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

Nohr, Laura; Ruíz, Alexis Lorenzo; Ferrer, Juan Emilio Sandoval; Buhlmann, Ulrike

doi:10.1371/journal.pone.0246501

Cited by 14 publications

(15 citation statements)

References 116 publications

(180 reference statements)

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“…Still, the globally recognized mental health care gap is present in Germany as well [3]. Further, Germans show less professional help-seeking intentions compared to Cubans [84]. Thus, previous literature hints both to possible similarities and differences in social support and help-seeking between Cuba and Germany.…”

Section: Cultural Contexts Of the Current Studymentioning

confidence: 99%

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Social and cultural determinants of help-seeking in Cuba and Germany – A structural equation model approach

Nohr¹,

P-C²,

Al³

et al. 2021

Preprint

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Social support is an important determinant of help-seeking in the context of mental health. Previous evidence shows differences in the relation between social support and help-seeking between more collectivistic vs. more individualistic cultures. Especially the cultural informed role of the family might play a key role in help-seeking decisions. Still, many studies have been conducted with minority groups in Western societies which have to face additional struggles due to immigration. The current study investigates help-seeking, social support, cultural values, and help-seeking intentions in the Cuban and German general populations. A cross-sectional questionnaire survey was applied to n = 340 Cuban and n = 340 German adults. Multiple-group structural equation modeling was used to examine measurement invariance between the groups and to explore relationships between the concepts under study in both cultural groups. No measurement invariance could be established for the overall model and most of the measures separately which impedes cross-cultural comparisons. Using plausible values, the structural model was estimated in both samples separately. Not all hypotheses could be supported for the Cuban and German samples. Yet, social support and the importance of family predicted informal and formal help-seeking significantly but differently in both samples. In the light of methodological limitations, their potential to support or to prevent different forms of help-seeking are discussed and possible practical implications derived.

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Section: Cultural Contexts Of the Current Studymentioning

confidence: 99%

“…In the context of mental health behavior, Cubans show comparatively positive attitudes towards professional help-seeking in Cuba and in the USA [45,84,85]. Further, both formal and informal help should be easily accessible for Cubans.…”

Section: Cultural Contexts Of the Current Studymentioning

confidence: 99%

Social and cultural determinants of help-seeking in Cuba and Germany – A structural equation model approach

Nohr¹,

P-C²,

Al³

et al. 2021

Preprint

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“…Propensity score matching was used to identify patients with and without a specific psychiatric disorder (Figure S1). The number of patients with incident psychiatric disorder were as follow: depression (21,609), anxiety disorder (20,070), schizophrenia (7,679), bipolar disorder (557) and personality disorder (194). The number of matched controls for each psychiatric disorder were as follow: depression (75,087), anxiety disorder (67,887), schizophrenia (23,130), bipolar disorder (1,636) and personality disorder (628) (Figure S1).…”

Section: Total Burden Of Non-fatal Self-harm Events and Risk Of Self-harm Following Psychiatric Disorder Diagnosismentioning

confidence: 99%

“…Notable barriers to mental health helpseeking include a preference for self-reliance, low perceived need and negative experience or dissatisfaction with previous healthcare encounters 5 . Individuals may also be worried about being labelled as mentally ill and may experience self-blame, which further prompts catastrophic emotional and behavioural reactions against themselves (self-harm or suicide) 7,8 . Systematic evidence of the total burden of psychiatric disorders, self-harm episodes and risk of suicide and unnatural deaths is essential to aid early identification and intervention of mental illness and suicidal thoughts.…”

Section: Introductionmentioning

confidence: 99%

“…Notable barriers to mental health help-seeking include a preference for self-reliance, low perceived need and negative experience or dissatisfaction with previous healthcare encounters 5 . Individuals may also be worried about being labelled as mentally ill and may experience self-blame, which further prompts catastrophic emotional and behavioural reactions against themselves (self-harm or suicide) 7,8 .…”

Section: Introductionmentioning

confidence: 99%

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Psychiatric disorders and self-harm across 26 adult cancers: cumulative burden, temporal variation, excess years of life lost and unnatural causes of deaths

Lai

2021

Preprint

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Background Cancer is a life-altering event causing considerable psychological distress. However, population-representative variations in the total burden of psychiatric episodes across cancer types and treatment modalities have not been examined. We sought to estimate the risk of self-harm after incident psychiatric disorder diagnosis in patients with cancer, and the risk of unnatural deaths after self-harm. Design, Setting, Participants Population-based cohort study with multiphase study designs. Population-based linked patient records in England (1998-2020) from primary care practices, hospitals, cancer registry and death registry were employed. We identified 459,542 individuals age ≥ 18 years with an incident diagnosis of a site-specific cancer of interest. Main outcome measures Using outpatient and inpatient records, we identified patients with five psychiatric disorders of interest: depression, anxiety disorder, schizophrenia, bipolar disorder and personality disorder. Cumulative burden for all psychiatric events was estimated using the mean cumulative count method. We considered 10 cancer treatment regimens, 11 chemotherapy drug classes, deprivation status and 21 non-cancer comorbidities in stratified analyses. Propensity score matching was employed to identify controls who did not have any record of a psychiatric disorder of interest. For each psychiatric disorder category, we fitted a Cox regression model to estimate the risk of self-harm. We also estimated the risk of all-cause mortality and excess years of life lost comparing patients with and without psychiatric disorders. A separate matched cohort was generated to explore the risk of suicide and unnatural deaths following self-harm. Results Depression was the most common psychiatric disorder in patients with cancer, where some of the highest cumulative burdens were observed in patients with testicular cancer (98.05 per 100 individuals [CI: 83.08-127.25]), cervical cancer (78.74 [73.61-90.14]) and Hodgkin lymphoma (69.87 [61.05-69.48]) by age 60. Patients who received chemotherapy, radiotherapy and surgery had the highest cumulative burden of psychiatric disorders, while patients who received radiotherapy alone had the lowest burden. Patients treated with alkylating agent chemotherapeutics had the highest burden of psychiatric disorders while those treated with kinase inhibitors had the lowest burden. Among patients with cancer, 5,683 individuals were identified as having an incident self-harm episode. A previous diagnosis of psychiatric disorder before self-harm was at least twice as prevalent than a subsequent diagnosis of psychiatric disorder where the prevalence ratio was the highest in patients with brain tumours (5.36, CI: 4.57-6.14). Younger individuals were more likely to be diagnosed with mental illness before the first self-harm episode. However, individuals from more deprived regions (2.46, CI: 2.32-2.60) and individuals with ≥4 pre-existing comorbidities (2.19, CI: 1.92-2.46) were less likely to be diagnosed with mental illness before self-harm. Patients with mental illness had a higher cumulative burden of self-harm events compared with matched controls. All mental illnesses were associated with an increased risk of subsequent self-harm, where the highest risk was observed within 12 months of the mental illness diagnosis. Risks of self-harm during the first year in matched cohorts were as follow: depression (adjusted HR 44.1, CI: 34.0-57.1), anxiety disorder (HR 21.1, CI: 16.4-27.0) and schizophrenia (HR 7.5, CI: 5.0-11.2). Patients with cancer and psychiatric disorder experienced excess years of life lost. Patients who harmed themselves were 6.8 times more likely to die of unnatural causes of death compared with controls within 12 months of self-harm (HR 6.8, CI: 4.3-10.7). The risk of unnatural death after 12 months was markedly lower (HR 2.0, CI: 1.5-2.7). Conclusions This study quantifies the total burden of psychiatric events and self-harm in patients with cancer. The cumulative burden of psychiatric events varies across cancer type, treatment regimen and chemotherapy type. Incident psychiatric disorder diagnoses were significantly associated with increased risk of subsequent self-harm, where risks varied across psychiatric diagnostic categories and follow-up periods. Patients who harm themselves experienced the highest risk of dying from unnatural deaths within the first year of self-harm. We provide an extensive knowledge base to help inform collaborative cancer-psychiatric care initiatives by prioritising patients who are most at risk.

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Compassion fatigue and psychological problems among women mental health practitioners: character strengths and psychological resilience act as buffers

Akhtar,

Khan,

Kazmi

et al. 2024

Curr Psychol

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

Cited by 14 publications

References 116 publications

Social and cultural determinants of help-seeking in Cuba and Germany – A structural equation model approach

Social and cultural determinants of help-seeking in Cuba and Germany – A structural equation model approach

Psychiatric disorders and self-harm across 26 adult cancers: cumulative burden, temporal variation, excess years of life lost and unnatural causes of deaths

Compassion fatigue and psychological problems among women mental health practitioners: character strengths and psychological resilience act as buffers

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