Major depressive disorder (MDD) is the main cause of disease and disability among young people worldwide (Achterbergh et al., 2020), with over 40% of first episodes occurring before the age of 20 (Malhi & Mann, 2018). Those with depression are met with stigma�others� negative societal views, including stereotypes, prejudices, and discriminatory behaviours (Joseph S DeLuca, 2020) � concerning their mental health that extends to global judgments of them as individuals (Katie Prizeman et al., 2023). Public stigma occurs when others act in a stigmatizing manner toward those who have mental illnesses, and internalized stigma occurs when those who have mental illness buy into stigmatizing stereotypes and anticipate that their diagnosed illness will be associated with those labels. Disclosing depression to others might not only make social connections more difficult, but it may also reduce the opportunity for treatment. 

As stigma may, in fact, be responsible for increased feelings of loneliness and a lack of disclosure, the aim of this research was to examine two alternative explanations for predicting social outcomes in young people with depression: namely, we explored whether it is depression symptoms directly or the stigma surrounding it that drives mental health secrecy and loneliness observed in this population.

N = 275 young people (M = 20.5 years, SD = 2.2) aged 17�25 years with a range of depression symptoms [Mood and Feelings Questionnaire (MFQ) � a score of ?27 considered clinical levels] were recruited from local schools and the student population via the University of Reading School of Psychology research panel, online advertisements, and posters. Participants also completed the Internalized Stigma of Mental Illness Inventory (ISMI-9*) to assess stigma, the 5-Item Link's Secrecy Scale to assess secrecy, and the UCLA Loneliness Scale (UCLA) to assess loneliness. N = 172 participants completed the same measures again at follow-up, one month later. Multiple regression analyses were used to examine the relationships between stigma, depression, secrecy, and loneliness.
 
Novel treatments for depression are needed that directly target internalized mental health stigma, as it has been found that the stigma associated with depression leads to secrecy. While mental health secrecy may temporarily safeguard people from stigma, it can also worsen negative effects such as loneliness, social isolation, and wellbeing. Future studies should examine the best ways to reduce internalized stigma and whether this can be achieved via current treatments such as cognitive behavioural therapies. It would also be of interest to know if and how psychopharmacological treatments impact internalized stigma.