\/test.psychologiemagazine.nl\/test\/hoe-positief-betrokken-ben-je-bij-je-kind."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1207\/s15374424jccp1802_8","article-title":"A Measure of Parenting Satisfaction and Efficacy","volume":"18","author":"Johnston","year":"1989","journal-title":"J. Clin. Child Psychol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1177\/0265407595123009","article-title":"The Parental Stress Scale: Initial Psychometric Evidence","volume":"12","author":"Berry","year":"1995","journal-title":"J. Soc. Pers. Relatsh."},{"key":"ref_49","unstructured":"Veerman, J.W., Janssen, J., Kroes, G., De Meyer, R., Nguyen, L., and Vermulst, A. (2012). Vragenlijst Gezinsfunctioneren Volgens Ouders (VGFO). Handleiding, Praktikon. Available online: https:\/\/www.nji.nl\/instrumenten\/vragenlijst-gezinsfunctioneren-voor-ouders-vgfo."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s10826-006-9064-7","article-title":"Parent beliefs about treatment credibility and effectiveness: Assessment and relation to subsequent treatment participation","volume":"16","author":"Nock","year":"2007","journal-title":"J. Child Fam. Stud."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s10826-006-9022-4","article-title":"Parent motivation to participate in treatment: Assessment and prediction of subsequent participation","volume":"15","author":"Nock","year":"2006","journal-title":"J Child Fam. Stud."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0049-089X(92)90017-B","article-title":"A standard international socio-economic index of occupational status","volume":"21","author":"Ganzeboom","year":"1992","journal-title":"Soc. Sci. Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1177\/0002764209331527","article-title":"Neighborhood Social Capital as Differential Social Organization","volume":"52","author":"Sampson","year":"2009","journal-title":"Am. Behav. Sci."},{"key":"ref_54","first-page":"1","article-title":"mice: Multivariate Imputation by Chained Equations inR","volume":"45","year":"2011","journal-title":"J. Stat. Softw."},{"key":"ref_55","unstructured":"R Core Team (2016). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.gbif.org\/tool\/81287\/r-a-language-and-environment-for-statistical-computing."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/j.1467-9868.2010.00740.x","article-title":"Stability selection","volume":"72","author":"Meinshausen","year":"2010","journal-title":"J. R. Stat.Soc. Ser. B Stat. Methodol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v033.i01","article-title":"Regularization paths for generalized linear models via coordinate descent","volume":"33","author":"Friedman","year":"2010","journal-title":"J. Stat. Softw."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1038\/mp.2016.5","article-title":"Predicting clinical outcome from reward circuitry function and white matter structure in behaviorally and emotionally dysregulated youth","volume":"21","author":"Bertocci","year":"2016","journal-title":"Mol. Psychiatry"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1037\/ort0000386","article-title":"Linking parents\u2019 self-stigma to the adjustment of children with disabilities","volume":"89","author":"Li","year":"2019","journal-title":"Am. J. Orthopsychiatry"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1056\/NEJMra1315612","article-title":"Conduct Disorder and Callous-Unemotional Traits in Youth","volume":"371","author":"Blair","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1097\/CHI.0b013e318160e3a0","article-title":"Public Knowledge and Assessment of Child Mental Health Problems: Findings From the National Stigma Study-Children","volume":"47","author":"Pescosolido","year":"2008","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s00787-020-01512-9","article-title":"Help-seeking attitudes and intentions for generalised anxiety disorder in adolescents: The role of anxiety literacy and stigma","volume":"30","author":"Calear","year":"2020","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_63","first-page":"705","article-title":"Mental illness stigma and willingness to seek mental health care in the European Union","volume":"45","author":"Mojtabai","year":"2010","journal-title":"Soc. Psychiatry"},{"key":"ref_64","first-page":"1063","article-title":"The relationship of multiple aspects of stigma and personal contact with someone hospitalized for mental illness, in a nationally representative sample","volume":"45","author":"Boyd","year":"2009","journal-title":"Soc. Psychiatry"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"s51","DOI":"10.1192\/bjp.bp.112.112979","article-title":"Public knowledge, attitudes and behaviour regarding people with mental illness in England 2009\u20132012","volume":"202","author":"Henderson","year":"2013","journal-title":"Br. J. Psychiatry"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1176\/ps.2007.58.5.613","article-title":"Stigmatizing Attitudes and Beliefs About Treatment and Psychiatric Medications for Children with Mental Illness","volume":"58","author":"Pescosolido","year":"2007","journal-title":"Psychiatr. Serv."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Zhang, Z., Sun, K., Jatchavala, C., Koh, J., Chia, Y., Bose, J., Li, Z., Tan, W., Wang, S., and Chu, W. (2020). Overview of Stigma against Psychiatric Illnesses and Advancements of Anti-Stigma Activities in Six Asian Societies. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17010280"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1080\/15295192.2014.914361","article-title":"A Parenting Competency Model","volume":"14","author":"Johnson","year":"2014","journal-title":"Parenting"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1007\/s12671-016-0580-2","article-title":"Self-Compassion: A Potential Buffer Against Affiliate Stigma Experienced by Parents of Children with Autism Spectrum Disorders","volume":"7","author":"Wong","year":"2016","journal-title":"Mindfulness"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s10578-018-0822-8","article-title":"The Parents\u2019 Self-Stigma Scale: Development, Factor Analysis, Reliability, and Validity","volume":"50","author":"Eaton","year":"2019","journal-title":"Child Psychiatry Hum. Dev."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1037\/a0031889","article-title":"Is stigma internalized? The longitudinal impact of public stigma on self-stigma","volume":"60","author":"Vogel","year":"2013","journal-title":"J. Couns. Psychol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1111\/jpm.12505","article-title":"Correlates of affiliate stigma among family caregivers of people with mental illness: A systematic review and meta-analysis","volume":"26","author":"Shi","year":"2019","journal-title":"J. Psychiatr. Ment. Health Nurs."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1111\/j.1467-9868.2005.00503.x","article-title":"Regularization and variable selection via the elastic net","volume":"67","author":"Zou","year":"2005","journal-title":"J. R. Stat. Soc. Stat. Methodol. Ser. B"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/19\/12767\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:47:07Z","timestamp":1760143627000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/19\/12767"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,6]]},"references-count":73,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["ijerph191912767"],"URL":"https:\/\/doi.org\/10.3390\/ijerph191912767","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,6]]}}}