Hostname: page-component-5db58dd55d-8lnk4 Total loading time: 0 Render date: 2026-06-01T18:40:49.870Z Has data issue: false hasContentIssue false
  • English
  • Français

Shame, perceived knowledge and satisfaction associated with mental health as predictors of attitude patterns towards help-seeking

Published online by Cambridge University Press:  18 July 2013

N. Rüsch ,
M. Müller ,
V. Ajdacic-Gross ,
S. Rodgers ,
P.W. Corrigan  and
W. Rössler
N. Rüsch*
Affiliation:
Section of Public Mental Health, Department of Psychiatry II, University of Ulm, Parkstrasse 11, 89073 Ulm, German Department of Psychiatry II, University of Ulm, Germany
M. Müller
Affiliation:
Section of Public Mental Health, Department of Psychiatry II, University of Ulm, Parkstrasse 11, 89073 Ulm, German
V. Ajdacic-Gross
Affiliation:
Section of Public Mental Health, Department of Psychiatry II, University of Ulm, Parkstrasse 11, 89073 Ulm, German
S. Rodgers
Affiliation:
Section of Public Mental Health, Department of Psychiatry II, University of Ulm, Parkstrasse 11, 89073 Ulm, German
P.W. Corrigan
Affiliation:
Illinois Institute of Technology, Chicago, USA
W. Rössler
Affiliation:
Section of Public Mental Health, Department of Psychiatry II, University of Ulm, Parkstrasse 11, 89073 Ulm, German
*
* Address for correspondence: Dr N. Rüsch, Section of Public Mental Health, Department of Psychiatry II, University of Ulm, Parkstrasse 11, 89073 Ulm, Germany. (Email: nicolas.ruesch@uni-ulm.de)
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

To examine stigma- and knowledge-related barriers to help-seeking among members of the general population.

Methods.

In a representative survey of young to middle-aged Swiss adults (n = 8875), shame about a potential own mental illness, perceived knowledge about and satisfaction with one's mental health, psychiatric symptoms and attitudes towards help-seeking were assessed.

Results.

A latent profile analysis of all participants yielded two groups with different attitudes towards help-seeking. Relative to the majority, a one-in-four subgroup endorsed more negative attitudes towards seeking professional help, including psychiatric medication, and was characterized by more shame, less perceived knowledge, higher satisfaction with their mental health, younger age, male gender and lower education. Among participants with high symptom levels (n = 855), a third subgroup was reluctant to seek help in their private environment and characterized by high symptoms as well as low satisfaction with their mental health.

Conclusions.

Shame as an emotional proxy of self-stigma as well as poor subjective mental health literacy may be independent barriers to help-seeking. Interventions to increase mental health service use could focus on both variables and on those individuals with more negative views about professional help, in the general public as well as among people with a current mental illness.

Keywords

Attitudes to help-seekingknowledgesatisfaction with mental healthshame

Information

Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 23 , Issue 2 , June 2014 , pp. 177 - 187
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Angermeyer, MC, Dietrich, S (2006). Public beliefs about and attitudes towards people with mental illness: a review of population studies. Acta Psychiatrica Scandinavica 113, 163–179.CrossRefGoogle ScholarPubMed
Angst, J, Dobler-Mikola, A, Binder, J (1984). The Zurich study – a prospective epidemiological study of depressive, neurotic and psychosomatic syndromes. I. Problem, methodology. European Archives of Psychiatry and Neurological Sciences 234, 13–20.CrossRefGoogle ScholarPubMed
Angst, J, Gamma, A, Rössler, W, Ajdacic-Gross, V, Klein, DN (2009). Long-term depression versus episodic major depression: results from the prospective Zurich study of a community sample. Journal of Affective Disorders 115, 112–121.Google Scholar
Barney, LJ, Griffiths, KM, Jorm, AF, Christensen, H (2006). Stigma about depression and its impact on help-seeking intentions. Australian and New Zealand Journal of Psychiatry 40, 51–54.Google Scholar
Clement, S, Brohan, E, Jeffery, D, Henderson, C, Hatch, SL, Thornicroft, G (2012). Development and psychometric properties the barriers to access to care evaluation scale (BACE) related to people with mental ill health. BMC Psychiatry 12, 36.Google Scholar
Codony, M, Alonso, J, Almansa, J, Bernert, S, de Girolamo, G, de Graaf, R, Haro, JM, Kovess, V, Vilagut, G, Kessler, RC (2009). Perceived need for mental health care and service use among adults in Western Europe: results of the ESEMeD project. Psychiatric Services 60, 1051–1058.Google Scholar
Compton, MT (2010). Clinical Manual of Prevention in Mental Health. American Psychiatric Publishing: Washington, DC.Google Scholar
Corrigan, PW, Rüsch, N (2002). Mental illness stereotypes and clinical care: do people avoid treatment because of stigma? Psychiatric Rehabilitation Skills 6, 312–334.Google Scholar
Corrigan, PW, Watson, AC (2002). The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice 9, 35–53.Google Scholar
Corrigan, PW, Morris, SB, Michaels, PJ, Rafacz, JE, Rüsch, N (2012). Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatric Services 63, 963–973.Google Scholar
Corrigan, PW, Kosyluk, KA, Rüsch, N (2013). Reducing self-stigma by coming out proud. American Journal of Public Health 103, 794–800.Google Scholar
de Girolamo, G, Dagani, J, Purcell, R, Cocchi, A, McGorry, PD (2012). Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles. Epidemiology and Psychiatric Sciences 21, 47–57.Google Scholar
Derogatis, LR (1977). SCL-90: Administration, Scoring, and Procedures Manual – I for the R(evised) Version and Other Instruments of the Psychopathology Rating Scale Series. Johns Hopkins University: Baltimore.Google Scholar
Edlund, MJ, Wang, PS, Berglund, PA, Katz, SJ, Lin, E, Kessler, RC (2002). Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. American Journal of Psychiatry 159, 845–851.Google Scholar
Evans-Lacko, S, Little, K, Meltzer, H, Rose, D, Rhydderch, H, Henderson, C, Thornicroft, G (2010). Development and psychometric properties of the Mental Health Knowledge Schedule (MAKS). Canadian Journal of Psychiatry 55, 440–448.Google Scholar
Evans-Lacko, S, Brohan, E, Mojtabai, R, Thornicroft, G (2012). Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries. Psychological Medicine 42, 1741–1752.CrossRefGoogle ScholarPubMed
Griffiths, KM, Christensen, H, Jorm, AF, Evans, K, Groves, C (2004). Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. British Journal of Psychiatry 185, 342–349.CrossRefGoogle ScholarPubMed
Hardt, J (2008). The Symptom Checklist-27-plus (SCL-27-plus): a modern conceptualization of a traditional screening instrument. Psychosocial Medicine 5, Doc08.Google Scholar
Henderson, C, Evans-Lacko, S, Thornicroft, G (2013). Mental illness stigma, help seeking, and public health programs. American Journal of Public Health 103, 777–780.CrossRefGoogle ScholarPubMed
Huxley, P (1996). Mental illness in the community: the Goldberg-Huxley model of the pathway to psychiatric care. Nordic Journal of Psychiatry 50 (Suppl. 37), 47–53.Google Scholar
Jagdeo, A, Cox, BJ, Stein, MB, Sareen, J (2009). Negative attitudes toward help seeking for mental illness in 2 population-based surveys from the United States and Canada. Canadian Journal of Psychiatry 54, 757–766.CrossRefGoogle Scholar
Jorm, AF (2012). Mental health literacy: empowering the community to take action for better mental health. American Psychologist 67, 231–243.Google Scholar
Jorm, AF, Wright, A (2007 a). Beliefs of young people and their parents about the effectiveness of interventions for mental disorders. Australian and New Zealand Journal of Psychiatry 41, 656–666.Google Scholar
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, 619–626.Google Scholar
Jorm, AF, Griffiths, KM, Christensen, H, Parslow, RA, Rogers, B (2004). Actions taken to cope with depression at different levels of severity: a community survey. Psychological Medicine 34, 293–299.Google Scholar
Jorm, AF, Wright, A, Morgan, AJ (2007 b). Where to seek help for a mental disorder? National survey of the beliefs of Australian youth and their parents. Medical Journal of Australia 187, 556–560.Google Scholar
King, D, Knapp, M, Patel, A, Amaddeo, F, Tansella, M, Schene, A, Koeter, M, Angermeyer, M, Becker, T (2013). The impact of non-adherence to medication in patients with schizophrenia on health, social care and societal costs: analysis of the QUATRO study. Epidemiology and Psychiatric Sciences, 1–10. doi:10.1017/S2045796013000097.Google Scholar
Lanfredi, M, Rossi, G, Rossi, R, van Bortel, T, Thornicroft, G, Quinn, N, Zoppei, S, Lasalvia, A (2013). Depression prevention and mental health promotion interventions: is stigma taken into account? An overview of the Italian initiatives. Epidemiology and Psychiatric Sciences, 1–12. doi:10.1017/S2045796013000085.Google ScholarPubMed
Lasalvia, A, Zoppei, S, van Bortel, T, Bonetto, C, Cristofalo, D, Wahlbeck, K, Bacle, SV, van Audenhove, C, van Weeghel, J, Reneses, B, Germanavicius, A, Economou, M, Lanfredi, M, Ando, S, Sartorius, N, Lopez-Ibor, JJ, Thornicroft, G (2013). Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet 381, 55–62.Google Scholar
Lauber, C, Nordt, C, Falcato, L, Rössler, W (2001). Lay recommendations on how to treat mental disorders. Social Psychiatry and Psychiatric Epidemiology 36, 553–556.Google Scholar
Link, BG (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.Google Scholar
Lo, Y, Mendell, NR, Rubin, DB (2001). Testing the number of components in a normal mixture. Biometrika 88, 767–778.Google Scholar
Luoma, JB, Kohlenberg, BS, Hayes, SC, Fletcher, L (2012). Slow and steady wins the race: a randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders. Journal of Consulting and Clinical Psychology 80, 43–53.Google Scholar
MacKinnon, DP, Fairchild, AJ, Fritz, MS (2007). Mediation analysis. Annual Review of Psychology 58, 593–614.Google Scholar
McLachlan, G, Peel, D (2000). Finite Mixture Models. Wiley: New York.CrossRefGoogle Scholar
Müller, M, Vetter, S, Buchli-Kammermann, J, Stieglitz, RD, Stettbacher, A, Riecher-Rössler, A (2010). The Self-screen-Prodrome as a short screening tool for pre-psychotic states. Schizophrenia Research 123, 217–224.Google Scholar
Muthén, LK, Muthén, BO (2002). How to use a Monte Carlo study to decide on sample size and determine power. Structural Equation Modeling 4, 599–620.CrossRefGoogle Scholar
Muthén, LK, Muthén, BO (2011). Mplus User's Guide. Muthén & Muthén: Los Angeles.Google Scholar
Nylund, KL, Asparouhov, T, Muthén, B (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Structural Equation Modeling 14, 535–569.Google Scholar
Phelan, JC, Yang, LH, Cruz-Rojas, R (2006). Effects of attributing serious mental illnesses to genetic causes on orientations to treatment. Psychiatric Services 57, 382–387.CrossRefGoogle ScholarPubMed
Riedel-Heller, SG, Matschinger, H, Angermeyer, MC (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
Rose, D, Willis, R, Brohan, E, Sartorius, N, Villares, C, Wahlbeck, K, Thornicroft, G (2011). Reported stigma and discrimination by people with a diagnosis of schizophrenia. Epidemiology and Psychiatric Sciences 20, 193–204.Google Scholar
Rüsch, N, Hölzer, A, Hermann, C, Schramm, E, Jacob, GA, Bohus, M, Lieb, K, Corrigan, PW (2006). Self-stigma in women with borderline personality disorder and women with social phobia. Journal of Nervous and Mental Disease 194, 766–773.Google Scholar
Rüsch, N, Corrigan, PW, Bohus, M, Jacob, GA, Brueck, R, Lieb, K (2007 a). Measuring shame and guilt by self-report questionnaires: a validation study. Psychiatry Research 150, 313–325.Google Scholar
Rüsch, N, Lieb, K, Göttler, I, Hermann, C, Schramm, E, Richter, H, Jacob, GA, Corrigan, PW, Bohus, M (2007 b). Shame and implicit self-concept in women with borderline personality disorder. American Journal of Psychiatry 164, 500–508.Google Scholar
Rüsch, N, Corrigan, PW, Wassel, A, Michaels, P, Larson, JE, Olschewski, M, Wilkniss, S, Batia, K (2009 a). Self-stigma, group identification, perceived legitimacy of discrimination and mental health service use. British Journal of Psychiatry 195, 551–552.Google Scholar
Rüsch, N, Corrigan, PW, Wassel, A, Michaels, P, Olschewski, M, Wilkniss, S, Batia, K (2009 b). Ingroup perception and responses to stigma among persons with mental illness. Acta Psychiatrica Scandinavica 120, 320–328.Google Scholar
Rüsch, N, Todd, AR, Bodenhausen, GV, Weiden, PJ, Corrigan, PW (2009 c). Implicit versus explicit attitudes toward psychiatric medication: implications for insight and treatment adherence. Schizophrenia Research 112, 119–122.Google Scholar
Rüsch, N, Corrigan, PW, Todd, AR, Bodenhausen, GV (2010). Implicit self-stigma in people with mental illness. Journal of Nervous and Mental Disease 198, 150–153.Google Scholar
Rüsch, N, Evans-Lacko, S, Henderson, C, Flach, C, Thornicroft, G (2011). Knowledge and attitudes as predictors of intentions to seek help and disclose a mental illness. Psychiatric Services 62, 675–678.Google Scholar
Schomerus, G, Angermeyer, MC (2008). Stigma and its impact on help-seeking for mental disorders: what do we know? Epidemiologia e Psichiatria Sociale 17, 31–37.Google Scholar
Schomerus, G, Matschinger, H, Angermeyer, MC (2009). The stigma of psychiatric treatment and help-seeking intentions for depression. European Archives of Psychiatry and Clinical Neuroscience 259, 298–306.Google Scholar
Schomerus, G, Auer, C, Rhode, D, Luppa, M, Freyberger, HJ, Schmidt, S (2012 a). Personal stigma, problem appraisal and perceived need for professional help in currently untreated depressed persons. Journal of Affective Disorders 139, 94–97.Google Scholar
Schomerus, G, Schwahn, C, Holzinger, A, Corrigan, PW, Grabe, HJ, Carta, MG, Angermeyer, MC (2012 b). Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica 125, 440–452.Google Scholar
Thornicroft, G (2007). Most people with mental illness are not treated. Lancet 370, 807–808.Google Scholar
Thornicroft, G (2012). No time to lose: onset and treatment delay for mental disorders. Epidemiology and Psychiatric Sciences 21, 59–61.Google Scholar
Vogel, DL, Wade, NG, Haake, S (2006). Measuring the self-stigma associated with seeking psychological help. Journal of Counseling Psychology 53, 325–337.Google Scholar
von Eye, A, Bergman, LR (2003). Research strategies in developmental psychopathology: dimensional identity and the person-oriented approach. Development and Psychopathology 15, 553–580.Google Scholar
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, 841–850.Google Scholar
Yanos, PT, Roe, D, Lysaker, PH (2011). Narrative Enhancement and Cognitive Therapy: a new group-based treatment for internalized stigma among persons with severe mental illness. International Journal of Group Psychotherapy 61, 576–595.Google Scholar
Yap, MB, Jorm, AF (2012). Parents' beliefs about actions they can take to prevent depressive disorders in young people: results from an Australian national survey. Epidemiology and Psychiatric Sciences 21, 117–123.Google Scholar
Yap, MB, Reavley, NJ, Jorm, AF (2013). The associations between psychiatric label use and young people's help-seeking preferences: results from an Australian national survey. Epidemiology and Psychiatric Sciences, 1–9. doi:10.1017/S2045796013000073.Google Scholar