Stigma as a barrier to recognizing personal mental illness and seeking help: a prospective study among untreated persons with mental illness

Abstract

It is unclear to what extent failure to recognize symptoms as potential sign of a mental illness is impeding service use, and how stigmatizing attitudes interfere with this process. In a prospective study, we followed a community sample of 188 currently untreated persons with mental illness (predominantly depression) over 6 months. We examined how lack of knowledge, prejudice and discrimination impacted on self-identification as having a mental illness, perceived need, intention to seek help, and help-seeking, both with respect to primary care (visiting a general practitioner, GP) and specialist care (seeing a mental health professional, MHP). 67% sought professional help within 6 months. Fully saturated path models accounting for baseline depressive symptoms, previous treatment experience, age and gender showed that self-identification predicted need (beta 0.32, p < 0.001), and need predicted intention (GP: beta 0.45, p < 0.001; MHP: beta 0.38, p < 0.001). Intention predicted service use with a MHP after 6 months (beta 0.31, p < 0.01; GP: beta 0.17, p = 0.093). More knowledge was associated with more self-identification (beta 0.21, p < 0.01), while support for discrimination was associated with lower self-identification (beta - 0.14, p < 0.05). Blaming persons with mental illness for their problem was associated with lower perceived need (beta - 0.16, p < 0.05). Our models explained 37% of the variance of seeking help with a MHP, and 33% of help-seeking with a GP. Recognizing one's own mental illness and perceiving a need for help are impaired by lack of knowledge, prejudice, and discrimination. Self-identification is a relevant first step when seeking help for mental disorders.

The treatment gap for mental disorders and associated factors in the Czech Republic

“…Causes for the treatment gap are multi-faceted, and include affected individuals, clinicians and societal factors [6,7]. Awareness of mental health symptoms and relating them to a potential mental health problem has been shown to be an important predictor of perceived need and help-seeking intentions in persons with untreated mental disorders [8]. However, there is no existing evidence assessing the extent of the treatment gap in the Czech Republic.…”

Validity and psychometric properties of the Self-Identification as Having a Mental Illness Scale (SELF-I) among currently untreated persons with mental health problems

“…As outlined in the introduction, selfidentification seems particularly relevant for help-seeking for mental disorders (Zimber et al, 2018), and is not well represented in general help-seeking theories such as the TPB, CSM or HBM. A longitudinal analysis of the present data showed that self-identification was strongly related to perceived need, which in turn was related to help-seeking intentions, which predicted help-seeking over six months, all contributing to a significant indirect effect of self-identification on help-seeking (Schomerus et al, 2018). Self-identification thus seems to be an important addition to established theories of help-seeking for mental disorders.…”

“…Details about our sampling method have been described in more detail elsewhere (e.g. Schomerus et al, 2018;Stolzenburg et al, 2017). Briefly, in order to recruit a community sample of currently untreated individuals with mental health problems, we used newspaper advertisements, social media posts and flyers in which we described several symptoms of depression without the 6 6 use of psychiatric wording or terminology, and invited those who had similar symptoms to call our study center (Stolzenburg et al, 2017).…”

Psychometric validation of the self-identification of having a mental illness (SELF-I) scale and the relationship with stigma and help-seeking among young people

“…In this German group, personal stigmatising attitudes were associated with lower self-identification, while higher mental health literacy and having been previously treated for mental health problems seemed to facilitate greater self-perception as having a mental illness. Higher self-identification at baseline also predicted help-seeking from a mental health professional during a 6-months follow-up period [7]. …”

“…Individuals who do not recognise their difficulties as mental health problems do not direct their help-seeking towards mental health services [6]. Indeed, personal appraisal of one’s own mental health was shown to be a key predictor of perceived need for help among a community sample of adults meeting criteria for depressive disorder [5] and of subsequent help-seeking behaviour in a prospective study of persons with untreated mental illness [7]. Self-appraisal of having a mental illness could also be an important link which mediates the relationship between personal stigma and service use.…”