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.     

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.     

Attitudes toward seeking professional psychological help among Chinese students at a UK university

Aim: In this study we aimed to investigate whether Chinese international and British home students at a university in the United Kingdom differed in their attitudes towards seeking psychological help. Method: The total sample comprised 323 participants. Participants completed measures to assess their attitudes toward seeking professional psychological help (recognition of need for psychological help, stigma tolerance, interpersonal openness, confidence in mental health practitioners). Results: Chinese students reported significantly less interpersonal openness than that reported by British students. Contrary to prediction, however, no significant group differences were found on any of the other mental health attitudes (i.e. recognition of need for psychological help, confidence in mental health practitioners or stigma tolerance). Within‐group contrasts also showed that Chinese students reported lower scores on interpersonal openness than on stigma tolerance and confidence in mental health practitioners. In contrast, British participants reported less confidence in mental health practitioners and recognition of the need for psychological help than reported for stigma tolerance and interpersonal openness. Conclusion: The findings highlight the need for a greater understanding of students' cultural inclinations toward mental health issues and cultural attitudes that may hinder and/or facilitate students' access and engagement with psychological services in higher education institutions.     

Relationships Between Treatment Attitudes,Psychological Symptoms,Emotional Competence,and Help‐Seeking Intentions

The authors examined whether emotional competence (i.e., awareness, coping strategies) predicted help‐seeking intentions above and beyond previously identified factors (i.e., attitudes and perceived stigma toward professional help, psychological symptom severity) in an undergraduate sample (N = 531). Emotional awareness predicted help‐seeking intentions for personal/emotional problems and suicidal thoughts. Emotional coping strategies predicted help‐seeking intentions for suicidal thoughts and moderated the relationship between symptom severity and help‐seeking intentions for suicidal thoughts. Efforts to increase help‐seeking should address students' emotional competence.     

United States and Japanese college students' attitudes toward seeking professional psychological help

The purpose of the study was to find how nationality, sex, and past experience of seeking professional psychological services are related to attitudes toward seeking professional psychological help. Three hundred Japanese college students and 300 US college students responded to the Attitudes Toward Seeking Professional Psychological Help (ATSPPH) questionnaire. The ATSPPH consists of four subscales: Need (recognition of need), Stigma Tolerance (the degree of tolerance against stigma associated with help‐seeking action), Openness (interpersonal openness), and Confidence (confidence in mental health professionals). As predicted, past experience of seeking professional psychological service and sex were important predictor variables of performance on the ATSPPH scales. Those who had past experience of seeking professional psychological help had more favourable attitudes toward seeking professional psychological help than those who never consulted psychological professionals. Similarly, in testing the past experience separately with the two nation groups, past experience with seeking professional psychological services was found to be a predictor of the overall attitudes toward seeking professional psychological help among Japanese and US participants. Furthermore, Japanese participants with past experience also showed greater recognition of need for professional psychological help and confidence in psychological health professions than Japanese without past experience. The degree of stigma tolerance associated with help‐seeking behaviour and the tendency of interpersonal openness, however, did not differ between Japanese participants with and without the past experience of seeking professional psychological services. The same results were also found among the US participants. In terms of sex as a predictor variable, females tended to have more positive attitudes toward seeking professional psychological help than males. There was a significant nationality by sex interaction effect. US females had significantly more favourable attitudes than the other three groups, indicating that there was sex difference in help‐seeking attitudes in the US group, but not in the Japanese group. If the sex variable is ignored, Japanese students have less favourable overall attitudes toward seeking professional psychological services than US students. Other results and limitations of the study are discussed.     

Intersecting cultural identities and help-seeking attitudes: the role of religious commitment,gender, and self-stigma of seeking help

ABSTRACT

The current study (N?=?404) used a moderated moderation model to examine how gender, religious commitment, and self-stigma toward seeking psychological help may interact in the prediction of help-seeking attitudes. Bivariate zero-order correlations indicated that help-seeking attitudes was negatively associated with self-stigma of seeking help (r?=??.55) and positively associated with religious commitment (r?=?.14), and self-stigma was not significantly associated with religious commitment. Men reported more negative attitudes than women (ΔM?=??.18). Furthermore, multiple regression results revealed a three-way interaction such that the relationship between gender and help-seeking attitudes was moderated by both self-stigma and religious commitment. Specifically, men with high religious commitment and high self-stigma endorsed the most negative help-seeking attitudes, suggesting that religious men’s help-seeking attitudes may be particularly susceptible to the influence of self-stigma. Implications for research and the development of targeted interventions 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.     

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.     

Self‐Stigma,Mental Health Literacy,and Attitudes Toward Seeking Psychological Help

This study examined self‐stigma of seeking psychological help and mental health literacy as predictors of college students’ (N = 1,535) help‐seeking attitudes, with additional attention to psychological and demographic correlates. Results indicated that mental health literacy predicted help‐seeking attitudes above and beyond self‐stigma. Asian American race/ethnicity, male gender, current psychological distress, and help‐seeking history were also significant predictors. Implications for addressing mental health literacy and self‐stigma while attending to demographic and psychological variations in help seeking are discussed.     

Attitudes towards psychological treatment among older Australians

Reasons behind older adults' under‐utilisation of mental health services are complex. Barriers to access to mental health services for this group include service access and availability, attitudes of medical and mental health professionals, and attitudes of older people themselves. This questionnaire‐based study sought to investigate variables that may influence attitudes towards psychological help seeking among a late mid‐age–young‐old Australian sample of 159 community‐dwelling adults. The results suggest that attitudes towards seeking psychological help in this population were relatively positive. In addition, >50% of participants in the sample indicated that they had sought treatment for emotional or psychological difficulties in the past, with the greatest proportion of those who sought help noting that it was for “family problems” (56%). The findings suggest that negative attitudes to help seeking in this age group may not be as pervasive as previously assumed, and that help‐seeking behaviours may be high among those with positive attitudes towards help seeking.     

Behavioral Health Services Influence Medical Treatment Utilization Among Primary Care Patients with Comorbid Substance Use and Depression

Although research has shown benefits of integrating psychological care in primary care settings, it is unclear how this form of treatment impacts individuals with comorbid substance use and depression. The findings are also mixed concerning how frequently this comorbid population seeks primary care services. This study examined the associations between substance use, depression, and medical treatment utilization among 224 primary care patients. The aim of the investigation was twofold. First, to determine if depression increases medical treatment utilization among patients with substance use disorders; second, to evaluate if behavioral health treatment reduces medical service utilization. A moderated mediation model with bootstrapping analyses revealed that depression strengthened the relationship between substance use and primary care treatment utilization (both medical and behavioral health). The model also indicated that behavioral health services were associated with fewer primary care visits for individuals with comorbid substance use and depression. Clinical and social implications are discussed.     

Comparing educational interventions: Correcting misperceived norms improves college students' mental health attitudes

This research targeted potential psychological contributors to college students' low levels of help‐seeking for mental distress using a field experiment. Researchers randomly assigned 520 undergraduates to 15‐min interventions: a novel, theory‐driven social norms intervention correcting misperceived distress, stigma, and help‐seeking norms; a general education intervention increasing mental health awareness; and a stress management active control condition. The norms intervention instilled more accurate perceptions of mental health norms and temporarily reduced perceived public stigma compared to other conditions. The norms and general education interventions improved attitudes toward seeking help for mental distress for at least 2 months, relative to the control. Effects on help‐seeking behavior were not observed in this timeframe. This research elucidates the robustness of brief social psychological mental health interventions on college campuses.     

Ethnicity,Life Satisfaction,Stress, Familiarity,and Stigma Toward Mental Health Treatment

The authors examined the relative contribution of ethnicity, life satisfaction, level of stress, familiarity with mental health treatment, and self- and public stigma on attitudes toward mental health treatment among a diverse sample (N = 632) of adults. Results indicated that ethnicity, stress, familiarity, and self-stigma of mental illness were significant predictors of attitudes. Additionally, familiarity with mental health treatment moderated the relationship between public stigma and attitude.     

Externalizing behavior challenges within primary care settings

Primary care providers encounter a substantial number of behavioral health concerns leading to the increasing provision of psychological interventions within medical settings. Externalizing disorders present a particular challenge to physicians and stand to benefit a great deal from early intervention. Providing behavioral health services in primary care can reduce barriers to treatment, stigma associated with mental health, and cost of service provision. Given these advantages, scholars have examined the provision of behavioral health interventions within primary care settings. This review provides a critical overview of the extant evidence base and offers suggestions for future efforts in this area.     

A Case Study of Cognitive-Behavioral Conjoint Therapy for Combat-Related PTSD in a Same-Sex Military Couple

Military deployments to Iraq and Afghanistan are associated with increased risk for posttraumatic stress disorder (PTSD), depression, and relationship impairment. Unfortunately, the perceived stigma associated with seeking deployment-related behavioral health care in military settings has been a significant barrier to care. Historically, active-duty military service members involved in same-sex intimate relationships have experienced further stressors and barriers to care related to additional stigma and lack of social support. Prior federal regulations excluded sexual minorities from openly serving in the military, thereby limiting the available behavioral health services for same-sex couples. Since this ban was lifted after the repeal of the U.S. policy known as "Don’t Ask, Don’t Tell" in 2010, gay and lesbian service members have increased opportunities to obtain behavioral health care. One therapy that is newly available to sexual minority military couples is Cognitive-Behavioral Conjoint Therapy (CBCT), which effectively addresses co-occurring PTSD and relationship dysfunction. This case study illustrates the use of CBCT for the treatment of deployment-related PTSD in a same-sex active-duty military couple. After completing all 15 CBCT sessions, the couple reported clinically meaningful changes in the service member’s PTSD symptoms, which was maintained at the 2-month follow-up. The results of this case study indicate that CBCT for PTSD can have positive treatment outcomes with military same-sex couples. Further clinical implications are discussed.     

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.     

Attitudes Toward Professional Psychological Help Seeking in South Asian Students: Role of Stigma and Gender

This study examined (a) the roles of perceived and personal stigma on attitudes toward professional psychological help seeking and (b) the effects of these constructs across gender in South Asians. Personal stigma and being male was negatively associated with attitudes toward professional psychological help seeking; no difference in the association between personal and perceived stigma and attitudes across genders was found. These findings have implications for the engagement of South Asians in mental health services in the United States. Este estudio examinó (a) los roles de estigmas percibidos y personales en las actitudes hacia la búsqueda de ayuda psicológica profesional y (b) los efectos de estos constructos en indiviuos sudasiáticos según su sexo. El estigma personal y la identidad masculina se asociaron negativamente con las actitudes hacia la búsqueda de ayuda psicológica profesional; no se halló diferencia en la asociación entre estigmas personales y percibidos y las actitudes de los distintos sexos. Estos hallazgos tienen implicaciones para la participación de los individuos sudasiáticos en los servicios de salud mental en Estados Unidos.     

Psychological distance reduces the effect of internalized stigma on mental health treatment decisions

Although stigma is a major barrier to treatment for those with mental health concerns, it is poorly understood when stigma is more or less influential in mental health treatment decisions. In the current work, we examined whether psychological distance—the removal of an event from direct experience—reduced the influence of internalized stigma on willingness to seek treatment. Specifically, we tested the hypothesis that psychological distance versus proximity (e.g., seeking treatment in three months vs. in two days, respectively) decreases the negative influence of stigma on willingness to seek treatment. We focused on a population for whom mental health treatment decisions are personally-relevant: individuals who had previously sought mental health treatment. Experiment 1 showed that the extent to which these individuals internalized (i.e., personally endorsed) stigma about mental illness predicted lower intentions to make an appointment with a mental health care provider for themselves (but not another person). Experiment 2 replicated this result using a different measure of psychological distance (temporal distance) and extended this finding to behavior (time spent reading mental health resources). Overall, this research demonstrated that internalized stigma disrupts mental health treatment-seeking intentions and behaviors when they are psychologically proximal, but not when they are distant. Potential applications of these results are discussed.     

Predictors of the change in self-stigma following a single session of group counseling

One of the major obstacles to seeking psychological help is the stigma associated with counseling and therapy. Self-stigma, the fear of losing self-respect or self-esteem as a result of seeking help, is an important factor in the help-seeking process. In the present study, college students meeting a clinical cutoff for psychological symptoms participated in 1 session of group counseling that either contained therapist self-disclosure or did not. In general, participants reported significantly less self-stigma following the session. Working alliance-bond and session depth significantly predicted the change in self-stigma. Furthermore, self-stigma (as well as bond, depth, psychological symptoms, and being female) predicted the intention to seek help following the session. Self-stigma and session depth also predicted interest in continuing with counseling. The therapist self-disclosure condition, however, had no effect on the change in self-stigma, intentions to seek help, or interest in continuing with group counseling.     

The Role of Attachment and Stigma in the Relationship Between Stress and Attitudes Toward Counseling in South Korea

Using structural equation modeling, the authors investigated the mediators between stress and attitudes toward seeking professional help among 298 undergraduate students in South Korea. Results indicated that attachment styles (avoidance and anxiety) and stigma (public and self‐stigma) mediated the relationship between stress and attitudes toward seeking help. Furthermore, public and self‐stigma had different paths depending on attachment styles related to help seeking. Regarding previous counseling experience, differences in the relationships between stress, attachment styles, stigma, and attitudes toward seeking help were evident.