Adolescence is a key life period for the development of attitudes, in which social relationships acquire great relevance. Visible physical characteristics or mental health problems that do not match what is expected or what is considered “normal” can make some young people more vulnerable, as difference is traditionally stigmatised and discriminated against. Stigmatisation refers to attributes, prejudices, and negative behaviours – including discrimination – towards people who have specific characteristics or belong to a given social group (e.g., gender, ethnicity, diseases, etc.). In this regard, it should be noted that, in recent years, mental health problems have increased among children and adolescents, which can make them doubly vulnerable: due to the mental disorders they present and to the stigmatisation that surrounds them. 

This article shows the results of a research study focusing on discrimination witnessed and experienced, together with the stigmatisation that accompanies various health conditions, in a representative sample of 1,000 adolescents whose families resided in Spain. For the study, a random selection method was used in a panel sample, stratified according to geography, gender, and age (12-16 years). 

The evaluation was carried out based on an online survey with questions designed ad hoc and using various instruments – including several questionnaires and scales – with proven measures of reliability and validity, and an open-ended question in which participants had to describe situations involving discrimination. 

Between 15% and 30% of the adolescents surveyed say that they are often discriminated against. This means that they are looked down upon – other people behave as if they are better than them – in up to 30% of cases, and between 15% and 17% say they are treated with little respect or courtesy, or as if they are not intelligent. Furthermore, 14% are subjected to nicknames or insults, and 6.2% say that they are either threatened or attacked at least several times a month. The main causes identified are age, physical appearance, and height or body weight, followed by family finances and mental health problems. Other relevant reasons include aspects related to the academic context or their personality, as well as gender and sexual orientation.  

In the study sample, the adolescents surveyed who live in large cities (over 200,000 inhab.) reveal that they have been significantly more discriminated against than those who live in smaller towns (under 10,000 inhab.). Similarly, adolescents who have a disability, physical illness, or mental health problem, or who have family members or friends who experience any of these disorders, also report being significantly more discriminated against than those who do not experience them or have not been diagnosed with any of these conditions or have any friends or family members affected by them, so that their contact with this type of disorder is negligible. 

More than half of the adolescents in the sample acknowledged having witnessed discrimination against some of their peers, mainly in the form of teasing or insults. This discrimination occurs mainly in the educational environment and is exercised by adolescents themselves. The main causes are: racialisation or belonging to an ethnic minority; physical appearance (obesity, clothing, or height); being gender non-conforming or having a different sexual orientation; aspects related to health, both physical and mental, and psychological aspects, such as academic ability or certain personality traits. It has also been observed that, on occasion, adolescents identify the existence of discrimination, but are not able to specify its cause.

In a hypothetical situation in which an adolescent has a disability, a physical illness or a mental health problem, certain stigmatising attributions are identified. Unanimously, the adolescents surveyed indicated that they would help that person, but they would also feel pity or sorry for him or her, and they show segregationist attitudes, since they think that the person affected would be better off in a different classroom. Adolescents with less contact with disability, physical illness, or mental health showed these attitudes to a greater extent. These results are similar to those obtained in 2023 in the National Survey on Stigma among the Spanish Population towards People with Mental Health Problems, which identifies the same attitudes in the face of a hypothetical situation in which the person experiencing a disability, a physical illness, or a mental health problem is an adult, which suggests that adolescents have internalised the stigmatisation present in society.

In a hypothetical situation in which an adolescent has a disability, a physical illness, or a mental health problem, relationships that involve greater intimacy and physical closeness (e.g., having a partner or friend with any of these conditions), or that involve giving them some responsibility (e.g., pet sitting), generate more rejection or desire for social distance compared to less close relationships (e.g., most teens would not mind being neighbours of a young person with these conditions). Once more, adolescents with less contact with disability, physical illness and mental health showed greater rejection. Similar results were obtained in the National Survey on Stigma among the Spanish Population towards People with Mental Health Problems. Thus, as with adults, in Spanish adolescents there is no clear and manifest stigmatisation towards other adolescents who are different for health reasons, but it is possible to speak of a subtle stigmatisation, which can even be camouflaged as compassion and usually ends in rejection and discrimination towards that group. An example would be: “I feel somewhat sorry for García. I think I should help him and that he would be better off in a special classroom, but I would not want to have a partner or a friend like García, nor would I want him to take care of my pet”.

The discrimination experienced by adolescents has a negative impact on their quality of life. Stigmatisation, on the other hand, also has a negative impact on it, although to a lesser extent. Both variables explain up to 20% of the differences in the quality of life of the members of the sample, and emphasise their importance for the well-being of young people. In addition, it must be taken into account that adolescents who have a health problem (physical, mental, or disability), in addition to dealing with the symptoms of their condition, will have to deal with stigmatisation and discrimination, which makes them doubly vulnerable.

The results of this research reveal the presence of discrimination, both experienced and witnessed, among Spanish adolescents, as well as the existence of stigmatisation associated with different health conditions. Both variables are fundamental for the vulnerability of this group, since they directly affect their quality of life. In addition, the greater vulnerability of certain groups is highlighted, such as racialised adolescents or those with a non-normative physical appearance or gender. Young people with health problems can be doubly vulnerable: because of the health disorder itself and because of the resulting stigma and discrimination.

Prevention and health promotion programmes and campaigns that address health literacy in relation to different diagnoses and focus on reducing and preventing stigma associated with various health conditions can benefit young people and improve their quality of life and well-being. 

This study has certain limitations related to the methodology used, since the use of an online survey made it difficult to reach certain groups. Although the sample of adolescents is representative and stratified according to gender, age, and territorial distribution, certain vulnerable groups – such as racialised people, those of non-binary gender, those living in rural areas and those with a low socioeconomic status – are underrepresented. In addition, the percentage of adolescents in the sample who have health problems is also low. All this may have affected the results, so it is likely that studies with a greater representation of these groups will show more significant differences, especially with respect to the discrimination experienced. However, despite these limitations, the results obtained are applicable to the majority of Spanish adolescents. 

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