Perceptions of mental health stigma toward diagnostic labels among health professionals and mental health users: a Delphi study

Abstract

Background The stigma associated with mental disorders influences help-seeking behavior, quality of care, and recovery outcomes. Although diagnostic labels are essential for clinical communication and research, they may also evoke negative social perceptions that contribute to discrimination and self-stigma. Accordingly, the present study aimed to evaluate the perceived degree of stigmatization of a set of diagnostic labels for mental disorders, and secondarily to explore their perceived sex-based applicability. Methods A total of 61 terms, including diagnostic labels derived from the DSM-5 were linguistically transformed into adjectival forms and evaluated using a Delphi methodology. The study was conducted between March and July 2025 and consisted of three sequential rounds. A multidisciplinary panel comprising 36 health professionals and 14 mental health service users rated each label on a 9-point Likert-type scale according to its perceived stigmatizing potential. Consensus was assessed following the criteria established by the RAND Corporation, using percentile distributions and interquartile ranges. Ratings on whether each label was perceived as more commonly associated with men, women, or both equally were also collected. Results A total of three Delphi rounds were conducted with the aim of achieving the highest possible level of consensus among participants. Of the 61 labels evaluated, 20 reached consensus (32.78%). Among these, 95% were classified as highly stigmatizing and 5% as low in stigma, while none reached consensus for a moderate level of stigmatization. In terms of sex-based applicability, 51% of the labels were perceived as applicable to both sexes, 31% as more applicable to men, and 18% as more applicable to women. Conclusion Results showed that only a limited number of labels reached consensus regarding their stigmatizing level, highlighting the subjective and complex nature of stigma surrounding diagnostic language.