Community perspectives on adolescent mental health stigma in American Samoa

Despite reports of mental health concerns among adolescents in American Samoa, little is known about the current mental health burden. Furthermore, previous literature has identified mental illness-related stigma as a significant global barrier to mental health care access and treatment. By gathering various perspectives from adult stakeholders and adolescent participants, this community-partnered qualitative study aimed to describe the perceived stigmatization of mental health in American Samoa. Employing the Pacific-specific Fa'afaletui research framework, 28 adult informants of differing professions, ages, and genders participated in semi-structured, in-depth virtual interviews from October 2020 to February 2021. In June 2022, 35 adolescents took part in five online focus groups to validate themes generated from the adult interviews. After duplicate coding of the transcripts, the research team adopted a deductive approach to identify levels of mental health stigmatization before mapping them on to a socio-ecological model. Participants described multiple levels of mental health stigma an adolescent struggling with mental health challenges in American Samoa may encounter. Although there is progress in mobilizing services and educational resources to address various mental health needs, the perceived structural, social, interpersonal, and self-stigma of mental illness may prevent an adolescent in American Samoa from seeking social support and utilizing mental health services. Current and future interventions promoting adolescent mental wellness in American Samoa should focus on addressing the multi-level aspects of mental health stigma.