Self-Stigma Fully Mediates the Association of Anticipated Enacted Stigma and Help-Seeking Intentions in National Guard Service Members

Higher self-stigma and anticipated enacted stigma from unit leaders are linked with lower intentions to seek help from a mental health professional in service members. Research in civilians suggests that the association between stigma perceived from others (e.g., anticipated enacted stigma) and help-seeking is fully mediated by self-stigma, but this has yet to be tested in military samples. The current study explored whether self-stigma mediated the association of anticipated enacted stigma from unit leaders and help-seeking intentions from a mental health professional in 138 Iraq/Afghanistan service members. Self-stigma and anticipated enacted stigma were positively correlated with one another and negatively associated with help-seeking intentions from a mental health professional. Test of direct and indirect effects using bootstrapping revealed that the direct effect of anticipated enacted stigma on help-seeking intentions was no longer significant after accounting for self-stigma. Stigma reduction interventions to facilitate help-seeking in this population are discussed.     

Promoting Ethical and Prosocial Behavior: The Combined Effect of Ethical Leadership and Coworker Ethicality

Ethical leadership encompasses the personal conduct of the leader and the leader’s expectations that followers behave ethically. Building on social learning and social exchange theory, we propose that ethical leadership interacts with coworker ethicality to predict personnel’s ethical intentions and organizational citizenship behavior (OCB). Using data collected from a large organizational sample, we use moderated regression analysis to test the main and interactive effects of ethical leadership and coworker ethicality on ethical intentions and OCB as it relates to conscientiousness, civic virtue, and altruism. Study 1 examines how ethical leadership and coworker ethicality interact to predict ethical intentions using a sample of 1,551 military personnel. Study 2 extends the results of Study 1 by examining how ethical leadership and coworker ethicality interact to predict OCB using a combined sample of 3,363 military and civilian personnel. Consistent with social learning theory, we found positive relationships between ethical leadership and coworker ethicality with ethical outcomes (i.e., intentions and OCB). Consistent with social exchange theory, we found that perceptions of ethical leadership strengthened the relationship between coworker ethicality and ethical intentions and OCB, highlighting the importance of leaders in shaping the behavior of organizational members.     

The impact of stigma on behavioral health care utilization among active duty service members

This study assessed the relationship between the stigma of seeking psychological help and use of outpatient behavioral health services over a 2-year period among active duty military service members initially referred for neuropsychological evaluation secondary to their histories of mild traumatic brain injury. Although research has examined how stigma predicts proxies for help-seeking (i.e., attitudes towards/intentions to use services), very little research has looked at actual behavior, and studies that do have largely focused on previous use. In this study, we examined the relationship between participants’ stigma and subsequent behavioral health use. Our results indicated that whereas greater self-stigma (i.e., negative self-judgments for seeking psychological help) was associated with attending fewer behavioral health care sessions, public stigma (i.e., perceptions of public attitudes towards people who seek psychological help) was not associated with service use. These findings support the need for addressing the self-stigma associated with seeking behavioral health care.     

How psychological resources mediate and perceived social support moderates the relationship between depressive symptoms and help-seeking intentions in college students

There is a high prevalence of depression among college students, which is linked to lower levels of help-seeking intentions. However, there has been a lack of research examining variables that may help explain this relationship. The present study aimed to address this gap by examining whether psychological resources (optimism and self-esteem) mediate the relationship between depressive symptoms and help-seeking intentions, and whether this relationship is moderated by perceived social support. Participants were 8121 college students (66% female) aged 17–25 years (M?=?20.42, SD?=?1.90), who completed the My World Survey Post-Second Level, a national survey on youth mental health. Linear regression analysis confirmed that depressive symptoms predicted lower informal help-seeking intentions. Moderated mediation indicated that social support moderated the direct relationship between depressive symptoms and informal help-seeking intentions and that optimism and self-esteem mediated this relationship, when gender was controlled for. Findings indicate that social support and psychological resources help further our understanding of the relationship between depressive symptoms and help-seeking in young people. Campaigns promoting help-seeking in college students should focus on the beneficial role of social support and on fostering optimism and self-esteem as facilitators of help-seeking intentions.     

Increasing help-seeking for eating pathology among collegiate athletes: An examination of a novel,customized intervention

Athletes experience elevated risk for eating pathology (EP), but evidence lower levels of help seeking for EP than the general population. Indeed, athletes experience general (e.g., stigma) and athlete-specific (e.g., “push past physical and mental pain” attitude) barriers to help-seeking. Although general mental health help-seeking interventions have improved help seeking outcomes in athlete samples, no study has developed an intervention to increase EP help-seeking among athletes. The current study examined the effects of a 75-min mental health literacy and stigma reduction intervention among 107 collegiate athletes (54.2% female) randomly assigned to an intervention or control group. All athletes completed measures of help-seeking stigma, attitudes, intentions, and behavior at baseline, post-intervention, and six-week follow-up.At post-intervention, the intervention group demonstrated significant improvements in attitudes and intentions towards seeking help for EP and general mental health, relative to the control group. No significant differences in stigma were found between the groups. At six-week follow-up, the intervention group demonstrated higher rates of help-seeking and/or referring a friend for help than the control group. However, sustained improvements in help-seeking attitudes and intentions were not present in the intervention group compared to the control group, apart from EP help-seeking attitudes. Findings support the effectiveness of a customized intervention to improve EP help-seeking variables among athletes.     

A Brief Online Video-Based Intervention to Promote Mental Health Help-Seeking in the Context of Injuries for Athletes: A pilot study

In the athletic population, sports injuries are often associated with mental health decline. Despite the availability of services, athletes frequently do not seek help for mental health problems. A range of barriers to help-seeking in athletes have been proposed, including poor mental health literacy and limited help-seeking knowledge. To address this, the current study piloted a newly designed online intervention that aimed to increase help-seeking attitudes, intentions, and mental health literacy (specifically depression literacy) in an athletic population. Using a pre-test post-test design, a total of 207 athletes were recruited using online convenience sampling from across Australia. Athletes were from a range of sports and competition levels and were provided a brief online intervention comprising three short educational videos with content addressing: (1) the athlete’s response to injury; (2) help-seeking and social support; and (3) signs/symptoms of depression. Participants completed pre- and post-intervention surveys which measured attitudes and intentions towards mental health help-seeking, and depression literacy. Data were analysed using RM-MANOVA, which demonstrated significant within-group improvement from pre-to post-intervention for help-seeking intentions, particularly when seeking help from mental health professionals, F(1, 93) = 24.64, p < .001, and online/phone services, F(1, 93) = 29.75, p < .001. Two separate paired samples t-test demonstrated a significant increase from pre-to post-intervention for both help-seeking attitudes, t(206) = 9.04, p < .001, d = 0.628, and depression literacy, t(203) = 8.66, p < .001, d = 0.606. The current study shows promise for brief video-based interventions that provide information targeting help-seeking during times of injury. However, further research using a rigorous randomised controlled trial design is needed. Additionally, more work is required to explore if an improvement in attitudes or intentions corresponds with increased help-seeking behaviour.     

Making the grade: a pilot investigation of an e-intervention to increase mental health literacy and help-seeking intentions among international university students

ABSTRACT

International students may have less understanding and awareness of mental health issues and appear unlikely to seek help. The purpose of the current study was to construct and evaluate a brief online educational intervention designed to increase mental health literacy (MHL) and help-seeking among international tertiary students studying in Australia. The intervention was tested among 45 international tertiary students (undergraduate and postgraduate), who were randomly allocated to control and intervention conditions. The intervention led to significant improvements in help-seeking attitudes, particularly in stigmatising attitudes. No significant effects were found for MHL or help-seeking intentions. A brief educational intervention can improve help-seeking attitudes among international tertiary students. Future research may focus on establishing optimal intervention dosage.     

Stigma in help-seeking: the case of adolescents

Stigma associated with seeking help has been found to be a key help-seeking barrier, however its role is less clear for: (a) adolescents, (b) groups outside the United States and (c) different types of therapy. This study addresses these omissions by examining the relationships between perceptions of public stigma of mental illness and the self-stigma of seeking help, and how they are related to help-seeking attitudes and intentions for both individual and group therapy among adolescents in Israel (N?=?238). Path analysis confirmed that self-stigma of seeking help was negatively related to attitudes towards psychological help which was then positively related to intentions to seek help, across both individual and group therapy. Consistent with the only other study conducted in Israel, but contrasting research from other parts of the world, the relationship between perceptions of public stigma of mental illness and self-stigma of seeking help was not present for either individual or group therapy. However, perceptions of public stigma of mental illness were a direct negative predictor of help-seeking attitudes for group therapy. Overall, participants reported more negative perceptions of group therapy than individual therapy. These results have implications for future interventions to increase help-seeking behaviours for adolescents.     

Effects of a brief media intervention on expectations, attitudes, and intentions of mental health help seeking

This study examined the effects of a mass-media video intervention on expectations, attitudes, and intentions to seek help from professional mental health care services. A public service announcement-style, mass-media video intervention was developed, with prior empirical research on help-seeking behaviors organized according to the theory of reasoned action/planned behavior. In total, 228 participants were randomly assigned to 1 of 2 conditions: (a) the media-exposed intervention group, who watched programming in which the media intervention was inserted, and (b) the control group, who watched the same programming without the media intervention. The media intervention was not influential on expectation and belief-based barrier variables. However, the media intervention was effective at increasing positive attitudes toward help seeking. Findings regarding the intervention's ability to increase help-seeking intentions for interpersonal problems were complex. Implications of these findings for future research are discussed.     

Do difficulties with emotions inhibit help-seeking in adolescence? The role of age and emotional competence in predicting help-seeking intentions

We examined whether adolescents who are poor at identifying, describing, and managing their emotions (emotional competence) have lower intentions to seek help for their personal-emotional problems and suicidal ideation, as observed in adult studies. We also examined whether age moderated the relationship between competence and help-seeking. Two hundred and seventeen adolescents completed measures of emotional competence, help-seeking, hopelessness, and social support. Results indicated that adolescents who were low in emotional competence had the lowest intentions to seek help from informal sources (i.e., family and friends) and from some formal sources (e.g., mental health professionals), and the highest intentions to seek help from no-one. There was one important age-related qualification: difficulty in identifying and describing emotions was associated with higher help-seeking intentions amongst young adolescents but lower intentions among older adolescents. Social support, hopelessness, and sex could not entirely explain these relationships. Thus, even those who had high quality social support had less intention to use it if they were low in emotional competence.     

Supportive school climate and student willingness to seek help for bullying and threats of violence

This study investigated the relations between student perceptions of support and student willingness to seek help for bullying and threats of violence in a sample of 7318 ninth-grade students from 291 high schools who participated in the Virginia High School Safety Study. Hierarchical linear modeling indicated that students who perceived their teachers and other school staff to be supportive were more likely to endorse positive attitudes toward seeking help for bullying and threats of violence. In schools with more perceived support, there was less of a discrepancy in help-seeking attitudes between girls and boys. Findings suggest that efforts by school staff to provide a supportive climate are a potentially valuable strategy for engaging students in the prevention of bullying and threats of violence.     

Seeking help when transgender: Exploring the difference in mental and physical health seeking behaviors between transgender and cisgender individuals in Ireland

Abstract

Background: While there is growing awareness of the need to support the physical and mental wellbeing of transgender people, some may be reluctant to seek help from healthcare professionals. Little is understood about the mechanisms that influence help-seeking behavior in this group.

Aims: This study aimed to compare transgender and cisgender participants in their likelihood to seek help for both physical and mental health conditions, and to explore whether this help-seeking behavior is predicted by a range of sociodemographic and psychological variables.

Methods: 123 participants living in Ireland (cisgender= 67; transgender= 56) completed a questionnaire which included demographic questions, as well as measures of optimism (LOT-R), self-esteem (RSES), psychological distress (GHQ-12), attitudes towards seeking psychological help (ATSPPH-SF), and attitudes towards seeking help for a physical health problem (Attitudes Towards Seeking Medical Help Scale- Action/Intervention subscale). Associations between predictor variables and mental and physical health seeking were explored using correlation analysis and stepwise regressions.

Results: Transgender participants were less likely to seek help for a physical health issue than cisgender participants, but did not differ in mental health help-seeking behaviors. Results suggest that this may be due to differences in optimism, self-esteem and psychological distress. Transgender participants had significantly lower optimism and self-esteem, which were two factors linked to poorer physical health seeking behaviors. Optimism also emerged as a significant predictor in mental health seeking behaviors.

Discussion: The lack of a significant difference for mental health help-seeking between the transgender and cisgender participants is encouraging, as it suggests that there is less stigma surrounding mental illness than expected, however findings also contradict previous findings suggesting that physical health is less stigmatized. This could be due to stigma relating to gender-specific healthcare and suggests that healthcare professionals should acknowledge the specific healthcare needs and concerns among transgender individuals.     

A comparison of mental health literacy,attitudes, and help-seeking intentions among domestic and international tertiary students

Limited research has examined distress or help-seeking knowledge and attitudes among international students. The aim of this study was to examine psychological distress, mental health literacy (MHL), and help-seeking attitudes and intentions among a sample of domestic and international tertiary students. The sample comprised 357 domestic and international tertiary students. Participants completed an online questionnaire package, with measures relating to distress, MHL, help-seeking attitudes, and help-seeking intentions. International student status was predictive of lower scores on MHL, help-seeking attitudes, and help-seeking intentions for suicidal ideation. Student group was not predictive of help-seeking intentions for emotional problems or psychological distress, but international students had lower help-seeking intentions for suicidal ideation. Educational interventions targeting MHL and help-seeking attitudes and intentions among international students may be required to improve help-seeking behaviours.     

Biological attributions for postdeployment distress relate to higher likelihood of seeking mental health treatment in Iraq/Afghanistan service members/veterans

Service members/veterans (SM/Vs) underuse mental health care. Attribution theory suggests that attributions for psychological distress might inform help-seeking. Given recent mental health campaigns leveraging military values aimed at facilitating help-seeking for postdeployment distress, understanding how SM/Vs explain psychological distress may contribute to a better grasp of the low help-seeking rate in this population. The authors examined the association of biological and psychological attributions for postdeployment distress with help-seeking intentions from a mental health professional and medical doctor in 162 Iraq/Afghanistan SM/Vs. At the bivariate level, biological attributions were positively associated with help-seeking intentions from a mental health professional and medical doctor with small effect sizes. Psychological attributions were unrelated to help-seeking intentions from either provider. Path analysis revealed that biological attributions were positively correlated with help-seeking intentions from a medical doctor with a small effect size above and beyond the effects of psychological attributions and correlates. Biological attributions were also positively correlated with help-seeking intentions from a mental health professional with a small effect size but the significance value only trended toward significance (p = .06). Emphasizing the role of biology in postdeployment distress may promote help-seeking in SM/Vs, particularly help-seeking from medical professionals. Interventions that test the effectiveness of promoting biological explanations in campaigns aimed at increasing help-seeking may be a necessary next step in this area of inquiry.     

An empirical examination of stigma toward mental health problems and psychotherapy use in Veterans and active duty service members

Although many Veterans and active duty service members experience mental health problems, most do not seek out any sort of mental health help. Stigma (a significant predictor of treatment-seeking) has been documented among Veterans and active duty service members; however, previous research on stigma in these groups has primarily utilized correlational and qualitative designs. The purpose of this study was to gain a better understanding of stigma toward mental health problems in Veterans and active duty service members using an experimental design. One hundred sixty-five Veterans and active duty service members were randomized to read a vignette that described a Veteran who either did or did not experience a mental health problem and did or did not seek psychotherapy. Results indicated that the participants held more stigmatizing attitudes toward the Veteran who was described as having a mental health problem, but not toward the Veteran who was described as seeking psychotherapy. Additionally, participants held more positive attitudes toward the Veteran, compared to the attitudes that they believed other military members would hold. Last, with this sample of Veterans and active duty service members, self-stigma toward seeking psychotherapy was found to partially mediate the relationship between perceived public stigma and attitudes. Implications for addressing stigma in military service members and Veterans are discussed.     

Preliminary Evidence of Differences Between Stigma Source Versus Type With Individual Functioning Variables in National Guard/Reserve Troops

Extant military studies show that stigma has a variable association with seeking mental health treatment and mental health distress. Previous studies used a general measure of stigma that does not differentiate between stigma source or type. Stigma source can be either self-perceived or perceived from others, and stigma type can include stigma for disorder or stigma for help-seeking. Civilian literature demonstrates that self-stigma is more detrimental to individual functioning than stigma perceived from others, and prior studies in National Guard service members (NGSMs) show that self-stigma and stigma perceived from unit leaders were associated with lower help-seeking intentions relative to stigma perceived from unit members or family members. No military study has simultaneously explored the associations of demographic and distress variables with various stigma types and sources. To determine if prior mixed findings were due to the use of a general measure of stigma, NGSMs (n = 163) completed demographic and distress measures, as well as stigma source (e.g., self, leader) and type (i.e., general, disorder, help-seeking) assessments. General stigma was positively associated with all stigma types and sources as well as a college education. Disorder stigma was positively associated with stigma from nonmilitary sources, and self-stigma for help-seeking was negatively associated with help-seeking intentions. Likelihood of deploying again was positively associated with disorder and help-seeking stigma when perceived from someone in authority. Given the unique associations observed, future studies should utilize specific measures of stigma when examining factors related to postdeployment functioning.     

The Soft Underbelly of System Change: The Role of Leadership and Organizational Climate in Turnover during Statewide Behavioral Health Reform

This study examined leadership, organizational climate, staff turnover intentions, and voluntary turnover during a large-scale statewide behavioral health system reform. The initial data collection occurred nine months after initiation of the reform with a follow-up round of data collected 18 months later. A self-administered structured assessment was completed by 190 participants (administrators, support staff, providers) employed by 14 agencies. Key variables included leadership, organizational climate, turnover intentions, turnover, and reform-related financial stress ("low" versus "high") experienced by the agencies. Analyses revealed that positive leadership was related to a stronger empowering climate in both high and low stress agencies. However, the association between more positive leadership and lower demoralizing climate was evident only in high stress agencies. For both types of agencies empowering climate was negatively associated with turnover intentions, and demoralizing climate was associated with stronger turnover intentions. Turnover intentions were positively associated with voluntary turnover. Results suggest that strong leadership is particularly important in times of system and organizational change and may reduce poor climate associated with turnover intentions and turnover. Leadership and organizational context should be addressed to retain staff during these periods of systemic change.     

Bystander Response to Sexual Assault Disclosures in the U.S. Military: Encouraging Survivors to use Formal Resources

Experiencing military sexual assault (MSA) results in serious mental health consequences. Sexual assault survivors often disclose to informal sources of support, and how these individuals respond can have a significant effect on survivors’ wellbeing. Bystander intervention is one mechanism through which institutions, such as the U.S. Military, aim to teach informal support providers to respond positively and effectively to sexual assaults. One bystander response that survivors may find helpful is the discussion of formal resources (e.g., counseling options, reporting options). The current study examined factors associated with U.S. Service members’ intentions to encourage sexual assault survivors to report and seek mental health counseling, including individual characteristics (rank, gender, personal experience of MSA) and perceptions of military sexual assault response efforts (exposure to sexual assault training, leader response to sexual assault, service barriers). The study also examined contextual factors (branch) and interactions between individual and contextual predictors. We analyzed survey data from 27,505 active duty Service members collected by the U.S. Department of Defense. As expected, rank, gender, experience of MSA, training exposure, leader response, and service barriers were associated with Service members’ intentions to encourage MSA survivors to report and seek‐help. Bystander responses to disclosures can have a significant effect on survivors’ response to the assault, and these findings can help in identifying why bystanders may or may not encourage the use of formal resources after receiving a sexual assault disclosure.     

青少年心理行为问题与专业心理求助态度：父母知晓的中介作用

摘 要 对831名中学生施测青少年自评量表、父母知晓量表、专业心理求助态度问卷,考察青少年心理行为问题、父亲知晓、母亲知晓与专业心理求助态度的关系。结果发现：（1）青少年的专业心理求助态度与心理行为问题、父母知晓呈显著相关。（2）父亲知晓在青少年心理行为问题与专业心理求助态度的关系中起部分中介作用,母亲知晓的中介作用不显著。研究结果对青少年专业心理求助的干预有着重要意义。     

Low Intensity Conflict Stress in Soldiers: Building Coping Skills and Resources

With the conventional wars being rarer, low intensity conflict (LIC) operations have now become a norm. This new military environment is characterized by ambiguous and unpredictable situations, complex goals, invisible enemy combatants, political sensitivities, undefined restraints on weaponry tactics and associated multiple microstressors that make it highly stressful and cognitively demanding for soldiers. Considering LIC stress under a holistic / interactionistic paradigm, this review paper examines (i) the unique stressors of LIC operations and their impact on soldiers?? mental health and fitness, cognitive functioning, combat readiness and effective performance; (ii) preventive training programmes (Hardiness Training and Comprehensive Soldier Fitness) for developing and sustaining resilience; (iii) the central role of military leadership and structure as key components of combat stress control, unit cohesion, institutional support and other HR practices (e.g., command consultation, grievance redresssal, performance appraisal, communication, conflict resolution); and (iv) mental health services as coping resources and potential stress countermeasures such as psychological first aid, after-action debriefing, operational stress training, suicide prevention, treatment of stress casualities, help-seeking skills and self-care as part of preventive mental health training and post-trauma rehabilitation. The roles of both the skill-building and the stress-combating aspects of training, leadership, organizational support / HR practices and mental health services seem important as potential moderators of stress-strain relationship in LIC operations.