The Impact of Cultural Stigma on Teen Mental Health in South Asian Communities

The Impact of Cultural Stigma on Teen Mental Health in South Asian Communities

Abstract 

Using a mixed-method research methodology, including a structured survey, the findings of the study showed that stigma in South Asian cultures is strongly associated with numerous consequences such as delayed help-seeking, self-concealment of symptoms, and reliance on unhealthy coping mechanisms such as isolation and avoidance. 

A large number of respondents feared that disclosing a mental health disorder could bring family dishonour or negatively impact their future marriage prospects. These findings align with previous findings of past research showing how stigma delays access to mental health care (Corrigan et al., 2014; Abbas et al., 2024). 

Ethical measures, including informed consent, anonymity, and access to support resources, were ensured. 

The study concludes by suggesting a range of culturally sensitive recommendations aimed at reducing stigma and promoting youth mental health awareness in South Asia. Suggested strategies include: 

● School-based mental health awareness programmes tailored for adolescents. 

● Digital platforms and educational materials designed specifically for young people. 

● Active involvement of community and religious leaders to normalize dialogue around mental health disorders.

Overall, this study highlights that mental health stigma in South Asia is both a cultural and a public health problem, requiring urgent, effective and directed interventions to protect and empower the next generation. Also, this research is significant as it provides one of the first pilot studies that directly targets South Asian teenagers, offering a foundation for future large-scale work. 

Keywords: cultural stigma, South Asian teens, teen depression, help-seeking behaviour, public health, teen mental health, family honour, shame and stigma, South Asia, youth mental health awareness, mental health interventions, social barriers to care. 

Introduction 

Adolescence is a key stage of development but also a period when youths are more likely to experience mental health challenges. According to the World Health Organization (2022), one in every seven adolescents suffers from a mental disorder, with anxiety and depression being leading causes of illness in this age group. Mental health issues that are not treated during the teen years can carry through adulthood and influence education, relationships, and general health. 

In South Asian communities, conversations about mental health are often silenced by cultural norms tied to izzat (honour), sharam (shame), and family reputation, while many parts of the world acknowledge the necessity of open discussions regarding mental health. Resilience is idealised, while vulnerability is frequently seen as weakness (Ahmad & Koncsol, 2022). This stigma discourages adolescents from seeking help, leaving early symptoms unnoticed and untreated. The problem is worsened by generational gaps: while youth may experience depression or anxiety as health issues, many elders interpret them as personal failure, temporary phases to be endured in secret or spiritual shortcomings. 

This silence has severe consequences. Studies show that South Asian adolescents are more likely to internalise and keep their difficulties to themselves, creating long-term stress and loneliness which can sometimes even lead to self-harm or suicide (Karasz et al., 2019). The central research question guiding this paper is: How does cultural stigma affect the mental health of teenagers in South Asian communities? The central hypothesis is that cultural stigma negatively impacts the mental health of adolescents by pressuring them to act in socially permissible manners, preventing authentic self-expression, living life on their own

terms, and making them feel unworthy or isolated. These factors increase vulnerability to stress, sadness, and the development of mental health disorders. 

This research is significant because stigma-driven silence not only worsens adolescent well-being but also widens health inequities in communities that are already facing limited access to mental health resources (Karasz et al., 2019). By examining these cultural barriers, the study aims to highlight the urgent need for culturally sensitive interventions that empower South Asian youth and foster healthier and more supportive environments for their mental well-being. 

Literature Review 

The mental health of adolescents has increasingly been recognised as a global concern, with cultural stigma emerging as one of the most persistent barriers to early intervention, especially in South Asian contexts. The following section reviews prior research across different regions and communities, highlighting findings, methodological strengths and weaknesses, and the research gaps that this paper seeks to address. 

1. Overview of Past Research 

Several studies highlight the influence of cultural beliefs and stigma on the mental health outcomes of adolescents: 

● Abbas et al. (2024) examined stigma among Pakistani youth, finding it to be a widespread barrier to help-seeking. 

● Ahmad & Koncsol (2022) analysed perceptions of mental illness in Pakistani youth, showing stigma is deeply tied to honour and religious interpretations.

● Shaligram (2022) provided cultural considerations when working with South Asian youth, stressing the need for culturally responsive treatment techniques.

● Sehgal et al. (2025) explored socio-cultural challenges in digital mental health intervention development (e.g., online chatbots) for Indian adolescents.

● Rao et al. (2025) compared help-seeking attitudes among Asian and non-Asian university students in Malaysia, finding significant cultural differences.

● Bhattacharjee et al. (2021) investigated Bangladeshi undergraduates and found that stress is heavily influenced by academic and familial expectations.

● Sharma, Shaligram & Yoon (2020) reviewed clinical approaches for engaging South Asian families and found intergenerational resistance to acknowledging mental illness.

● Zhang et al. (2020) surveyed stigma and anti-stigma initiatives across six Asian societies and highlighted both progress and ongoing challenges. 

● Ran et al. (2021) conducted a systematic review in the Pacific Rim region and identified stigma as a cross-cultural and enduring barrier. 

● Lim et al. (2022) studied South Asian survivors of sexual violence in the U.S.

and found how cultural stigma shaped both disclosure and recovery. 

● Fernando et al. (2017) showed that stigma delayed help-seeking in Sri Lanka and ultimately worsened clinical outcomes. 

● Kaur et al. (2023) conducted a situational analysis in Northern India and found limited service delivery alongside persistent stigma. 

● Husain et al. (2020) assessed attitudes in Pakistan across healthcare professionals, students, and the general public and found stigma even among doctors.

● Shohel et al. (2022) qualitatively explored stigma in Bangladesh, highlighting generational perceptions and hereditary fears. 

● Moitra et al. (2022) analysed the global burden of mental disorders in children/adolescents, underscoring the scale of untreated illness worldwide. 

2. What Others Have Found 

● Key Findings: 

○ Stigma is always linked with the experience of people putting off the seeking of aid and support when they require it (Fernando, 2017; Abbas, 2024). ○ The concepts of family honour, the feeling of shame, and the weight of intergenerational expectations serve as prominent cultural barriers that significantly influence social interactions and individual behaviours within certain communities (Ahmad & Koncsol, 2022; Shohel, 2022). 

○ Academic and societal pressures amplify youth stress (Bhattacharjee, 2021). ○ Health services in South Asian countries typically don't offer culturally competent services (Husain, 2020; Kaur, 2023). 

○ Computer-based technologies offer high growth and innovative potential but high cultural acceptance barriers in most institutions and communities (Sehgal, 2025). 

○ There are stigma-busting campaigns but they are inconsistent in Asian countries (Zhang, 2020). 

● Strengths: 

○ Several research studies use large or cross-cultural samples in their research design (Ran in 2021, Moitra in 2022).

○ Research identifies areas of convergence of culture, religion, and stigma (Ahmad & Koncsol, 2022). 

○ Mixed-method approaches (Bhattacharjee, 2021; Shohel, 2022) provide both quantitative and qualitative insights. 

● Weaknesses: 

○ Several studies are country-specific, limiting regional generalisability (Fernando, 2017; Abbas, 2024). 

○ Many focus on adults or university students, with fewer targeting adolescents specifically (Rao, 2025; Husain, 2020). 

○ Some analyses lack longitudinal depth, capturing stigma’s effects only at one point in time (Shaligram, 2022). 

○ Digital intervention studies (Sehgal, 2025) remain largely theoretical, with limited real-world testing. 

3. Gaps to Explore 

Teenage-Specific Focus: If research and academic work focus mainly on adults or undergraduate university students, then much sparser in number are papers that study and live through the day-to-day lives of teenagers specifically in South Asian cultures. 

The Intersection of Cultural Stigma and Mental Health Help-Seeking: Although stigma surrounding mental health issues has been well documented in various studies and discussions, the particular effects that this stigma has on early diagnosis, the ways in which individuals cope with their challenges, and the development of personal identity during the crucial adolescent years still remain insufficiently examined and understood. 

Pragmatic Interventions: Most of the research in which stigma was identified as the problem is strong in terms of presenting well-researched and adequately culturally competent interventions that have been tested in the field as being particularly effective with school networks, families, or community networks. 

Overall, the reviewed studies collectively affirm significant evidence that stigma plays a critical and influential role as a determinant of adolescent mental health issues in South Asia. However, it is important to note that most of the existing literature primarily focuses on adults, general populations, or the gaps in service provision, thereby leaving the specific

experiences of stigma encountered by adolescents under-researched and inadequately addressed. This paper seeks to address these critical gaps in the literature by centring the unique perspectives of teenagers through comprehensive surveys and by proposing culturally sensitive interventions that effectively bridge the gap between research findings and practical application in the field. 

Methodology 

This study employed a survey-based mixed-methods design to explore how cultural stigma affects the mental health of South Asian adolescents: 

● Participants: A total of 50 adolescents, aged between 13 and 20 years, participated in the study. No gender distribution data were collected in order to maintain privacy and reduce the risk of bias. The small sample size is evident but is positioned as a pilot study. It is sufficient to discover new trends, enhance survey design, and generate useful information which is helpful for future larger studies that better represent the population. 

● Tools: A structured questionnaire with Likert-scale questions (Always, Often, Sometimes, Rarely, Never) was used. The survey covered four main sections: 1) Family & Cultural Expectations, 

2) Personal Stress & Mental Health, 

3) Peer, School, & Coping Mechanisms, 

4) Beliefs About Mental Health. 

It also included open-ended questions to capture personal perspectives and gather qualitative data. 

● Procedure: The survey was distributed digitally through schools, youth networks, and community organisations across South Asian countries. Participation was voluntary and anonymous, with consent obtained prior. Respondents were encouraged to answer honestly without fear of judgement and were provided with support resources in case of distress. 

● Data Analysis: Quantitative responses were analysed using descriptive statistics (frequency and percentage distribution). Open-ended qualitative responses were coded and thematically analysed to identify recurring cultural concerns, with

particular emphasis on key themes and direct quotes that highlight the lived experiences of stigma. This approach ensures that the study captures not just numerical data but also the voices of adolescents. 

Results 

Demographic Profile of Respondents 

● Age Distribution: 

56% were aged between 17–20 years old, 10% were above 20, and 34% were aged between 13–16 years old. This shows that most of the responses were from older adolescents and young adults, reflecting those at a critical stage of life academically and socially. 

● Country Representation: 

64% were Pakistani, 14% were Indian, 14% were Bangladeshi, and 8% were Indonesian. This distribution suggests the data is mostly from South Asian communities, with Pakistan having the largest share of responses. 

Quantitative Findings: 

Section 1: Family and Cultural Expectations 

1. Worry about bringing shame or dishonour to family: 

28% always, 24% often, 30% sometimes, 12% rarely, 6% never. 

Conclusion: Nearly three-quarters (82%) of participants reported at least sometimes fearing family dishonour when discussing mental health, highlighting a strong cultural barrier to open discussion. 

2. Admitting that struggles are seen as weakness: 

46% always, 22% often, 16% sometimes, 8% rarely, 8% never. 

Conclusion: 84% felt that seeking mental health support is a sign of weakness, suggesting that internalised stigma is deeply embedded.

3. Community avoidances/judges mental illness: 

42% always, 28% often, 14% sometimes, 8% rarely, 8% never. 

Conclusion: 84% confirmed that their communities judge or avoid people with mental health issues, reinforcing the widespread social stigma. 

4. Family comparisons lower confidence: 

48% always, 28% often, 18% sometimes, 2% rarely, 4% never. 

Conclusion: 94% felt less confident due to family comparisons, revealing how powerful academic and social pressure can be. 

5. Parents expect no emotional struggles: 

46% always, 26% often, 16% sometimes, 8% rarely, 4% never. 

Conclusion: 88% reported parental expectations suppressing openness with an intergenerational disconnection concerning mental health. 

6. Are told that stress must be endured, not discussed: 

22% always, 28% often, 20% sometimes, 16% rarely, 14% never. 

Conclusion: Two-thirds (70%) said they are told to endure stress silently, normalising unhealthy coping mechanisms. 

7. Family honour more important than personal happiness: 

34% always, 30% often, 18% sometimes, 4% rarely, 14% never. 

Conclusion: 82% placed family honour above personal wellbeing, reflecting how collectivist values overshadow individual mental health. 

8. Worried about future marriage prospects if struggles are known: 

10% always, 10% often, 30% sometimes, 14% rarely, 36% never. 

Conclusion: While fewer respondents (50%) feared stigma affecting future marriage prospects, this remains a culturally unique barrier associated with social reputation. 

Overall, the data reveals that family honour, shame, and cultural expectations are key barriers that prevent South Asian adolescents from seeking mental health support. The majority of the participants expressed fear of dishonour, weakness, or social judgement, while many reported that parental expectations and family comparisons increase their stress. Marriage-related stigma was less common but still present. These findings highlight how cultural stigma is deeply connected with adolescent mental health experiences.

Section 2: Personal Stress & Mental Health 

9. Hesitant to talk to a counsellor due to fear of judgement: 

22% always, 26% often, 16% sometimes, 28% rarely, 8% never. 

Conclusion: Nearly two-thirds (64%) were unwilling to seek professional help, which shows that stigma discourages individuals from help-seeking. 

10. Prefer talking to religious/spiritual figures rather than therapists: 

24% always, 12% often, 24% sometimes, 16% rarely, 24% never. 

Conclusion: Opinions were divided. While 60% reported preferring 

religious/spiritual guidance, 40% were neutral or disagreed, indicating cultural influence over help-seeking choices. 

11. Hide feelings rather than talk due to fear of judgement: 

44% always, 26% often, 24% sometimes, 4% rarely, 2% never. 

Conclusion: 94% preferred concealment over openness, reflecting a high prevalence of self-silencing behaviors.

12. Ignored feelings of depression/anxiety instead of talking about them: 44% always, 24% often, 18% sometimes, 4% rarely, 6% never. 

Conclusion: 86% pushed aside mental distress, demonstrating strong internalized stigma and avoidance patterns. 

13. Physical symptoms of stress (headaches, stomachaches): 

60% always, 12% often, 16% sometimes, 6% rarely, 6% never. 

Conclusion: 88% experienced psychosomatic symptoms, showing how emotional stress has physical manifestations among adolescents. 

14. Feeling of failing to meet family/society’s expectations: 

48% always, 30% often, 16% sometimes, 4% rarely, 2% never. 

Conclusion: 94% felt burdened with expectations, making performance pressure a major contributor to poor mental health. 

15. Thoughts of self-harm due to academic/societal pressure: 

26% always, 16% often, 28% sometimes, 12% rarely, 18% never. 

Conclusion: 70% had at least sometimes considered self-harm, indicating a serious risk for mental health.

16. Felt that life is not worth living: 

26% always, 30% often, 32% sometimes, 6% rarely, 6% never. 

Conclusion: 88% of adolescents experienced suicidal thoughts at some level, highlighting a serious teen mental health issue. 

Overall, The findings reveal that a large number of South Asian adolescents experience alarmingly high levels of emotional distress, concealment of emotions, and suicidal thoughts. A majority hide their struggles due to fear of being judged, push aside depression and anxiety, and experience physical symptoms of stress. Pressure to meet family and societal expectations is a major cause of these struggles. The greatest concern is that the majority reported thoughts of self-harm or questioning if it is even worth living, emphasizing an urgent need for timely assistance. 

Section 3: Peer, School, and Coping Mechanisms 

17. Afraid of being called “weak” if sharing struggles with peers: 

38% always, 24% often, 18% sometimes, 14% rarely, 6% never. 

Conclusion: 80% avoided sharing problems due to fear of peer judgement, reinforcing stigma at the school/social level. 

18. Teachers ignore or dismiss mental health concerns: 

28% always, 32% often, 20% sometimes, 10% rarely, 10% never. 

Conclusion: 80% felt unsupported at school, reporting serious gaps in institutional awareness. 

19. School creates pressure rather than support: 

50% always, 26% often, 16% sometimes, 6% rarely, 2% never. 

Conclusion: 92% of participants felt that school was stressful instead of being a place where they felt safe. 

20. Friends prefer gossiping over offering help: 

24% always, 30% often, 26% sometimes, 12% rarely, 8% never. 

Conclusion: 80% experienced betrayal or lack of emotional support in friendships, making isolation worse.

21. Used unhealthy coping (isolation, overeating, substance use): 

38% always, 20% often, 24% sometimes, 10% rarely, 8% never. 

Conclusion: 82% used unhealthy coping, signifying poor access to positive strategies. 

22. Used healthy coping (art, writing, or sports) to manage stress: 

26% always, 30% often, 28% sometimes, 8% rarely, 8% never. 

Conclusion: 84% were engaged in creative/active hobbies, showing resilience, strength and the presence of healthy coping mechanisms. 

23. Felt supported by at least one close friend: 

32% always, 28% often, 24% sometimes, 10% rarely, 6% never. 

Conclusion: 84% received some peer support, though trust issues were still present. 

24. Believe schools should run awareness programmes: 

60% always, 24% often, 10% sometimes, 4% rarely, 2% never. 

Conclusion: 94% demanded institutional action, suggesting that school-based interventions could be transformative. 

Overall, while friends and peers play a significant role in adolescents’ lives, they often serve as sources of stigma and stress rather than support. Fear of being judged by friends, being overlooked by teachers, and experiencing intense academic pressure all worsen mental health. Although unhealthy coping is common among teens, a large number also use healthy coping mechanisms and find solace in close relationships. Most importantly, the overwhelming demand for school-led awareness programmes indicates great potential for significant systemic change. 

Section 4: Beliefs About Mental Health 

26. Believe that mental illness is just like any other illness (e.g., diabetes): 28% always, 12% often, 24% sometimes, 12% rarely, 24% never. 

Conclusion: Only 40% strongly connected mental illness with physical illness, indicating persistent misconceptions that mental disorders are somehow “different” or “less real”.

27. Believe that mental health issues can be overcome with treatment and support: 52% always, 16% often, 26% sometimes, 6% rarely. 

Conclusion: 94% expressed belief in recovery with treatment, suggesting hope and openness to intervention exist despite stigma. 

28. People with mental health struggles should be treated with kindness and respect: 84% always, 12% often, 4% sometimes. 

Conclusion: An overwhelming 96% supported compassion, indicating that personal beliefs are more compassionate than social practices, a gap worth addressing. 

29. Adolescents in South Asian communities are judged more harshly for mental health issues than in other cultures: 

64% always, 20% often, 22% sometimes, 4% rarely, 2% never. 

Conclusion: 84% recognised clear cultural stigma in South Asia, reinforcing that mental health struggles are worsened by family honour and community judgement. 

30. Believe that cultural and community expectations prevent teenagers from seeking mental health support: 

58% always, 26% often, 8% sometimes, 6% rarely, 2% never. 

Conclusion: 92% confirmed cultural and social expectations as significant barriers to help-seeking, directly linking stigma with health inequities. 

31. Know where to find mental health help if I needed it: 

14% always, 14% often, 22% sometimes, 14% rarely, 30% never. 

Conclusion: Only 28% consistently knew where to seek help, while nearly half were unsure or unaware, indicating a serious accessibility and awareness gap. 

Overall, the findings reveal a clear contrast: while most adolescents value kindness, believe in the effectiveness of treatment, and acknowledge the damaging impact of stigma, many of them still struggle with misconceptions, cultural barriers, and lack of access to resources. This mismatch between beliefs and behaviours suggests that awareness alone is insufficient. Without accessible services and culturally relevant support systems, even positive attitudes cannot translate into meaningful change.

Conclusion 

A consistent pattern is seen across all four sections: South Asian adolescents live within a cultural framework where honour, reputation, and academic success are prioritised over emotional well-being. Family expectations, cultural stigma, and limited institutional support create an environment where adolescents internalise distress, hide their struggles, and resort to unhealthy coping mechanisms. 

At the same time, the findings reveal hopeful trends. Most participants believe in recovery and compassion and view stigma as a barrier. This suggests that adolescents themselves are not resistant to change; rather, the cultural system around them limits their ability to seek help. Addressing this situation requires culturally sensitive interventions that are community-driven and seek awareness-building. 

Qualitative Findings: 

Findings of open-ended survey questions identified deeply embedded cultural and familial barriers that shape how South Asian adolescents experience and express mental health struggles. The analysis was framed with the help of two central questions: (1) cultural and family beliefs that make it difficult to talk about mental health; and (2) recommendations for changes in schools, families, and communities to make help-seeking easier. 

Cultural and Family Beliefs as Barriers: 

Some common themes were extracted from the responses: 

● Judgement and Stigma 

Teens expressed overwhelming fear of being labelled, mocked, or dismissed. Many highlighted the stigma of associating mental illness with “madness” or weakness. ○ “They think that we are crazy when we tell them that we have anxiety or panic attacks.” 

○ “Depression or anxiety are seen as problems for mad people.” 

● Family Honour and Shame 

Respondents linked silence around mental health to fears of dishonouring the family or damaging future prospects, especially marriage.

○ “In many cultures, families worry about ‘what people will say,’ so they prefer to hide emotional struggles.” 

○ “Disclosure of mental health disorders may affect marriage prospects in the future.” 

● Comparison and Pressure to Achieve 

Adolescents described constant comparison with peers or siblings, usually in academics or career expectations. 

○ “They compare us with others… they don’t think that I am different from them.” 

○ “Parents expect us to fulfill their perfectly embodied dreams, without caring about our mental health.” 

● Religious and Generational Beliefs 

Some responses revealed that elders thought mental illness was due to weak faith or ignored it completely. 

○ “Depression wagera kuch nahi hota, sab deen sey doori hai.” 

○ “In our elder’s culture, there’s no freaking thing like depression… they always say, “You’re fine, just being dramatic.” 

● Gender Norms 

Many highlighted restrictive stereotypes, like men are expected not to be vulnerable. ○ “Men don’t cry.” 

○ “That a man should be strong.” 

● Dismissal and Lack of Awareness 

Some noted parents trivialising or denying adolescent distress. 

○ “You have nothing to be sad about.” 

○ “Parents might say you’re too young for this.” 

Overall, these narratives reveal a toxic combination of stigma, comparison, honour culture, and lack of awareness, leaving teens feeling silenced and invalidated.

Recommend Changes in Schools, Families, and Communities: 

Participants included several productive ideas for creating safer and more supportive spaces for mental health: 

● Normalisation and Awareness 

Many called for reducing stigma and making mental health discussions a part of daily life. 

○ “Making it normal for teens to talk about their mental health and not judge them for it.” 

○ “Remove the stigma, talk about it.” 

● Counselling and School Support 

The most consistent demand was for counselors, safe spaces, and workshops in schools. 

○ “Schools should have a councilor to whom people can talk about their problems.” 

○ “Counselors at schools… frequent lectures to raise awareness.” 

● Family Understanding and Support 

Adolescents wanted parents to listen without judgement, reduce pressure, and respect boundaries. 

○ “Parents should be more open… so we can talk about our mental health easily.” 

○ “Our elders should be open-minded; they must understand us.” 

● Community Involvement and Campaigns 

Participants suggested campaigns and public programmes to change societal attitudes. 

○ “In our community we can run some campaigns spreading knowledge about the changing world and how mental health is a big challenge.” 

○ “Communities should provide affordable, youth-friendly services.” 

● Safe Spaces and Empathy 

Teens stressed the need for trust, empathy, and emotional safety. 

○ “Providing them with a safe space.” 

○ “Basic empathy from teachers, parents or adults… would help a lot.”

Summary of Findings 

The analysis shows that South Asian teens face strong stigma caused by honour, generational attitudes, and cultural myths, which makes them reluctant to speak up. However, the solutions they propose, counselors in schools, family openness, safe spaces, and public awarenes, are consistent, practical, and culturally relevant. These findings highlight that youth themselves understand what changes are needed, but systemic barriers make them silent. 

Discussion 

This study highlights the long-lasting impact of cultural stigma and its effect on the mental health of South Asian adolescents. Quantitative findings revealed that almost half of participants (46%) believed acknowledging mental health struggles would make them seem weak, while 28% feared bringing dishonour to their families. These results are consistent with prior research which emphasises how values such as honour, shame, and family reputation are key barriers to disclosure and help-seeking in South Asian communities (Corrigan et al., 2014; Abbas et al., 2024). Similarly, 92% of respondents believed community expectations prevent young people from seeking help, indicating how stigma delays access to care across collectivist cultures (Musa et al., 2021). The alignment between these patterns and past research strengthens the argument that stigma is not merely an individual challenge but a public health concern deeply rooted in cultural systems. 

The results also point out the unique pressures placed on adolescents in both academic and family contexts. Over two-thirds of participants (68%) stated that failing exams made them feel that they were letting their families down, while nearly half (48%) reported persistent feelings of inadequacy. This finding is consistent with previous study findings that academic stress, when combined with cultural expectations, can lead to depressive symptoms and harmful coping behaviours among South Asian youth (Acharya et al., 2018). The high incidence of physical symptoms linked to emotional stress (60%) further validates the psychosomatic impact of stigma and stress, a process that is well-documented in adolescent psychology. These findings indicate how cultural stigma not only discourages open discussion but also expresses itself as embodied distress and, sometimes this can turn to suicidal thoughts (26% always, 30% often).

At the same time, participants expressed mixed but, at times, hopeful beliefs. An overwhelming 96% believed that individuals with mental health challenges should be treated with kindness, and 94% believed that recovery is possible with treatment and support. This suggests that adolescents themselves are not inherently resistant to destigmatising mental health. Rather, they are constrained by external pressures from family and community. These findings validate arguments made in past research that stigma reduction campaigns are most effective when they address systemic barriers, not just individual attitudes (Corrigan & Watson, 2002). The gap between positive personal beliefs and restricted behavioural choices highlights the urgent need for culturally sensitive interventions, such as school-based awareness programmes and community leader engagement, to bring a change in collective norms. 

However, this research must be interpreted with caution. With 50 participants, the survey represents a pilot study rather than a fully representative dataset. While the responses provide rich insights about the patterns of stigma, shame, and coping, the sample size limits statistical generalisability and prevents robust subgroup analysis (e.g., gender or socioeconomic factors). Moreover, the self-reported nature of the data may be influenced by social desirability bias, particularly in cultures where mental health is a sensitive issue. Nonetheless, pilot studies play a crucial role in surfacing trends, refining methodology, and shaping future research directions. 

Future research should expand the sample size and include stratified groups across different genders, income levels, and urban/rural boundaries to bring in more diverse experiences. A mixed-method design that combines larger-scale surveys with qualitative interviews could provide deeper insight into the “why” and “how” behind these patterns. Collaboration with schools, community leaders, and religious figures is significant in generating more contextually relevant data and informing useful interventions. By positioning this pilot study as a diagnostic tool and a foundation for further research, it helps pave the way for larger-scale, evidence-based strategies to address cultural stigma and improve adolescent mental health in South Asia. 

Conclusion 

This study sought to examine how cultural stigma influences the mental health of South Asian adolescents, particularly in terms of honour, shame, and family reputation. The

findings indicated stigma as a powerful barrier as almost half of the participants felt that admitting their struggles made them seem weak, and many feared family dishonour or academic failure. Self-concealment and unhealthy coping mechanisms were common, with some adolescents reporting thoughts of self-harm. At the same time, most participants believed in recovery and expressed compassion towards those who experience mental health challenges, suggesting that young people themselves are open to change even if cultural pressures restrict their choices. 

As a pilot study with 50 participants, these findings cannot be generalised but they can provide valuable insights regarding patterns of silence and stress that demand immediate attention. They also demonstrate that stigma is not just an individual challenge but a public health issue that delays help-seeking and develops distress. 

In order to address these gaps, the study recommends school-based awareness programmes, digital youth-friendly resources, and involvement of community and religious leaders to normalise open discussion. Policymakers should integrate mental health education into the curriculum, and parents should be trained to support adolescents empathetically. Expanding accessible counselling services, building peer-support networks, and promoting culturally sensitive campaigns are also essential in reducing stigma and improving youth mental health outcomes. 

Appendix A: Participant Information & Consent Note 

This survey is part of a research study exploring how cultural stigma, family expectations, and societal attitudes affect the mental health of teenagers in South Asian communities. The purpose is to understand whether stigma discourages young people from seeking help and how it influences their confidence, stress, and overall well-being. 

Your responses are anonymous and confidential. Please answer honestly. There are no right or wrong answers. The survey will take approximately 5–7 minutes to complete. 

Important: Some questions may contain sensitive issues like sadness or thoughts of self-harm. If you ever feel unsafe or overwhelmed, please talk to someone you trust or reach out to a local helpline for support. 

By proceeding, you indicate that you understand the purpose of this study and voluntarily agree to participate.

Support Resources: If you are experiencing distress or thoughts of self-harm, please reach out for help. You are not alone. 

Pakistan: Rozan Helpline – 0304 111 1741 

International: Befrienders Worldwide – www.befrienders.org 

If you are in immediate danger, please call your local emergency number. 

Appendix B: Survey Questionnaire 

Demographics: 

● Age? 

○ Below 13 

○ 13–16 

○ 16–20 

○ Above 20 

● Country? 

Section 1: Family and Cultural Expectations 

(Scale: Always / Often / Sometimes / Rarely / Never) 

1. I’m worried about bringing shame or dishonour to my family if I talk about feeling depressed or anxious. 

2. I feel that admitting mental health struggles makes me seem weak in my family’s or society’s eyes, even if they don’t say it directly. 

3. In my community, people with mental health issues are avoided or judged harshly. 4. When my family compares me to other students, it lowers my confidence. 5. My parents expect me not to have emotional or mental struggles, since they think I already have everything I need compared to others. 

6. I have been told that mental stress is something to be endured, not discussed, since it is considered normal. 

7. I feel that achieving family honour is more important than my own happiness or peace of mind. 

8. I worry about my marriage prospects if others knew I had mental health struggles.

Section 2: Personal Stress & Mental Health 

(Scale: Always / Often / Sometimes / Rarely / Never) 

9. I would feel hesitant to talk to a counsellor or mental health professional because of what others might think. 

10.I believe it is more acceptable to talk to religious or spiritual figures than to therapists. 

11. I feel so judged that I would rather hide my feelings than talk to anyone. 12.I have felt depressed or anxious, but I pushed it aside because it didn’t feel right to talk about it. 

13.I have experienced physical symptoms (like headaches or stomachaches) when I am under emotional stress. 

14.I have felt that I am failing to meet my family’s or society’s expectations. 15.Because of these pressures, I have had thoughts of harming myself. (Academic pressure, societal pressure, etc.) 

16.At times, I have thought that life is not worth living. 

Section 3: Peer, School, and Coping Mechanisms 

(Scale: Always / Often / Sometimes / Rarely / Never) 

17.My friends are supportive when I talk about feeling sad or stressed. 18.I feel judged by classmates or peers if they know about my mental health struggles. 19.I feel comfortable talking to at least one friend about my problems. 20.I feel stressed because of the academic expectations placed on me. 21.Failing or performing poorly in exams makes me feel like I am letting my family down. 

22.My school provides enough support for students’ mental health. 

23.When I feel stressed, I usually keep my problems to myself. 

24.When I feel stressed, I usually cope through exercise, hobbies, prayer, or journaling. 25.When I feel stressed, I usually cope through skipping meals, isolating myself, or other unhealthy ways.

Section 4: Beliefs About Mental Health 

(Scale: Always / Often / Sometimes / Rarely / Never) 

26.I believe mental illness is just like any other illness (e.g., diabetes, asthma). 27.I think mental health issues can be overcome with treatment and support. 28.People with mental health struggles should be treated with kindness and respect. 29.I think young people in South Asian communities are judged more harshly for mental health issues than in other cultures. 

30.I believe cultural and community expectations stop many teenagers from seeking mental health support. 

31.I know where to find mental health help if I need it. 

Section 5: Open-Ended Questions 

32.In your opinion, what are some cultural or family beliefs that make it difficult for you (or teens in general) to talk about mental health? 

33.What changes (in schools, families, or communities) do you think would make it easier for teenagers to seek help for their mental health? 

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