Perceived control moderates the internalized stigma model of seeking mental health services in distressed older adults.

Abstract

Older adults are especially unlikely to seek mental health services, and internalized stigma is a key reason why. However, little research has investigated which older adults are particularly likely to have stigma influence help-seeking. To address this, we tested whether perceived control (PC) moderates an internalized stigma model in which public stigma is internalized as self-stigma, which negatively predicts help-seeking attitudes and help-seeking intentions. We employed moderated mediation analysis of cross-sectional, secondary data from 348 psychologically distressed Canadian adults aged 65 years and older. Participants completed an online survey that included measures of public stigma of help-seeking, self-stigma of help-seeking, help-seeking attitudes, conditional help-seeking intentions, psychological distress, and PC. PC emerged as a moderator of the internalized stigma model. Those lower in PC were more likely to have public stigma negatively predict help-seeking intentions through the serial mediation of (a) self-stigma and (b) help-seeking attitudes. Further, those lower in PC were more likely to have public stigma internalized as self-stigma and more likely to have negative help-seeking attitudes predict lower help-seeking intentions. Finally, those lower in PC also had lower help-seeking intentions in the face of low levels of self-stigma. These results contribute to a nuanced understanding of which older adults are unlikely to seek help. Identifying PC as a moderator of the internalized stigma model suggests that interventions that enhance PC should protect against public stigma's internalization and improve help-seeking behaviors for older adults who need such help. Public Significance StatementThis study demonstrates that if distressed older adults are low in perceived control (i.e., they feel they have little control over influencing outcomes and events), they are more likely to avoid seeking psychological help when exposed to help-seeking stigma. This is important because older adults are the age demographic least likely to seek help for mental health concerns, and enhancing perceptions of control is one way to improve treatment seeking.

The impact of the Big Five personality traits on help-seeking stigmas, attitudes, and intentions.

“…First, this work can be extended to clinical samples to understand the influence of personality on the help seeking of more at-risk populations. Second, research has found other established predictors, such as experiential avoidance (Brenner et al, 2020; Murphy & Mackenzie, 2023), perceived control (Murphy et al, 2024), and mental health literacy (Mackenzie et al, 2023) to moderate the internalized stigma model, and research might explore personality as a moderator. Third, research has explored longitudinal changes in personality (e.g., Roberts et al, 2006; Srivastava et al, 2003); similar work that includes mental health service use variables would help clarify the interactions among these variables over time.…”