Elsevier

Psychiatry Research

Volume 210, Issue 3, 30 December 2013, Pages 1154-1160
Psychiatry Research

Associations between stigma and help-seeking intentions and beliefs: Findings from an Australian national survey of young people

https://doi.org/10.1016/j.psychres.2013.08.029Get rights and content

Abstract

To reduce stigma and improve help seeking by young people for mental illness, we need a better understanding of the associations between various dimensions of stigma and young people's help-seeking intentions and helpfulness beliefs for various sources of help and for different disorders. This study assessed stigmatizing attitudes and help-seeking intentions and helpfulness beliefs via a national telephone survey of 3021 youths aged 15–25. Five stigma scales were used: social distance, personally held weak-not-sick and dangerousness beliefs, and weak-not-sick and dangerousness beliefs perceived in others. Respondents were presented with a vignette of a young person portraying depression, depression with suicidal thoughts, depression with alcohol abuse, post-traumatic stress disorder, social phobia, or psychosis. Beliefs that mental illness is a sign of personal weakness and preference for social distance were associated with less intention to seek professional help and less endorsement of their helpfulness. In contrast, dangerousness/unpredictability beliefs were associated with more intention to seek professional help and more endorsement of their helpfulness. Findings highlight the importance of examining the associations between different dimensions of stigma with different sources of help, specifically for various mental disorders, to better inform future efforts to reduce stigma and increase help seeking in young people.

Introduction

Mental disorders are the largest contributors to disability in young people (Mathews et al., 2011). In particular, the long-term sequelae of mental disorders are often exacerbated by delayed help seeking or the lack thereof (Harris et al., 2005, de Girolamo et al., 2012). The stigma attached to having a mental disorder is one important impediment to help seeking by young people (Andrews et al., 2001, Penn et al., 2005, Fröjd et al., 2007, Pescosolido et al., 2008, Gulliver et al., 2010). Young people's stigmatizing attitudes have been found to influence their intentions to seek help for mental health problems (Yap et al., 2011), which in turn influence their subsequent help-seeking behaviours (Reavley et al., 2011). Beliefs about the helpfulness of interventions for mental disorders have also been found to influence help seeking (Komiti et al., 2006, ten Have et al., 2010), and limited evidence to-date suggests that stigma may influence these beliefs (Yap et al., 2011). In order to increase appropriate help seeking by young people, we need a better understanding of how stigmatizing attitudes influence their help-seeking intentions and beliefs.

Whilst extant evidence is unequivocal about the associations between stigma and help seeking, several key questions remain unanswered. Firstly, given the multifaceted nature of stigma, it is important to elucidate how different dimensions of stigma influence help-seeking intentions and helpfulness beliefs differentially. Studies have varied in the dimensions of stigma examined. These have included ‘perceived or public stigma’, which refers to one's belief that others (i.e., the public) perceive an individual as socially unacceptable (Corrigan, 2004, Griffiths et al., 2004, Griffiths et al., 2006b); ‘personal stigma’, which refers to one's own discriminating perceptions of others (Griffiths et al., 2004, Griffiths et al., 2006b); ‘social distance’, which refers to one's desire to maintain distance from the stigmatised individual (Jorm and Griffiths, 2008); and ‘dangerousness’, which refers to one's belief that the individual is dangerous (Jorm and Griffiths, 2008, Mojtabai, 2010).

The diverse stigma literature suggests that different dimensions of stigma may indeed influence help seeking differentially. For example, perceived stigma has been found to be unrelated to help seeking in some studies (Komiti et al., 2006, Golberstein et al., 2009, Schomerus et al., 2009, Yap et al., 2011); and dangerousness has been found to be unrelated to (Cooper et al., 2003) or even to increase willingness to seek help (Mojtabai, 2010, Yap et al., 2011, Jorm et al., 2012). Few studies have examined the association between social distance and help seeking, but preliminary evidence suggests that greater preference for social distance is associated with less willingness to seek help from a psychiatrist (Schomerus et al., 2009), less intention to seek any help (for young adults aged 18–25 years) or from a teacher (for adolescents aged 12–15 years; Yap et al., 2011), and less favourable beliefs about the helpfulness of informal sources of help (Yap et al., 2011).

Emerging evidence of the association between personal stigma and help seeking is somewhat equivocal. A recent national survey of Australian youth (Yap et al., 2011) and a survey of the general population in four European countries (Coppens et al., 2013) found that greater personal stigma, in the form of believing that mental disorders are a sign of personal weakness rather than an illness, was associated with less favourable attitudes towards professional help seeking. Similarly, in a small sample of currently depressed persons in the general population, personal stigma was found to be associated with lower perceived need for treatment, an association which was partially mediated by lower appraisal of their depressive symptoms as a mental health problem (Schomerus et al., 2012). However, a survey of adults with depression in the general population of Finland found that personal stigma was not associated with mental health service use in the last 12 months (Aromaa et al., 2011). One major limitation of evidence to date is that most studies have examined a limited number of stigma dimensions, hence it remains unclear if differences in findings may be partly due to different measures of help seeking or differences in the sample (e.g. hypothetical help seeking in the general population versus actual help seeking by individuals with mental disorders). One way to address this limitation is to examine a wider range of stigma dimensions within one large study.

A second key question for this field of research is related to the fact that most studies have focussed primarily on professional help seeking; hence little is known about the effects of stigma on help seeking from informal or non-professional sources. Although professionals are the ideal source of help for mental disorders, they are often not the first port of call for young people, who prefer to turn to family or friends for help (Rickwood and Braithwaite, 1994, Rickwood et al., 2007). Hence it is important to examine how stigma might stop young people from seeking help even from close others like family and friends, especially if they can become conduits to appropriate professional treatment (Rickwood et al., 2007).

Finally, many studies to date have failed to examine the stigma-help seeking associations specifically for different mental disorders, although there is clear evidence that some disorders are more stigmatized than others (Dinos et al., 2004, Corrigan et al., 2005, Griffiths et al., 2006a), and that certain disorders which are more stigmatized in one component may not necessarily be more stigmatized in another (Jorm and Wright, 2008b). To facilitate stigma reduction efforts and increase help seeking for specific disorders, research examining the influence of stigma specifically on different disorders is required.

The current study seeks to address the above questions by examining the associations between young people's stigmatizing attitudes and their help-seeking intentions and beliefs for a range of mental disorders and from various formal and informal sources, using data from a 2011 national survey of Australian youth. Specifically, this study examined stigma-help seeking associations separately for six vignettes: depression, depression with alcohol abuse, psychosis, social phobia, depression with suicidal thoughts, and post-traumatic stress disorder (PTSD).

Section snippets

Participants

The survey involved computer-assisted telephone interviews with 3021 young people aged between 15 and 25. The survey was carried out by the survey company Social Research Centre using random-digit dialling of both landlines and mobile phones covering the whole of Australia from January to May 2011. Up to six calls were made to establish contact. The response rate was 47.9%, defined as completed interviews (3021) out of sample members who could be contacted and were confirmed as in scope (6306).

Results

The 3021 respondents were randomly presented one of the six vignettes as follows: depression n=506, depression with suicidal thoughts n=502, depression with alcohol abuse n=499, social phobia n=507, PTSD n=506, and Psychosis n=501.

As previously reported (Yap et al., 2013), the five most frequently mentioned sources of help were family (34% of all respondents), GP (23%), friend (16%), counsellor (15%), and mental health professional or service (10%). The per cent frequencies of respondents who

Discussion

This study found that the five stigma scales examined all had some associations with young people's help-seeking intentions and helpfulness beliefs from various sources and for different disorders. However, the personal-weak-not-sick scale had the most consistent associations with help seeking, and the stigma scales had more associations with helpfulness beliefs than with intentions. By examining help seeking from both formal and informal sources, our findings suggest that young people may be

Acknowledgements

Funding for the current study was provided by the Department of Health and Ageing and the National Health and Medical Research Council.

References (43)

  • A.E. Cooper et al.

    Mental illness stigma and care seeking

    Journal of Nervous and Mental Disease

    (2003)
  • P. Corrigan

    How stigma interferes with mental health care

    American Psychologist

    (2004)
  • P.W. Corrigan et al.

    How adolescents perceive the stigma of mental illness and alcohol abuse

    Psychiatric Services

    (2005)
  • G. de Girolamo et al.

    Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles

    Epidemiology and Psychiatric Sciences

    (2012)
  • S. Dinos et al.

    Stigma: the feelings and experiences of 46 people with mental illness. Qualitative study

    British Journal of Psychiatry

    (2004)
  • S. Fröjd et al.

    Adult and peer involvement in help-seeking for depression in adolescent population

    Social Psychiatry and Psychiatric Epidemiology

    (2007)
  • E. Golberstein et al.

    Perceived stigma and help-seeking behavior: longitudinal evidence from the healthy minds study

    Psychiatric Services

    (2009)
  • K. Griffiths et al.

    Stigma in response to mental disorders: a comparison of Australia and Japan

    BMC Psychiatry

    (2006)
  • K.M. Griffiths et al.

    Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression – randomised controlled trial

    British Journal of Psychiatry

    (2004)
  • K.M. Griffiths et al.

    Stigma in response to mental disorders: a comparison of Australia and Japan

    BMC Psychiatry

    (2006)
  • A. Gulliver et al.

    Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review

    BMC Psychiatry

    (2010)
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