The use of cross-sectional data precludes causal inferences. It is possible that increased social support leads to decreases in stigma (Mueller et al. 2006). While in stigma research, labeling status is commonly inferred from treatment receipt (as in the present study), comparisons with untreated persons may be confounded by other characteristics of treatment seekers beyond those considered here. While we also considered persons who perceived a need for treatment as labeled, sensitivity analyses indicated that the inclusion or exclusion of perceived need from our labeling criteria did not alter the findings. Also, self-reports of perceived stigma may be influenced by characteristics such as personality traits or social desirability, which were not addressed in the current analyses. While we used a split-sample approach to identify and confirm the factor structure of the PDD, these models should be replicated in other samples. Future work should evaluate the measurement invariance of the PDD to ensure that item bias does not influence differences in PAS across subgroups.
