Andrew Subica, a professor of social medicine, population, and public health in the UC Riverside School of Medicine, and Shinichi Nagata, an associate professor at the University of Tsukuba, surveyed 1,012 Japanese adults using a geographically representative national online sample. Rather than treating stigma as a single attitude, the researchers broke it into several measurable dimensions: perceptions of how serious and how treatable mental illness is, beliefs about its causes, judgments about perceived dangerousness, and desired social distance from people living with mental disorders. This multidimensional approach matters because different components of stigma can operate independently, and interventions that target one component may leave others untouched.

To place the Japanese data in comparative context, the team compared their results with nationally representative data from the United States drawn from the 2018 General Social Survey, a long-running instrument that tracks American attitudes and behaviors. The comparison revealed a striking treatment gap. Only about 54 percent of Japanese participants reported being willing to seek mental health treatment for serious emotional problems, compared with roughly 70 percent of U.S. participants. Willingness to seek care is a critical behavioral indicator, because even in health systems with abundant clinical resources, treatment that is never requested is treatment that is never delivered.

The social distance findings were even more pronounced. About 84 percent of Japanese participants said they would want to socially distance themselves from people with depression, compared with about 28 percent of U.S. participants. Yet the pattern did not extend to every dimension of stigma. Japanese participants were actually less likely than Americans to view individuals with mental disorders as dangerous. This dissociation between perceived dangerousness and desired social distance is analytically important: it suggests that in Japan, stigma operates less through fear of violence and more through a broader relational withdrawal, a preference for separation that may reflect norms around family reputation, social standing, and the historical concealment of mental illness from public view.

Beliefs about treatability diverged as well. For major depression, about 78 percent of Japanese participants believed treatment would help, compared with approximately 95 percent of U.S. participants. Japanese respondents were also more likely to believe that mental disorders would improve without treatment. These beliefs are not trivial. Expectations about treatability are among the strongest predictors of whether people convert distress into help-seeking behavior, and the belief that problems will resolve on their own can function as a cognitive substitute for clinical care, particularly in cultures where acknowledging psychological suffering carries social cost.

Subica argued that the cross-cultural variation carries a direct lesson for public health practice. In the United States, anti-stigma campaigns have frequently concentrated on correcting the perception that people with mental illness are dangerous, an emphasis grounded in decades of American survey research. The Japanese data suggest that reducing social distance, rather than defusing perceived dangerousness, may be the more relevant target there. Mental health stigma, the study indicates, can take different forms across cultures and nations, and an intervention validated in one country cannot simply be transplanted to another with the assumption that it will work equivalently somewhere else.

The most unexpected result concerned a psychological construct known as mattering, the belief that one is important to and cared about by others. Subica and Nagata found that a stronger sense of mattering was associated with greater willingness to seek treatment in Japan, even within a highly stigmatizing environment. Prior treatment experience and stronger beliefs that mental illness can improve with treatment were also associated with greater willingness to seek care, while a greater desire for social distance and the belief that disorders would improve without treatment were associated with lower willingness. The prominence of mattering surprised the researchers themselves; they had not anticipated such a strong connection between the construct and treatment seeking.

Subica was careful to note the limits of the finding. The study does not establish that increasing people’s sense of mattering will cause them to seek treatment; the data are cross-sectional and associational. Nevertheless, he said, the result provides a basis for further research into social connection and mattering as potentially modifiable factors in promoting treatment engagement. If subsequent experimental or longitudinal work confirms the pathway, mattering could become a practical lever for interventions, one that operates not by changing attitudes toward mental illness in the abstract but by strengthening the interpersonal bonds that make help-seeking feel safe and worthwhile.

The cultural context underlying these numbers is essential to interpreting them. Subica explained that mental illness has historically been hidden from public view in Japan, and that concerns about family reputation and social standing can shape how mental illness is perceived and disclosed. In some cultures, he noted, mental illness is not seen simply as something that affects one person; it can be seen as something that affects the family’s status and reputation. That framing helps explain why desired social distance is so elevated even while perceived dangerousness is comparatively low: the stigma is relational and reputational rather than fear-based, woven into expectations about how individuals and families present themselves to their communities.

For Subica, the research also carries a personal dimension. His mother is Japanese, and he had not returned to Japan for many years before beginning this work. His broader research program has consistently shown that the culture and communities people live in strongly shape both mental and physical health outcomes in the United States, and he wanted to understand whether similar cultural factors were at play in Japan and what could be learned about helping people overcome barriers to care. The study’s central lesson, he said, is that culture matters: researchers and practitioners need to understand the specific cultural factors affecting stigma and treatment seeking and design interventions around those factors, rather than assuming that strategies developed elsewhere will translate. Amid Japan’s ongoing mental health crisis, the survey offers both a diagnosis of the treatment gap and a starting point for closing it.

Subject of Research: Mental illness stigma and treatment-seeking willingness among Japanese adults

Article Title: Mental health stigma in Japan may deter care

Article References: Mental health stigma in Japan may deter care. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: mental health stigma, Japan, social distance, treatment-seeking, mattering, cross-cultural comparison, depression, public health, General Social Survey, anti-stigma interventions, health equity, survey research

The theoretical foundation of the study comes from the social psychologist Serge Moscovici, who developed the Theory of Social Representations by building on Émile Durkheim’s earlier notion of collective representations. A social representation is a shared reconstruction of reality, shaped by the dominant norms, values, and ideologies of a society, and it arises through interpersonal interaction and communication. Where money attitudes describe an individual’s personal beliefs, emotions, and behavioral inclinations, social representations frame money as a social object, embedded in a constellation of relationships with saving, debt, investment, trust, and politics, and evolving over time as new events are assimilated. This distinction matters because attitudes do not form in a vacuum: they grow out of a cultural, historical, and economic framework that the collective supplies in advance.

The authors identified three gaps in the existing literature that their study was designed to fill. First, most psychological research on money has focused on attitudes rather than on the social representations that underpin them. Second, the field has relied overwhelmingly on quantitative methods with closed-ended questions, which reveal little about how specific money attitudes form in context. Third, genuinely cross-cultural and cross-national comparisons remain scarce, even though evidence shows that culture shapes how people perceive and categorize monetary resources. In many Western societies money is closely associated with autonomy and personal achievement, whereas in several Asian countries it is more often linked to relational and familial obligations, respect, and ethics. Earlier work in France by Vergès found that work and well-being anchored the representation of money, while a study in Turkey placed work in a more peripheral position, hinting at meaningful cultural variation.

Italy and the United States made an intriguing comparison because they share some cultural traits while diverging sharply on others. Both score similarly on individualism and on perceptions of power equality, yet they differ in willingness to accept uncertainty, time orientation, and indulgence. Italians tend to experience more stress and anxiety when facing unpredicted events, adapt traditions to circumstances, and encourage thrift, while Americans are more flexible in the face of challenges, focus on the present, and report higher happiness and life satisfaction. The economic backdrop also diverges: the United States has outperformed Italy in GDP growth in recent decades and recovered more strongly from the pandemic, while Italy continues to struggle with unemployment rates among the highest in Europe, trailing only Greece and Spain. The two welfare systems differ too, with Italy’s conservative-corporatist model tying benefits to employment and family support, and the American liberal model emphasizing individual responsibility and means-testing.

Methodologically, the researchers used the free association technique, the classic instrument of social representation research. Between March and May 2022 they collected data from 305 Italian participants, and by December 2022 they had gathered 515 participants in the United States, all recruited through an online panel and surveyed via Qualtrics. Each participant was asked to write up to ten words or expressions that came to mind when thinking about money, then to assign a positive, neutral, or negative valence to each one. They also completed three validated scales: the Financial Threat Scale, measuring fear and uncertainty about financial security; a Financial and General Vulnerability scale, assessing the likelihood of future hardship; and the Multidimensional Subjective Financial Well-being Scale, capturing satisfaction with one’s current financial situation. The Italian protocol was approved by an ethics committee at Università Cattolica, and the American protocol by Kansas State University’s research compliance office.

The analysis proceeded in three steps. A prototypical analysis, run with the IRAMuTeQ software, applied Abric’s Central Core theory, which holds that a social representation has a dual structure: a central core embodying its essence, and a peripheral zone reflecting individual differences and more adaptable meanings. Words were grouped semantically and plotted by frequency and mean rank of evocation, with lower ranks indicating greater salience. A correspondence analysis using the HOMALS procedure then mapped the associations in a two-dimensional space, and finally correlational analyses linked the resulting dimensions and emotional valence to the financial scales. A diversity index, computed by dividing the number of distinct terms by total occurrences, gauged the level of consensus in each sample.

The Italian results revealed a representation organized around abstract, symbolic values. The word money elicited 302 different associations with a mean valence of 0.31, and the most frequent responses were Work, cited by 21 percent of respondents, followed by Peacefulness at 16 percent, Well-being at 15 percent, Expenses at 15 percent, and Necessity at 13 percent. The prototypical structure placed Work and Well-being in the central core, with negative concepts entirely absent and only neutral terms such as Expenses, Necessity, and Cash in the periphery. The correspondence analysis produced two axes: a horizontal one contrasting an instrumental perspective, anchored by words like coins, paper money, cash, and wage, with a symbolic perspective marked by peacefulness, autonomy, freedom, and power; and a vertical one contrasting an individual dimension of daily practices such as effort, free time, saving, and investment with a universal dimension evoked by richness and poverty. Correlations showed that Italians who attributed a more positive valence to money reported less financial threat, less vulnerability, and higher subjective financial well-being.

The American picture was strikingly different in content, though structurally parallel. Money evoked 462 different associations with a higher mean valence of 0.42 and a diversity index of just 0.13, indicating strong consensus. The most frequent associations were Cash, cited by 25 percent of respondents, Necessity at 21 percent, Bills at 20 percent, Happiness at 19 percent, and Saving at 19 percent. The central core contained four elements, two tangible, Cash and Bills, and two psychological, Necessity and Happiness, while the periphery was dominated by pragmatic terms such as Saving, Paying, Salary, Funds, and Investing, with abstract words like Life, Power, and Importance relegated to the distant periphery. The correspondence analysis again yielded instrumental and symbolic poles, and individual and universal dimensions, but the overall image was of money as a practical, functional tool whose centrality to happiness is taken for granted. In the American sample, a more positive valence correlated strongly with higher subjective financial well-being and with lower perceived financial threat.

The convergence in structure alongside divergence in content is the study’s most theoretically interesting result. In both countries, money proved to be a polymorphous object, simultaneously symbolic and utilitarian, individual and universal. But the emotional center of gravity differs: Italians defend an abstract, strongly symbolic vision in which money connects to work, security, freedom, and long-term well-being, and their outlook is more ambivalent and cautious, consistent with earlier Italian studies that found negative visions of money centered on job loss, uncertainty, and fear of the future. Americans, by contrast, hold a pragmatic, positive representation in which money determines happiness, echoing prior cross-national research showing that Americans attribute more importance to money than Europeans do, and even Alexis de Tocqueville’s observation in 1835 that love of wealth lies at the bottom of the actions of Americans. The authors interpret the difference as a reflection of both economic conditions, with Italian unemployment making work central to the meaning of money, and cultural values, with American individual responsibility fostering a transactional view of money as the key to immediate satisfaction.

The practical implications reach into financial education and professional practice. In Italy, the authors suggest, financial education should foster a more constructive vision of money as a tool for achieving meaningful goals, emphasizing long-term security and the link between financial habits and quality of life. In the United States, programs should encourage a shift from a transactional state of happiness toward more stable well-being, helping people recognize the risks of equating money with happiness. Across both countries, the findings argue for moving beyond basic financial literacy to address the psychological dimensions of money, using strategies such as journaling, group discussion, and values-clarification exercises, since objective knowledge alone seldom changes behavior. Financial planners and mental health practitioners alike can use these insights to surface clients’ underlying beliefs about money. The authors caution that their samples were not nationally representative and that social representations are snapshots of a precise historical moment, calling for longitudinal replications in more diverse cultural settings. Even so, the message is clear: money means different things in different places, and any policy or education that ignores those shared meanings risks missing the point entirely.

Subject of Research: Cross-national comparison of social representations of money in Italy and the United States

Article Title: Thinking About Money: Cross-national Comparison of Social Representations of “Money” in Italy and the United States

Article References: Sesini, G., Gray, B., McCoy, M., Seay, M., & Lozza, E. (2026). Thinking About Money: Cross-national Comparison of Social Representations of “Money” in Italy and the United States. Trends in Psychology. https://doi.org/10.1007/s43076-026-00518-7

Image Credits: AI Generated

DOI: 10.1007/s43076-026-00518-7

Keywords: social representations, money psychology, economic psychology, cross-cultural comparison, Italy, United States, free association, financial well-being, money attitudes, financial education, Serge Moscovici, happiness