Stigma and its impact on help-seeking for mental disorders: what do we know?

SummaryAims – Many people suffering from serious mental illness do not seek appropriate medical help. The stigma of mental illness has often been considered a potential cause for reluctance in seeking help. We review recent evidence on this topic. Methods – Narrative review of the recent literature on stigma and helpseeking for psychiatric disorders. Results – There is proof of a particular stigma attached to seeking help for a mental problem. Anticipated individual discrimination and discrimination qua self-stigmatisation are associated with a reduced readiness to seek professional help for mental disorders. Intervention studies show that destigmatisation may lead to increased readiness to seek professional help, but other aspects like knowledge about mental diseases seem to be at least as important. The belief that seeking help for a mental health problem is actually helpful has been shown to be at the core of help-seeking intentions and thus offers a promising target for information programmes. Population based time-trend studies show that public attitudes towards help-seeking have improved over the last decade. Discussion – The relationship between help-seeking intentions and actual help-seeking needs further exploration. While many studies have been able to relate attitudes to intentions, predicting actual help-seeking has proved more difficult.Declaration of Interest: None.

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Mental health stigma and professional help-seeking attitudes a comparison between Cuba and Germany

PLoS ONE ◽

10.1371/journal.pone.0246501 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246501

Author(s):

Laura Nohr ◽

Alexis Lorenzo Ruiz ◽

Juan E. Sandoval Ferrer ◽

Ulrike Buhlmann

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Disorders ◽

Cultural Context ◽

Help Seeking ◽

Mental Health Stigma ◽

Professional Help ◽

Help Seeking Attitudes ◽

German Sample ◽

Community Attitudes

Globally the burden due to mental disorders is continuously increasing. Still, professional help-seeking behavior is not fully understood. To conceive cultural determinants of help-seeking is crucial to reduce personal and social costs of (untreated) mental disorders. The current study investigates mental health stigma and help-seeking attitudes in a Cuban (n = 195) and a German (n = 165) sample. In a questionnaire survey we asked for attitudes towards mental illness and professional help-seeking in the general Cuban and German populations. The cultural context was associated with mental health stigma and professional help-seeking attitudes. Interestingly, Cuban participants reported stronger mental health stigma and more willingness to seek help. In multiple hierarchical regression analyses, community attitudes towards the mentally ill significantly predicted help-seeking attitudes, especially in the Cuban sample. Only in the German sample, more negative individual beliefs about mental illness predicted more self-stigma on help-seeking. Beyond that, cultural context moderated the association between mental health stigma and help-seeking attitudes with a stronger association between the measures in the German sample. However, gender did not predict help-seeking attitudes and self-stigma on help-seeking and no interactions between community attitudes, cultural context, and gender were found in the prediction of help-seeking attitudes. Similarities and differences between the samples are discussed in the light of the cultural contexts and peculiarities of the current samples. Concluding, implications of the current findings are reviewed.

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Attitudes towards psychiatric treatment and people with mental illness: changes over two decades

The British Journal of Psychiatry ◽

10.1192/bjp.bp.112.122978 ◽

2013 ◽

Vol 203 (2) ◽

pp. 146-151 ◽

Cited By ~ 158

Author(s):

Matthias C. Angermeyer ◽

Herbert Matschinger ◽

Georg Schomerus

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Disorders ◽

Alcohol Dependence ◽

Mental Health Professionals ◽

Mental Health Treatment ◽

Help Seeking ◽

Psychiatric Treatment ◽

Public Attitudes ◽

People With Mental Illness

BackgroundOver the past decades, psychiatry, as a science and a clinical discipline, has witnessed profound changes.AimsTo examine whether these changes are reflected in changes in the public's conceptualisation of mental disorders, the acceptance of mental health treatment and attitudes towards people with mental illness.MethodIn 1990 and 2011, population surveys were conducted in Germany on public attitudes about schizophrenia, depression and alcohol dependence.ResultsAlthough the public has become more inclined to endorse a biological causation of schizophrenia, the opposite trend was observed with the other two disorders. The public's readiness to recommend help-seeking from mental health professionals and using psychotherapy and psychotropic medication has increased considerably. Attitudes towards people with schizophrenia worsened, whereas for depression and alcohol dependence no or inconsistent changes were found.ConclusionsThe growing divide between attitudes towards schizophrenia and other mental disorders should be of particular concern to future anti-stigma campaigns.

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Mental health literacy among Arab university students in Israel: A qualitative study

International Journal of Social Psychiatry ◽

10.1177/00207640211036167 ◽

2021 ◽

pp. 002076402110361

Author(s):

Anwar Khatib ◽

Fareeda Abo-Rass

Keyword(s):

Mental Health ◽

Health Literacy ◽

Mental Disorders ◽

Low Socioeconomic Status ◽

Help Seeking ◽

Mental Health Literacy ◽

Mental Health Problems ◽

Arab Population ◽

Professional Help ◽

Arab Students

Background: There has been a noticeable increase in the number of studies concerned with mental health literacy (MHL), specifically among students. Still, very few studies have examined MHL among students of non-Western minority groups. Aims: This study examined MHL among Arab students in Israel based on Jorm’s conceptual framework. Methods: Twenty-eight Arab students in Israel took part in semi-structured, in-depth interviews. Most were single and Muslim, in their second year of studies, and most reported low socioeconomic status. The data were analyzed thematically, guided by the Jorm’s six MHL dimensions. Results: Different levels of literacy were found in the various MHL dimensions. The participants identified severe mental disorders more easily than mood disorders; reported a variety of possible causes of mental disorders; were well aware of available professional help (apart for rehabilitative services); identified significant barriers to mental health help seeking, as Arabs; and reported the internet as a major source of information about mental health problems and their treatment Conclusions: The participants’ MHL appeared to be associated with their unique sociocultural characteristics. This study stresses the need to raise MHL among Arab students in Israel, and in particular to promote positive attitudes to seeking professional help. It also highlights the need to develop culturally adapted mental health interventions for the Arab population in Israel.

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Help-Seeking Behavior and Treatment Barriers in Anxiety Disorders: Results from a Representative German Community Survey

Community Mental Health Journal ◽

10.1007/s10597-020-00767-5 ◽

2021 ◽

Author(s):

Ingmar Heinig ◽

Hans-Ulrich Wittchen ◽

Susanne Knappe

Keyword(s):

Anxiety Disorders ◽

Help Seeking ◽

Public Attitudes ◽

Treatment Barriers ◽

Help Seeking Behavior ◽

Target Individual ◽

Seeking Behavior ◽

Seeking Help ◽

Nationally Representative ◽

Receive Treatment

AbstractAlthough effective therapies exist, treatment rates of anxiety disorders (AD) are low, raising the question why affected individuals do not receive treatment. We provide data from the nationally representative German Health Interview and Examination Survey-2011 (DEGS1) on the help-seeking behavior and perceived treatment barriers of 650 subjects with Diagnostic and Statistical Manual of Mental Disorders’ (DSM-IV AD). Only 26% of all cases with AD in the community reported having had contact with mental health services because of their anxiety problems in their lifetime. 16% were currently receiving professional help, most frequently by psychotherapists (8%), psychiatrists (5%) and general practitioners (5%). 40% of all cases never even considered seeking help and 31% reported barriers to treatment, such as self-reliance (18%) or beliefs that treatments were ineffective (9%), unavailable (8%) or too stigmatizing (7%). Measures to increase treatment rates should thus target individual as well as public attitudes and health literacy to increase awareness of and access to evidence-based interventions.

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Shame, perceived knowledge and satisfaction associated with mental health as predictors of attitude patterns towards help-seeking

Epidemiology and Psychiatric Sciences ◽

10.1017/s204579601300036x ◽

2013 ◽

Vol 23 (2) ◽

pp. 177-187 ◽

Cited By ~ 42

Author(s):

N. Rüsch ◽

M. Müller ◽

V. Ajdacic-Gross ◽

S. Rodgers ◽

P.W. Corrigan ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Help Seeking ◽

Latent Profile Analysis ◽

Service Use ◽

Psychiatric Symptoms ◽

Mental Health Service Use ◽

Psychiatric Medication ◽

Perceived Knowledge ◽

Professional Help

Aims.To examine stigma- and knowledge-related barriers to help-seeking among members of the general population.Methods.In a representative survey of young to middle-aged Swiss adults (n = 8875), shame about a potential own mental illness, perceived knowledge about and satisfaction with one's mental health, psychiatric symptoms and attitudes towards help-seeking were assessed.Results.A latent profile analysis of all participants yielded two groups with different attitudes towards help-seeking. Relative to the majority, a one-in-four subgroup endorsed more negative attitudes towards seeking professional help, including psychiatric medication, and was characterized by more shame, less perceived knowledge, higher satisfaction with their mental health, younger age, male gender and lower education. Among participants with high symptom levels (n = 855), a third subgroup was reluctant to seek help in their private environment and characterized by high symptoms as well as low satisfaction with their mental health.Conclusions.Shame as an emotional proxy of self-stigma as well as poor subjective mental health literacy may be independent barriers to help-seeking. Interventions to increase mental health service use could focus on both variables and on those individuals with more negative views about professional help, in the general public as well as among people with a current mental illness.

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Licensing and Physician Mental Health: Problems and Possibilities

Journal of Medical Regulation ◽

10.30770/2572-1852-93.2.6 ◽

2007 ◽

Vol 93 (2) ◽

pp. 6-11

Author(s):

Herbert Hendin ◽

Charles Reynolds ◽

Dan Fox ◽

Steven I. Altchuler ◽

Phillip Rodgers ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Medical Care ◽

Help Seeking ◽

Psychiatric Care ◽

Mental Health Problems ◽

Health Related ◽

Seeking Help ◽

Medical License

ABSTRACT A number of factors appear to discourage physicians from seeking help for mental illness. This reluctance may be exacerbated by fears – well-founded or imagined – that by seeking help, physicians may put their medical license in jeopardy. To examine this risk, an analysis of all state medical board (SMB) license applications was followed by a seven-item survey mailed to SMB executive directors, and 70 percent responded. Follow up interviews were conducted with a sample of those not responding and also with a small group of directors whose responses were problematic. Thirteen of the 35 SMBs responding indicated that the diagnosis of mental illness by itself was sufficient for sanctioning physicians. The same states indicated that they treat physicians receiving psychiatric care differently than they do physicians receiving medical care. In follow-up interviews all 13 indicated that without evidence of impairment or misrepresentation any such sanctioning was likely to be temporary. A significant percentage (37 percent) of states sanction or have the ability to sanction physicians on the basis of information revealed on the licensing application about the presence of a psychiatric condition rather than on the basis of impairment. The same percentage state they treat physicians receiving psychiatric care differently than they do those receiving medical care. Physicians’ perceptions of this apparent discrimination is likely to play a role in their reluctance to seek help for mental health-related conditions. Suggestions are made for how SMBs and state physician health programs and state and county medical societies might collaborate in ways that while protecting patients decreases barriers to physicians help seeking.

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Stigma associated with and attitude regarding mental health help-seeking among undergraduate nursing students in Karachi, Pakistan

10.21203/rs.3.rs-710107/v1 ◽

2021 ◽

Author(s):

Salima Farooq ◽

Yasmin Parpio ◽

Saadia Sattar ◽

Zahra Ali ◽

Shirin Rahim ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Nursing Students ◽

Living Arrangements ◽

Help Seeking ◽

Undergraduate Nursing Students ◽

Undergraduate Nursing ◽

History Of ◽

Seeking Help ◽

The Mean

Abstract Background Globally, the prevalence of mental illness amongst university students is a major concern; same is the case with nursing students. Unaddressed mental illness stigma contributes towards hiding of symptoms hampers timely identification of the disease, and leads to reluctance in attitude towards seeking help. This study determined personal and perceived depression stigma and attitude towards help-seeking behaviors and its associated factors, among undergraduate nursing students at a private nursing institution in Karachi, Pakistan. Methods We conducted a cross-sectional study by recruiting 246 first and second-Year undergraduate nursing students using consecutive sampling. Data were collected using the Depression Stigma Scale (DSS) and the Attitude toward Seeking Professional Psychological Help Scale (ATSPPHS), along with a demographic questionnaire. Chi-square test, Fischer’s exact test and student T test were used to determine significance of difference of each response between first and second year students. Multiple linear regression was employed to determine predictors of DSS and ATSPPHS. Approval was obtained from the university’s Ethics Review Committee. Results The study findings revealed that the mean scores of the personal and perceived stigma scales were 29.7 ± 4.9 and 24.3 ± 6.1, respectively. The mean score of ATSPPHS was 16.5 ± 3.8. The participants reported a mean openness score of7.8 ± 2.6 and a value scale score of 8.7 ± 3.0. A history of psychiatric illness, current living arrangements, and personal depression stigma were found to be significant predictors of ATSPHHS. The year of study was a significant predictor of personal depression stigma whereas both years of study and the current living arrangements were significantly associated with perceived depression stigma. Conclusion Attitude towards seeking help for mental illness was significantly influenced by personal and perceived stigma. Moreover, previous history of psychiatric illness and living arrangements also predicted attitudes towards seeking help. In order to encourage positive attitudes towards seeking help for students’ well-being, it is essential to destigmatize mental health issues by adapting context-based, individualized, and group mental health interventions.

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Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness: Population-based, randomized survey experiment in rural Uganda

PLoS Medicine ◽

10.1371/journal.pmed.1002908 ◽

2019 ◽

Vol 16 (9) ◽

pp. e1002908 ◽

Cited By ~ 3

Author(s):

Justin D. Rasmussen ◽

Bernard Kakuhikire ◽

Charles Baguma ◽

Scholastic Ashaba ◽

Christine E. Cooper-Vince ◽

...

Keyword(s):

Mental Illness ◽

Population Based ◽

Survey Experiment ◽

Stigma Of Mental Illness ◽

Mental Illness Treatment

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Attitudinal and demographic factors associated with seeking help and receiving antidepressant medication for symptoms of common mental disorder

BMC Psychiatry ◽

10.1186/s12888-020-02971-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Elena A. Manescu ◽

Emily J. Robinson ◽

Claire Henderson

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Disorder ◽

Mental Health Problem ◽

Health Problem ◽

Help Seeking ◽

Common Mental Disorder ◽

General Health Questionnaire ◽

Seeking Help ◽

Positive Effect

Abstract Background Despite the increased attention given to improvement of mental health-related knowledge and attitudes, rates of help-seeking for mental illness remain low even in countries with well-developed mental health services. This study examines the relationships between attitudes to mental illness, symptoms of common mental disorder and seeking-help and receiving medication for a mental health problem. Methods We used data from the nationally representative Health Survey for England 2014 to design three logistic regression models to test for the effects of attitudes to mental illness (measured by a shortened version of the Community Attitudes toward the Mentally Ill, CAMI scale) on: recent contact with a doctor for a mental health problem; use of any type of mental health service in the last 12 months; and having antidepressants currently prescribed, while controlling for symptoms of common mental disorder (measured by the General Health Questionnaire, GHQ). We also tested for an interaction between attitudes to mental illness and symptoms of common mental disorder on the outcomes. Results A significant but very small effect of CAMI score was found on ‘antidepressants currently prescribed’ model (OR = 1.01(1.00, 1.02) but not on the two indicators of help-seeking. We also found a significant but very small interaction between CAMI and GHQ scores on recent contact with a doctor (OR = 0.99, 95% CI (0.990, 0.998); adjusted Wald test P = 0.01)). Knowing someone with a mental illness had a significant positive effect on help-seeking indicated by: (a) recent contact with a doctor (2.65 (1.01, 6.98)) and (b) currently prescribed antidepressant (2.67 (1.9, 3.75)) after controlling for attitudes to mental illness. Conclusions Our results suggest that knowing someone with a mental health problem seems to have a further positive effect on help-seeking, beyond improving attitudes to mental illness. Furthermore, multiple different types and aspects of stigma may contribute to help-seeking behaviours, consequently multi-faceted approaches are likely to be most efficient.

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Individuals with currently untreated mental illness: causal beliefs and readiness to seek help

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796017000828 ◽

2018 ◽

Vol 28 (04) ◽

pp. 446-457 ◽

Cited By ~ 11

Author(s):

S. Stolzenburg ◽

S. Freitag ◽

S. Evans-Lacko ◽

S. Speerforck ◽

S. Schmidt ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Childhood Trauma ◽

Mental Health Treatment ◽

Help Seeking ◽

Causal Beliefs ◽

Professional Help ◽

Health Treatment ◽

Causal Explanations ◽

Perceived Need

Aims.Many people with mental illness do not seek professional help. Beliefs about the causes of their current health problem seem relevant for initiating treatment. Our aim was to find out to what extent the perceived causes of current untreated mental health problems determine whether a person considers herself/himself as having a mental illness, perceives need for professional help and plans to seek help in the near future.Methods.In a cross-sectional study, we examined 207 untreated persons with a depressive syndrome, all fulfilling criteria for a current mental illness as confirmed with a structured diagnostic interview (Mini International Neuropsychiatric Interview). The sample was recruited in the community using adverts, flyers and social media. We elicited causal explanations for the present problem, depression literacy, self-identification as having a mental illness, perceived need for professional help, help-seeking intentions, severity of depressive symptoms (Patient Health Questionnaire – Depression), and whether respondents had previously sought mental healthcare.Results.Most participants fulfilled diagnostic criteria for a mood disorder (n = 181, 87.4%) and/or neurotic, stress-related and somatoform disorders (n = 120, 58.0%) according to the ICD-10. N = 94 (45.4%) participants had never received mental health treatment previously. Exploratory factor analysis of a list of 25 different causal explanations resulted in five factors: biomedical causes, person-related causes, childhood trauma, current stress and unhealthy behaviour. Attributing the present problem to biomedical causes, person-related causes, childhood trauma and stress were all associated with stronger self-identification as having a mental illness. In persons who had never received mental health treatment previously, attribution to biomedical causes was related to greater perceived need and stronger help-seeking intentions. In those with treatment experience, lower attribution to person-related causes and stress were related to greater perceived need for professional help.Conclusions.While several causal explanations are associated with self-identification as having a mental illness, only biomedical attributions seem to be related to increase perceived need and help-seeking intentions, especially in individuals with no treatment experiences. Longitudinal studies investigating causal beliefs and help-seeking are needed to find out how causal attributions guide help-seeking behaviour. From this study it seems possible that portraying professional mental health treatment as not being restricted to biomedical problems would contribute to closing the treatment gap for mental disorders.

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