Depression Stigma and Treatment Attitudes in Relation to Depression Severity and Health Outcomes: A Cross-Sectional Study in Taiwan

Background Although Taiwan’s universal health coverage provides accessible psychiatric services, help-seeking and antidepressant adherence among individuals with depression remain suboptimal. Stigma related to depression and negative attitudes toward treatment are key barriers. This study examined the associations between depression stigma, treatment attitudes, depression severity, and health-related quality of life (HRQoL) in Taiwanese patients with major depressive disorder. Methods A cross-sectional survey was conducted among 186 adult outpatients with major depressive disorder across eight psychiatric institutions in Taiwan. Participants completed standardized self-report questionnaires, including the Depression Stigma Scale (DSS), Antidepressant Compliance Questionnaire (ADCQ), Patient Health Questionnaire-9 (PHQ-9), and the 12-item Short Form Health Survey (SF-12). Multiple linear regression analyses were performed to identify independent predictors of depression severity and HRQoL. Results Higher levels of depression stigma were initially associated with more severe depressive symptoms and lower HRQoL. However, these associations were no longer significant after adjusting for treatment attitudes. Positive beliefs about antidepressants and a preserved sense of autonomy were independently associated with lower depression severity, while positive beliefs were also associated with better HRQoL. These findings were consistent with the study hypothesis and suggest that treatment attitudes may mediate the relationship between stigma and clinical outcomes. Conclusions Positive treatment attitudes, especially toward antidepressants and autonomy, are linked to better depression outcomes. Addressing stigma and promoting these attitudes may enhance care effectiveness.