Sources of adolescent mental disorder self-stigma and the effect of mental health on its formation: a moderated mediation model.

Background: Adolescent mental disorders affect 14% of youth globally, yet treatment rates remain low (38%), particularly in low-resource settings. While stigma is a recognized barrier to care, limited evidence exists on how multi-level stigma (public, peer, family) transforms into self-stigmatization during adolescence-a critical developmental period characterized by heightened peer sensitivity. Methods: This cross-sectional study utilized a dyadic design to examine the transmission of stigma from caregivers to adolescents. We distributed survey sets to 8,500 dyads in Shandong, China. After matching and data cleaning, 4,702 valid adolescent-primary caregiver dyads remained. Validated instruments measured public stigma (STIG-9), peer stigma (PMHSS-R), family stigma (PDD), self-stigma (ISMI-10), and mental health status (GHQ-12). Results: Public stigma directly predicted peer stigma ( Conclusion: Peer stigma operates as the primary conduit through which societal stigma becomes internalized during adolescence, whereas family stigma plays a non-significant direct role. The paradoxical moderating effect of mental health-where affected youth show high baseline self-stigma but reduced reactivity-calls for developmentally tailored interventions. School-based peer initiatives should be prioritized alongside public awareness campaigns, while family programs should focus on support rather than stigma reduction.