Study Design and Participants
The research was led by Andrew Subica, professor of social medicine, population, and public health at UC Riverside School of Medicine, alongside Shinichi Nagata from Tsukuba University in Japan. It analyzed survey data from 1,012 geographically representative Japanese adults. Researchers examined multiple aspects of public stigma, including perceived severity of mental illness, treatability, beliefs about causes, perceived dangerousness, and desire for social distancing. These results were compared with data from a similar survey conducted in the United States in 2018.
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Only about 54% of Japanese participants said they would value seeking psychological help for serious emotional problems, compared to approximately 70% of Americans. Additionally, around 84% of Japanese respondents expressed a desire to avoid contact with someone suffering from depression, versus just 28% of Americans. The study also found that Japanese participants were less likely to believe mental illnesses can be cured through treatment. For major depression, only 78% believed therapy could lead to significant improvement, while the equivalent figure among Americans was approximately 95%.
Cultural Differences in Stigma and Implications
Subica noted that these findings show mental health stigma can take different forms depending on culture and country. He emphasized that an effective intervention in one location cannot automatically be assumed to work elsewhere. In the U. S., anti-stigma campaigns have focused on combating the perception that people with mental illness are dangerous. However, the study suggests that reducing social distance may be a more appropriate goal in Japan.
Unexpected Links Between Self-Worth and Help-Seeking
One unexpected finding was the connection between a sense of „mattering”—the belief that one is important and valued by others—and willingness to seek mental health treatment in Japan. Subica and Nagata discovered that a stronger sense of social significance was associated with greater likelihood of accessing psychological services. Other factors increasing this likelihood included prior treatment experience and stronger belief that mental illnesses can be managed effectively. Conversely, desire to avoid social contact and belief that conditions can be overcome without intervention were linked to lower help-seeking intent.
Interpretation and Future Research
Subica acknowledged that this correlation does not necessarily imply a direct causal relationship but offers a valuable starting point for future research. He said they did not expect this factor—sense of mattering—to show such a clear link to treatment access. Still, even in highly stigmatizing environments, people who feel they matter to others tend to be more willing to seek help for their mental health struggles.
Context of Mental Health Care in Japan
These findings emerge amid growing concern over mental health care utilization in Japan. Although the country’s health system has substantial resources, use of psychological treatments remains very low, creating a gap between real needs and actual action. Subica explained that cultural context plays an essential role in understanding this issue. Historically, mental illness has been kept hidden from public view in Japan, and fears about family honor and social status can influence how these conditions are perceived and discussed.
Broader Cultural Lesson
Subica stated that in some cultures, mental illness is not seen as affecting only an individual but can be perceived as impacting the reputation and status of the entire family. The biggest lesson, he said, is that culture matters. We must understand the specific cultural factors that generate stigma and influence treatment access, then design interventions based on these particularities.
Researcher’s Personal Connection
Subica has a personal connection to this field of research.