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.     

Psychological distress and help-seeking among Taiwanese college students: role of gender and student status

This study investigated the relationship between psychological distress and attitudes toward seeking professional help and whether the relationship was moderated by gender and student status (traditional vs. non-traditional) among Chinese college students in Taiwan. 961 first-year university students completed standardised measures of depression, anxiety, attitudes toward seeking professional psychological help, and a demographic questionnaire. Results from the multiple regression analysis found that while higher levels of depression were adversely correlated with help-seeking attitudes, gender was positively correlated with help-seeking attitudes. Chinese female students held more favourable attitudes toward seeking psychological help than their male counterparts. Additionally, gender interacted with depression and anxiety in affecting attitudes toward help-seeking. These results were discussed within the Chinese cultural context and recommendations were given for student outreach programme aimed at increasing utilisation of mental health services on campus.     

Attachment style, ethnicity and help-seeking attitudes among adolescent pupils

The present study set out to explore influences on help-seeking attitudes among adolescents. The roles of attachment style, ethnicity and symptomatology were examined, as previous research (predominantly from outside the UK) has shown they have an influence on help-seeking. A self-report questionnaire survey of help-seeking attitudes was carried out among 112 Asian, black and white UK pupils (age 15 years). Teachers were identified as the most frequently used source of previous professional help. Greater intentions to seek help were associated with being female, having a secure attachment style and having had previous experience of obtaining professional psychological help, but ethnicity and level of emotional and behavioural difficulties did not predict. Results are discussed in terms of implications for enhancing adolescent help-seeking.     

归因、自我效能和社会容认度对心理求助行为的影响

在江光荣心理求助行为的“阶段-决策模型”框架下,探查处于第三阶段的被试的求助行为,侧重研究⑴对心理问题的归因、⑵作为心理咨询当事人的自我效能和⑶心理求助行为的社会容认度这三个变量对实际求助行为的影响,同时探讨变量之间的作用机制。结果表明,这三个变量对求助行为均有预测作用。其中心理求助行为的社会容认度除了对求助行为有直接作用外,还以作为心理咨询当事人的自我效能为中介变量间接影响求助行为。整个模型对求助行为解释的变异量达到26％     

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.     

Help-seeking for AIDS-related concerns: A comparison of gay men with various HIV diagnoses

Examined help-seeking and psychological distress among four groups of gay men (30 AIDS-diagnosed, 107 HIV-seropositive, 149 HIV-seronegative, 244 untested) in the AIDS Behavioral Research Project, a longitudinal survey of San Francisco gay men. The men reported high levels of anxiety, depression, and help-seeking from their social networks. AIDS-diagnosed and HIV-positives reported the most AIDS worry and were the most likely to seek help. High percentages of AIDS-diagnosed men sought help from all sources (peers, professionals, family), whereas nondiagnosed men were more likely to seek help from peers. Regardless of the men's HIV status, peers were perceived to be the most helpful source. Family members were less likely sought and perceived as least helpful. The strengths and limitations of peers as social support providers for AIDS-related concerns are discussed, including implications for the design of community programs to enhance the abilities of peer helpers.     

Professional help use among Black Americans: Implications for unmet need

Previous findings on black utilization have been largely obtained from racial comparison studies. Little attention has been paid to sociodemographic differences or the social psychological processes that affect help-seeking behavior within the black group. The present study analyzed data obtained from a national probability sample of the black population. A multidimensional contingency table analysis revealed that problems experienced by the lower income group were more serious than those experienced by the upper income group. Low-income respondents were also more likely to state that their personal distress was caused by a physical health problem. Income, however, was not related to the decision to seek professional help. The implications of these findings for understanding black illness behavior and the underutilization of services was discussed.     

Parental detection of youth's self-harm behavior

The rate and predictors of parental detection of youth self-harm behavior and relationship with help-seeking were examined in 7,036 parent-child dyads from the 1999 and 2004 surveys of Mental Health of Children and Young People in Great Britain. Youth self-harm behavior was reported by 463 (6.6%) children and adolescents but only 190 (2.7%) of the parents (kappa=0.30). Reports were more accurate if parents were from majority White ethnicity, were mothers of girls, experienced psychological distress themselves, or if children were older or had emotional/behavioral problems. Parental detection of youth self-harm was associated with increased likelihood of professional help-seeking.     

Help-seeking atititudes among Israeli adolescents

This study investigated the willingness of Israeli adolescents to seek help for emotional and health problems, and their preference for various helping agents. Nearly fifteen hundred students in grades 7-12 participated in a comprehensive survey of attitudes, health status, and concerns, and the data were analyzed. Gender and age were identified as factors associated with help-seeking attitudes. Females reported a higher level of distress and greater willingness to seek help than did males. Younger adolescents tended to state that they would turn to parents for help, whereas older adolescents increasingly preferred peers. In general, the adolescents preferred to seek help from family and peers for emotional and social problems, rather than turning to professionals. Adolescents in grades 9-10 reported the highest level of distress and were least willing to seek help for interpersonal problems and depressed mood. Overall, level of distress was not directly related to willingness to seek help. In subgroups of depressed and suicidal adolescents, an inverse relationship was found between willingness to seek help and levels of depression and suicidal ideation. Recommendations for health care services and counseling programs are discussed.     

Locus-of-Hope and Help-Seeking Intentions of Filipino Women Victims of Intimate Partner Violence

Correlates of help-seeking intentions of a sample of Filipino women victims of intimate partner violence were explored in this study, with a focus on the influence of locus-of-hope dimensions. Results indicated that self-esteem, most demographic and relationship factors were not systematically related to help-seeking intentions, but more educated battered women were less likely to seek help. As regards locus-of-hope dimensions, external-peer locus-of-hope positively predicted help-seeking intentions, whereas external-spiritual locus-of-hope negatively predicted help-seeking intentions. Results are discussed in terms of the psychological processes that guide decisions to seek help among battered women in the Philippines.     

An internet survey of emotional health,treatment seeking and barriers to accessing mental health treatment among Chinese-speaking international students in Australia

The present internet survey examined the demographic characteristics of Chinese-speaking international students in Australia, psychological distress levels as measured by the Kessler-10 (K-10) Item scale, help-seeking history and preferences, as well as treatment barriers. Of the 144 respondents, 54% reported high psychological distress (mean K-10 score?=?23.96; SD?=?9.03). However, only 9% of those who were highly distressed reported they had sought mental health services in the past year. While the majority preferred help from informal social networks, they tended to favour mental health services over traditional culture-specific forms of help. Common barriers to accessing mental health services reported by respondents with high psychological distress included costs or transportation concerns, limited knowledge of available services, time constraints, the perception that symptoms were not severe enough to warrant treatment, language difficulties and lack of knowledge of symptoms of psychological distress. Although the majority preferred face-to-face treatments over internet treatments, a considerable percentage of respondents were willing to try either treatment modality. Chinese-speaking international students are a high risk group for developing psychological distress, yet they tend to underuse mental health services. Education about the effectiveness of face-to-face and online treatments may increase treatment seeking by this population.     

Seeking professional help: Etiology beliefs about mental illness across cultures

In the present study, the authors examined the contributions of cultural beliefs about the etiology of mental illness to the seeking of help from mental health professionals among college students in 4 cultural groups, European Americans, Chinese Americans, Hong Kong Chinese, and Mainland Chinese. Group differences were found in help-seeking history and likelihood, with European and Chinese Americans being more likely to seek help than Hong Kong and Mainland Chinese. Multiple-group path analysis showed that lay beliefs about causes of mental illness and prior help-seeking history significantly predicted help-seeking likelihood, which was related positively to environmental/hereditary causes but negatively to social-personal causes. Our findings demonstrate the importance of understanding help-seeking patterns within specific cultural contexts and the effects of Western influences on shaping help-seeking propensities. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

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.     

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.     

"Company motivates the miserable": the impact of consensus information on help seeking for psychological problems

Based on an attribution theory analysis, it was predicted that normal individuals (people who do not evidence a particular target problem) would be least motivated to seek help for a psychological problem when they believe that the problem is actuarially common (i.e., high consensus). Based on an analysis of how target problem people evaluate their psychological problem, however, it was predicted that such individuals (unlike normal individuals) should be maximally motivated to seek help when they believe that the problem is common. To test these predictions, target problem and normal individuals (high vs. average test anxious females) were given feedback that they possessed a problem (test anxiety). Individuals were then told that their problem was either common, uncommon, or given no consensus information. As predicted, the higher consensus information led to the least help-seeking behavior for the normal individuals and to the most help-seeking behavior for the target problem individuals.     

Effects of gender and sex role orientation on help-seeking attitudes

This study investigated the effects of gender and sex role orientation (masculinity and femininity) on attitudes toward seeking professional psychological help in a sample of 163 student trainee teachers (52 males and 111 females) in Singapore. The mean age of students was 25.39 years (SD = 3.80). ANOVAs revealed statistically significant main effects for gender and femininity on attitudes toward help-seeking. Specifically, females were reported to have more positive overall attitudes toward professional help-seeking and were more willing to recognize a personal need for professional help compared to males. Femininity significantly influenced students’ level of stigma tolerance. These findings suggest that both gender and sex role orientation play an independent role in influencing help-seeking attitudes. In addition, these variables appear to have a differential impact on different aspects of helpseeking.     

Effects of gender and sex role orientation on help-seeking attitudes

This study investigated the effects of gender and sex role orientation (masculinity and femininity) on attitudes toward seeking professional psychological help in a sample of 163 student trainee teachers (52 males and 111 females) in Singapore. The mean age of students was 25.39 years (SD = 3.80). ANOVAs revealed statistically significant main effects for gender and femininity on attitudes toward help-seeking. Specifically, females were reported to have more positive overall attitudes toward professional help-seeking and were more willing to recognize a personal need for professional help compared to males. Femininity significantly influenced students’ level of stigma tolerance. These findings suggest that both gender and sex role orientation play an independent role in influencing help-seeking attitudes. In addition, these variables appear to have a differential impact on different aspects of helpseeking.     

Sex differences in professional help seeking among adult black Americans

This paper provides baseline data on sex differences in the use of professional help for serious personal problems in a nationally representative sample of adult black Americans. Bivariate analyses revealed that women had higher levels of psychological distress and were significantly more likely to seek professional help than were men. They were also more likely to utilize physicians and social service agencies. The relationship of gender to these help resources remained significant even when the effects of problem severity and differential problem definition were taken into account. Controlling for income, however, eliminated the sex difference for social services use but not for physician use.     

Diagnostic Features,Symptom Severity,and Help-Seeking in a Media-Recruited Sample of Women with Driving Fear

This paper examines the clinical features, symptom severity, diagnostic profile, and help-seeking behaviour of a media-recruited sample of driving-fearful women. Results support previous findings of the primary foci of fear as motor vehicle accidents as well as specific driving situations and conditions. Consistent with prior research, there was difficulty relating the foci of fear to current diagnostic concepts. Social concerns were identified as having a role in driving fear for some individuals. Fearful participants exhibited high levels of fear and symptom severity according to various diagnostic and self-report measures, although most reported that they would be unlikely to seek professional psychological help or driving instruction. Assessment of cognitions indicated a range of errors likely to maintain anxiety and fear reactions that would be a target of treatment. There were no group differences in number of major recent accidents, although fearful drivers learnt to drive later than controls, suggesting early fearfulness.

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.