Social milieu: Arelevant concept for a better understanding of stigma and help-seeking?

Abstract

The sociocultural interconnections surrounding stigmatizing attitudes and the treatment gap in mental healthcare are complex and insufficiently understood. Is the social milieu including personal values apotentially useful instrument for psychiatric research into attitudes and healthcare provision? This article describes individual barriers to treatment which pertain to literacy and attitudes, with contextualization of the social milieu concept. It gives a narrative review of the literature (PubMed, PsycINFO, Google Scholar) relating to the associations of different social milieu dimensions (e.g. sociodemographics, values, place of residence, ethnicity) with stigmatizing attitudes and utilization of psychiatric treatment options. Sociodemographically, lower educational attainment and male gender are often associated with psychiatric undertreatment and prevailing stigmatizing attitudes towards mental illness and its treatment. Simple sociodemographic parameters alone appear to be insufficient for predicting stigma and undertreatment. Stigmatizing attitudes and mental health literacy constitute important individual barriers to treatment. These sociodemographic and individual aspects can culminate in certain social milieus. This could allow the identification of specific target groups and communication requirements for interventions. The concept of the social milieu constitutes apotentially important and so far barely used intersection between sociology and medicine. Against the backdrop of rising public polarization and social inequality, the concept could contribute to achieving abetter understanding of the stigma of mental illness. It appears to be of relevance in anumber of ways for secondary and tertiary preventive considerations regarding the treatment gap in mental healthcare.