The more shame they carry, the less likely they are to reach out.
Over 25% of university students may develop psychological problems, yet stigma—including public prejudice and self-stigmatization—prevents many from seeking professional help. The validated SASS scale identifies five interconnected stigma dimensions: attitudes toward others, social distance, anticipated stigma, self-stigma, and help-seeking barriers.
- Over 25% of university students develop psychological problems during their studies
- 378 students from University of La Rioja participated; average age 20.78 years, 61.6% women
- Five validated stigma dimensions: public stigma, social distance, anticipated stigma, self-stigma, help-seeking barriers
- Men showed significantly higher stigma levels across multiple dimensions compared to women
A new study validates the SASS scale to measure mental health stigma in Spanish university students, revealing that stigma remains a major barrier to seeking psychological help, with men showing significantly higher stigma levels across multiple dimensions.
A quarter of university students will struggle with their mental health at some point during their time in school. Most of them will not ask for help. The reason is not always lack of resources or awareness that help exists. Often, it is shame—the belief that admitting to psychological distress means something is fundamentally wrong with them, or the fear that others will judge them for it. Researchers in Spain have now created a tool to measure this shame in all its forms, and the results reveal how deeply it runs, especially among men.
The study, published recently by Ciulin and colleagues, validates a scale called the Stigma and Self-Stigma Scales (SASS) in a population of Spanish university students. The researchers worked with 378 students from the University of La Rioja, with an average age of just over 20 years old, about 62 percent of them women. What they found was that mental health stigma is not a single thing—it is a web of interconnected beliefs and fears that trap people in silence.
The researchers identified five distinct dimensions of stigma. There is public stigma: the stereotypes and prejudices that society holds about people with mental health problems. There is social distance: the degree to which people are willing to accept or reject someone struggling psychologically. There is anticipated stigma: the fear of being judged or discriminated against if one's struggles become known. There is self-stigma: when a person absorbs these negative beliefs and turns them inward, believing them about themselves. And there are the practical barriers: the reluctance to seek professional help, rooted in all the shame and fear that precedes it. These dimensions do not exist in isolation. The strongest connections appeared between anticipated stigma and self-stigma, and between self-stigma and unwillingness to seek professional support. In other words, the more someone fears judgment, the more they internalize shame; and the more shame they carry, the less likely they are to reach out.
The consequences ripple outward. Stigma damages self-esteem and emotional wellbeing. It interferes with academic performance and relationships. It makes people hide their distress rather than address it, which increases the risk of depression and suicidal thoughts. The university years are a particularly vulnerable time, yet they are also a moment when intervention is possible.
One of the study's most striking findings concerns gender. Men in the sample showed significantly higher levels of stigma across multiple dimensions—toward others, in terms of social distance, and in self-stigma. This aligns with previous research suggesting that men carry stronger public stigma about mental health, and that this public stigma can lead them to internalize negative beliefs about their own psychological struggles. The implication is clear: prevention and awareness programs in universities need to be tailored, and they need to reach men specifically.
The researchers acknowledge the study's limitations. All the data came from self-reports, which can be biased. The sample came from a single region of Spain, which may not represent the full diversity of Spanish university life. Future work should include larger, more diverse samples and qualitative methods that explore what stigma actually means to students—the stories and beliefs underneath the numbers.
But the validation of the SASS scale itself is significant. It is a brief, reliable tool that universities can now use to assess stigma among their students and identify where prevention efforts are most needed. The message from this research is not that stigma is inevitable. It is that stigma is measurable, and what can be measured can be addressed. Universities have a strategic role to play in reducing it—through education, through awareness campaigns, through making it safer and more normal to talk about mental health. The students are there, struggling in silence. The question now is whether institutions will use what researchers have learned to reach them.
Citações Notáveis
Stigma constitutes a multidimensional phenomenon in which negative social beliefs can become internalized and affect willingness to seek psychological support— Study authors (Ciulin et al., 2026)
A Conversa do Hearth Outra perspectiva sobre a história
Why does it matter that researchers can now measure stigma in five separate dimensions rather than just asking whether students think mental illness is bad?
Because stigma doesn't work as a single force. A student might intellectually accept that depression is real and treatable, but still fear that their peers will reject them if they find out. Or they might believe others deserve help, but feel deep shame about needing it themselves. Measuring each dimension separately lets us see where the real barriers are for each person.
The study found that men have higher stigma levels. Does that mean men are more prejudiced, or something else?
It's more subtle than prejudice. The research suggests that men internalize stronger social messages about mental health—that struggling psychologically is weakness, that you should handle it alone. So they develop higher self-stigma. They're not necessarily more judgmental of others; they're harsher on themselves.
If over a quarter of students will have mental health problems, and stigma keeps them from seeking help, what's the actual harm we're talking about?
Depression that goes untreated deepens. Anxiety spirals. And the research is clear: untreated mental health struggles increase the risk of suicidal ideation. We're talking about preventable suffering and preventable deaths, happening in a population that has access to help but won't reach for it because of shame.
The study came from one region of Spain. Does that limit what we can learn from it?
It does, in terms of whether these exact numbers apply everywhere. But the structure of stigma—the way public beliefs become internalized shame, which then blocks help-seeking—that's likely universal. The scale itself is now validated and can be used in other places to see if the pattern holds.
What would actually change if a university used this scale to measure stigma on campus?
They'd know where to focus. If men show high self-stigma but low social distance, you design different interventions than if the opposite were true. You'd also have a baseline to measure whether awareness campaigns actually work. Right now, most universities guess at what students need. This gives them data.