0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
Public Stigma and Self-Stigma: Differential Association With Attitudes Toward Formal and Informal Help Seeking
Elise Pattyn, M.Sc.; Mieke Verhaeghe, Ph.D.; Charlotte Sercu, M.Sc.; Piet Bracke, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200561
View Author and Article Information

Ms. Pattyn, Ms. Sercu, and Dr. Bracke are with the Department of Sociology, Ghent University, Ghent, Belgium (e-mail: elise.pattyn@ugent.be). Dr. Verhaeghe is with the Department of Social Work, Katho University College, Kortrijk, Belgium.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Individuals in need of psychiatric treatment often avoid seeking help because of stigma. This study examined the impact of two stigma dimensions on help-seeking attitudes. Perceived public stigma refers to discrimination and devaluation by others, and anticipated self-stigma refers to internalization of negative stereotypes about people who seek help.

Methods  Data were from the 2009 Stigma in a Global Context–Belgian Mental Health Study, in which face-to-face interviews were conducted with a representative sample of the general Belgian population. The study reported here included 728 respondents who received a vignette depicting major depression or schizophrenia. Perceived public stigma and anticipated self-stigma were measured with validated instruments. Respondents’ attitudes toward help seeking were measured by the importance they assigned to care from formal and informal providers: general practitioners, psychiatrists, psychologists, family members, or friends. Multiple linear regression models were estimated.

Results  Respondents with higher levels of anticipated self-stigma attached less importance to care provided by general practitioners or psychiatrists, and those with higher levels of perceived public stigma rated informal help seeking as less important. The gender and the ethnicity of the person and respondents’ sociodemographic characteristics had relatively little effect on help-seeking attitudes.

Conclusions  Anticipated self-stigma and perceived public stigma appeared to have a differential impact on attitudes toward formal and informal help seeking. Internalization of negative stereotypes was negatively associated with the perceived importance of care from medical providers (general practitioners and psychiatrists). Awareness of stereotypes held by others deterred respondents from acknowledging the importance of informal care.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Anchor for Jump
Table 1Characteristics of the study population (N=728)a
Table Footer Note

a Data (weighted) were from the 2009 Stigma in a Global Context–Belgian Mental Health Study.

Table Footer Note

b Range 18 to 94

Table Footer Note

c Range 0 to 24

Table Footer Note

d Possible scores range from 0 to 34, with higher scores representing worse mental health status with more complaints.

Table Footer Note

e Possible scores range from 1 to 4, with higher scores representing greater perceived public stigma.

Table Footer Note

f Possible scores range from 1 to 5, with higher scores representing greater anticipated self-stigma.

Table Footer Note

g Rated on a scale from 1 to 10, with higher scores indicating greater importance

Anchor for Jump
Table 2Association between two dimensions of stigma and ratings of the importance of help seeking from formal and informal providersa
Table Footer Note

a Data (weighted) were from the 2009 Stigma in a Global Context–Belgian Mental Health Study.

Table Footer Note

* p<.05, **p<.01

+

References

Alonso  J;  Codony  M;  Kovess  V  et al:  Population level of unmet need for mental healthcare in Europe.  British Journal of Psychiatry 190:299–306, 2007
[CrossRef] | [PubMed]
 
Kessler  RC;  Berglund  PA;  Bruce  ML  et al:  The prevalence and correlates of untreated serious mental illness.  Health Services Research 36:987–1007, 2001
[PubMed]
 
Scheff  TJ:  Being Mentally Ill: A Sociological Theory .  Chicago,  Aldine, 1966
 
Steele  CM:  A threat in the air: how stereotypes shape intellectual identity and performance.  American Psychologist 52:613–629, 1997
[CrossRef] | [PubMed]
 
Sartorius  N:  Stigma and mental health.  Lancet 370:810–811, 2007
[CrossRef] | [PubMed]
 
Corrigan  P:  How stigma interferes with mental health care.  American Psychologist 59:614–625, 2004
[CrossRef] | [PubMed]
 
Corrigan  PW;  Rüsch  N:  Mental illness stereotypes and clinical care: do people avoid treatment because of stigma? Psychiatric Rehabilitation Skills 6:312–334, 2002
[CrossRef]
 
Corrigan  PW;  Watson  AC:  The paradox of self-stigma and mental illness.  Clinical Psychology: Science and Practice 9:35–53, 2002
[CrossRef]
 
Link  BG:  Understanding labeling effects in the area of mental disorders: an assessment of the effects of expectations of rejection.  American Sociological Review 52:96–112, 1987
[CrossRef]
 
Corrigan  PW:  Empowerment and serious mental illness: treatment partnerships and community opportunities.  Psychiatric Quarterly 73:217–228, 2002
[CrossRef] | [PubMed]
 
Hinshaw  SP:  The Mark of Shame: Stigma of Mental Illness and an Agenda for Change .  New York,  Oxford University Press, 2007
 
Vogel  DL;  Wade  NG;  Hackler  AH:  Perceived public stigma and the willingness to seek counseling: the mediating roles of self-stigma and attitudes toward counseling.  Journal of Counseling Psychology 51:40–50, 2007
[CrossRef]
 
Mead  GH:  Mind, Self, and Society .  Chicago,  University of Chicago, 1934
 
Wrigley  S;  Jackson  H;  Judd  F  et al:  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, 2005
[CrossRef] | [PubMed]
 
Barney  LJ;  Griffiths  KM;  Jorm  AF  et al:  Stigma about depression and its impact on help-seeking intentions.  Australian and New Zealand Journal of Psychiatry 40:51–54, 2006
[CrossRef] | [PubMed]
 
Corrigan  PW;  Watson  AC;  Barr  L:  The self-stigma of mental illness: implications for self-esteem and self-efficacy.  Journal of Social and Clinical Psychology 25:875–884, 2006
[CrossRef]
 
Rüsch  N;  Angermeyer  MC;  Corrigan  PW:  Mental illness stigma: concepts, consequences, and initiatives to reduce stigma.  European Psychiatry 20:529–539, 2005
[CrossRef] | [PubMed]
 
Link  BG;  Struening  EL;  Neese-Todd  S  et al:  Stigma as a barrier to recovery: the consequences of stigma for the self-esteem of people with mental illnesses.  Psychiatric Services 52:1621–1626, 2001
[CrossRef] | [PubMed]
 
Rüsch  N;  Todd  AR;  Bodenhausen  GV  et al:  Do people with mental illness deserve what they get? Links between meritocratic worldviews and implicit versus explicit stigma.  European Archives of Psychiatry and Clinical Neuroscience 260:617–625, 2010
[CrossRef] | [PubMed]
 
Schomerus  G;  Matschinger  H;  Angermeyer  MC:  The stigma of psychiatric treatment and help-seeking intentions for depression.  European Archives of Psychiatry and Clinical Neuroscience 259:298–306, 2009
[CrossRef] | [PubMed]
 
Sirey  JA;  Bruce  ML;  Alexopoulos  GS  et al:  Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression.  American Journal of Psychiatry 158:479–481, 2001
[CrossRef] | [PubMed]
 
Yap  MBH;  Wright  A;  Jorm  AF:  The influence of stigma on young people’s help-seeking intentions and beliefs about the helpfulness of various sources of help.  Social Psychiatry and Psychiatric Epidemiology 46:1257–1265, 2011
[CrossRef] | [PubMed]
 
Depression: A Global Crisis. Occoquan, Va, World Federation for Mental Health, 2012. Available at www.wfmh.org/2012DOCS/WMHDay%202012%20SMALL%20FILE%20FINAL.pdf
 
Pearlin  LI;  Lieberman  MA;  Menaghan  EG  et al:  The stress process.  Journal of Health and Social Behavior 22:337–356, 1981
[CrossRef] | [PubMed]
 
Breier  A;  Strauss  JS:  The role of social relationships in the recovery from psychotic disorders.  American Journal of Psychiatry 141:949–955, 1984
[PubMed]
 
Jorm  AF;  Griffiths  KM;  Christensen  H  et al:  Actions taken to cope with depression at different levels of severity: a community survey.  Psychological Medicine 34:293–299, 2004
[CrossRef] | [PubMed]
 
Pescosolido  BA:  Illness careers and network ties: a conceptual model of utilization and compliance.  Advances in Medical Sociology 2:164–184, 1991
 
Pescosolido  BA:  Beyond rational choice: the social dynamics of how people seek help.  American Journal of Sociology 97:1096–1138, 1992
[CrossRef]
 
Milstein  G;  Manierre  A;  Yali  AM:  Psychological care for persons of diverse religions: a collaborative continuum.  Professional Psychology, Research and Practice 41:371–381, 2010
[CrossRef]
 
Perry  BL:  The labeling paradox: stigma, the sick role, and social networks in mental illness.  Journal of Health and Social Behavior 52:460–477, 2011
[CrossRef] | [PubMed]
 
Oliver  MI;  Pearson  N;  Coe  N  et al:  Help-seeking behaviour in men and women with common mental health problems: cross-sectional study.  British Journal of Psychiatry 186:297–301, 2005
[CrossRef] | [PubMed]
 
Mackenzie  CS;  Gekoski  WL;  Knox  VJ:  Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes.  Aging and Mental Health 10:574–582, 2006
[CrossRef] | [PubMed]
 
Bijl  RV;  Ravelli  A:  Psychiatric morbidity, service use, and need for care in the general population: results of the Netherlands Mental Health Survey and Incidence Study.  American Journal of Public Health 90:602–607, 2000
[CrossRef] | [PubMed]
 
Good  GE;  Wood  PK:  Male gender role conflict, depression and help seeking: do college men face double jeopardy? Journal of Counseling and Development 74:70–75, 1995
[CrossRef]
 
Rickwood  DJ;  Braithwaite  VA:  Social-psychological factors affecting help-seeking for emotional problems.  Social Science and Medicine 39:563–572, 1994
[CrossRef] | [PubMed]
 
Cole  MG;  Yaffe  MJ:  Pathway to psychiatric care of the elderly with depression.  International Journal of Geriatric Psychiatry 11:157–161, 1998
[CrossRef]
 
ten Have  M;  Oldehinkel  A;  Vollebergh  W  et al:  Does educational background explain inequalities in care service use for mental health problems in the Dutch general population? Acta Psychiatrica Scandinavica 107:178–187, 2003
[CrossRef] | [PubMed]
 
Bracke  PF;  Colman  E;  Symoens  SAA  et al:  Divorce, divorce rates, and professional care seeking for mental health problems in Europe: a cross-sectional population-based study.  BMC Public Health 10:224–235, 2010
[CrossRef] | [PubMed]
 
Gouwy  A;  Christiaens  W;  Bracke  P:  Mental health services use in the general Belgian population: estimating the impact of mental health and social determinants.  Archives of Public Health 66:50–68, 2008
 
Holzinger  A;  Matschinger  H;  Angermeyer  MC:  What to do about depression? Help-seeking and treatment recommendations of the public.  Epidemiology and Psychiatric Sciences 20:163–169, 2011
[CrossRef] | [PubMed]
 
Lauber  C;  Carlos  N;  Wulf  R:  Lay beliefs about treatments for people with mental illness and their implications for antistigma strategies.  Canadian Journal of Psychiatry 50:745–752, 2005
 
Angermeyer  MC;  Matschinger  H;  Riedel-Heller  SG:  What to do about mental disorder: help-seeking recommendations of the lay public.  Acta Psychiatrica Scandinavica 103:220–225, 2001
[CrossRef] | [PubMed]
 
Angermeyer  MC;  Matschinger  H;  Riedel-Heller  SG:  Whom to ask for help in case of a mental disorder? Preferences of the lay public.  Social Psychiatry and Psychiatric Epidemiology 34:202–210, 1999
[CrossRef] | [PubMed]
 
Angermeyer  MC;  Matschinger  H:  Causal beliefs and attitudes to people with schizophrenia: trend analysis based on data from two population surveys in Germany.  British Journal of Psychiatry 186:331–334, 2005
[CrossRef] | [PubMed]
 
Angermeyer  MC;  Breier  P;  Dietrich  S  et al:  Public attitudes toward psychiatric treatment: an international comparison.  Social Psychiatry and Psychiatric Epidemiology 40:855–864, 2005
[CrossRef] | [PubMed]
 
Lauber  C;  Nordt  C;  Falcato  L  et al:  Lay recommendations on how to treat mental disorders.  Social Psychiatry and Psychiatric Epidemiology 36:553–556, 2001
[CrossRef] | [PubMed]
 
Lauber  C;  Nordt  C;  Rössler  W:  Recommendations of mental health professionals and the general population on how to treat mental disorders.  Social Psychiatry and Psychiatric Epidemiology 40:835–843, 2005
[CrossRef] | [PubMed]
 
Riedel-Heller  SG;  Matschinger  H;  Angermeyer  MC:  Mental disorders—who and what might help? Help-seeking and treatment preferences of the lay public.  Social Psychiatry and Psychiatric Epidemiology 40:167–174, 2005
[CrossRef] | [PubMed]
 
Link  BG;  Phelan  JC;  Bresnahan  M  et al:  Public conceptions of mental illness: labels, causes, dangerousness, and social distance.  American Journal of Public Health 89:1328–1333, 1999
[CrossRef] | [PubMed]
 
Hopper  K;  Harrison  G;  Wanderling  J:  An overview of course and outcome in the ISoS; in  Recovery From Schizophrenia: An International Perspective: A Report From the WHO Collaborative Project, the International Study of Schizophrenia . Edited by Hopper  K;  Harrison  G;  Janca  A  et al.  New York,  Oxford University Press, 2007
 
Response Rate: An Overview. Deerfield, Ill, American Association for Public Opinion Research. Available at www.aapor.org/Response_Rates_An_Overview1.htm
 
Brohan  E;  Slade  M;  Clement  S  et al:  Experiences of mental illness stigma, prejudice and discrimination: a review of measures.  BMC Health Services Research 10:80–90, 2010
[CrossRef] | [PubMed]
 
Fife  BL;  Wright  ER:  The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer.  Journal of Health and Social Behavior 41:50–67, 2000
[CrossRef] | [PubMed]
 
Vogel  DL;  Wade  NG;  Haake  S:  Measuring the self-stigma associated with seeking psychological help.  Journal of Counseling Psychology 53:325–337, 2006
[CrossRef]
 
Schneider SL: Measuring educational attainment in cross-national surveys: the case of the European Social Survey. Presented at the EDUC Research Group Workshop, EQUALSOC, Dijon, France, Nov 22–24, 2007. Available at www.nuffield.ox.ac.uk/users/Schneider/pdfs/schn07.pdf
 
Goldberg  DP;  Gater  R;  Sartorius  N  et al:  The validity of two versions of the GHQ in the WHO study of mental illness in general health care.  Psychological Medicine 27:191–197, 1997
[CrossRef] | [PubMed]
 
Moore DS, McCabe GP: Statistics in Practice [in Dutch]. The Hague, Netherlands, Academic Service, 1999
 
ten Have  M;  de Graaf  R;  Ormel  J  et al:  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 45:153–163, 2010
[CrossRef] | [PubMed]
 
Gharaibeh  NM:  The psychiatrist’s image in commercially available American movies.  Acta Psychiatrica Scandinavica 111:316–319, 2005
[CrossRef] | [PubMed]
 
Rosen  A;  Walter  G;  Politis  T  et al:  From shunned to shining: doctors, madness and psychiatry in Australian and New Zealand cinema.  Medical Journal of Australia 167:640–644, 1997
[PubMed]
 
Schulze  B:  Stigma and mental health professionals: a review of the evidence on an intricate relationship.  International Review of Psychiatry  19:137–155, 2007
[CrossRef] | [PubMed]
 
Wahl  OF:  Media Madness: Public Images of Mental Illness .  New Brunswick, NJ,  Rutgers University Press, 1995
 
Hamre  P;  Dahl  AA;  Malt  UF:  Public attitudes to the quality of psychiatric treatment, psychiatric patients, and prevalence of mental disorders.  Nordic Journal of Psychiatry 48:275–281, 1994
[CrossRef]
 
Nadler  A:  Help-seeking behavior: Psychological costs and instrumental benefits; in  Prosocial Behavior: Review of Personality and Social Psychology . Edited by Clark  MS.  New York,  Academic Press, 1991
 
Pescosolido  BA;  Olafsdottir  S:  The cultural turn in sociology: can it help us resolve an age-old problem in understanding decision making for health care? Sociological Forum 25:655–676, 2010
[CrossRef]
 
Olafsdottir  S;  Pescosolido  BA:  Drawing the line: the cultural cartography of utilization recommendations for mental health problems.  Journal of Health and Social Behavior 50:228–244, 2009
[CrossRef] | [PubMed]
 
Verhaak  PFM;  van den Brink-Muinen  A;  Bensing  JM  et al:  Demand and supply for psychological help in general practice in different European countries: access to primary mental health care in six European countries.  European Journal of Public Health 14:134–140, 2004
[CrossRef] | [PubMed]
 
Jorm  AF:  Mental health literacy: public knowledge and beliefs about mental disorders.  British Journal of Psychiatry 177:396–401, 2000
[CrossRef] | [PubMed]
 
Freidson  E:  Profession of Medicine .  New York,  Dodd, Mead, 1970
 
McKinlay  JB:  Social networks, lay consultation and help-seeking behavior.  Social Forces 51:275–279, 1973
[CrossRef]
 
Birkel  RC;  Reppucci  ND:  Social networks, information-seeking, and the utilization of services.  American Journal of Community Psychology 11:185–205, 1983
[CrossRef] | [PubMed]
 
Narrow  WE;  Regier  DA;  Norquist  G  et al:  Mental health service use by Americans with severe mental illnesses.  Social Psychiatry and Psychiatric Epidemiology 35:147–155, 2000
[CrossRef] | [PubMed]
 
Golberstein  E;  Eisenberg  D;  Gollust  SE:  Perceived stigma and mental health care seeking.  Psychiatric Services 59:392–399, 2008
[CrossRef] | [PubMed]
 
Golberstein  E;  Eisenberg  D;  Gollust  SE:  Perceived stigma and help-seeking behavior: longitudinal evidence from the Healthy Minds Study.  Psychiatric Services 60:1254–1256, 2009
[CrossRef] | [PubMed]
 
Eisenberg  D;  Downs  MF;  Golberstein  E  et al:  Stigma and help seeking for mental health among college students.  Medical Care Review 66:522–541, 2009
[CrossRef]
 
Cooper  AE;  Corrigan  PW;  Watson  AC:  Mental illness stigma and care seeking.  Journal of Nervous and Mental Disease 191:339–341, 2003
[PubMed]
 
Vogel  DL;  Wester  SR;  Wei  M  et al:  The role of outcome expectations and attitudes on decisions to seek professional help.  Journal of Counseling Psychology 52:459–470, 2005
[CrossRef]
 
Komiya  N;  Good  GE;  Sherrod  NB:  Emotional openness as a predictor of college students’ attitudes toward seeking psychological help.  Journal of Counseling Psychology 47:138–143, 2000
[CrossRef]
 
Komiti  A;  Judd  F;  Jackson  H:  The influence of stigma and attitudes on seeking help from a GP for mental health problems: a rural context.  Social Psychiatry and Psychiatric Epidemiology 41:738–745, 2006
[CrossRef] | [PubMed]
 
Hoyt  DR;  Conger  RD;  Valde  JG  et al:  Psychological distress and help seeking in rural America.  American Journal of Community Psychology 25:449–470, 1997
[CrossRef] | [PubMed]
 
Bruffaerts  R;  Bonnewyn  A;  Demyttenaere  K:  Delays in seeking treatment for mental disorders in the Belgian general population.  Social Psychiatry and Psychiatric Epidemiology 42:937–944, 2007
[CrossRef] | [PubMed]
 
Fisher  EH;  Farina  A:  Attitudes Toward Seeking Professional Psychological Help: a shortened form and considerations for research.  Journal of College Student Development 36:368–373, 1995
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 1

Related Content
Articles
Books
Textbook of Psychotherapeutic Treatments > Chapter 24.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 23.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 44.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 8.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 45.  >
Topic Collections
Psychiatric News
PubMed Articles