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Stigma and its impact on help-seeking for mental disorders: what do we know?

Published online by Cambridge University Press:  18 May 2011

Georg Schomerus  and
Matthias C. Angermeyer
Georg Schomerus*
Affiliation:
Department of Psychiatry, Leipzig University, Leipzig (Germany)
Matthias C. Angermeyer
Affiliation:
Department of Psychiatry, Leipzig University, Leipzig (Germany)
*
Address for correspondence: Dr. G. Schomerus, Department of Psychiatry, Leipzig University, Johannisallee 20, 04317 Leipzig (Germany). Fax: +49-341-972.4539 E-mail: Georg.Schomerus@medizin.uni-Ieipzig.de
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Summary

Aims – Many people suffering from serious mental illness do not seek appropriate medical help. The stigma of mental illness has often been considered a potential cause for reluctance in seeking help. We review recent evidence on this topic. Methods – Narrative review of the recent literature on stigma and helpseeking for psychiatric disorders. Results – There is proof of a particular stigma attached to seeking help for a mental problem. Anticipated individual discrimination and discrimination qua self-stigmatisation are associated with a reduced readiness to seek professional help for mental disorders. Intervention studies show that destigmatisation may lead to increased readiness to seek professional help, but other aspects like knowledge about mental diseases seem to be at least as important. The belief that seeking help for a mental health problem is actually helpful has been shown to be at the core of help-seeking intentions and thus offers a promising target for information programmes. Population based time-trend studies show that public attitudes towards help-seeking have improved over the last decade. Discussion – The relationship between help-seeking intentions and actual help-seeking needs further exploration. While many studies have been able to relate attitudes to intentions, predicting actual help-seeking has proved more difficult.

Declaration of Interest: None.

Type
Special Articles
Information
Epidemiology and Psychiatric Sciences , Volume 17 , Issue 1 , March 2008 , pp. 31 - 37
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

Ajzen, I. (1991). The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes 50, 179–211.CrossRefGoogle Scholar
Alonso, J.Codony, M., Kovess, V., Angermeyer, M.C., Katz, S. J., Haro, J.M., de Girolamo, G., De Graaf, R.O.N., Demyttenaere, K., Vilagut, G., Almansa, J., Pierre Lépine, J. & Brugha, T. (2007). Population level of unmet need for mental healthcare in Europe. British Journal of Psychiatry 190, 299–306.CrossRefGoogle ScholarPubMed
Andrews, G., Issakidis, C. & Carter, G. (2001). Shortfall in mental health service utilisation. British Journal of Psychiatry 179, 417–425.CrossRefGoogle ScholarPubMed
Angermeyer, M.C. & Dietrich, S. (2006). Public beliefs about and attitudes toward people with mental illness: A review of population studies. Ada Psychiatrica Scandinavica 113, 163–179.CrossRefGoogle Scholar
Angermeyer, M.C. & Matschinger, H. (2005). Have there been any changes in the public's attitudes towards psychiatric treatment? Results from representative population surveys in Germany in the years 1990 and 2001. Ada Psychiatrica Scandinavica 111, 68–73.CrossRefGoogle ScholarPubMed
Barney, L.J., Griffiths, K.M., Jorm, A.F. & Christensen, H. (2006). Stigma about depression and its impact on help-seeking intentions. Australian and New Zealand Journal of Psychiatry 40, 51–54.CrossRefGoogle ScholarPubMed
Bayer, J.K. & Peay, M.Y. (1997). Predicting intentions to seek help from professional mental health services. Australian and New Zealand Journal of Psychiatry 31, 504–513.CrossRefGoogle ScholarPubMed
Beck, M., Dietrich, S., Matschinger, H. & Angermeyer, M.C. (2003). Alcoholism: Low standing with the public? Attitudes towards spending financial resources on medical care and research on alcoholism. Alcohol and Alcoholism 38, 602–605.CrossRefGoogle ScholarPubMed
Becker, T. & Vazquez-Barquero, J.L. (2001). The European perspective of psychiatric reform. Ada Psychiatrica Scandinavica 104, 8–14.CrossRefGoogle Scholar
Ben-Porath, D.D. (2002). Stigmatization of individuals who receive psychotherapy: an interaction between help-seeking behavior and the presence of depression. Journal of Social and Clinical Psychology 21,400–413.CrossRefGoogle Scholar
Britt, T.W. (2000). The stigma of psychological problems in a work environment: Evidence from the screening of service members returning from Bosnia. Journal of Applied Social Psychology 30, 1599–1618.CrossRefGoogle Scholar
Cooper, A.E., Corrigan, P.W. & Watson, A.C. (2003). Mental illness stigma and care seeking. Journal of Nervous and Mental Disease 191, 339–341.CrossRefGoogle ScholarPubMed
Corrigan, P.W. & Rüsch, N. (2003). Mental illness stereotypes and clinical care: Do people avoid treatment because of stigma? Psychiatric Rehabilitation Skills 6, 312–334.CrossRefGoogle Scholar
Crisp, A.H., Gelder, M.G., Rix, S., Meltzer, H.I. & Rowlands, O.J. (2000). Stigmatisation of people with mental illnesses. British Journal of Psychiatry 177,4–7.CrossRefGoogle ScholarPubMed
Demyttenaere, K., Bruffaerts, R., Posada-Villa, J., Gasquet, I., Kovess, V., Lepine, J.P., Angermeyer, M.C, Bernert, S., de Girolamo, G. & Morosini, P. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of American Medical Association 291,2581–2590.Google ScholarPubMed
Esters, I.G., Cooker, P.G. & Ittenbach, R.F. (1998). Effects of a unit of instruction in mental health on rural adolescents' conceptions of mental illness and attitudes about seeking help. Adolescence 33, 469–476.Google ScholarPubMed
Fishbein, A. & Ajzen, I. (1975). Beliefs, Attitudes, Intentions and Behavior: An Introduction to Theory and Research. Addison-Wesley: Reading, MA.Google Scholar
Gaebel, W., Zäske, H. & Baumann, A (2004). Stigma erschwert Behandlung und Integration. Weltweit - auch in Deutschland - bekampfen Antistigma-Programme Vorurteile und Diskriminierung gegenüber psychisch Kranken. Deutsches Ärzteblatt 101, 3253–3255.Google Scholar
Grabe, H.J., Alte, D., Adam, C., Sauer, S., John, U. & Freyberger, H.J. (2005). Seelische Belastung und Inanspruchnahme psychiatrischer und psychotherapeutischer Versorgung - Ergebnisse der Study of Health in Pomerania (SHIP) [Mental distress and the use of psychiatric and psychotherapeutic treatments services - Results of the Study of Health in Pomerania (SHIP)]. Psychiatrische Praxis 32, 299–303.CrossRefGoogle Scholar
Han, D.-Y., Chen, S.-H., Hwang, K.-K. & Wei, H.-L. (2006). Effects of psychoeducation for depression on help-seeking willingness: Biological attribution versus destigmatization. Psychiatry and Clinical Neurosciences 60, 662–668.CrossRefGoogle ScholarPubMed
Hanson, K.W. (1998). Public opinion and the mental health parity debate: Lessons from the survey literature. Psychiatric Services 49, 1059–1066.CrossRefGoogle ScholarPubMed
Jorm, A.F. (2000). Mental health literacy - Public knowledge and beliefs about mental disorders. British Journal of Psychiatry 177, 396–401.CrossRefGoogle ScholarPubMed
Jorm, A.F., Korten, A.E., Jacomb, P.A., Christensen, H., Rodgers, B. & Pollitt, P. (1997). “Mental health literacy”: a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia 166, 182–186.CrossRefGoogle ScholarPubMed
Jorm, A.F., Korten, A.E., Jacomb, P.A., Christensen, H. & Henderson, S. (1999). Attitudes towards people with a mental disorder: a survey of the Australian public and health professionals. Australian and New Zealand Journal of Psychiatry 33, 77–83.CrossRefGoogle ScholarPubMed
Jorm, A.F., Medway, J., Christensen, H., Korten, A.E., Jacomb, P.A. & Rodgers, B. (2000a). Attitudes towards people with depression: effects on the public's help-seeking and outcome when experiencing common psychiatric symptoms. Australian and New Zealand Journal of Psychiatry 34, 612–618.CrossRefGoogle ScholarPubMed
Jorm, A.F., Medway, J., Christensen, H., Korten, A.E., Jacomb, P.A. & Rodgers, B. (2000b). Public beliefs about the helpfulness of interventions for depression: effects on actions taken when experiencing anxiety and depression symptoms. Australian and New Zealand Journal of Psychiatry 34, 619–626.CrossRefGoogle ScholarPubMed
Jorm, A.F., Griffiths, K.M., Christensen, H., Korten, A.E., Parslow, R.A. & Rodgers, B. (2003). Providing information about the effectiveness of treatment options to depressed people in the community: A randomized, controlled trial of effects on mental health literacy, help-seeking and symptoms. Psychological Medicine 33, 1071–1079.CrossRefGoogle ScholarPubMed
Jorm, A.F., Christensen, H. & Griffiths, K.M. (2006). The public's ability to recognize mental disorders and their beliefs about treatment: changes in Australia over 8 years. Australian and New Zealand Journal of Psychiatry 40, 36–41.CrossRefGoogle ScholarPubMed
Kluge, H., Becker, T., Kallert, T.W., Matschinger, H. & Angermeyer, M.C. (2007). Auswirkungen struktureller Faktoren auf die Inanspruchnahme Sozialpsychiatrischer Dienste-eine Mehrebenenanalyse [Impact of structure and context on utilization of socio-psychiatric services in Saxony-A multi-level-analysis]. Psychiatrische Praxis 34, 20–25.CrossRefGoogle Scholar
Komiti, A., Judd, F. & Jackson, H. (2006). The influence of stigma and attitudes on seeking help from a GP for mental health problems. Social Psychiatry and Psychiatric Epidemiology 41, 738–745.CrossRefGoogle ScholarPubMed
Link, B.G. (1987). Understanding labeling effects in the area of mental disorders - an assessment of the effects of expectations of rejection. American Sociological Review 52, 96–112.CrossRefGoogle Scholar
Link, B.G. & Phelan, J.C. (2001). Conceptualizing stigma. Annual Review of Sociology 27, 363–385.CrossRefGoogle Scholar
Link, B.G., Struening, E.L., Neese-Todd, S., Asmussen, S. & Phelan, J.C. (2001). The consequences of stigma for the selfesteem of people with mental illnesses. Psychiatric Services 52, 1621–1626.CrossRefGoogle ScholarPubMed
Marshall, M. & Lockwood, A. (2004). Early intervention for psychosis. Cochrane Database Systematic Reviews Issue 2.Google Scholar
Mojtabai, R. (2007). Americans' attitudes toward mental health treatment seeking: 1990-2003. Psychiatric Services 58, 642.CrossRefGoogle ScholarPubMed
Nordt, C., Rossler, W. & Lauber, C. (2006). Attitudes of mental health professionals toward people with schizophrenia and major depression. Schizophrenia Bulletin 32, 709.CrossRefGoogle ScholarPubMed
Pincus, F.L. (1996). Discrimination comes in many forms - Individual, institutional, and structural. American Behavioral Scientist 40, 186–194.CrossRefGoogle Scholar
Regier, D.A., Narrow, W.E., Rae, D.S., Manderscheid, R.W., Locke, B.Z. & Goodwin, F.K. (1993). The de facto US mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry 50, 85–94.CrossRefGoogle Scholar
Rickwood, D., Cavanagh, S., Curtis, L. & Sakrouge, R. (2004). educating young people about mental health and mental illness: Evaluating a school-based programme. International Journal of Mental Health Promotion 6, 23–32.CrossRefGoogle Scholar
Riedel-Heller, S.G. (2006). 1st die Primärprävention psychischer Störungen möglich? [Is primary prevention of mental illness possible?]. Psychiatrische Praxis 33, 145–147.CrossRefGoogle Scholar
Riedel-Heller, S. G., Matschinger, H. & Angermeyer, M.C. (2005). Mental disorders - who and what might help? Help-seeking and treatment preferences of the lay public. Social Psychiatry and Psychiatric Epidemiology 40, 167–174.CrossRefGoogle ScholarPubMed
Rogler, L.H. & Cortes, D.E. (1993). Help-seeking pathways-A unifying concept in mental-healthcare. American Journal of Psychiatry 150,554–561.Google Scholar
Sartorius, N. (2007). Stigma and mental health. Lancet 370, 810–811.CrossRefGoogle ScholarPubMed
Saxena, S., Thornicroft, G., Knapp, M. & Whiteford, H. (2007). Resources for mental health: scarcity, inequity, and inefficiency. Lancet 370, 878–889.CrossRefGoogle ScholarPubMed
Schomerus, G., Matschinger, H. & Angermeyer, M. C. (2006). Preferences of the public regarding cutbacks in expenditure for patient care: Are there indications of discrimination against those with mental disorders? Social Psychiatry and Psychiatric Epidemiology 41, 369–377.CrossRefGoogle ScholarPubMed
Schomerus, G., Angermeyer, M.C, Matschinger, H. & Riedel-Heller, S.G. (2008). Public attitudes towards prevention of depression. Journal of Affective Disorders 106, 257–263.CrossRefGoogle ScholarPubMed
Sirey, J.A., Bruce, M.L., Alexopoulos, G.S., Perlick, D.A., Raue, P., Friedmann, S.J. & Meyers, B.S. (2001). Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression. American Journal of Psychiatry 158, 479–481.CrossRefGoogle Scholar
Van Voorhees, B.W., Fogel, J., Houston, T.K., Cooper, L.A., Wang, N.Y. & Ford, D.E. (2005). Beliefs and attitudes associated with the intention to not accept the diagnosis of depression among young adults. Annals of Family Medicine 3, 38–46.CrossRefGoogle Scholar
Van Voorhees, B.W., Fogel, J., Houston, T.K., Cooper, L.A., Wang, N.Y. & Ford, D.E. (2006). Attitudes and illness factors associated with low perceived need for depression treatment among young adults. Social Psychiatry and Psychiatric Epidemiology 41, 746–754.CrossRefGoogle ScholarPubMed
Wang, P.S., Berglund, P., Olfson, M., Pincus, H.A., Wells, K.B. & Kessler, R.C. (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the national comorbidity survey replication. Archives of General Psychiatry 62, 603–613.CrossRefGoogle ScholarPubMed
Wang, P.S., Aguilar-Gaxiola, S., Alonso, J., Angermeyer, M.C, Borges, G., Bromet, E.J., Bruffaerts, R., de Girolamo, G., de Graaf, R. & Gureje, O. (2007). Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370, 841–850.CrossRefGoogle ScholarPubMed
Wittchen, H.-U. & Jacobi, F. (2001). Die Versorgungssituation psychischer Störungen in Deutschland. Bundesgesundheitsblatt-Gesundheitsforschung - Gesundheitsschutz 44, 993–1000.CrossRefGoogle Scholar
Wright, A., Jorm, A.F., Harris, M.G. & McGorry, P.D. (2007). What's in a name? Is accurate recognition and labelling of mental disorders by young people associated with better help-seeking and treatment preferences? Social Psychiatry and Psychiatric Epidemiology 42, 244–250.CrossRefGoogle Scholar
Wrigley, S., Jackson, H., Judd, F. & Komiti, A. (2005). Role of stigma and attitudes toward help-seeking from a general practitioner for mental health problems in a rural town. Australian and New Zealand Journal of Psychiatry 39, 514–521.CrossRefGoogle Scholar