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What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies

  • S. Clement (a1), O. Schauman (a1), T. Graham (a1), F. Maggioni (a1), S. Evans-Lacko (a1), N. Bezborodovs (a1), C. Morgan (a1), N. Rüsch (a2), J. S. L. Brown (a3) and G. Thornicroft (a1)...
Abstract
Background

Individuals often avoid or delay seeking professional help for mental health problems. Stigma may be a key deterrent to help-seeking but this has not been reviewed systematically. Our systematic review addressed the overarching question: What is the impact of mental health-related stigma on help-seeking for mental health problems? Subquestions were: (a) What is the size and direction of any association between stigma and help-seeking? (b) To what extent is stigma identified as a barrier to help-seeking? (c) What processes underlie the relationship between stigma and help-seeking? (d) Are there population groups for which stigma disproportionately deters help-seeking?

Method

Five electronic databases were searched from 1980 to 2011 and references of reviews checked. A meta-synthesis of quantitative and qualitative studies, comprising three parallel narrative syntheses and subgroup analyses, was conducted.

Results

The review identified 144 studies with 90 189 participants meeting inclusion criteria. The median association between stigma and help-seeking was d = − 0.27, with internalized and treatment stigma being most often associated with reduced help-seeking. Stigma was the fourth highest ranked barrier to help-seeking, with disclosure concerns the most commonly reported stigma barrier. A detailed conceptual model was derived that describes the processes contributing to, and counteracting, the deterrent effect of stigma on help-seeking. Ethnic minorities, youth, men and those in military and health professions were disproportionately deterred by stigma.

Conclusions

Stigma has a small- to moderate-sized negative effect on help-seeking. Review findings can be used to help inform the design of interventions to increase help-seeking.

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Copyright
Corresponding author
* Address for correspondence: Dr S. Clement, Section of Community Mental Health, PO29, Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email sarah.clement@kcl.ac.uk)
References
Hide All
Adler AB, Bliese PD, McGurk D, Hoge CW, Castro CA (2009). Battlemind debriefing and battlemind training as early interventions with soldiers returning from Iraq: randomization by platoon. Journal of Consulting and Clinical Psychology 77, 928940.
Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H (2004). Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica 420, 4754.
Barrett MS, Chua W, Crits-Christoph P, Gibbons MB, Casiano D, Thompson D (2008). Early withdrawal from mental health treatment: implications for psychotherapy practice. Psychotherapy: Theory, Research, Practice, Training 46, 247267.
Blank MB, Mahmood M, Fox JC, Guterbock T (2002). Alternative mental health services: the role of the black church in the South. American Journal of Public Health 92, 16681672.
Boonstra N, Klaassen R, Sytema S, Marshall M, De Haan L, Wunderink L, Wiersma D (2012). Duration of untreated psychosis and negative symptoms: a systematic review and meta-analysis of individual patient data. Schizophrenia Research 142, 1219.
Brohan E, Henderson C, Wheat K, Malcolm E, Clement S, Barley EA, Slade M, Thornicroft G (2012). Systematic review of beliefs, behaviours and influencing factors associated with disclosure of a mental health problem in the workplace. BMC Psychiatry 12, 11.
Brown JSL, Elliott SA, Boardman J, Ferns J, Morrison J (2004). Meeting the unmet need for depression services with psycho-educational self-confidence workshops: preliminary report. British Journal of Psychiatry 185, 511515.
Brown JSL, Elliott SA, Butler C (2006). Can large-scale self-referral psycho-educational stress workshops help improve the psychological health of the population? Behavioural and Cognitive Psychotherapy 34, 165177.
Clement S, Brohan E, Jeffery D, Henderson C, Hatch SL, Thornicroft G (2012 a). Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE) related to people with mental ill health. BMC Psychiatry 12, 36.
Clement S, van Nieuwenhuizen A, Kassam A, Flach C, Lazarus A, de Castro M, McCrone P, Norman I, Thornicroft G (2012 b). Filmed v. live social contact interventions to reduce stigma: randomised controlled trial. British Journal of Psychiatry 201, 5764.
Cohen J (1992). A power primer. Psychological Bulletin 112, 155159.
Corrigan PW (2004). How stigma interferes with mental health care. American Psychologist 59, 614625.
Corrigan P, Rüsch N (2002). Mental illness stereotypes and clinical care: do people avoid treatment because of stigma? Psychiatric Rehabilitation Skills 6, 312334.
Crombie I (1996). The Pocket Guide to Critical Appraisal: A Handbook for Healthcare Professionals. BMJ Books: London.
Dell'Osso B, Glick ID, Baldwin DS, Altamura AC (2013). Can long-term outcomes be improved by shortening the duration of untreated illness in psychiatric disorders: a conceptual framework. Psychopathology 14, 1421.
Gary F (2005). Stigma: barrier to mental health care among ethnic minorities. Issues in Mental Health Nursing 26, 979999.
Grimshaw J, McAuley LM, Bero LA, Grilli R, Oxman AD, Ramsay C, Vale L, Zwarenstein M (2003). Systematic reviews of the effectiveness of quality improvement strategies and programmes. Quality and Safety in Health Care 12, 298303.
Gulliver A, Griffiths KM, Christensen H (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 10, 113.
Gulliver A, Griffiths KM, Christensen H, Brewer JL (2012). A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC Psychiatry 12, 1281.
Hackler AH, Vogel DL, Wade NG (2010). Attitudes toward seeking professional help for an eating disorder: the role of stigma and anticipated outcomes. Journal of Counseling and Development 88, 424431.
Halter MJ (2004). The stigma of seeking care and depression. Archives of Psychiatric Nursing 18, 178184.
Hammer JH, Vogel DL (2010). Men's help seeking for depression: the efficacy of a male-sensitive brochure about counseling. The Counseling Psychologist 38, 296313.
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, 662668.
Held P, Owens GP (2013). Stigmas and attitudes toward seeking mental health treatment in a sample of veterans and active duty service members. Traumatology 19, 136143.
Henderson C, Brohan E, Clement S, Williams P, Lassman F, Schauman O, Dockery L, Farrelly S, Murray J, Murphy C, Slade M, Thornicroft G (2013). Decision aid on disclosure of mental health status to an employer: feasibility and outcomes of a randomised controlled trial. British Journal of Psychiatry 203, 350357.
Henderson M, Brooks SK, del Busso L, Chalder T, Harvey SB, Hotopf M, Madan I, Hatch S (2012). Shame! Self-stigmatisation as an obstacle to sick doctors returning to work: a qualitative study. Brtish Medical Journal Open 2, e001776.
Johnson S, Bingham C, Billings J, Pilling S, Morant N, Bebbington P, McNicholas S, Dalton J (2004). Women's experiences of admission to a crisis house and to acute hospital wards: a qualitative study. Journal of Mental Health 13, 247262.
Jorm AF, Medway J, Christensen H, Korten AE, Jacomb PA, Rodgers B (2000). 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, 619626.
Judd F, Komiti A, Jackson H (2008). How does being female assist help-seeking for mental health problems? Australian and New Zealand Journal of Psychiatry 42, 2429.
Kessler R, Demler O, Frank R, Olfson M, Pincus H, Walters E, Wang P, Wells K, Zaslavsky A (2005). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine 352, 25152523.
Kitchener BA, Jorm AF (2006). Mental health first aid training: review of evaluation studies. Australian and New Zealand Journal of Psychiatry 40, 68.
Kovandžić M, Chew-Graham C, Reeve J, Edwards S, Peters S, Edge D, Aseem S, Gask L, Dowrick D (2011). Access to primary mental health care for hard-to-reach groups: from ‘silent suffering’ to ‘making it work’. Social Science and Medicine 72, 763772.
Kroger J (2004). Identity in Adolescence: The Balance Between Self and Other. Routledge: New York.
Kushner M, Sher K (1991). The relation of treatment fearfulness and psychological service utilization: an overview. Professional Psychology: Research and Practice 22, 196203.
Link B, Phelan JC (2001). Conceptualizing stigma. American Review of Sociology 27, 363385.
Marshall M, Lockwood A, Lewis S, Fiander M (2004). Essential elements of an early intervention service for psychosis: the opinions of expert clinicians. BMC Psychiatry 4, 17.
Mishra S, Lucksted A, Gioia D, Barnet B, Baquet C (2009). Needs and preferences for receiving mental health information in an African American focus group sample. Community Mental Health Journal 45, 117126.
Mittal D, Sullivan G, Chekuri L, Allee E, Corrigan P (2012). Empirical studies of self-stigma reduction strategies: a critical review of the literature. Psychiatric Services 63, 974981.
Mojtabai R, Olfson M, Sampson N, Jin R, Druss B, Wang P, Wells K, Pincus H, Kessler R (2011). Barriers to mental health treatment: results from the National Comorbidity Survey Replication. Psychological Medicine 41, 17541761.
Morgan C, Mallett R, Hutchinson G, Leff J (2004). Negative pathways to psychiatric care and ethnicity: the bridge between social science and psychiatry. Social Science and Medicine 58, 739752.
Nose M, Barbui C, Tansella M (2003). How often do patients with psychosis fail to adhere to treatment programmes? A systematic review. Psychological Medicine 33, 11491160.
Oliver MI, Pearson N, Coe N, Gunnell D (2005 a). Help-seeking behaviour in men and women with common mental health problems: cross-sectional study. British Journal of Psychiatry 186, 297301.
Oliver S, Harden A, Rees R, Shepherd J, Brunton G, Garcia J, Oakley A (2005 b). An emerging framework for including different types of evidence in systematic reviews for public policy. Evaluation 11, 428446.
Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, Britten N, Roen K, Duffy S (2006). Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. ESRC Methods Programme: University of Lancaster, UK.
Pope C, Mays NJP (2007). Synthesising Qualitative and Quantitative Health Evidence: A Guide to Methods. Open University Press: Maidenhead.
Public Health Resource Unit (2006). Critical Skills Appraisal Programme (CASP): qualitative research (www.pillole.org/public/aspnuke/downloads/documenti/strumentiappraisal.pdf). Accessed 20 December 2012.
Rüsch N, Lieb K, Göttler I, Hermann C, Schramm E, Richter H, Jacob GA, Corrigan PW, Bohus M (2007). Shame and implicit self-concept in women with borderline personality disorder. American Journal of Psychiatry 164, 500508.
Schomerus G, Angermeyer M (2008). Stigma and its impact on help-seeking for mental disorders: what do we know? Epidemiologia e Psichiatria Sociale 17, 3137.
ten Have M, de Graaf R, Ormel J, Vilagut G, Kovess V, Alonso J (2010). Are attitudes towards mental health help-seeking associated with service use? Results from the European Study of Epidemiology of Mental Disorders. Social Psychiatry and Psychiatric Epidemiology 45, 153163.
Thomas J, Harden A (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology 8, 45.
Thornicroft G (2007). Most people with mental illness are not treated. Lancet 370, 807808.
Thornicroft G (2008). Stigma and discrimination limit access to mental health care. Epidemiologia e Psichiatria Sociale 17, 1419.
Vogel DL, Gentile DA, Kaplan SA (2008). The influence of television on willingness to seek therapy. Journal of Clinical Psychology 64, 276295.
Vogel DL, Wade NG, Hackler AH (2007). Perceived public stigma and the willingness to seek counseling: the mediating roles of self-stigma and attitudes toward counseling. Journal of Counseling Psychology 54, 4050.
Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, Haro JM, Karam EG, Kessler RC, Kovess V, Lane MC, Lee S, Levinson D, Ono Y, Petukhova M, Posada-Villa J, Seedat S, Wells JE (2007). Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370, 841850.
Wittchen H, Jacobi F (2005). Size and burden of mental disorders in Europe: a critical review and appraisal of 27 studies. European Neuropsychopharmacology 15, 357376.
Wright A, McGorry PD, Harris MG, Jorm AF, Pennell K (2006). Development and evaluation of a youth mental health community awareness campaign: the Compass Strategy. BMC Public Health 6, 215.
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