How can the utilisation of help for mental disorders be improved? A quasi-experimental online study on the changeability of stigmatising attitudes and intermediate variables in the process of utilisation
Abstract:Background
Epidemiological studies show that even in highly developed countries many people with depression do not seek help for their mental health issues, despite promising prevention approaches encouraging people to seek help and reduce self-stigma. Therefore, an anti-stigma intervention study to support help-seeking behaviour will be developed on the basis of the newly explicated “Seeking Mental Health Care Model”.
Methods
A quasi-experimental … Show more
“…In the following paragraphs, we will summarise key empirical findings on attitudinal and cognitive variables influencing professional help-seeking. We refer to the illness representations of the Common Sense Model of Self-Regulation (CSM, [ 7 ]) as the underlying theoretical framework, which Scott et al [ 3 ] also used in their model. Fig.…”
Section: Introductionmentioning
confidence: 99%
“…Help-seeking for mental illness is understood as a process of experiencing symptoms, identifying them as such, forming an intention, and lastly actual help-seeking [ 7 – 9 ]. The identification of symptoms of mental illness is a crucial starting point to forming intention [ 10 – 13 ].…”
Section: Introductionmentioning
confidence: 99%
“…They might influence present internal beliefs and attitudes (i.e., intermediary variables ) with direct influences on the help-seeking process . Figure 1 presents our Seeking Mental Health Care Model [ 7 ], which includes hypotheses most interesting for the total model whilst controlling for others. This is especially relevant for the multiple empirical associations between treatment experience and intermediary variables that are mentioned in the following sections.…”
Section: Introductionmentioning
confidence: 99%
“…Expanding the view to general health-related decision making, the Common-Sense Model of Self-Regulation (CSM; [ 7 ]) is applied. CSM has been investigated extensively in the context of physical health [ 44 ], but has also been replicated for the mental health context [ 45 ].…”
Background
Only about half the people with depression seek professional health care services. To constitute the different predictors and associating variables of health care utilisation, we model the process and aim to test our hypothesised Seeking Mental Health Care Model. The model includes empirical influences on the help-seeking process to predict actual behaviour and incorporates superordinate (stigma, treatment experiences) as well as intermediate attitudinal variables (continuum and causal beliefs, depression literacy and self-efficacy).
Method
All variables are examined in an online study (baseline, three- and six-month follow-up). The sample consisted of adults with depressive symptoms (PHQ-9 sum score ≥ 8), currently not receiving mental health care treatment. To examine the prediction of variables explaining help-seeking behaviour, a path model analysis was carried out (lavaan package, software R).
Results
Altogether, 1368 participants (Mage = 42.38, SDage = 15.22, 65.6% female) were included, 983 participating in at least one follow-up. Model fit was excellent (i.e., RMSEA = 0.059, CFI = 0.989), and the model confirmed most of the hypothesised predictions. Intermediary variables were significantly associated with stigma and experiences. Depression literacy (ß = .28), continuum beliefs (ß = .11) and openness to a balanced biopsychosocial causal model (ß = .21) significantly influenced self-identification (R2 = .35), which among the causal beliefs and self-efficacy influenced help-seeking intention (R2 = .10). Intention (ß = .40) prospectively predicted help-seeking behaviour (R2 = .16).
Conclusion
The Seeking Mental Health Care Model provides an empirically validated conceptualisation of the help-seeking process of people with untreated depressive symptoms as a comprehensive approach considering internal influences. Implications and open questions are discussed, e.g., regarding differentiated assessment of self-efficacy, usefulness of continuum beliefs and causal beliefs in anti-stigma work, and replication of the model for other mental illnesses.
Trial registration
German Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111–1264-9954. Registered 16 February 2021.
“…In the following paragraphs, we will summarise key empirical findings on attitudinal and cognitive variables influencing professional help-seeking. We refer to the illness representations of the Common Sense Model of Self-Regulation (CSM, [ 7 ]) as the underlying theoretical framework, which Scott et al [ 3 ] also used in their model. Fig.…”
Section: Introductionmentioning
confidence: 99%
“…Help-seeking for mental illness is understood as a process of experiencing symptoms, identifying them as such, forming an intention, and lastly actual help-seeking [ 7 – 9 ]. The identification of symptoms of mental illness is a crucial starting point to forming intention [ 10 – 13 ].…”
Section: Introductionmentioning
confidence: 99%
“…They might influence present internal beliefs and attitudes (i.e., intermediary variables ) with direct influences on the help-seeking process . Figure 1 presents our Seeking Mental Health Care Model [ 7 ], which includes hypotheses most interesting for the total model whilst controlling for others. This is especially relevant for the multiple empirical associations between treatment experience and intermediary variables that are mentioned in the following sections.…”
Section: Introductionmentioning
confidence: 99%
“…Expanding the view to general health-related decision making, the Common-Sense Model of Self-Regulation (CSM; [ 7 ]) is applied. CSM has been investigated extensively in the context of physical health [ 44 ], but has also been replicated for the mental health context [ 45 ].…”
Background
Only about half the people with depression seek professional health care services. To constitute the different predictors and associating variables of health care utilisation, we model the process and aim to test our hypothesised Seeking Mental Health Care Model. The model includes empirical influences on the help-seeking process to predict actual behaviour and incorporates superordinate (stigma, treatment experiences) as well as intermediate attitudinal variables (continuum and causal beliefs, depression literacy and self-efficacy).
Method
All variables are examined in an online study (baseline, three- and six-month follow-up). The sample consisted of adults with depressive symptoms (PHQ-9 sum score ≥ 8), currently not receiving mental health care treatment. To examine the prediction of variables explaining help-seeking behaviour, a path model analysis was carried out (lavaan package, software R).
Results
Altogether, 1368 participants (Mage = 42.38, SDage = 15.22, 65.6% female) were included, 983 participating in at least one follow-up. Model fit was excellent (i.e., RMSEA = 0.059, CFI = 0.989), and the model confirmed most of the hypothesised predictions. Intermediary variables were significantly associated with stigma and experiences. Depression literacy (ß = .28), continuum beliefs (ß = .11) and openness to a balanced biopsychosocial causal model (ß = .21) significantly influenced self-identification (R2 = .35), which among the causal beliefs and self-efficacy influenced help-seeking intention (R2 = .10). Intention (ß = .40) prospectively predicted help-seeking behaviour (R2 = .16).
Conclusion
The Seeking Mental Health Care Model provides an empirically validated conceptualisation of the help-seeking process of people with untreated depressive symptoms as a comprehensive approach considering internal influences. Implications and open questions are discussed, e.g., regarding differentiated assessment of self-efficacy, usefulness of continuum beliefs and causal beliefs in anti-stigma work, and replication of the model for other mental illnesses.
Trial registration
German Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111–1264-9954. Registered 16 February 2021.
“…In addition, young people are often familiar with new technologies ( Lupton, 2021 ) and because of that, we believe that the application of the UP in an online format may reduce the barriers to accessing treatment ( Osma et al, 2021 ). We already know that evidence-based therapies can be administered online without sacrificing their effectiveness ( Andersson et al, 2014 ; McLaren et al, 2021 ). In a recent review, videoconferencing interventions proved to be reliable and highly acceptable for patients with psychotic disorders ( Santesteban-Echarri et al, 2020 ).…”
BackgroundCognitive Behavioral Therapy is delivered in most of the early intervention services for psychosis in different countries around the world. This approach has been demonstrated to be effective in decreasing or at least delaying the onset of psychosis. However, none of them directly affect the comorbidity of these types of patients that is often the main cause of distress and dysfunctionality. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is a psychological intervention that combines cognitive-behavioral and third-generation techniques that address emotional dysregulation as an underlying mechanism that these disorders have in common. The application of this intervention could improve the comorbid emotional symptoms of these patients.Materials and methodsThe study is a randomized controlled trial in which one group receives immediate UP plus standard intervention and the other is placed on a waiting list to receive UP 7 months later, in addition to standard care in one of our early psychosis programs. The sample will be 42 patients with UHR for psychosis with comorbid emotional symptoms. The assessment is performed at baseline, at the end of treatment, and at 3-months’ follow-up, and includes: general psychopathology, anxiety and depression, positive and negative emotions, emotional dysregulation, personality, functionality, quality of life, cognitive distortions, insight, and satisfaction with the UP intervention.DiscussionThis will be the first study of the efficacy, acceptability, and viability of the UP in a sample of young adults with UHR. The results of this study may have clinical implications, contributing to improving the model of care for young people who consult for underlying psychotic, anxiety, and/or depressive symptoms that can lead to high distress and dysfunctionality.Clinical trial registration[https://clinicaltrials.gov/], identifier [NCT04929938].
Background
Mental illness is a global concern and the leading cause of years lived with disability. Research on help-seeking behaviour has focused on individual factors, but there is still much unexplained variance. Suggesting complex interactions between determinants of human behaviour a new framework called Self-Milieux is proposed to represent a person’s sociocultural background. The article introduces a statistical approach to determine Self-Milieux and exemplarily examines its predictive validity for health-related research.
Methods
Self-Milieux are determined through a two-stage clustering method based on the determinants socioeconomic status and self-construal profile. Descriptive analyses are used to compare Self-Milieux characteristics. Hierarchical binary logistic regression models test the association between Self-Milieux and help-seeking behaviour, while controlling for socioeconomic status as an established predictor.
Results
The sample size was N = 1535 (Mage = 43.17 and 64.89% female participants). Average depression severity was M = 12.22, indicating mild to moderate symptoms. Six Self-Milieux were determined and named. Participants from privileged (aOR = 0.38) and self-sufficient (aOR = 0.37) milieux were less likely to seek help from a general practitioner than those from the entitled milieu. Participants from privileged (aOR = 0.30), collaborators (aOR = 0.50), disadvantaged (aOR = 0.33), and self-sufficient (aOR = 0.21) milieux were less likely to seek help from family members than those from the entitled and family-bound milieux.
Discussion
The study’s strengths and limitations, as well as the cluster methodology, are discussed. The comparative results for the six Self-Milieux are interpreted based on current research. For example, participants from some milieux follow a help-seeking process proposed in previous research, while participants from other milieux seem to show a different process, one that ends in informal help-seeking.
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